Children

14 pages, 1461 KiB

Open AccessCase Report

Fatal Influenza B–MRSA Coinfection in a Healthy Adolescent: Necrotizing Pneumonia, Cytokine Storm, and Multi-Organ Failure

by Irina Profir, Cristina-Mihaela Popescu and Aurel Nechita

Children 2025, 12(6), 766; https://doi.org/10.3390/children12060766 (registering DOI) - 13 Jun 2025

Abstract

Background: Influenza B usually causes mild illness in children. Severe and fatal cases can occur when complicated by secondary Staphylococcus aureus (S. aureus) pneumonia, including community-acquired methicillin-resistant Staphylococcus aureus (MRSA). We present a rare, rapidly progressive fatal case in an adolescent with [...] Read more.

Background: Influenza B usually causes mild illness in children. Severe and fatal cases can occur when complicated by secondary Staphylococcus aureus (S. aureus) pneumonia, including community-acquired methicillin-resistant Staphylococcus aureus (MRSA). We present a rare, rapidly progressive fatal case in an adolescent with no known medical history to highlight diagnostic and therapeutic pitfalls. Case Presentation: A 16-year-old boy with no known underlying conditions (unvaccinated for influenza) presented critically ill at “Sf. Ioan” Clinical Emergency Pediatric Hospital in Galați after one week of high fever and cough. He was in respiratory failure with septic shock, requiring immediate intubation and vasopressors. Chest X-ray (CXR) showed diffuse bilateral infiltrates (acute respiratory distress syndrome, ARDS). Initial laboratory tests revealed leukopenia, severe thrombocytopenia, disseminated intravascular coagulation (DIC), rhabdomyolysis, and acute kidney injury (AKI). Reverse transcription polymerase chain reaction (RT-PCR) confirmed influenza B, and blood cultures grew MRSA. Despite maximal intensive care, including mechanical ventilation, antibiotics (escalated for MRSA), antiviral therapy, and cytokine hemoadsorption therapy, the patient developed refractory multi-organ failure and died on hospital day 6. Autopsy revealed bilateral necrotizing pneumonia (NP) without radiographic cavitation, underscoring the diagnostic challenge. Discussion: The initial chest radiography showed diffuse bilateral pulmonary infiltrates, predominantly in the lower zones, with an ill-defined, patchy, and confluent appearance. Such appearance, in our case, was more suggestive of rapid progressive NP caused by MRSA rather than the typical pneumococcal one. This is one of the few reported cases of influenza B–MRSA coinfection with fulminant rhabdomyolysis and autopsy-confirmed necrosis. Our fulminant case illustrates the synergistic virulence of influenza and MRSA. Toxin-producing MRSA strains can cause NP and a “cytokine storm,” causing capillary leak, ARDS, shock, and DIC. Once multi-organ failure ensues, the prognosis is grim despite aggressive care. The absence of early radiographic necrosis and delayed anti-MRSA therapy (initiated after culture results) likely contributed to the poor outcome. Conclusions: Influenza B–MRSA co-infection, though rare, demands urgent empiric anti-MRSA therapy in severe influenza cases with leukopenia or shock, even without radiographic necrosis. This fatal outcome underscores the dual imperative of influenza vaccination and early, aggressive dual-pathogen targeting in high-risk presentations. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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13 pages, 417 KiB

Open AccessReview

Current Applications and Outcomes of Robotic Surgery in Pediatric Upper Airway and Neck Procedures: A Systematic Review

by Irene Claudia Visconti, Marella Reale, Virginia Dallari, Eleonora M. C. Trecca, Antonella Miriam Di Lullo, Mario Turri-Zanoni and Michele Gaffuri

Children 2025, 12(6), 765; https://doi.org/10.3390/children12060765 (registering DOI) - 13 Jun 2025

Abstract

Objectives: This review summarizes current evidence on robotic-assisted upper airway and neck surgery in pediatric patients, highlighting clinical indications, outcomes, limitations, and areas for future research. Methods: A systematic review was conducted in accordance with PRISMA guidelines, including studies on robotic [...] Read more.

Objectives: This review summarizes current evidence on robotic-assisted upper airway and neck surgery in pediatric patients, highlighting clinical indications, outcomes, limitations, and areas for future research. Methods: A systematic review was conducted in accordance with PRISMA guidelines, including studies on robotic surgery for pediatric patients (≤18 years) with upper airway conditions and cervical pathologies. Data on study characteristics, patient demographics, surgical details, outcomes, and robotic system advantages or limitations were extracted. Results: Twenty studies met inclusion criteria, comprising 104 pediatric patients who underwent 110 robotic procedures, mostly transoral robotic surgery (TORS) for base of tongue, laryngeal, and cervical pathologies. The Da Vinci Si was the most used system. The mean operative time was ~74 min, with minimal blood loss and no intra/post operative tracheostomies. Reported advantages included enhanced visualization, precision, and reduced morbidity. Limitations involved size mismatches, limited working space, and high costs. Follow-up (mean 11.4 months) revealed no recurrences, confirming feasibility and safety in selected pediatric cases. Conclusions: Robotic-assisted surgery appears to be a feasible and safe option for managing pediatric upper airway and neck conditions, offering promising functional and aesthetic outcomes with low complication rates. However, its use is currently limited by anatomical constraints, high costs, and the need for surgeon training. Long-term prospective studies with larger cohorts are needed to confirm its efficacy and define its role compared to traditional techniques. Full article

(This article belongs to the Special Issue Pediatric Laryngeal Surgery: Emerging Trends)

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20 pages, 723 KiB

Open AccessArticle

Teacher Personality Predicts Emotional Well-Being and Academic Achievement in Students with Specific Learning Disorders

by Wanqin Yu, Olivia F. Ward, Brianna Paquette, Sylvie Mrug and Caroline G. Richter

Children 2025, 12(6), 764; https://doi.org/10.3390/children12060764 - 13 Jun 2025

Abstract

Background/Objectives: Students with specific learning disorders (SLDs) are at increased risk for emotional and academic difficulties. While teacher characteristics can influence student outcomes, few studies have examined the role of teacher personality in supporting students with SLDs. This study investigated whether teacher personality [...] Read more.

Background/Objectives: Students with specific learning disorders (SLDs) are at increased risk for emotional and academic difficulties. While teacher characteristics can influence student outcomes, few studies have examined the role of teacher personality in supporting students with SLDs. This study investigated whether teacher personality traits predicted student emotional well-being and academic achievement in a school-based intervention context. Methods: Participants were 64 students with SLDs (Mage = 13.28) nested within 21 teachers. Students completed measures of emotional well-being at baseline and post-intervention, and grade point average (GPA) was obtained from school records at the end of the school year. Teachers completed the Big Five Inventory mid-intervention. Two-level multilevel models were conducted in Mplus using maximum likelihood estimation with robust standard errors (MLR). The models controlled for student and teacher demographics, baseline emotional well-being, and the intervention group. Missing data were addressed using full information maximum likelihood (FIML). Results: Teacher female sex, higher neuroticism, and lower teaching experience were associated with higher student emotional well-being post-intervention. Follow-up analyses confirmed that teacher sex, neuroticism, and conscientiousness each explained substantial between-teacher variance. In the GPA model, student sex and teacher openness were significant predictors, with female students and students taught by more open teachers earning higher GPAs. Conclusions: Teacher personality traits, specifically neuroticism, conscientiousness, and openness, were associated with emotional and academic outcomes among students with SLDs. The findings highlight the importance of considering teacher characteristics in designing school-based interventions to support the development of learners with SLDs or other neurodevelopmental disorders. Full article

(This article belongs to the Special Issue Children’s Well-Being and Mental Health in an Educational Context)

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14 pages, 215 KiB

Open AccessArticle

Mental Health Professionals’ Views on Artificial Intelligence as an Aide for Children Anticipating or Suffering the Loss of a Parent to Cancer: Helpful or Harmful?

by Mary Rose Yockel, Marcelo M. Sleiman, Jr., Heather Doherty, Rachel Adams, Kimberly M. Davis, Hunter Groninger, Christina Sharkey, Matthew G. Biel, Muriel R. Statman and Kenneth P. Tercyak

Children 2025, 12(6), 763; https://doi.org/10.3390/children12060763 - 12 Jun 2025

Abstract

Purpose: Assess mental health professionals’ attitudes regarding the timing and characteristics of therapeutic interventions for children whose parents have incurable cancer, and whether professionals would use artificial intelligence (AI) in these interventions. Methods: Professionals were surveyed about their therapeutic approaches to [...] Read more.

Purpose: Assess mental health professionals’ attitudes regarding the timing and characteristics of therapeutic interventions for children whose parents have incurable cancer, and whether professionals would use artificial intelligence (AI) in these interventions. Methods: Professionals were surveyed about their therapeutic approaches to caring for children when parents have incurable cancer under different scenarios. Data from N = 294 (69% male, 72% white, 26% Latine, 56% rural or underserved communities) physicians, psychologists, social workers, hospital chaplains, community health workers, and others were analyzed. Attitudes surrounding the timing and characteristics of interventions across the parent’s cancer journey were compared, including how professionals believed interventions should attend to dimensions of the child or family, and if, how, and when AI technology could be introduced. Results: Across 10 dimensions of childhood, (1) the child’s premorbid exposure to traumatic events, (2) a surviving parent’s presence, and (3) the child’s age were important factors to consider when making mental health care decisions in this context. The professionals reported being more likely to introduce therapeutic resources as early as possible in the parent’s illness (i.e., upon diagnosis). Regarding the use of AI, 87% foresaw its role in supporting children’s mental health. While 93.2% agreed that a grieving child could be helped by interacting with an AI-generated likeness of the deceased parent, when AI’s use was contextualized in providing support for a child who lost a parent to cancer, only 49% believed AI was appropriate. The participants were conflicted over when AI could be first introduced, either upon a parent’s illness diagnosis (19.4%), during a parent’s treatment (19.0%), or as part of a parent’s hospice care (12.6%). None believed it to be appropriate following the loss of the parent to cancer. Conclusions: AI is increasingly present in children’s daily lives and quickly infiltrating health care with widely accessible mental health chatbots. Concerns about privacy, the accuracy of information, and the anthropomorphism of AI tools by children give professionals pause before introducing such technology. Proceeding with great caution is urged until more is known about the impact of AI on children’s mental health, grief, and psychological well-being in the context of parental cancer. Full article

(This article belongs to the Section Pediatric Mental Health)

14 pages, 1112 KiB

Open AccessSystematic Review

Association Between Hypertensive Disorders of Pregnancy and Patent Ductus Arteriosus in Very Preterm Infants: A Bayesian Model-Averaged Meta-Analysis

by Moreyba Borges-Luján, Gloria Galán-Henríquez, Rosa I. Rodríguez-Viera, František Bartoš, Gema E. González-Luis and Eduardo Villamor

Children 2025, 12(6), 762; https://doi.org/10.3390/children12060762 - 12 Jun 2025

Abstract

Background/Objectives: Prenatal adverse events may influence the development of complications of prematurity, including patent ductus arteriosus (PDA). We conducted a systematic review and Bayesian model-averaged (BMA) meta-analysis of observational studies exploring the association between hypertensive disorders of pregnancy (HDP) and the risk [...] Read more.

Background/Objectives: Prenatal adverse events may influence the development of complications of prematurity, including patent ductus arteriosus (PDA). We conducted a systematic review and Bayesian model-averaged (BMA) meta-analysis of observational studies exploring the association between hypertensive disorders of pregnancy (HDP) and the risk of PDA in preterm infants. Methods: PubMed/Medline and Embase databases were searched. We used BMA analysis to calculate Bayes factors (BFs). The BF₁₀ is the ratio of the probability of the data under the alternative hypothesis (H₁, presence of association) over the probability of the data under the null hypothesis (H₀, absence of association). Results: We included 41 studies (58,004 infants). BMA analysis showed moderate evidence in favour of H₀ for the association between HDP and any PDA (BF₁₀ = 0.20) as well as for the association between HDP and hemodynamically significant PDA (BF₁₀ = 0.27). Subgroup analyses based on the subtype of HDP showed that the moderate evidence in favour of H₀ was only conclusive (i.e., BF₁₀ < 0.33) for the associations of any PDA with preeclampsia (BF₁₀ = 0.30) and hemodynamically significant PDA with preeclampsia (BF₁₀ = 0.17). Conclusions: The currently available evidence suggests a lack of association between HDP and the risk of developing PDA. 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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8 pages, 579 KiB

Open AccessCase Report

Changes in Motor Function in a Child with Cerebral Palsy Following Multiple Botulinum Toxin Injections: A Case Report

by Nancy Lennon, Chris Church, Jose J. Salazar-Torres, Faithe Kalisperis, Freeman Miller and Jason J. Howard

Children 2025, 12(6), 761; https://doi.org/10.3390/children12060761 - 12 Jun 2025

Abstract

Objective: The objective of this study was to examine 7 years of clinical physical therapy measures in a child with spastic diplegic cerebral palsy (CP) who received multiple botulinum toxin type A (BoNT-A) injections. Methods: A boy diagnosed with spastic diplegic CP, Gross [...] Read more.

Objective: The objective of this study was to examine 7 years of clinical physical therapy measures in a child with spastic diplegic cerebral palsy (CP) who received multiple botulinum toxin type A (BoNT-A) injections. Methods: A boy diagnosed with spastic diplegic CP, Gross Motor Function Classification System level II, received four episodes of BoNT-A from ages 4 to 10 years. Serial clinical measures of muscle strength, spasticity, lower extremity passive range of motion, gait kinematics, and gross motor function were collected in the gait analysis lab from age 3 to 10 years. Results: After improvements from ages 3 to 7 years, gait and motor function declined from ages 8 to 10 years with no improvement in spasticity or range of motion measurements. Muscle testing and gait kinematics defined a loss of plantarflexion strength. Conclusions: A decline in gross motor skills and gait is not typical for a child with spastic diplegia at age 8 years and its association with BoNT-A injections needs to be considered. This case demonstrates the importance of evaluating treatment outcomes for youth with spastic CP utilizing a set of reliable, and clinically useful measures of strength, spasticity, contracture, gait, and motor function. Critical examination of impairment and functional level measures defines goals, guides treatment, and evaluates outcomes. With this approach, pediatric therapists can empower families to make well-informed decisions. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

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15 pages, 505 KiB

Open AccessReview

Skewfoot Deformity: State of the Art

by Antonio Mazzotti, Federico Sgubbi, Alberto Arceri, Gianmarco Di Paola, Elena Artioli, Simone Ottavio Zielli, Lorenzo Marcucci, Nicola Guindani, Cesare Faldini and Maurizio De Pellegrin

Children 2025, 12(6), 760; https://doi.org/10.3390/children12060760 - 12 Jun 2025

Abstract

Background: Skewfoot, also known as Z-foot, is a rare and complex deformity characterized by a combination of forefoot adduction and hindfoot valgus, resulting in a “Z” shape. Due to its rarity, diagnostic criteria and standardized treatment guidelines are lacking. This scoping review [...] Read more.

Background: Skewfoot, also known as Z-foot, is a rare and complex deformity characterized by a combination of forefoot adduction and hindfoot valgus, resulting in a “Z” shape. Due to its rarity, diagnostic criteria and standardized treatment guidelines are lacking. This scoping review aims to systematically map and summarize the current knowledge regarding skewfoot. Methods: A comprehensive literature search of the PubMed, Cochrane Library, and Scopus databases was conducted to identify relevant articles. Patient-specific data were meticulously extracted from eligible studies and analyzed in detail. Results: A total of 12 studies met the inclusion criteria. Each study was independently reviewed, and data on epidemiology, etiology, clinical presentation, imaging assessment, and treatment options were extracted. Conclusions: The true incidence of skewfoot remains unknown. Etiology is likely multifactorial, often associated with systemic and neurological disorders. Skewfoot management ranges from conservative approaches to surgery. A medial cuneiform opening wedge osteotomy is the most used technique; however, the frequent need for additional procedures emphasizes the complexity of the deformity and the importance of a personalized approach. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery (2nd Edition))

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11 pages, 368 KiB

Open AccessReview

Controversies in Parenteral Protein Intake in Preterm Infants

by Ira Holla and Pradeep Alur

Children 2025, 12(6), 759; https://doi.org/10.3390/children12060759 - 12 Jun 2025

Abstract

As the limit of viability is extended to lower gestational ages, neonatologists caring for preterm infants must discover the optimal nutritional combination to support postnatal growth. It has been well established that introducing protein soon after birth is associated with improved short-term growth [...] Read more.

As the limit of viability is extended to lower gestational ages, neonatologists caring for preterm infants must discover the optimal nutritional combination to support postnatal growth. It has been well established that introducing protein soon after birth is associated with improved short-term growth at 36 weeks postmenstrual age and neurodevelopment. However, it remains unclear what the optimal level of protein is for parenteral nutrition at various gestational ages. Several studies have shown possible adverse effects of high-protein delivery in very low birth weight infants. Inborn errors in amino acid metabolism also caution us that higher levels of specific amino acids can harm the growing brain. Full article

(This article belongs to the Special Issue Advances in Nutritional and Feeding Approaches in the Very Extreme Preterm Infant Born Under 27 Weeks Gestation)

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15 pages, 412 KiB

Open AccessArticle

Enhancing Physical Fitness in Primary School Children Through Inclusive Sports Activities

by Nikola Utvić, Lidija Marković, Radenko Arsenijević, Nikola Aksović, Bojan Bjelica, Stanimir Stojljković, Saša Bubanj, Gabriela Raveica, Daniel-Lucian Dobreci, Nicolae-Lucian Voinea, Vasile-Cătălin Ciocan, Mihaela Anghel, Bogdan-Alexandru Antohe and Tatiana Dobrescu

Children 2025, 12(6), 758; https://doi.org/10.3390/children12060758 - 11 Jun 2025

Abstract

(1) Background: The aim of this study is to investigate whether the application of adaptive sports programs, initially designed for children with disabilities, can have a positive effect on physical fitness and body composition in healthy primary school children; (2) Methods: The sample [...] Read more.

(1) Background: The aim of this study is to investigate whether the application of adaptive sports programs, initially designed for children with disabilities, can have a positive effect on physical fitness and body composition in healthy primary school children; (2) Methods: The sample comprised 80 participants, equally divided by gender (50% male, 50% female), with a mean age of 11.5 (SD = 0.03). They were divided into two groups, an experimental and a control group, with an even gender distribution. The research lasted 12 weeks, with additional classes allocated for the initial and the final measurements. The Eurofit test battery assessed physical fitness; (3) Results: ANCOVA revealed significant group differences in body composition variables within the total sample and gender distribution (p < 0.001). Significant differences were observed in handgrip strength (HGR), flamingo balance test (FBL), shuttle run 10 × 5 m (SHR) (p < 0.001), and also hand tapping (HTP) (p = 0.01). Participants in the experimental group outperformed the control group, highlighting the effectiveness of the intervention program. Specifically, boys in the experimental group showed significant improvements in HGR and SHR (p < 0.001), while girls improved significantly in HGR, FBL, and SHR (p < 0.001); (4) Conclusions: The experimental program, which incorporates sports elements for disabled individuals, led to significant improvements in the physical fitness parameters of children. Full article

(This article belongs to the Special Issue Physical Education and Exercise Promotion and Intervention in Children and Adolescents for Health and Wellbeing, 2nd Edition)

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12 pages, 315 KiB

Open AccessArticle

Not a Quiet Place: Understanding Noise Level in a Newborn Intensive Care Unit (NICU) and Its Relation with Newborn’s Vital Parameters, a Pilot Feasibility Study

by Silvia Rossi, Alessia Salvatore, Giulia Ottonello, Ilaria Artuso, Roberta Da Rin Della Mora, Simona Serveli and Silvia Scelsi

Children 2025, 12(6), 757; https://doi.org/10.3390/children12060757 - 11 Jun 2025

Abstract

Background/Objectives: Adaptation to extrauterine life is challenging for preterm newborns. Environmental stimuli, such as noise, can lead to adverse health outcomes, causing instability of vital parameters and impairment of neurodevelopment. The American Academy of Pediatrics recommends a maximum environmental noise level of 45 [...] Read more.

Background/Objectives: Adaptation to extrauterine life is challenging for preterm newborns. Environmental stimuli, such as noise, can lead to adverse health outcomes, causing instability of vital parameters and impairment of neurodevelopment. The American Academy of Pediatrics recommends a maximum environmental noise level of 45 decibels (dB) or less in the NICU. The study’s primary aim was to describe environmental noise in a neonatal intensive care unit and to analyze potential associations between noise and vital parameters of preterm newborns, including heart rate, respiratory rate, and oxygen saturation levels. Methods: A pilot observational feasibility study was conducted in a level III NICU. Sound levels and vital parameters were recorded over four hours for each preterm newborn. Confounding variables were controlled. Data were analyzed using descriptive statistics, Kendall’s τ-b, and logistic regression analysis. Ethical approval and parental consent were obtained. Results: The average environmental noise level was consistently above 45 dB. Six patients were enrolled, and 22 recordings (ranging in length from 1 to 4 h) were performed. Data adjusted for confounding variables show a statistically significant Kendall’s correlation between heart rate and decibels (τ-b = 0.89, p = 0.003, n = 520), suggesting a monotonous crescent tendency between these two variables, although the relationship is not strong. The logistic regression model indicates that the odds ratio (OR) for decibels related to tachycardia is 1.066, meaning that for each 1 dB increase, the probability of tachycardia rises by 6.6% (p < 0.001). Conversely, the OR for respiratory rate is 0.959, suggesting that for each unit increase in respiratory rate, the probability of tachycardia decreases by approximately 4.1% (p < 0.001). Conclusions: The study reveals that the mean environmental noise level in the NICU consistently exceeds the recommended safety level. Decibels are one of the significant variables contributing to the likelihood of tachycardia, and an increase in decibels has a significant effect on this, but it is not the only one. Further analysis of a larger sample is needed. Full article

(This article belongs to the Special Issue The Latest Challenges and Explorations in Pediatric Nursing)

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9 pages, 230 KiB

Open AccessArticle

Final Adult Height in Girls Treated with GnRH Analogues for Precocious Puberty Around Age Eight

by Semra Bahar Akın and İlker Tolga Özgen

Children 2025, 12(6), 756; https://doi.org/10.3390/children12060756 - 11 Jun 2025

Abstract

Introductions: Precocious puberty initiated at a very young age causes a severe loss in height potential and should be treated with gonadotropin-releasing hormone agonists (GnRHa). Controversial findings exist regarding the efficacy of GnRHa treatment in girls with central precocious puberty (CPP) onset around [...] Read more.

Introductions: Precocious puberty initiated at a very young age causes a severe loss in height potential and should be treated with gonadotropin-releasing hormone agonists (GnRHa). Controversial findings exist regarding the efficacy of GnRHa treatment in girls with central precocious puberty (CPP) onset around the age of 8. This research assessed the impact of GnRHa treatment on the final height (FAH) of 117 girls diagnosed with CPP within this age group. Methods: This retrospective study included 117 CPP girls diagnosed at around age 8 (7–9 years old). Girls who started treatment between the ages of 8 and 9 (n = 71) and 7 and 8 (n = 46) were divided into groups 1 and 2, respectively. Predicted height (PAH), target height (TH), and FAH were calculated from medical records. Girls’ PAH, TH, and FAH were also compared between groups. Results: At beginning of treatment, the girls’ average ages were 8.59 ± 0.27 in group 1 and 7.50 ± 0.47 in group 2. In groups 1 and 2, GnRHa therapy durations were 1.97 ± 0.54 and 2.91 ± 0.61, respectively. There were no significant differences in TH (160.53 ± 5.49 vs. 160.57 ± 4.94), PAH (158.72 ± 5.23 vs. 158.35 ± 5.57), and FAH (162.42 ± 5.32 vs. 162.14 ± 5.70) between groups. FAH improved 4 cm from PAH in both (p = 0.001). Multivariate linear regression analysis showed that baseline height SDS was the main FAH predictor (Beta: 0.572, p = 0.001). Conclusions: GnRHa may improve FAH even if the treatment is delayed after age 8. However, as this improvement is limited for this age group, the therapy option should be individualized and should not be considered for all children. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

11 pages, 216 KiB

Open AccessArticle

Association Between Patent Ductus Arteriosus and the Development of Treatment-Requiring Retinopathy of Prematurity in Preterm Infants: A Single-Center Cohort Study

by Sezgin Gunes, Suzan Sahin, Ceren Durmaz Engin, Fırat Ergin, Alev Aldemir Sonmez, Özlem Bozkurt and Mehmet Yekta Oncel

Children 2025, 12(6), 755; https://doi.org/10.3390/children12060755 - 11 Jun 2025

Abstract

Background/Objectives: Retinopathy of prematurity (ROP) is a significant cause of childhood blindness, particularly among preterm infants. Patent ductus arteriosus (PDA) is commonly observed in neonates and may contribute to the development of ROP through increased oxygen delivery to the retina. However, the [...] Read more.

Background/Objectives: Retinopathy of prematurity (ROP) is a significant cause of childhood blindness, particularly among preterm infants. Patent ductus arteriosus (PDA) is commonly observed in neonates and may contribute to the development of ROP through increased oxygen delivery to the retina. However, the association between PDA and the severity of ROP remains unclear. This study aims to evaluate the relationship between PDA and the development of treatment-requiring ROP in preterm infants. Methods: A retrospective cohort study was conducted on preterm infants born between 2014 and 2020 at Izmir Private Medical Park Hospital. Infants with a birth weight of less than 2000 g and a gestational age of ≤36 + 6 weeks were included. Data on demographics, prematurity-related complications, PDA status, ROP severity, and treatment requirements were collected. Statistical analysis was performed using univariate and multivariate logistic regression models to identify predictors of ROP. Results: Of 516 infants, 328 did not have PDA, 117 had spontaneous PDA closure, and 71 required PDA treatment. Neonates requiring PDA treatment had significantly lower gestational age and birth weight, as well as longer respiratory support duration. PDA presence was associated with increased ROP incidence in univariate analysis (p < 0.001); however, it was not an independent predictor of treatment-requiring ROP in multivariate models. Significant predictors for treatment-requiring ROP included longer non-invasive ventilation duration (OR = 1.029) and total respiratory support (OR = 1.009). Conclusions: The findings of this study highlight the central role of respiratory morbidity in ROP pathogenesis and suggest that optimal respiratory management may be more critical for ROP prevention than PDA treatment alone. Full article

15 pages, 590 KiB

Open AccessArticle

Sex/Gender Differences in the Effects of Childhood Abuse on Future Risk of Depression: Longitudinal Evidence from the Global Flourishing Study

by Shervin Assari, Babak Najand and Alexandra Donovan

Children 2025, 12(6), 754; https://doi.org/10.3390/children12060754 - 11 Jun 2025

Abstract

Background: Adverse childhood experiences (ACEs) such as abuse (defined as emotional, physical, or sexual abuse without distinguishing type or severity) have long been linked to mental health challenges in adulthood. However, less is known about how these effects differ by sex/gender in global [...] Read more.

Background: Adverse childhood experiences (ACEs) such as abuse (defined as emotional, physical, or sexual abuse without distinguishing type or severity) have long been linked to mental health challenges in adulthood. However, less is known about how these effects differ by sex/gender in global samples, particularly using large-scale, multi-country panel data. Objectives: To examine whether the long-term association between childhood abuse and changes in depressive symptoms during adulthood differ between men and women, after adjusting for demographic and socioeconomic factors. Methods: We conducted a secondary analysis of Waves 1 and 2 of the Global Flourishing Study (GFS), a longitudinal panel study covering 22 diverse countries. The sample included adult participants with complete data on childhood abuse (yes/no); depression at baseline and follow-up; sex/gender; and relevant covariates (age; education; marital status; immigration status; smoking status; and employment). Depression was measured using a two-item scale. Multi-group structural equation models were used to test the effect of ACE on changes in depression over time where groups were defined based on sex/gender. Results: Overall, childhood abuse was associated with a statistically significant increase in depression scores between Wave 1 and Wave 2. This association was significant among women but not among men. Conclusions: Our findings suggest that the mental health consequences of childhood abuse extend into adulthood and disproportionately affect women. These sex/gender differences may reflect variations in stress processing; coping; and social roles. Interventions addressing early adversity may need to be tailored to recognize and respond to such sex/gender-specific vulnerabilities. Full article

(This article belongs to the Special Issue Adverse Childhood Experiences: Assessment and Long-Term Outcomes)

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18 pages, 257 KiB

Open AccessArticle

Health Behavior of Young People Aged 12–18 with Autism Spectrum Disorder and Intellectual Disabilities in Hungary

by Ágota Barabás, Renáta J. Erdei, Mariann Móré, Viktória Pázmány, Attila Sárváry, Emil Toldy-Schedel, Anita M. Grestyák, Attila Csaba Nagy, Orsolya P. Kiss and Péter Takács

Children 2025, 12(6), 753; https://doi.org/10.3390/children12060753 - 10 Jun 2025

Abstract

Introduction: People with disabilities are characterized by suboptimal health and lower self-rating health. Their need for health care is greater, they often have a higher prevalence of health problems and they have more difficulty accessing health care. The aim of this study was [...] Read more.

Introduction: People with disabilities are characterized by suboptimal health and lower self-rating health. Their need for health care is greater, they often have a higher prevalence of health problems and they have more difficulty accessing health care. The aim of this study was to assess the health behaviors and health indicators of 12–18-year-old young people with intellectual disabilities and autism spectrum disorder, and to explore their school-related perceptions in the Northern Great Plain region of Hungary. Materials and Methods: A cross-sectional questionnaire survey was conducted with the participation of 185 young people. A custom questionnaire was used, based on the Health Behavior in School-aged Children (HBSC) survey, assessing eating habits, oral care, physical activity, mental well-being, and self-reported health status. The sample was categorized into three groups: the ID1 (Intellectual Disability level 1) group, encompassing young individuals with mild intellectual disability; the ID2 group, encompassing young people with moderate intellectual disability; and the ID+ASD group, encompassing young individuals affected by both intellectual disability and autism spectrum disorder. Results: Consumption of various food types was below optimal levels. Low intake of fruits and vegetables was common, with only 21.6% of the respondents consuming fruit daily and 23.8% consuming vegetables daily. ID1 group reported significantly higher rates of nervousness several times a week (17.8% vs. 5.6% and 6.9%, p < 0.001), sleep difficulties (28.8% vs. 7.4% and 15.5%, p = 0.032), and dizziness (9.6% vs. 1.9% and 3.4%, p = 0.022) compared to the other two groups. A third school-related factor, related to negative emotions, showed a near-significant difference (p = 0.064), suggesting that students with both autism spectrum disorder and intellectual disability perceive lower levels of acceptance from teachers. On school-free days, computer usage was significantly highest in the ID+ASD group; 50% of them used a computer for at least 4 h per day. Conclusions: To improve mental well-being among affected children, psychological support and the implementation of mental health programs are recommended. In addition to teaching stress management techniques and coping mechanisms, integrating relaxation techniques into comprehensive developmental programs—both individually and in groups—is advised. For teachers, it is recommended to acquire disability-specific communication strategies. Full article

(This article belongs to the Special Issue Health Behaviour, Health Literacy and Mental Health in Children: 2nd Edition)

9 pages, 4551 KiB

Open AccessArticle

Pediatric Heterotopic Gastric Mucosa of the Cervical Esophagus (Inlet Patch): Case Series with Clinical, Endoscopic, and Histopathological Correlation

by Javier Arredondo Montero, Samuel Sáez Álvarez, Andrea Herreras Martínez, Ana Fernández-García and Cristina Iglesias Blázquez

Children 2025, 12(6), 752; https://doi.org/10.3390/children12060752 - 10 Jun 2025

Abstract

Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with [...] Read more.

Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with IP between 2018 and 2025. Sociodemographic and clinical data were collected. A blinded pathologist assessed the presence and severity of inflammation within the IP. Results: Nine patients (median age, 12 years; range, 6–14 years) were included, with 78% beingmale. Cervical esophageal symptoms were identified in 67%, primarily dysphagia and gastroesophageal reflux disease-related complaints, although concomitant conditions such as eosinophilic esophagitis were frequently present. Three patients had symptoms potentially attributable to IP (33%). Endoscopic examination revealed characteristic well-demarcated salmon-red plaques in all patients, with multiple lesions observed in three cases. Histology confirmed gastric heterotopia with varying degrees of chronic inflammation in all cases. A potential association was observed between the severity of gastritis in the stomach, the severity of inflammation in the IP, and the presence of H. pylori, with 75% of patients with moderate-to-severe IP inflammation also exhibiting gastric H. pylori-associated gastritis. All patients except one received proton pump inhibitors, and symptoms improved in all cases. Conclusions: A thorough and targeted examination of the cervical esophagus significantly increased IP detection at our center, with most cases (89%) being diagnosed in the last 12 months. While mostly asymptomatic and incidental, IP can be symptomatic. In this case, series, we found a possible association between the severity of inflammation in the IP, the severity of gastritis, and the presence of H. pylori. Further studies are needed to define the clinical significance of pediatric IP and optimal management. Full article

(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)

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10 pages, 198 KiB

Open AccessArticle

The Use of Vasodilator Therapy in Fontan Patients: A Single-Centre Experience

by Alessia Faccini, Martina Avesani, Roberta Biffanti, Elettra Pomiato, Domenico Sirico, Alice Pozza, Alessia Cerutti, Elena Reffo, Biagio Castaldi and Giovanni Di Salvo

Children 2025, 12(6), 751; https://doi.org/10.3390/children12060751 - 10 Jun 2025

Abstract

Background: The aim of this study was to describe our centre experience in the use of pulmonary vasodilator therapy in Fontan patients. Methods: We retrospectively enrolled patients that underwent Fontan operation between 2000 and 2024, reporting demographic and operative data and noting complications [...] Read more.

Background: The aim of this study was to describe our centre experience in the use of pulmonary vasodilator therapy in Fontan patients. Methods: We retrospectively enrolled patients that underwent Fontan operation between 2000 and 2024, reporting demographic and operative data and noting complications and the use of pulmonary vasodilators. Results: A total of 117 patients were followed for a median time of 150 months (90–207). In total, 36.7% were female, and the median age during the intervention was 50 months (37–64), and 53% had a single left ventricle physiology. In 20 of these 117 patients (17.1%), at least one pulmonary vasodilator drug was used during their life for the following reasons: 6 elevated pressures in the circuit, 3 low oxygen saturation, 2 plastic bronchitis, 2 pleural effusion, 1 chylothorax, 1 persistent pericardial effusion, 1 haemoptysis, 1 protein losing enteropathy, 1 poor exercise tolerance, 1 pulmonary arterial hypertension present since birth and 1 diastolic dysfunction. They had a significantly higher prevalence of single right ventricle physiology (65% vs. 37%, p = 0.03), pulmonary hypertension (60% vs. 0, p = 0.0001), plastic bronchitis (10% vs. 0, p = 0.03) and declivous oedema in the follow-up period (10% vs. 0, p = 0.03), with a higher assumption of warfarin (35% vs. 6.2%, p = 0.001). Conclusions: We found that in the absence of a standardise protocol, we usually use pulmonary vasodilator therapy in Fontan patients, as it is guided by clinical aspects and hemodynamic conditions, which lead us to start and stop this therapy. Full article

(This article belongs to the Section Pediatric Cardiology)

14 pages, 559 KiB

Open AccessReview

Significance of Oral Care for Children with Autism Spectrum Disorder—A Narrative Literature Review

by Sirma Angelova, Desislava Konstantinova, Anna Nenova-Nogalcheva and Rouzha Pancheva

Children 2025, 12(6), 750; https://doi.org/10.3390/children12060750 - 9 Jun 2025

Abstract

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition in children that typically involves challenges in cognition, behavior, and communication. While many children with ASD exhibit significant impairments in both verbal and non-verbal communication, the severity and nature of these difficulties can vary [...] Read more.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition in children that typically involves challenges in cognition, behavior, and communication. While many children with ASD exhibit significant impairments in both verbal and non-verbal communication, the severity and nature of these difficulties can vary widely. In addition to its impact on overall health, ASD also affects oral health, leading to increased vulnerability to dental disease. Aim: This narrative review aims to summarize key oral health challenges and care strategies for children with ASD, focusing on clinical risks, behavioral barriers, caregiver roles, and effective interventions. Materials and Methods: A comprehensive literature search was conducted using four databases—PubMed, Scopus, Web of Science, and Google Scholar—as well as relevant study registries where applicable. Peer-reviewed articles published in English between 2010 and 2024 were identified using keywords and their synonyms, such as autism spectrum disorder, children, oral care, dental practitioners, and parents. Studies were included based on relevance to oral health challenges and interventions in children diagnosed with ASD. Results: Children with ASD experience a range of sensory sensitivities, attention deficits, hyperactivity, and behavioral resistance, which significantly hinder the performance of adequate oral hygiene practices. These challenges contribute to a lack of effective dental prophylaxis and limited access to regular preventive care, ultimately resulting in poorer oral health outcomes and reduced oral health-related quality of life. Conclusion: Due to the multifaceted characteristics of ASD, children with this condition face significant barriers in accessing appropriate and individualized oral care. This increases their risks of developing oral health disorders, underscoring the need for coordinated efforts between caregivers and dental professionals to improve oral health outcomes in this vulnerable population. Full article

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

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14 pages, 345 KiB

Open AccessArticle

Construct Validity and Internal Consistency of the Italian Version of the PedsQL^TM 4.0 Generic Core Scale and PedsQL^TM 3.0 Cerebral Palsy Module

by Ilaria Pedrinelli, Sofia Biagi, Domenico Marco Romeo, Elisa Musto, Valeria Fagiani, Martina Lanza, Erika Guastafierro, Alice Colombo, Andrea Giordano, Cristina Montomoli, Cristiana Rezzani, Tiziana Casalino, Eugenio Mercuri, Daria Riva, Matilde Leonardi, Giovanni Baranello and Emanuela Pagliano

Children 2025, 12(6), 749; https://doi.org/10.3390/children12060749 - 9 Jun 2025

Abstract

Background: Health-related quality of life (HRQoL) has emerged as a meaningful outcome measure in clinical trials and healthcare interventions in children with cerebral palsy (CwCP). We assessed the construct validity and internal consistency of the Italian version of the Paediatric QoL inventory (PedsQL [...] Read more.

Background: Health-related quality of life (HRQoL) has emerged as a meaningful outcome measure in clinical trials and healthcare interventions in children with cerebral palsy (CwCP). We assessed the construct validity and internal consistency of the Italian version of the Paediatric QoL inventory (PedsQL^TM) 4.0 Generic Core Scales (GCS) and PedsQL^TM 3.0 Cerebral Palsy Module (CPM). Methods: A total of 125 CwCP and their parents were enrolled. Participants completed both the GCS and the CPM modules, and the results were compared to those of a sample of 121 healthy peers and their parents. The dimensionality of the two modules was assessed through exploratory factor analysis. Construct validity was assessed by a known-groups method evaluating the differences between CwCP and healthy sample. Results: Only a few GCS subscales were unidimensional, while all CPM subscales proved to be unidimensional, except for the Speech and Communication subscales of child self-reports. GCS internal consistency was good for all subscales of the parent proxy-reports, as well as for the Physical Activities and Psychosocial Health subscales of child self-reports. CPM internal consistency was good for both parent proxy-reports and—with a few exceptions—child self-reports. As for the PedsQL^TM validity, the GCS proved effective in discriminating between CwCP and healthy participants; the CPM showed a significant association between lower neurofunctional abilities and lower HRQoL. Parent–child concordance shows that child self-report scores were always higher than the those of the proxy-reports for both the GCS and CPM modules. Conclusions: The present study confirms the internal consistency and construct validity of the Italian version of both PedsQL^TM modules. In CwCP, greater functional disability resulted in lower HRQoL scores, and there was significant discrepancy between the parent and child ratings. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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10 pages, 612 KiB

Open AccessArticle

Role of Combined Use of Adiponectin and hsCRP in Cardiovascular Risk in Pediatric Neurogenic Bladder

by Joanna Bagińska-Chyży, Alicja Szymańska and Agata Korzeniecka-Kozerska

Children 2025, 12(6), 748; https://doi.org/10.3390/children12060748 - 9 Jun 2025

Abstract

Background/Objectives: Myelomeningocele (MMC) is the most severe form of spina bifida, often accompanied by impaired motor function due to paralysis of the lower limbs, as well as neurogenic bladder (NB). These factors may contribute to nutritional disorders and cardiovascular diseases (CVDs) in the [...] Read more.

Background/Objectives: Myelomeningocele (MMC) is the most severe form of spina bifida, often accompanied by impaired motor function due to paralysis of the lower limbs, as well as neurogenic bladder (NB). These factors may contribute to nutritional disorders and cardiovascular diseases (CVDs) in the future. High-sensitivity CRP (hsCRP) is a positive marker of unstable atherosclerotic plaques and is commonly used in the diagnosis of CVDs. Adiponectin has an opposite, anti-inflammatory function. The aim of this study was to assess the risk of CVDs in a group of children with NB and a control group, based on serum levels of adiponectin, hsCRP, and lipid profiles. Methods: A prospective clinical estimation based on 87 children (67 NB, 20 control group) was conducted. Data collected from medical histories included the following: sex, age, anthropometric parameters (height, weight, BMI), level of spinal lesion, and activity according to Hoffer’s scale. Lipid profile values (cholesterol, HDL, LDL, triglycerides) were assessed using standard blood sample tests. hsCRP and adiponectin were measured using an ELISA kit. Results: A comparison of adiponectin and hsCRP levels revealed statistically significant differences between the NB group and the control. Additionally, significant correlations were identified between BMI and the biomarkers: hsCRP was positively associated with BMI, whereas adiponectin exhibited a negative association. The highest concentrations of hsCRP were detected in MMC patients with a Th lesion level and in non-walker patients. Conclusions: Elevated hsCRP may reflect increased cardiovascular risk in children with NB. While adiponectin levels were also altered, their association with cardiovascular risk appears more complex and may involve additional metabolic mechanisms. Full article

(This article belongs to the Section Pediatric Nephrology & Urology)

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