Children

12 pages, 502 KiB

Open AccessFeature PaperArticle

Intervention Effects of Group Sandplay Therapy on Children at Risk of Smartphone Addiction: Focusing on Internalizing and Externalizing Problems in the Korean Youth Self Report

by Yang Hee Lee, Heajin Shin, Eunju Bae, Youngil Lee, Chang Min Lee, Se Hoon Shim, Min Sun Kim and Myung Ho Lim

Children 2025, 12(5), 593; https://doi.org/10.3390/children12050593 (registering DOI) - 1 May 2025

Abstract

Objectives: this study examined the intervention effects of group sandplay therapy (GST) on children at risk of smartphone addiction. Methods: The participants consisted of 113 elementary school students in grades 5 and 6 (ages 11–12), with 57 in the intervention group [...] Read more.

Objectives: this study examined the intervention effects of group sandplay therapy (GST) on children at risk of smartphone addiction. Methods: The participants consisted of 113 elementary school students in grades 5 and 6 (ages 11–12), with 57 in the intervention group and 56 in the control group. The intervention group participated in the GST program once a week for 40 min over 10 weeks, while the control group received no intervention. The Youth Smartphone Addiction Scale (S-scale) and the Korean Youth Self Report (K-YSR) were used to assess the program. Additionally, a repeated measures ANOVA was employed to examine changes between pre- and post-tests. Results: compared to the control group, the intervention group that received GST showed a significant reduction in smartphone addiction (F = 7.355, p = 0.020), withdrawal/depression (F = 5.540, p = 0.032), and somatic symptoms (F = 4.542, p = 0.040) compared to the control group. Conclusions: GST was found to be effective in reducing smartphone addiction, depression, and somatic symptoms in children at risk for smartphone addiction. Full article

(This article belongs to the Special Issue Behavioral and Mental Health Problems in Children: 2nd Edition)

12 pages, 428 KiB

Open AccessArticle

Pandemic as an Organizational Paradigm for Neonatal Care: Long-Term Impact of Mother–Infant Separation Practice During COVID-19

by Maria Di Chiara, Benedetta De Santis, Flavia Gloria, Fabio Natale, Annarita Ferazzoli, Gianluigi Laccetta, Alessandra Marciano, Roberto Brunelli and Gianluca Terrin

Children 2025, 12(5), 592; https://doi.org/10.3390/children12050592 (registering DOI) - 1 May 2025

Abstract

Objectives: The hospital organizational model can have an impact on people’s health. A critical lesson can be drawn from the pandemic. The possible negative sequelae of the practice of separation of maternal–infant dyads adopted during an infant’s first SARS-CoV-2 pandemic infection on infants [...] Read more.

Objectives: The hospital organizational model can have an impact on people’s health. A critical lesson can be drawn from the pandemic. The possible negative sequelae of the practice of separation of maternal–infant dyads adopted during an infant’s first SARS-CoV-2 pandemic infection on infants have not been considered. Our purpose was to investigate the short- and long-term effects on neonates born to SARS-CoV-2 infected mothers of two different mother–infant dyad management strategies after birth (Separation vs. Rooming-In). Methods: This prospective cohort study enrolled 60 pregnant women who tested positive for SARS-CoV-2 infection and their newborns. We identified two cohorts of study based on mother–infant dyad management after delivery: Cohort A (Separation) and Cohort B (Rooming-In). Inclusion criteria were neonates born from mothers infected with SARS-CoV-2 during the pregnancy undergoing or not undergoing separation. Main Outcome: Rate of exclusive breastfeeding at 6 months of age was the primary outcome. The rate of mother–infant transmission of SARS-CoV-2 infection, growth, incidence of acute infections and neurodevelopment up to 12 months of life were also evaluated. Results: In total, 60 mother–infant dyads (maternal age 30.6 vs. 33.8 years, p = 0.335; gestational age 39.0 vs. 38.9 weeks, p = 0.451) were enrolled at delivery, and 53 dyads completed the study at the 6-month follow-up. Baseline clinical characteristics were similar between the two cohorts. At 6-month follow-up, the rate of breastfeeding was significantly decreased in Cohort A compared with Cohort B (4% vs. 46%, p < 0.001). The rate of SARS-CoV-2 infection was similar between the two cohorts of the study. Weight gain at 6 months of life was significantly higher in Cohort A compared to Cohort B (8129 g, 95% CI, 7562 to 8695; vs. 7393 g, 95% CI, 6912 to 7874; p = 0.005). No differences were detected in terms of rate of acute neonatal infections and neurodevelopment outcomes. Conclusions: The separation practice led to a reduction in the rate of breastfeeding after discharge and to a consequently increased implementation of formula milk, which might justify the alarming increased weight gain of newborns who did not undergo the Rooming-In practice. Given the potential of recurrent outbreaks of other viral pandemics, our results suggest more caution early in life towards the disruption of consolidated procedures that may have long-term consequences. However, the COVID-19 pandemic offered a unique context to observe the effects of temporary mother–infant separation; clinicians should be reassured that the temporary separation practice did not affect neurodevelopment and be aware that it could be considered an option, at least if Rooming-In cannot be carried out due to severe reasons such as lack of staff or adequate space. Full article

(This article belongs to the Section Pediatric Neonatology)

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27 pages, 4893 KiB

Open AccessSystematic Review

Probiotic, Prebiotic, and Synbiotic Supplementation for the Prevention and Treatment of Acute Otitis Media: A Systematic Review and Meta-Analysis

by Freiser Eceomo Cruz Mosquera, Mayerli de la Rosa Caldas, Anisbed Naranjo Rojas, Claudia Lorena Perlaza and Yamil Liscano

Children 2025, 12(5), 591; https://doi.org/10.3390/children12050591 (registering DOI) - 30 Apr 2025

Abstract

Background and Aim: Probiotics, prebiotics, and synbiotics have been documented to modulate the microbiota, enhance immunity, and reduce antibiotic resistance, making them a promising alternative in the management of acute otitis media (AOM). Accordingly, the aim of this study was to determine their [...] Read more.

Background and Aim: Probiotics, prebiotics, and synbiotics have been documented to modulate the microbiota, enhance immunity, and reduce antibiotic resistance, making them a promising alternative in the management of acute otitis media (AOM). Accordingly, the aim of this study was to determine their effectiveness in the prevention and treatment of AOM in patients. Methods: A systematic review and meta-analysis of randomized controlled trials published between 2000 and 2024 was conducted using Science Direct, PubMed, LILACS, SCOPUS, Web of Science, and Cochrane Clinical Trials, following PRISMA guidelines. The methodological quality was evaluated using the Jadad scale, and the meta-analysis was performed with RevMan 5.4^® and Jamovi 2.3.28^®. Results: A total of 16 trials with 4034 patients were included. The meta-analysis showed that the intervention did not affect the time to AOM presentation (MD: −7.98; 95% CI: −19.74 to 3.78; p = 0.18), the recurrence of the disease (RR: 0.99; 95% CI: 0.74–1.33; p = 0.96), or the requirement for antibiotics (RR: 1.31; 95% CI: 0.92 to 1.84; p = 0.13); however, it was associated with a reduced probability of developing AOM (RR: 0.80; 95% CI: 0.66 to 0.96; p = 0.02). Subgroup analysis suggests that the effect of probiotic supplementation on AOM incidence is influenced by treatment duration, patient age, and the number of probiotic strains in the product. Conclusions: Supplementation with probiotics, prebiotics, or synbiotics is associated with a significant reduction in the incidence of AOM in children, although no significant impact was observed on other key clinical parameters. These interventions may be considered as a complementary strategy to conventional treatments; however, further high-quality, standardized trials are needed to confirm these findings and to define optimal protocols. Full article

(This article belongs to the Section Pediatric Gastroenterology and Nutrition)

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14 pages, 1288 KiB

Open AccessArticle

General Movements in Infants with Neurological Risk: Associations with Motor Development and Referral Patterns for Brain Magnetic Resonance Imaging

by María Eugenia Serrano-Gómez, Núria Massó-Ortigosa, Adriana Lucía Castellanos-Garrido, Eduardo Acuña De La Rosa, Víctor Mauricio García-Barriga, Adriana López-Dóriga, Małgorzata Domagalska-Szopa, Andrzej Szopa, Magdalena Hagner-Derengowska and Myriam Guerra-Balic

Children 2025, 12(5), 590; https://doi.org/10.3390/children12050590 (registering DOI) - 30 Apr 2025

Abstract

The main goal of this study was to determine the associations between the quality of presentation of GM, motor development, and brain integrity as seen through magnetic resonance imaging. Methods: This is an observational, descriptive, and association study; information derived from it was [...] Read more.

The main goal of this study was to determine the associations between the quality of presentation of GM, motor development, and brain integrity as seen through magnetic resonance imaging. Methods: This is an observational, descriptive, and association study; information derived from it was used to analyze associations between the following variables: Writhing Movements, Fidgety Movements, motor development, and brain integrity. With a confidence level of 95% and an estimation error of 5%, the sample was comprised of 60 children under 5 months old with any neurological risk criteria; these children were either hospitalized in the Neonatal Intensive Care Unit (NICU) or attending the Kangaroo Mother Care Program (KMCP) at the University Hospital of La Samaritana (UHS), Colombia. The data were analyzed using Fisher’s exact test. Results: Over 90% of children with Absent or Sporadic Fidgety Movements had either abnormal or suspicious motor development. We observed a trend of association between the absence of Fidget Movements and alterations in White Matter. Conclusions: Quality of presentation of General Movements is associated with motor development and alterations of brain tissue at an early age, primarily in the White Matter; it is important for early prediction of neurological risk in infants. Full article

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

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14 pages, 492 KiB

Open AccessCase Report

New Trigger for Stroke-like Episode in Sturge–Weber Syndrome: A Case Report

by Emiliano Altavilla, Andrea De Giacomo, Anna Maria Greco, Fernanda Tramacere, Marilena Quarta, Daniela Puscio, Massimo Corsalini, Sara Pistilli, Dario Sardella and Flavia Indrio

Children 2025, 12(5), 589; https://doi.org/10.3390/children12050589 (registering DOI) - 30 Apr 2025

Abstract

Background. Sturge–Weber syndrome (SWS) is a rare non-hereditary neurovascular disorder characterized by capillary–venous malformations on the face, ocular vascular anomalies, and leptomeningeal capillary–venous malformations. Patients with SWS often experience cerebral perfusion impairment, increasing their risk for stroke-like episodes, seizures, and motor and [...] Read more.

Background. Sturge–Weber syndrome (SWS) is a rare non-hereditary neurovascular disorder characterized by capillary–venous malformations on the face, ocular vascular anomalies, and leptomeningeal capillary–venous malformations. Patients with SWS often experience cerebral perfusion impairment, increasing their risk for stroke-like episodes, seizures, and motor and cognitive impairments. Methods. We report the case of a 2-year-old boy diagnosed with SWS who developed a stroke-like episode following dye laser therapy under deep sedation. Results. Despite initial diagnostic challenges and persistent seizures, appropriate management led to full neurological recovery. Conclusions. This case highlights the importance of considering stroke-like episodes in children with SWS after stressful events such as medical procedures. Full article

(This article belongs to the Special Issue Neonatal Hypoxic–Ischemic Brain Injury: Latest Advances)

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11 pages, 824 KiB

Open AccessArticle

Impact of Exclusive Breastfeeding and Extrauterine Growth Restriction on Post-Discharge Growth in Preterm Infants: A Longitudinal Cohort Study in a Kangaroo Mother Care Program

by Sergio Agudelo-Pérez, Diana Marcela Díaz Quijano, Eduardo Acuña, Juan Pablo Valderrama and Ariana Rojas

Children 2025, 12(5), 588; https://doi.org/10.3390/children12050588 (registering DOI) - 30 Apr 2025

Abstract

Background/Objectives: Extrauterine growth restriction (EUGR) and exclusive breastfeeding (EBF) are critical factors influencing early post-discharge growth in preterm infants. Although EBF is recommended in Kangaroo Mother Care (KMC) programs, its association with early anthropometric recovery remains unclear. This study evaluated the association between [...] Read more.

Background/Objectives: Extrauterine growth restriction (EUGR) and exclusive breastfeeding (EBF) are critical factors influencing early post-discharge growth in preterm infants. Although EBF is recommended in Kangaroo Mother Care (KMC) programs, its association with early anthropometric recovery remains unclear. This study evaluated the association between EUGR at 40 weeks of corrected age and EBF at 40 weeks, 3 months, and 6 months with anthropometric growth and acute malnutrition in preterm infants during the first six months of corrected age. Methods: A retrospective longitudinal cohort study was conducted, including 117 preterm infants (≤34 weeks of gestation) enrolled in the KMC program. Changes in weight, length, and head circumference z-scores and the incidence of acute malnutrition were analyzed using generalized estimating equations (GEEs). EUGR was defined as weight <10th percentile at 40 weeks. Acute malnutrition was defined as a weight-for-length z-score ≤−2. Results: EUGR was observed in 23.9% of the infants. EBF prevalence was 53% at 40 weeks and 40% at three and six months, respectively. EBF at 40 weeks was associated with a reduced weight z-score (coefficient: −0.29; p = 0.030), EBF at 3 months increased the weight z-score (coefficient: 0.34; p = 0.014), and EBF at 6 months reduced the risk of acute malnutrition (coefficient: −1.02; p = 0.036). Infants with EUGR showed greater weight gain over time (coefficient: 0.37; p = 0.020) yet remained below their non-EUGR peers. Conclusions: EBF during the first six months post-discharge supports weight gain and reduces the risk of malnutrition. However, EBF at 40 weeks may not ensure the immediate recovery of weight. EUGR is a key determinant of early growth. Full article

(This article belongs to the Special Issue Promoting Breastfeeding and Human Milk in Infants)

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8 pages, 185 KiB

Open AccessReview

Bilateral Wilms Tumour: Is Neoadjuvant Doxorubicin Necessary?

by Tristan Boam, Sri Paran and Israel Fernández-Pineda

Children 2025, 12(5), 587; https://doi.org/10.3390/children12050587 (registering DOI) - 30 Apr 2025

Abstract

Approximately 5% to 8% of patients with Wilms tumour have bilateral disease. The prevalence of bilateral Wilms tumour (BWT) is higher in individuals with genetic predisposition syndromes than in those without. The goal of therapy is to preserve as much renal tissue as [...] Read more.

Approximately 5% to 8% of patients with Wilms tumour have bilateral disease. The prevalence of bilateral Wilms tumour (BWT) is higher in individuals with genetic predisposition syndromes than in those without. The goal of therapy is to preserve as much renal tissue as possible without compromising the overall oncological outcomes, utilising neoadjuvant chemotherapy followed by nephron sparing surgery (NSS) if possible. The Children’s Oncology Group (COG) in North America and the International Society of Paediatric Oncology (SIOP) in Europe have developed the main protocols for the treatment of BWT. Both protocols are similar: initial biopsies are not indicated, and they both recommend surgical resection at week 6 or no later than week 12. Chemotherapy includes the use of vincristine and actinomycin-D in both protocols, but the COG approach also includes the use of doxorubicin, which is a cardiotoxic drug with important long-term effects on the cardiac function of childhood cancer survivors. What doxorubicin adds to patients with BWT in terms of radiological tumour response, resectability, long-term renal function and overall survival, is still not very well described and it may be variable depending on the tumour biology. This article describes the current approach for BWT in North America and Europe, focusing on the potential effect that doxorubicin may have on patient outcomes. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

10 pages, 344 KiB

Open AccessArticle

Extubation Failure and Timing to Tracheostomy in Children Surviving Acute Neurological Injury

by Ethan L. Gillett, Sneha Jayadeep, Chary Akmyradov and Salim Aljabari

Children 2025, 12(5), 586; https://doi.org/10.3390/children12050586 (registering DOI) - 30 Apr 2025

Abstract

Background/Objectives: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for extubation readiness or [...] Read more.

Background/Objectives: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for extubation readiness or the need for tracheostomy challenging. This study aims to better delineate the incidence of extubation failure and factors associated with the need for tracheostomy in pediatric patients surviving an acute neurologic injury. Methods: We conducted a retrospective cohort study using the Virtual Pediatric System (VPS) database of neonates, infants, children, and adolescents < 18 years of age with a neurological injury requiring intubation from 2012 to 2022. Demographic and clinical variables were compared between subjects that were successfully extubated, those with early tracheostomy placement (≤14 days), and those with late tracheostomy placement (>14 days). Results: Of the 38,810 enrolled subjects, 37,661 (97.04%) were successfully extubated, 481 (1.24%) underwent early tracheostomy, and 668 (1.72%) underwent late tracheostomy. The most common etiologies were seizures (60.6%), trauma (20.9%), and intoxication (9.1%). The successfully extubated subjects had a higher median initial GCS score (8 vs. 5 and 4, p < 0.001) and fewer extubation attempts (1 vs. 3 and 3, p < 0.001) than the tracheostomy cohorts. There was a significant difference in median ICU days between the three groups (2.52 vs. 18.3 vs. 38.3, p < 0.001). Conclusions: The majority of pediatric patients requiring intubation following an acute neurological injury can be successfully extubated. Among patients requiring a tracheostomy, those who received it early had significantly shorter ICU and hospital stays. Full article

(This article belongs to the Special Issue Rehabilitation and Neurological Considerations: Post Pediatric Resuscitation)

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19 pages, 1716 KiB

Open AccessReview

How Delayed Cord Clamping Saves Newborn Lives

by Judith Mercer, Elisabeth Saether, Tekoa King, Holger Maul, Holly Powell Kennedy, Debra Erickson-Owens, Ola Andersson and Heike Rabe

Children 2025, 12(5), 585; https://doi.org/10.3390/children12050585 (registering DOI) - 30 Apr 2025

Abstract

Interest in the subject of umbilical cord clamping is long-standing. New evidence reveals that placental transfusion, facilitated by delayed cord clamping (DCC), reduces death and need for blood transfusions for preterm infants without evidence of harm. Even a brief delay in clamping the [...] Read more.

Interest in the subject of umbilical cord clamping is long-standing. New evidence reveals that placental transfusion, facilitated by delayed cord clamping (DCC), reduces death and need for blood transfusions for preterm infants without evidence of harm. Even a brief delay in clamping the cord shows improved survival and well-being, but waiting at least two minutes is even better. We propose that three major benefits from DCC contribute to reduced mortality of preterm infants: (1) benefits from the components of blood; (2) assistance from the continued circulation of blood; and (3) the essential mechanical interactions that result from the enhanced volume of blood. The enhanced blood volume generates mechanical forces within the microcirculation that support the newborn’s metabolic and cardiovascular stability and secure short- and long-term organ health. Several unique processes prime preterm and term newborns to receive the full placental transfusion, not to be misinterpreted as extra blood or over-transfusion. Disrupting cord circulation before the newborn’s lung capillary bed has been fully recruited and the lungs can replace the placenta as a respiratory, gas-exchanging organ may be harmful. Early cord clamping also denies the newborn a full quota of iron-rich red blood cells as well as valuable stem cells for regeneration, repair, and seeding of a strong immune system. We propose that delayed cord clamping and intact-cord stabilization have the potential to save lives by protecting many neonates from hypovolemia, inflammation, and ischemia. Full article

(This article belongs to the Section Pediatric Neonatology)

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11 pages, 439 KiB

Open AccessArticle

Relationship Between the Use of Screens and the Motor Development of Children from 8 to 10 Years of Age

by Jacqueline Páez-Herrera, Simón Álvarez-González, Sebastián López-Lara, Cristóbal Otero-Tricio, Waldo Rojas-Martínez, Sofía Salgado-Díaz, Rodrigo Yáñez-Sepúlveda and Juan Hurtado-Almonacid

Children 2025, 12(5), 584; https://doi.org/10.3390/children12050584 (registering DOI) - 30 Apr 2025

Abstract

Background: The considerable increase in screen exposure causes negative effects on the motor development of boys and girls, which results in a decrease in the level of physical activity and an increase in sedentary behaviors. In Chile, this problem has been widely addressed [...] Read more.

Background: The considerable increase in screen exposure causes negative effects on the motor development of boys and girls, which results in a decrease in the level of physical activity and an increase in sedentary behaviors. In Chile, this problem has been widely addressed in adolescence; however, it is necessary to address it in childhood and early adolescence with a preventive approach. Objectives: To know the relationship between the use of screens and motor development in children. Methods: The sample was composed of 206 boys and girls (girls = 126 and boys = 80). The ages of the students ranged from 8 to 10 years old with a mean in months of 89.6 ± 7.54. The Gross Motor Development-2 was applied to identify motor development, screen time was measured using the Questionnaire to measure physical activity and sedentary behavior. Results: Girls have a greater weekly time than females in the use of consoles (p = 0.004). Girls and boys who are in the very poor, poor, and low average levels of motor development have more time in front of TV, PC, consoles, and total time with screens. There is an inverse relationship between the level of motor development and weekly screen time (r = −0.252). Conclusions: Screen exposure has a negative effect on the motor development of boys and girls. Although there is compliance with World Health Organization recommendations for screen exposure, the motor development of the participants is mostly very poor, poor, and low average. Full article

(This article belongs to the Special Issue Screen Time, Adverse Childhood Experiences and Childhood Mental Health on Child and Adolescent Development: Current Research and Future Directions)

18 pages, 8035 KiB

Open AccessArticle

Construction and Validation of a PCA-Based Prediction Model for Preterm Infant Stunting Risk: A Retrospective Study

by Kun Dai, Rong Yu, Yushi Meng, Xiaomeng Yang, Yixin Jiang, Jing Luo, Kui Fang, Suqing Wang and Zhihui Rong

Children 2025, 12(5), 583; https://doi.org/10.3390/children12050583 (registering DOI) - 30 Apr 2025

Abstract

Objectives: Developmental delay in preterm infants is a critical clinical issue, and early risk identification and prediction are essential. This study aims to develop and validate a predictive model for developmental delay, providing a scientific basis for clinical risk assessment and early intervention. [...] Read more.

Objectives: Developmental delay in preterm infants is a critical clinical issue, and early risk identification and prediction are essential. This study aims to develop and validate a predictive model for developmental delay, providing a scientific basis for clinical risk assessment and early intervention. Methods: This study included preterm infants and their primary caregivers who were followed up at our center from May 2023 to September 2024. The samples were randomly divided into a training cohort, an internal validation cohort, and an external validation cohort. Independent risk factors for stunting were identified through univariate and multivariate logistic regression analyses, and predictive models and calibration were constructed accordingly. Results: The five standardized indicators at 3, 6, 9, and 12 months for 507 preterm infants were analyzed using principal component analysis, and their developmental outcomes were grouped accordingly. Logistic regression analyses showed that gestational age, high-risk factors, knowledge of caregiving, caregiving experience, and the presence of other caregivers in the home were independent risk factors for the risk of preterm infants with stunted growth at 3, 6, 9, and 12 months. The nomogram showed the area under the receiver operating characteristic curve values of 0.743, 0.735, 0.752, and 0.774 in the training cohort; 0.855, 0.771, 0.870, and 0.786 in the internal validation cohort; 0.822, 0.804, 0.717, and 0.678 in the external validation cohort, respectively. The calibration curves, consistency index, and decision curve analysis all showed that the model was significantly better than a single indicator in predicting the risk of stunting in preterm infants. Conclusions: The stunting risk prediction model constructed in this study shows good predictive ability, which can help clinicians assess the risk of stunting in preterm infants and support the development of early intervention strategies. Full article

(This article belongs to the Section Pediatric Neonatology)

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12 pages, 748 KiB

Open AccessArticle

Can the Oxygen Saturation Index Predict Severe Bronchopulmonary Dysplasia?

by Hulya Ozdemir, Sinem Gulcan Kersin, Asli Memisoglu, Ibrahim Kandemir and Hulya Selva Bilgen

Children 2025, 12(5), 582; https://doi.org/10.3390/children12050582 (registering DOI) - 30 Apr 2025

Abstract

Background/Objectives: Even with improvements in perinatal care, bronchopulmonary dysplasia (BPD) continues to be a major challenge, especially in smaller and more premature infants. Early detection of severe BPD can improve treatment outcomes. This study aims to evaluate the correlation between the oxygen [...] Read more.

Background/Objectives: Even with improvements in perinatal care, bronchopulmonary dysplasia (BPD) continues to be a major challenge, especially in smaller and more premature infants. Early detection of severe BPD can improve treatment outcomes. This study aims to evaluate the correlation between the oxygen saturation index (OSI) and severe BPD/death in preterm infants, with a focus on the OSI’s predictive value. Methods: In this retrospective observational study, infants with a gestational age of less than 32 weeks who required either invasive or non-invasive mechanical ventilation were included. Ventilator settings and OSI values were collected on days 3, 7, 14, 21, and 28 of life. The correlations between postnatal OSIs and outcomes such as death or severe BPD were analyzed using logistic regression. Results: Out of the 210 eligible infants, 54 (25.7%) either died or were diagnosed with severe BPD. In our study, OSI values on postnatal days 14, 21, and 28 were significantly higher in preterm infants who developed severe BPD or died, with mean OSI-14, OSI-21, and OSI-28 values of 4.9, 3.5, and 2.8, respectively. The OSI showed the highest sensitivity and specificity on postnatal days 14 and 21, with cut-off points of 3.6 and 3.1, respectively. We built a basic chart to predict severe BPD/death with OSI-14 and OSI-21 and delivery room intubation with 86% sensitivity and 84.5% specificity (increasing up to 98.8% specificity). Conclusions: This study showed that the diagnostic power of the OSI in predicting severe BPD or death was highest for OSI-14 and OSI-21. We demonstrated that calculating the OSI, a non-invasive clinical tool, can predict severe BPD/death in infants born before 32 weeks as early as the 14th day of life. Full article

(This article belongs to the Special Issue Bronchopulmonary Dysplasia: Challenges and Advances)

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13 pages, 288 KiB

Open AccessArticle

Cardiorespiratory Fitness in Spanish Youth: The Roles of Sex, Age, Body Composition, and Healthy Lifestyle Habits in Cor-School Study

by Saül Aixa-Requena, Álvaro Pano-Rodríguez, Vicenç Hernández-González, Enric Conesa-Milian, Abraham Batalla-Gavaldà, Jose Vicente Beltrán-Garrido, Isaac López-Laval, Francisco Corbi, Rosa Arnau-Salvador and Joaquín Reverter-Masia

Children 2025, 12(5), 581; https://doi.org/10.3390/children12050581 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: Cardiorespiratory fitness (CRF) is a key indicator of current and future health in children and adolescents, and is influenced by both physiological and behavioral factors. This study examined the associations between CRF, body composition, and health-related habits in 685 children and [...] Read more.

Background/Objectives: Cardiorespiratory fitness (CRF) is a key indicator of current and future health in children and adolescents, and is influenced by both physiological and behavioral factors. This study examined the associations between CRF, body composition, and health-related habits in 685 children and adolescents (aged 8–16 years) who regularly participated in extracurricular sports programs in northeastern Spain. Methods: Participants underwent anthropometric assessments, completed a 20 m shuttle run test to evaluate CRF, and filled out validated questionnaires on physical activity levels, sleep quality, and adherence to the Mediterranean diet. Results: Significant sex differences were observed, with boys achieving higher CRF performance (p < 0.001), primarily associated with greater muscle mass (p < 0.001) and lower body fat percentage (p < 0.001). Age positively correlated with improved CRF (p < 0.001), whereas higher body mass index (p = 0.003) and fat mass (p = 0.020) negatively impacted fitness outcomes. Conclusions: These findings underscore the critical role of physical activity and optimal body composition in promoting cardiorespiratory fitness among youth, emphasizing the importance of targeted interventions to foster healthy behaviors from early childhood. Future research should adopt longitudinal designs to better elucidate the dynamic interactions between lifestyle factors, body composition, and physical fitness throughout childhood and adolescence. Full article

(This article belongs to the Section Global Pediatric Health)

16 pages, 720 KiB

Open AccessArticle

Child Abuse and Family Social Support: The Practice of Resolutions Approach

by Annemariek J. W. Sepers, Marija Maric and Trudy M. Mooren

Children 2025, 12(5), 580; https://doi.org/10.3390/children12050580 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: Child abuse is a devastating problem, and effective interventions are needed. Interventions incorporating social support have been found to be more effective in reducing parental abuse than those that do not. The resolutions approach (RA) emphasizes collaborating with the family’s social network. [...] Read more.

Background/Objectives: Child abuse is a devastating problem, and effective interventions are needed. Interventions incorporating social support have been found to be more effective in reducing parental abuse than those that do not. The resolutions approach (RA) emphasizes collaborating with the family’s social network. The present study aims to examine the role of social networks in RA. Methods: This report presents the cases of two families (children aged 8–18) who are alleged to have committed child abuse. A mixed-method study was conducted. Qualitative data based on in-depth interviews, and quantitative data obtained by repeated assessments following a single-case design were integrated. Incidents of child abuse were assessed before treatment, at the end of treatment, and at follow-up, using the Conflict Tactics Scales. An idiosyncratic measurement was administered every fortnight during the intervention. Results: In both families, members acknowledged the value of involving their social network and reported decreased incidents of child abuse. One family succeeded in involving the network, and in this family, aggressive behavior stopped soon after RA started. Results were maintained during follow-up. In the other family, aggression stopped after the baseline period, according to the parents, but not according to their youngest child. Conclusions: Although the involvement of social support is prescribed through the intervention protocol, several challenges hamper its realization. Recommendations are formulated for how to involve social network members in the context of family therapy when child safety is at risk. RA might be a valuable intervention to stop child abuse, but it needs further research. Full article

(This article belongs to the Section Global Pediatric Health)

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14 pages, 1629 KiB

Open AccessArticle

Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style

by Jiaoyang Cao, Jing Song, Baoju Shan, Changxin Zhu and Liping Tan

Children 2025, 12(5), 579; https://doi.org/10.3390/children12050579 (registering DOI) - 29 Apr 2025

Abstract

Background: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. Methods: A retrospective analysis of 456 pediatric patients [...] Read more.

Background: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. Methods: A retrospective analysis of 456 pediatric patients with IHCA (2018–2022) at the Children’s Hospital of Chongqing Medical University assessed demographics, arrest characteristics, outcomes and mortality risk factors. The primary outcome was survival to discharge; the secondary outcomes included return of spontaneous circulation (ROSC) > 20 min, 24 h survival, and favorable neurological outcomes. Logistic regression was used to identify the mortality risk factors. Results: ROSC > 20 min was achieved in 78.07% of cases, with 37.94% surviving to discharge (86.13% of survivors had favorable neurological outcomes). Etiological stratification identified general medical conditions (52.63%) as the predominant diagnoses, with surgical cardiac patients demonstrating superior resuscitation outcomes (ROSC > 20 min: 86.84%, discharge survival: 64.04%). Initial arrest rhythms predominantly featured non-shockable patterns, specifically bradycardia with poor perfusion (79.39%), whereas shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia) constituted only 4.17% of cases. Multivariable regression analysis identified five independent risk factors: vasoactive infusion before arrest (OR = 7.69), CPR > 35 min (OR = 13.92), emergency intubation (OR = 5.17), administration of >2 epinephrine doses (OR = 3.12), and rearrest (OR = 8.48). Notably, prolonged CPR (>35 min) correlated with higher mortality (8.96% survival vs. 48.54% for 1–15 min), yet all six survivors with CPR > 35 min had favorable neurological outcomes. Conclusions: These findings underscore the persistent challenges in pediatric IHCA management while challenging the conventional CPR duration thresholds for futility. The identified mortality risk factors inform resuscitation decision making and future studies. Full article

(This article belongs to the Special Issue Emergency Management and Treatment Strategies in Children Cardiac Arrest)

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16 pages, 433 KiB

Open AccessArticle

Summer Success: SKIPing to Motor Competence for Disadvantaged Preschoolers

by Dimetrius Brandon, Ruri Famelia, E. Kipling Webster and Jacqueline D. Goodway

Children 2025, 12(5), 578; https://doi.org/10.3390/children12050578 (registering DOI) - 29 Apr 2025

Abstract

Background: Disadvantaged children often enter kindergarten with delays in fundamental motor skill (FMS) competence, which is critical for future physical activity engagement. The Summer Success—Successful Kinesthetic Instruction for Preschoolers (SS-SKIP) program was designed to address these developmental gaps, with a short, intensive [...] Read more.

Background: Disadvantaged children often enter kindergarten with delays in fundamental motor skill (FMS) competence, which is critical for future physical activity engagement. The Summer Success—Successful Kinesthetic Instruction for Preschoolers (SS-SKIP) program was designed to address these developmental gaps, with a short, intensive intervention. This pilot study evaluated the impact of a 4-week SS-SKIP program on FMS, perceived motor competence (PMC), and executive function (EF). Methods: Twenty-one preschool children (mean age = 62.62 ± 4.61 months) from disadvantaged communities participated in an intensive, month-long (240 min) program. FMS were assessed using the Test of Gross Motor Development-2 (TGMD-2), PMC was evaluated using the Pictorial Scale for Perceived Competence, and EF was measured via the Head–Toes–Knees–Shoulders (HTKS), Go/No-Go, and Sorting cards tests. Standing long jump was measured in meters. A pretest–post-test design assessed program impact using 2 Gender X 2 Session MANOVAs/ANOVAs on dependent variables. Results: Analysis of differences in baseline measures of FMS competence and EF by Gender and Session revealed no significant main effects of Gender, Session, or their interaction across measures (all p > 0.05). Repeated measures ANOVAs by Gender revealed a significant main effect for Time for locomotor standard scores (p < 0.001), object control standard scores (p < 0.001), and HTKS scores (p < 0.001), indicating improvement from pretest to post-test. By contrast, jump distance, PMC, Go/No-Go and Card Sorting scores were non-significant (p > 0.05). Conclusions: A short, intense SS-SKIP FMS intervention significantly enhanced FMS and improved HTKS performance. This pilot study was limited by the lack of a control group and small N. These findings underscore the potential of short, targeted interventions in addressing early motor delays in disadvantaged preschoolers, warranting further investigation into their long-term impacts. Full article

(This article belongs to the Special Issue Promoting Healthy Lifestyles in Children and Adolescents)

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10 pages, 204 KiB

Open AccessArticle

Second Attempt for Patent Ductus Arteriosus (PDA) Closure: Room for Acetaminophen? A Retrospective Single-Center Experience at Gaslini Children’s Hospital

by Samuele Caruggi, Andrea Calandrino, Gaia Cipresso, Marcella Battaglini, Paolo Massirio, Francesco Vinci, Irene Bonato, Chiara Andreato, Federica Mela, Lorenzo Curcio, Alessandro Parodi and Luca Antonio Ramenghi

Children 2025, 12(5), 577; https://doi.org/10.3390/children12050577 (registering DOI) - 29 Apr 2025

Abstract

Background: The diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) occurs in 55% of very low birth weight (VLBW) preterm infants. There is no agreement on the best approach to ensure a quick hsPDA closure. Drug treatment of hsPDA fails in approximately [...] Read more.

Background: The diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) occurs in 55% of very low birth weight (VLBW) preterm infants. There is no agreement on the best approach to ensure a quick hsPDA closure. Drug treatment of hsPDA fails in approximately 20% of cases with an increasing risk of prolonged ventilation, BPD, and NEC, as well as the need for surgical duct ligation. This study aims to highlight the efficacy of ibuprofen versus acetaminophen in the case of a second cycle of medical therapy after the failure of the first pharmacological approach for hsPDA closure. Methods: Every VLBW infant admitted to our NICU and treated for hsPDA was included in our retrospective research. Information about the clinical course, hsPDA diagnosis and treatment, and common complications associated with preterm birth was collected. A comparison was made between patients treated with acetaminophen or ibuprofen to assess effectiveness in hsPDA closing. Results: A total of 286 VLBW infants were included. First-course ibuprofen was effective in 87 of 115 infants (75.7%) treated, acetaminophen in 138 of 171 (80.7%). Second-course therapy with ibuprofen was effective in 62.5% of the patients, while acetaminophen was effective in 69.2%. No statistically significant difference was observed in the first-course and second-course success rates. Conclusions: This study confirms that acetaminophen is not inferior to ibuprofen in the closure of hsPDA in VLBW infants. Our data demonstrate that a second course of medical therapy after the failure of the first course could help close the majority of hsPDA cases without surgery. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

12 pages, 919 KiB

Open AccessArticle

Influence of Screen Time on Physical Activity and Lifestyle Factors in German School Children: Interim Results from the Hand-on-Heart-Study (“Hand aufs Herz”)

by Jennifer Wieprecht, Delphina Gomes, Federico Morassutti Vitale, Simone Katrin Manai, Samar Shamas, Marcel Müller, Maren Baethmann, Anja Tengler, Roxana Riley, Guido Mandilaras, Nikolaus Alexander Haas and Meike Schrader

Children 2025, 12(5), 576; https://doi.org/10.3390/children12050576 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: Today, digital technologies are integral to children’s lives; their increasing use, however, may raise health concerns. This study aims to examine the effect of screen time on physical activity and lifestyle factors in German school children. Methods: As part of [...] Read more.

Background/Objectives: Today, digital technologies are integral to children’s lives; their increasing use, however, may raise health concerns. This study aims to examine the effect of screen time on physical activity and lifestyle factors in German school children. Methods: As part of the prospective hand-on-heart-study (“Hand-aufs-Herz”), a comprehensive cardiovascular system check-up examination was conducted on 922 German schoolchildren. The pupils were asked for a self-report on their daily physical activities and club sports. The examinations on-site contained measurements of the pupils’ weight and height as well as their physical fitness, which was assessed by a stair-climbing test. Results: A large proportion of pupils had a screen time of more than 2 h daily, regardless of the day of the week (63–76%). In fact, pupils with a screen time ≥ 2 h were more likely to achieve poor grades in school (weekday ORs 3.23, 95% CI 1.76, 5.95; weekend ORs 3.28, 95% CI 1.53, 7.00) and not be members of a sports club (weekday ORs 2.35, 95% CI 1.68, 3.29; weekend ORs 2.13, 95% CI 1.44, 3.14). Pupils who did not meet both recommendations for physical activity and screen time walked <5000 steps daily (60%), had a high proportion of overweight/obesity (40%), were non-swimmers (38.5%), spent ≥7 h sitting (35.8%), and slept fewer hours than recommended (30%). It has also been shown that longer screen time has a negative impact on the lifestyle of children and young people. Conclusions: Our results show that excessive screen time in children is linked to higher weight and an unhealthy lifestyle, increasing long-term cardiovascular risks. Public health initiatives aimed at reducing screen time, promoting physical activity, and encouraging healthier habits are essential to improve children’s overall health and prevent future chronic diseases. Full article

(This article belongs to the Special Issue The Health Effects of Daily Physical Activity Behaviours in Children: Physical and Psychological Outcomes)

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12 pages, 571 KiB

Open AccessArticle

Family Factors and the Psychological Well-Being of Children and Adolescents with Inflammatory Bowel Disease—An Exploratory Study

by Chantal Hieronymi, Kalina Kaul, Jan de Laffolie, Burkhard Brosig and on behalf of Cedata-GPGE AG

Children 2025, 12(5), 575; https://doi.org/10.3390/children12050575 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: The aim of our study was to examine the influence of family structure and the number of siblings on psychological problems and illness-related emotions in children and adolescents with inflammatory bowel disease (IBD) and the relationship between emotional coping in children [...] Read more.

Background/Objectives: The aim of our study was to examine the influence of family structure and the number of siblings on psychological problems and illness-related emotions in children and adolescents with inflammatory bowel disease (IBD) and the relationship between emotional coping in children and parents. Methods: CEDNA is a nationwide German online paper-based questionnaire administered between October 2021 and April 2022. Adolescents with IBD, aged 12 to 17 years, and parents of children aged 0 to 17 years with diagnosed IBD, were included. SAS was used for descriptive statistics and logistic regression analysis was performed using R Studio (PBC; 2023.06.0 + 421). Results: 1158 participants (450 adolescents and 708 parents) were included in the study. A two-parent household could not be associated with mental illness as a comorbidity in pediatric IBD patients (p = 0.06) but was shown to decrease the risk of sadness (p < 0.001), helplessness (p < 0.01), and feeling left alone and lonely (p < 0.05). A single-parent household increased the risk of sadness (p = 0.001), helplessness (p = 0.002), and loneliness (p = 0.006). Having one to two siblings was associated with a lower risk of mental health problems (p = 0.03) and reduced anxiety (p = 0.005). An association was also found between parents and children’s emotional coping skills. Conclusions: Further research on family structure and siblings in pediatric IBD is needed, given the potential impact on children’s psychological well-being. Full article

(This article belongs to the Section Pediatric Gastroenterology and Nutrition)

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