Children

22 pages, 722 KB

Open AccessReview

Microneedles: Selected Applications for Pediatrics

by Alexis A. Ayala and Hassan Almoazen

Children 2026, 13(3), 360; https://doi.org/10.3390/children13030360 - 2 Mar 2026

Microneedles are a pediatric-friendly drug delivery system that has attracted many novel research endeavors. The fact that it creates a tiny cavity in the epidermis, which can allow peptides, proteins, nucleotides, and other large-sized molecules to penetrate the skin barrier, is very advantageous [...] Read more.

Microneedles are a pediatric-friendly drug delivery system that has attracted many novel research endeavors. The fact that it creates a tiny cavity in the epidermis, which can allow peptides, proteins, nucleotides, and other large-sized molecules to penetrate the skin barrier, is very advantageous for transdermal delivery. In this review article, we shed light on several pediatric applications of microneedles, such as the delivery of proteins, vaccines, and diagnostics. We believe the advantages of microneedles will continue to expand and be applied to other sites in the body. Full article

(This article belongs to the Special Issue The Pediatric Formulations: The Present and a Challenge for Future)

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11 pages, 895 KB

Open AccessSystematic Review

Muscle Imaging Approaches in Marinesco–Sjögren Syndrome: A Systematic Review and Two New Clinical Reports

by Bianca Buchignani, Giada Vega, Rosa Pasquariello, Gemma Marinella, Michela Tosetti, Guja Astrea and Roberta Battini

Children 2026, 13(3), 359; https://doi.org/10.3390/children13030359 - 2 Mar 2026

Abstract

Background: Marinesco–Sjögren syndrome (MSS, MIM #248800) is a condition that is characterized by biallelic pathogenic variants in the SIL1 gene. Manifestations include congenital cataracts, cerebellar ataxia, progressive muscle weakness and skeletal deformities, delay in psychomotor development, hypergonadotropic hypogonadism and short stature. Muscular [...] Read more.

Background: Marinesco–Sjögren syndrome (MSS, MIM #248800) is a condition that is characterized by biallelic pathogenic variants in the SIL1 gene. Manifestations include congenital cataracts, cerebellar ataxia, progressive muscle weakness and skeletal deformities, delay in psychomotor development, hypergonadotropic hypogonadism and short stature. Muscular involvement has been extensively discussed as a clinical finding but there is little literature on muscle imaging. The aim of this paper is to systematically review muscular imaging techniques in MSS reported in the literature, and to describe the clinical and imaging features of two pediatric subjects with MSS. Methods: Having searched through three electronic databases (PubMed, Scopus and Web of Science) two articles, written in English, describing twelve patients with MSS mutations on whom muscle MRI imaging was performed, were selected. In addition, two paediatric cases (brother and sister) with Marinesco–Sjögren syndrome (MSS) and MRI muscle findings were added. Data on type of study, cohort characteristics, type of mutation, neuromuscular signs and symptoms, imaging assessment, electrophysiological findings, biopsies, CNS symptoms, ocular signs and muscle imaging data were collected and stored in a table. Results: Of the 239 articles examined, only 3 used a muscle imaging technique to describe myopathy in MSS; one used a CT while another a muscle MRI. All 14 patients showed signs of fatty replacement. The infiltration mainly affected the lower limbs, but involvement in the upper limb was described in some adult patients. Conclusions: Performing a muscle MRI in MSS can lead to the early identification of muscle involvement and may be a useful biomarker to monitor disease progression. Full article

(This article belongs to the Special Issue Pediatric Neuropsychiatric Disorders: Diagnostic Challenges and Therapeutic Frontiers)

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16 pages, 776 KB

Open AccessArticle

Early Prediction of Acute Kidney Injury Using the Furosemide Stress Test in Pediatric Cardiac Surgery Patients

by Ömer Özden, Murat Tanyildiz, Aslı Ece Yakici, Ezgi Nur Alper, Mete Han Kızılkaya, Mehmet Biçer, Cemile Pehlivanoğlu, Ender Ödemiş and Atıf Akçevin

Children 2026, 13(3), 358; https://doi.org/10.3390/children13030358 - 28 Feb 2026

Abstract

Introduction: We evaluated the furosemide stress test as an early predictor of acute kidney injury following pediatric cardiac surgery, in comparison with the Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria. Materials and Methods: This single-centre retrospective study evaluated pediatric patients who underwent [...] Read more.

Introduction: We evaluated the furosemide stress test as an early predictor of acute kidney injury following pediatric cardiac surgery, in comparison with the Kidney Disease: Improving Global Outcomes (KDIGO) diagnostic criteria. Materials and Methods: This single-centre retrospective study evaluated pediatric patients who underwent open cardiac surgery between March 2019 and September 2024 at Koç University Hospital. The evaluation included pre-operative, intra-operative, and postoperative variables; a two-hour assessment of urinary response to the first dose of furosemide upon admission to the intensive care unit; and rates of acute kidney injury. Results: A total of 254 patients were included, and 53 patients (20.8%) developed acute kidney injury according to KDIGO criteria. The mean furosemide stress test response was 9.86 ± 5.84 (median: 9.10) mL/kg/h in the non-AKI group and was significantly lower in the AKI group at 5.07 ± 4.73 (median: 3.33) mL/kg/h (p < 0.001). Receiver operating characteristic analysis demonstrated that the furosemide stress test has discriminative ability to predict acute kidney injury. The cut-off value was 6.104 mL/kg/h, and patients with a lower response had a higher risk of developing acute kidney injury. Sensitivity and specificity were 69.8% and 69.7%, respectively. Acute kidney injury was diagnosed at a median of 18 h using KDIGO criteria, whereas the furosemide stress test enabled earlier prediction of acute kidney injury risk at a median of 5 h. Conclusion: The findings support the potential clinical utility of the furosemide stress test in the early stages after pediatric cardiac surgery to predict acute kidney injury. Full article

(This article belongs to the Special Issue Critical Care of Medically Complex Children: New Studies and Challenges)

15 pages, 1723 KB

Open AccessArticle

Sport-Specific Muscle Architectural Adaptations and Jump Performance in Preadolescent Rhythmic Gymnasts

by Vasiliki Gaspari, Gregory C. Bogdanis, Ioli Panidi, Dimitra A. Kanna, Andreas Salagas, Anastasia Donti, Gerasimos Terzis and Olyvia Donti

Children 2026, 13(3), 357; https://doi.org/10.3390/children13030357 - 28 Feb 2026

Abstract

Objective: We examined vastus lateralis (VL), gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and biceps femoris (BF) muscle architecture and force–time parameters recorded during a countermovement jump (CMJ). Methods: Eighty-nine 9 year-old girls (43 rhythmic gymnasts and 46 recreationally active controls) were assessed in: [...] Read more.

Objective: We examined vastus lateralis (VL), gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and biceps femoris (BF) muscle architecture and force–time parameters recorded during a countermovement jump (CMJ). Methods: Eighty-nine 9 year-old girls (43 rhythmic gymnasts and 46 recreationally active controls) were assessed in: (a) muscle architecture (fascicle length—FL; angle; muscle thickness; and anatomical cross-sectional area—CSA) using ultrasonography, (b) CMJ performance (maximum force—Fmax; rate of force development—RFD; jump height; and peak power) using force–time data, and (c) anthropometrics and body composition. Results: Rhythmic gymnasts exhibited greater BF fascicle length and muscle thickness than controls (7.84 ± 0.73 vs. 7.26 ± 0.75 cm and 1.76 ± 0.19 vs. 1.61 ± 0.22 cm, respectively, p < 0.001), while VL muscle CSA was larger in controls (p = 0.001). When normalized to the respective segment length (thigh or shank), the FL was longer in gymnasts across all muscles (p ≤ 0.017). Gymnasts also demonstrated greater CMJ height (13.1%, p = 0.005), power scaled to body mass, and RFD (p < 0.005), while controls produced a greater Fmax (16.9%, p = 0.002). Body mass was the strongest predictor of Fmax in both groups (p < 0.001). CMJ power was best predicted by gastrocnemius CSA in gymnasts and by VL CSA combined with maturity offset in controls (all p < 0.001). Maturity offset and gastrocnemius CSA also predicted allometrically scaled power in controls. Conclusions: Rhythmic gymnasts are characterized by muscle-specific adaptations, specifically in the BF muscle FL and muscle thickness, which favor superior CMJ performance. In developing athletes, body mass is primarily related to maximal force, whereas muscle CSA is more closely associated with power output. Full article

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

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24 pages, 972 KB

Open AccessReview

Biological Risk Factors for Suicidal Behavior in Children and Adolescents: A Narrative Review

by Martin Vatrál, Juraj Jurík, Barbora Katrenčíková, Jana Muchová, Zdeňka Ďuračková and Jana Trebatická

Children 2026, 13(3), 356; https://doi.org/10.3390/children13030356 - 28 Feb 2026

Abstract

Suicidal behavior in children and adolescents is a major global public health issue, and suicide is one of the leading causes of death in this age group. While psychosocial determinants of suicidality are well established, understanding its biological risk factors is crucial for [...] Read more.

Suicidal behavior in children and adolescents is a major global public health issue, and suicide is one of the leading causes of death in this age group. While psychosocial determinants of suicidality are well established, understanding its biological risk factors is crucial for targeted prevention and treatment. This review presents a narrative synthesis of recent literature examining current evidence on the biological mechanisms that contribute to youth suicidality. Genetic liability plays a substantial role, often interacting with environmental stressors. Key neurobiological factors include dysfunction of the serotonin system and impaired neuroplasticity, characterized by a glutamate–gamma-aminobutyric acid imbalance and reduced brain-derived neurotrophic factor. Psychosocial stress appears linked to these changes through several pathways, including dysregulation of the hypothalamic–pituitary–adrenal axis, chronic low-grade inflammation, oxidative stress, and activation of the kynurenine pathway. Neurodevelopmental conditions like autism spectrum disorders and attention deficit hyperactivity disorder, as well as sleep disturbances, may further increase risk. While therapeutic agents such as ketamine and lithium target these neurobiological systems, evidence for their anti-suicidal efficacy in youth remains limited, with only a small number of randomized controlled trials conducted in pediatric populations. Biological research offers valuable insights, but the use of varied study methods and a lack of longitudinal data complicate its translation into clinical practice. Future studies should employ integrative, developmentally informed models to elucidate causal mechanisms and inform more effective interventions. Full article

(This article belongs to the Special Issue Precision Treatment and Medication Strategies for Childhood Mental Illness)

15 pages, 2677 KB

Open AccessCase Report

22q11.2 Deletion Syndrome, Oral-Maxillo-Facial Manifestations and Cognitive Functioning: Three Illustrative Case Reports

by Dario Sardella, Andrea De Giacomo, Andrea Ricci, Luisa Limongelli and Massimo Corsalini

Children 2026, 13(3), 355; https://doi.org/10.3390/children13030355 - 28 Feb 2026

Abstract

Background: 22q11.2 deletion syndrome (22q11.2 DS) is a rare genetic syndrome characterized by high phenotypic variability, with an incidence of approximately 1:4000 live births. Most of the existing literature consists of case reports or case series, making it challenging to obtain large cohorts [...] Read more.

Background: 22q11.2 deletion syndrome (22q11.2 DS) is a rare genetic syndrome characterized by high phenotypic variability, with an incidence of approximately 1:4000 live births. Most of the existing literature consists of case reports or case series, making it challenging to obtain large cohorts for data comparison and drawing generalizable conclusions. Aim: The aim of this article is to share the clinical experience of patients with 22q11.2 DS who were previously evaluated by Child Neuropsychiatry and underwent odontoiatric procedures at the Dental Unit of the Policlinico di Bari. Methods: We report three clinical cases of pediatric patients with 22q11.2 DS who were managed at the University Dental Unit of the Policlinico di Bari for dental procedures, including pre/post-treatment images and child neuropsychiatric characteristics. Results: Cleft lip and cleft palate are the most commonly encountered facial malformations. Enamel hypoplasia and hypomineralizations, caries, dental agenesis, and hypodontia are reported with variable frequency in almost all studies considering the oral health of these patients. Our experience is coherent with the data present at the moment. The clinical examinations showed diffuse hypomineralization and several caries, concordant with the literature. One patient received moderate sedation and another received general anesthesia; oral prophylaxis, fluoride application, pulp therapy, extractions of hopeless teeth and restorations of carious and hypomineralized teeth were performed. Conclusions: 22q11.2 DS is a genetic condition with a variable prognosis, but current trends show that patients often reach adulthood, primarily due to advancements in cardiology, which was previously the leading cause of mortality in these patients. From this perspective, collaboration among various medical specialties is crucial to implement holistic patient management programs and early interventions. Full article

(This article belongs to the Collection Advance in Pediatric Dentistry)

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15 pages, 1060 KB

Open AccessReview

Integrating the ICF and the F-Words Framework to Support Family-Centered Pediatric Care for Children with Neurodevelopmental Disorders: A Narrative Review

by Anna Gogola, Rafał Gnat, Aneta Skworc, Jerzy Luszawski and Sławomir Snela

Children 2026, 13(3), 354; https://doi.org/10.3390/children13030354 - 28 Feb 2026

Abstract

Background: Family-centered care is a core principle of contemporary pediatric rehabilitation, particularly for children with neurodevelopmental disorders. Conceptual frameworks emphasizing functioning, participation, and contextual factors are essential to operationalize this approach in clinical practice. The International Classification of Functioning, Disability and Health [...] Read more.

Background: Family-centered care is a core principle of contemporary pediatric rehabilitation, particularly for children with neurodevelopmental disorders. Conceptual frameworks emphasizing functioning, participation, and contextual factors are essential to operationalize this approach in clinical practice. The International Classification of Functioning, Disability and Health (ICF) and the F-words framework are widely used models aligned with these principles; however, their practical integration remains challenging. Methods: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases to identify English-language publications (2005–2025) addressing the ICF, the F-words framework, and pediatric neurodevelopmental disability. Results: Thirty-one publications were included. The findings indicate increasing international adoption of both frameworks in pediatric rehabilitation. However, persistent challenges were identified, including conceptual ambiguity between activity and participation domains, limited operationalization of personal factors, overlap between the ICF and F-words constructs, limited standardization, difficulties in outcome measurement, and inconsistent involvement of families in clinical decision-making. Conclusions: The ICF and the F-words framework offer complementary strengths for advancing family-centered pediatric care. A structured dual-layer integration approach may enhance shared decision-making, clarify goal-setting, and improve communication with families. Further methodological refinement and practice-oriented guidance are needed to support consistent clinical implementation. Full article

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

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12 pages, 1284 KB

Open AccessArticle

Force Metrics During the Boyle–Davis Gag in Children Undergoing Adenotonsillectomy

by Enriqueta Arevalo Asensio, Anelise Schifino Wolmeister, Thomas Engelhardt, Sam J. Daniel, Samuel D. F. Wasserman and Gianluca Bertolizio

Children 2026, 13(3), 353; https://doi.org/10.3390/children13030353 - 28 Feb 2026

Abstract

Background: In adults, the forces generated during Boyle–Davis Gag suspension correlate with postoperative pain, but no data are available in pediatrics. This study investigates the force metrics and postoperative opioid consumption, pain, emergence delirium (ED), and hypoactive delirium in children. Methods: [...] Read more.

Background: In adults, the forces generated during Boyle–Davis Gag suspension correlate with postoperative pain, but no data are available in pediatrics. This study investigates the force metrics and postoperative opioid consumption, pain, emergence delirium (ED), and hypoactive delirium in children. Methods: Children undergoing elective partial or total adenotonsillectomy or adenoidectomy were enrolled. Intraoperative maximum and average forces, suspension time, total impulse (area under the curve of force vs. time), and postoperative opioid consumption, pain, ED, and hypoactive delirium were assessed. Results: Data from 43 children were analyzed. Force metrics were not associated with postoperative opioid consumption, ED, or hypoactive delirium. Compared to no pain, total impulse decreased with mild (mean difference 2.3 kN·s; 95% CI, 3.8 to 4.2; p = 0.02), moderate (mean difference 2.8 kN·s; 95% CI, 5.4 to 3.9; p = 0.011), and severe pain (mean difference 2.3 kN·s; 95% CI, 7.6 to 3.9; p = 0.005). Suspension time was negatively correlated with pain score (r = −0.32, p = 0.041). Conclusions: The force metrics are low and not associated with opioid consumption, ED, or hypoactive delirium. Suspension correlates weakly with postoperative pain in children. Full article

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

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17 pages, 3592 KB

Open AccessArticle

Diagnostic Pitfalls and Management of Transphyseal Fractures of the Distal Humerus: A Retrospective Review of 25 Cases

by Li Zhang, Yang Yuan, Haoqi Cai, Yufeng Wang, Yuchan Li, Haiqing Cai, Zhigang Wang and Mingyuan Miao

Children 2026, 13(3), 352; https://doi.org/10.3390/children13030352 - 28 Feb 2026

Abstract

Background/Objectives: Transphyseal fracture of the distal humerus (TFDH) is a rare but clinically important pediatric elbow injury that predominantly affects children under 3 years of age. Due to the radiolucent nature of the cartilaginous distal humeral epiphysis in this age group, TFDH [...] Read more.

Background/Objectives: Transphyseal fracture of the distal humerus (TFDH) is a rare but clinically important pediatric elbow injury that predominantly affects children under 3 years of age. Due to the radiolucent nature of the cartilaginous distal humeral epiphysis in this age group, TFDH is often misdiagnosed as elbow dislocation, supracondylar fracture, or lateral/medial condyle fracture. Time pressures, limited pediatric musculoskeletal expertise, and incomplete clinical histories in emergency settings further compound this diagnostic challenge. Despite the importance of early and accurate diagnosis to prevent complications such as cubitus varus, systematic studies on diagnostic pitfalls and strategies for improving recognition remain scarce. We therefore aim to characterize misclassification patterns, standardize radiographic cues, and evaluate management outcomes. Methods: We conducted a single-center retrospective review of 25 pediatric patients with TFDH who were misdiagnosed at initial presentation between 2012 and 2022. Clinical records, radiographic features, treatment modalities, and complications were analyzed over a minimum follow-up period of 24 months. Results: All 25 cases were initially misdiagnosed. The most common misdiagnoses were supracondylar and lateral condyle fractures (each 6/25, 24%), followed by elbow dislocation (4/25, 16%). Misclassification was primarily attributed to failure to assess global forearm–humerus alignment and misinterpretation of the radiocapitellar line. All patients underwent emergency management, with 18/25 (72%) receiving closed reduction and percutaneous K-wire fixation, and 7/25 (28%) undergoing closed reduction and cast immobilization. Cubitus varus developed in 5/25 (20%) overall and was more frequent after closed reduction with cast immobilization (3/7, 43%) than after K-wire fixation (2/18, 11%). Overall, 92% achieved excellent functional outcomes according to the Mayo Elbow Performance Index (MEPI). The implementation of a targeted curriculum improved diagnostic accuracy among trainees from 70% to 100%. Conclusions: TFDH poses substantial cognitive and radiographic diagnostic challenges. A structured radiographic assessment, early senior review, and targeted education may improve recognition and outcomes. These findings offer actionable insights to enhance diagnostic accuracy and optimize care for this vulnerable patient population. Full article

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

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10 pages, 304 KB

Open AccessArticle

by Ali Brian, Andrea Taliaferro, Pamela Beach, Benjamin Lytle, Adam Pennell, Lauren Lieberman and Ingi Einarsson

Children 2026, 13(3), 351; https://doi.org/10.3390/children13030351 - 28 Feb 2026

Abstract

Background/Objectives: Health-related quality of life (HRQoL) is a critical indicator of developmental progress, educational engagement, and psychosocial resilience. By identifying both shared and context-specific differences in HRQoL, we aim to contribute to a more nuanced understanding of well-being that can inform the development [...] Read more.

Background/Objectives: Health-related quality of life (HRQoL) is a critical indicator of developmental progress, educational engagement, and psychosocial resilience. By identifying both shared and context-specific differences in HRQoL, we aim to contribute to a more nuanced understanding of well-being that can inform the development of assessment approaches and future research tailored to the diverse contexts in which children with disabilities live and learn. Thus, the purpose of this study is to explore HRQoL and its putative influencing factors among youth with multiple disabilities across two distinct cultural settings, the United States and Iceland. Methods: Participants (N = 26; Icelandic = 50%; Mage = 16.34 ± 2.33 years) completed height, weight, the Test of Perceived Physical Competence (TPPC), Supine-to-Stand (STS), Rapid Assessment of Physical Activity (RAPA), and VISIONS QL. We conducted five, 2 group × 2 sex ANOVA and several independent samples t-tests within groups by sex for our variables of interest. Results: There was a significant difference between Icelandic boys and girls for BMI (p = 0.087, d = 0.65) and STS (p = 0.027, d = 1.04). Conversely, a significant difference was found in the American group between boys and girls for RAPA (p = 0.092, d = 0.81) and TPPC (p = 0.068, d = 0.92). Conclusions: Preliminary findings suggest that patterns in objective and self-reported health indicators may vary by context. These results highlight the importance of considering both measured performance and self-perceived health when examining HRQoL among adolescents with multiple disabilities, while underscoring the need for further research in larger samples to clarify these relationships. Full article

(This article belongs to the Special Issue Advances in Motor Competence and Physical Activity in School Children (2nd Edition))

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22 pages, 979 KB

Open AccessArticle

Case Series and Literature Narrative Review of Immune-Mediated Thrombotic Thrombocytopenic Purpura in Children

by Letiția-Elena Radu, Andreea Nicoleta Șerbănică, Andra Daniela Marcu, Ana-Maria Bică, Cristina Georgiana Jercan, Radu Obrișcă, Georgiana Gherghe, Gabriela Droc, Dana Tomescu and Anca Coliță

Children 2026, 13(3), 350; https://doi.org/10.3390/children13030350 - 28 Feb 2026

Abstract

Background/Objectives: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare but life-threatening thrombotic microangiopathy in children. Secondary forms, occurring in association with immune dysregulation, autoimmune disease, or other triggers, are particularly challenging to diagnose and manage, and pediatric-specific data remain limited. This study [...] Read more.

Background/Objectives: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare but life-threatening thrombotic microangiopathy in children. Secondary forms, occurring in association with immune dysregulation, autoimmune disease, or other triggers, are particularly challenging to diagnose and manage, and pediatric-specific data remain limited. This study aimed to describe the clinical characteristics, diagnostic pathways, and management of pediatric iTTP and to contextualize these findings within the recent literature. Methods: We conducted a retrospective case series of pediatric patients diagnosed with iTTP at a tertiary referral center, between November 2021 and January 2026. Clinical presentation, laboratory findings, including ADAMTS13 activity and ADAMTS13 inhibitors, associated conditions, treatment strategies, and outcomes were reviewed. In parallel, a narrative literature review was performed focusing on pediatric immune-mediated secondary TTP published over the past five years. Results: Four pediatric patients (three females, one male; median age 14 years) met inclusion criteria. All presented with severe thrombocytopenia and microangiopathic hemolytic anemia, accompanied by prominent neurologic manifestations in three cases. Severe ADAMTS13 activity deficiency (≤10%) with positive inhibitors was documented in all patients. Secondary iTTP occurred in association with evolving systemic autoimmunity, systemic lupus erythematosus, common variable immunodeficiency, or without an identifiable trigger at presentation. High clinical probability scores facilitated early diagnosis. Management required plasma exchange, corticosteroids, and targeted and immunomodulatory therapy. Conclusions: Pediatric secondary iTTP is a heterogeneous condition that frequently presents with diagnostic ambiguity and severe neurologic involvement. Early recognition, prompt initiation of TTP-directed therapy, and comprehensive immunologic evaluation are critical for favorable outcomes. Case series combined with narrative reviews remain valuable for advancing understanding and optimizing individualized care in this rare pediatric disorder. Full article

(This article belongs to the Special Issue Advances in the Epidemiology of Hemostasis Disorders in Children)

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14 pages, 471 KB

Open AccessReview

Pre-, Pro-, Post- and Synbiotics in Pediatric Short Bowel Syndrome: A Narrative Review of Current Evidence

by Roberta Giusy Ruiz, Annalisa Morelli, Rosangela Grieco, Sabrina Cardile, Teresa Capriati, Chiara Maria Trovato, Giulia Bolasco, Daniela Knafelz, Fiammetta Bracci, Arianna Alterio and Antonella Diamanti

Children 2026, 13(3), 349; https://doi.org/10.3390/children13030349 - 28 Feb 2026

Abstract

Background: Pediatric Short bowel syndrome (SBS) is the leading cause of intestinal failure and is characterized by persistent dysbiosis that negatively impacts intestinal adaptation and growth. Although microbiota modulation via pre-, pro-, and synbiotics represents a promising strategy, current evidence remains fragmented. This [...] Read more.

Background: Pediatric Short bowel syndrome (SBS) is the leading cause of intestinal failure and is characterized by persistent dysbiosis that negatively impacts intestinal adaptation and growth. Although microbiota modulation via pre-, pro-, and synbiotics represents a promising strategy, current evidence remains fragmented. This narrative review aims to critically assess the efficacy and safety of such interventions in the management of pediatric SBS. Methods: A structured literature search was conducted on PubMed up to November 2025. Fourteen relevant studies were included, comprising clinical trials, preclinical animal models, and significant case reports regarding the use of biotics in SBS. Results: The analysis reveals a microbiological dichotomy based on nutritional status: parenteral nutrition (PN)-dependent patients exhibit an excess of Proteobacteria associated with infectious risk, whereas weaned patients present a metabolic risk of D-lactic acidosis due to carbohydrate fermentation. Regarding efficacy, long-term synbiotic treatments (>12 months) demonstrated significant improvements in growth and nutritional status, likely mediated by increased production of short-chain fatty acids (SCFAs) and mucosal adaptation, unlike short-term probiotic cycles. However, serious adverse events (Lactobacillus sepsis and D-lactic acidosis) were reported, predominantly in patients with central venous catheters or malabsorption. Conclusions: Biotics offer therapeutic potential for intestinal failure, but their use cannot be empirical. The safety profile should be carefully selected, especially in central venous catheter (CVC) carriers. Future strategies must evolve towards precision medicine, prioritizing non-D-lactate-producing strains and personalized protocols based on the patient’s nutritional phase. Full article

(This article belongs to the Special Issue Advances in Pediatric Gastroenterology (2nd Edition))

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16 pages, 461 KB

Open AccessReview

Advantages of Remimazolam in Pediatric Anesthesia: A Narrative Review

by Alessandro Vittori, Cecilia Di Fabio, Elisa Francia, Ilaria Mascilini, Riccardo Tarquini, Corrado Cecchetti, Giuliano Marchetti, Franco Marinangeli, Teresa Grimaldi Capitello and Marco Cascella

Children 2026, 13(3), 348; https://doi.org/10.3390/children13030348 - 27 Feb 2026

Abstract

Remimazolam is an ultra-short-acting benzodiazepine developed according to the “soft drug” concept and characterized by rapid onset, predictable offset, organ-independent metabolism, and the availability of a specific antagonist. Due to these pharmacological features, this drug represents a particularly attractive option for pediatric anesthesia [...] Read more.

Remimazolam is an ultra-short-acting benzodiazepine developed according to the “soft drug” concept and characterized by rapid onset, predictable offset, organ-independent metabolism, and the availability of a specific antagonist. Due to these pharmacological features, this drug represents a particularly attractive option for pediatric anesthesia and sedation, a field in which traditional agents are often limited by hemodynamic instability, prolonged recovery, and adverse respiratory effects. This narrative review summarizes and discusses the current evidence regarding the use of remimazolam in pediatric patients, focusing on pharmacokinetics, pharmacodynamics, clinical applications, and safety. Available data indicate that remimazolam provides effective sedation and anesthesia in children across multiple settings, including induction of general anesthesia, non-operating room anesthesia, and intensive care unit sedation. Compared with propofol and midazolam, remimazolam is generally associated with greater hemodynamic stability, rapid recovery, reduced emergence delirium, and a favorable respiratory profile, while maintaining comparable efficacy. Intranasal administration has also shown promise as a premedication strategy for reducing preoperative anxiety, although it may occasionally be associated with pain. Even if remimazolam lacks intrinsic analgesic properties, its use appears to indirectly improve postoperative comfort by attenuating stress responses and emergence agitation. Despite encouraging results, pediatric use of remimazolam remains off-label in many countries, and evidence is still limited by small sample sizes and heterogeneous protocols. Further large-scale randomized controlled trials are needed to define optimal dosing strategies, long-term safety, and their definitive role in pediatric anesthetic and sedative practice. Full article

(This article belongs to the Special Issue Anesthesia and Perioperative Management in Pediatrics)

19 pages, 819 KB

Open AccessArticle

Seeing Food Through Young Children’s Eyes: Children’s Representations of Parental Feeding Strategies and Food Choice Reasoning

by Irith Freedman, Anat Gesser-Edelsburg and Billie Eilam

Children 2026, 13(3), 347; https://doi.org/10.3390/children13030347 - 27 Feb 2026

Abstract

Background/Objectives: Research on children’s eating has primarily focused on parental feeding practices and dietary outcomes, with less attention to how young children themselves understand parental food-related messages and relate them to their own food choices. Recognizing children as active participants in food socialization, [...] Read more.

Background/Objectives: Research on children’s eating has primarily focused on parental feeding practices and dietary outcomes, with less attention to how young children themselves understand parental food-related messages and relate them to their own food choices. Recognizing children as active participants in food socialization, this study aimed to examine preschool children’s representations of parental feeding strategies alongside their expressed food-choice considerations. Methods: A qualitative, exploratory, multi-method design was employed within a constructivist framework. Forty kindergarten children aged 4 years 10 months to 5 years 8 months participated in individual, play-based sessions conducted in familiar educational settings. Data were generated using two complementary tools: a doll role-play task eliciting children’s representations of parental feeding strategies and a simulated grocery shopping task eliciting food-choice considerations. All sessions were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Results: During role-play, children frequently portrayed parents as emphasizing health-related arguments, control, and negotiation when guiding food intake. Less frequently, they represented strategies such as encouragement to try, deception, or references to body weight. In contrast, during the food-choice task, children’s selections were primarily guided by personal preference, with health considerations mentioned less often. For most participants, the feeding strategies attributed to parents did not closely align with the considerations guiding their own food choices. Conclusions: The findings highlight young children’s active and selective engagement with parental feeding discourse and underscore the contextual nature of food-related meaning-making in early childhood. Rather than reflecting a straightforward transmission of parental messages, children’s food choices appear shaped by situational affordances and perceived autonomy, supporting child-centered approaches to nutrition education and health promotion. Full article

(This article belongs to the Special Issue Assessing and Improving Diet Quality in Pediatric and Public Health Nutrition)

13 pages, 3356 KB

Open AccessArticle

Foot Weight-Bearing in Supported Standing: Influence of Verticalization Angles and Hip/Knee Flexion in Children and Adolescents with Cerebral Palsy (GMFCS IV-V)

by Eva M. Steindl and René Althaus

Children 2026, 13(3), 346; https://doi.org/10.3390/children13030346 - 27 Feb 2026

Abstract

Background: Supported standing is commonly prescribed for children and adolescents with cerebral palsy (CP) to support musculoskeletal health and participation. However, objective data on plantar loading under different positioning conditions are limited, particularly in individuals with severe motor impairment (GMFCS IV–V). This study [...] Read more.

Background: Supported standing is commonly prescribed for children and adolescents with cerebral palsy (CP) to support musculoskeletal health and participation. However, objective data on plantar loading under different positioning conditions are limited, particularly in individuals with severe motor impairment (GMFCS IV–V). This study quantified plantar loading as an operational measure of foot weight-bearing during supported standing across combinations of verticalization angle and hip/knee flexion. Methods: Twenty-six children and adolescents with CP (GMFCS IV–V; 6–17 years) were assessed using a standardized back-supported standing system. Plantar loading was measured with two calibrated force plates at six verticalization angles (0°, 30°, 45°, 60°, 75°, 90°) combined with four hip/knee flexion angles (0°, 15°, 30°, 45°). Loading was expressed as a percentage of body weight (% BW). Effects were analyzed using repeated-measures analysis of variance. Results: Plantar loading increased progressively with increasing verticalization angles across all hip/knee flexion conditions. Clinically relevant loading levels (>70% BW) were achieved at a verticalization angle of 60° in most flexion conditions. Maximum plantar loading was observed at 90° verticalization combined with 30° hip/knee flexion (96.4% BW). At 90° verticalization, plantar loading remained substantial even with 45° hip/knee flexion (81.4% BW). Increasing hip/knee flexion did not result in a linear reduction in plantar loading; a significant decrease was observed only at 45° flexion. Conclusions: Verticalization angle is the primary determinant of plantar loading during supported standing in children and adolescents with severe CP. Clinically meaningful plantar loading—and thus effective foot weight-bearing—can be achieved at moderate verticalization angles despite hip and knee flexion, supporting flexible positioning strategies. Full article

(This article belongs to the Special Issue Cerebral Palsy in Children: Improving Quality of Life and Preventing Painful Musculoskeletal Disorders)

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15 pages, 749 KB

Open AccessArticle

Exploratory Associations of Targeted Genetic Variants with Cephalometric Airway Parameters in Children with Skeletal Class II Sleep-Disordered Breathing Symptoms

by Nazlı Karaca Kurt, Hilal Algul, Serdar Ceylaner, Gulay Ceylaner, Ayse Tuba Altug and Tulin Ufuk Toygar Memikoglu

Children 2026, 13(3), 345; https://doi.org/10.3390/children13030345 - 27 Feb 2026

Abstract

Background/Objectives: Pediatric sleep-disordered breathing (SDB) is influenced by craniofacial morphology and host susceptibility. Evidence integrating cephalometric airway features with targeted genetic variation in symptomatic skeletal Class II children remains limited. We explored whether children with skeletal Class II mandibular retrognathia and SDB symptoms [...] Read more.

Background/Objectives: Pediatric sleep-disordered breathing (SDB) is influenced by craniofacial morphology and host susceptibility. Evidence integrating cephalometric airway features with targeted genetic variation in symptomatic skeletal Class II children remains limited. We explored whether children with skeletal Class II mandibular retrognathia and SDB symptoms harbor selected genetic variants and whether carriers show distinct cephalometric airway characteristics. Methods: This cross-sectional study included 48 children with skeletal Class II malocclusion, mandibular retrognathia, and snoring/mouth-breathing symptoms. Craniofacial and airway parameters were assessed on lateral cephalograms. SDB burden was evaluated by a baseline home sleep study (respiratory event index, REI). Targeted sequencing screened TNFRSF1A, PSTPIP1, SLC6A4 (5HTT), ACE, APOE, IRS1, and additionally PHOX2B and PMP22. Exploratory group comparisons used Student’s t-test. Results: Variants were identified in 13/48 participants (27%) in TNFRSF1A, PSTPIP1, SLC6A4, ACE, APOE, and IRS1; none were detected in PHOX2B or PMP22. C3–H was higher in variant carriers (39.90 ± 6.40 vs. 36.48 ± 3.95 mm; p < 0.05). HH1 (perpendicular distance from the hyoid bone to the C3–RGN line) was higher but not significant (16.99 ± 7.58 vs. 14.61 ± 5.25 mm; p > 0.05). Conclusions: In this clinically screened pediatric skeletal Class II cohort with SDB symptoms, selected genetic variants co-occurred with specific hyoid–cervical cephalometric features. Given the cross-sectional design, absence of a control group, and small number of carriers, findings are exploratory and require replication in larger, controlled cohorts with standardized phenotyping. Full article

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

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16 pages, 1110 KB

Open AccessArticle

Mechanisms of Change Underlying Effects of an Early Parenting Intervention on Child Development Among Vulnerable Families in Rwanda

by Sarah K. G. Jensen, Matias Placencio-Castro, Shauna M. Murray, Vincent Sezibera and Theresa S. Betancourt

Children 2026, 13(3), 344; https://doi.org/10.3390/children13030344 - 27 Feb 2026

Abstract

Background: Intervention effectiveness studies rarely empirically assess Theories of Change (ToC) to determine how an intervention worked. We examine the ToC underlying the Sugira Muryango (SM) parenting program in rural Rwanda to understand whether the intervention improved child development outcomes via changes in [...] Read more.

Background: Intervention effectiveness studies rarely empirically assess Theories of Change (ToC) to determine how an intervention worked. We examine the ToC underlying the Sugira Muryango (SM) parenting program in rural Rwanda to understand whether the intervention improved child development outcomes via changes in caregivers’ behaviors to improve the home caregiving environment, as hypothesized. Methods: SM uses coaching of parents to create a safe, affectionate, stimulating, and violence-free home environment. A cluster randomized trial enrolled 1049 families with young children. SM had immediate effects on caregiver behaviors, improving scores on the Home Observation for Measurement of the Environment (HOME), harsh discipline, caregiver emotion regulation, and provision of dietary diversity. We use structural equation modeling to examine whether change in caregivers’ behaviors explains intervention-related improvements in child development (Ages and Stages Questionnaire) one year after the intervention ended. Results: Improvements in positive caregiving practices, including stimulation and early language learning as captured by the HOME, explained some of the intervention-related changes in child development, including gross motor, communication, problem-solving, and personal-social development. Increased dietary diversity explained intervention-related change in gross motor, problem-solving, and personal-social development. Change in harsh discipline and caregiver emotion regulation did not explain child outcomes. Conclusions: Intervention-related changes related to constructs captured on the HOME and dietary diversity were associated with changes in child development scores, but violent discipline and caregiver emotion regulation were not. Future research should examine whether these components of the intervention can be strengthened and may influence child development via other pathways, for example, via caregiver mental health. Full article

(This article belongs to the Section Global Pediatric Health)

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10 pages, 726 KB

Open AccessArticle

The Outcomes of Myeloid Sarcoma in 64 Pediatric Patients and the Impact of Allogeneic Hematopoietic Stem Cell Transplantation on Treatment Results

by Magdalena Samborska, Jolanta Skalska-Sadowska, Jacek Wachowiak, Małgorzata Czogała, Walentyna Balwierz, Szymon Skoczeń, Natalia Bartoszewicz, Jan Styczyński, Tomasz Ociepa, Tomasz Urasiński, Grażyna Wróbel, Krzysztof Kałwak, Katarzyna Muszyńska-Rosłan, Anna Szmydki-Baran, Iwona Malinowska, Paweł Łaguna, Agnieszka Mizia-Malarz, Renata Tomaszewska, Tomasz Szczepański, Agnieszka Chodała-Grzywacz, Grażyna Karolczyk, Lucyna Maciejka-Kembłowska, Marta Kozłowska, Ninela Irga-Jaworska, Katarzyna Mycko, Wanda Badowska, Katarzyna Bobeff, Wojciech Młynarski, Radosław Chaber, Joanna Zawitkowska, Katarzyna Drabko and Katarzyna Derwich Show full author list Hide full author list

Children 2026, 13(3), 343; https://doi.org/10.3390/children13030343 - 27 Feb 2026

Abstract

Background: Myeloid sarcoma (MS) is a malignant extramedullary tumor that occurs in patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or chronic myeloid leukemia (CML). The standard first-line treatment for MS is intensive chemotherapy according to the AML protocol, regardless of bone [...] Read more.

Background: Myeloid sarcoma (MS) is a malignant extramedullary tumor that occurs in patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or chronic myeloid leukemia (CML). The standard first-line treatment for MS is intensive chemotherapy according to the AML protocol, regardless of bone marrow involvement. The role of allogeneic hematopoietic stem cell transplantation (alloHSCT) in the treatment of pediatric patients with MS requires further investigation. The aim of the study was to evaluate treatment outcomes for MS in pediatric patients with a focus on assessing the impact of allogeneic hematopoietic stem cell transplantation (alloHSCT) on treatment efficacy. Material and Methods: The study included 64 patients aged 0 to 19 years from 15 pediatric oncology centers in Poland who were diagnosed with MS between 1998 and 2024. An Excel database was created to collect data on clinical features and treatment methods and outcomes. Results: The probability of 5-year overall survival (pOS) for the entire cohort was 0.63 ± 0.07, while the 5-year event-free survival (pEFS) and 5-year relapse-free survival (pRFS) were 0.62 ± 0.07 and 0.72 ± 0.07, respectively. Treatment outcomes were compared between patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT) in first complete remission (ICR) (n1 = 17/64; 27%) and those who did not receive alloHSCT (n2 = 47/64; 73%). In the alloHSCT group (n1), the estimated survival probabilities were pOS = 0.49 ± 0.13, pEFS = 0.44 ± 0.14, and pRFS = 0.40 ± 0.14. In the non-alloHSCT group (n2), these values were pOS = 0.68 ± 0.08, pEFS = 0.68 ± 0.08, and pRFS = 0.84 ± 0.06. The difference in pRFS between groups n1 and n2 was statistically significant (p = 0.0049). Extramedullary relapses were more frequently observed in patients who had undergone allogeneic hematopoietic stem cell transplantation (alloHSCT) (p = 0.0001). Conclusions: Allogeneic hematopoietic stem cell transplantation (alloHSCT) does not improve the outcome of patients with MS. Further research is needed to identify effective strategies for sustaining remission in patients with MS after alloHSCT. Full article

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

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14 pages, 926 KB

Open AccessArticle

Early Postoperative Analgesic Outcomes Following Pre-Induction Intravenous Ibuprofen in Children Undergoing Hypospadias Repair: A Randomized Controlled Study

by Xiaohuan Cui, Jianmin Zhang, Zhengzheng Gao, Jingjing Cai, Fang Wang, Lijing Li and Shanshan Zhang

Children 2026, 13(3), 342; https://doi.org/10.3390/children13030342 - 27 Feb 2026

Abstract

Background: Hypospadias repair is a pediatric surgical procedure associated with relatively pronounced postoperative pain. However, evidence guiding procedure-specific perioperative analgesic strategies remains limited. Although preoperative intravenous ibuprofen has demonstrated analgesic benefits in other pediatric surgical settings, data specific to pediatric urological surgery are [...] Read more.

Background: Hypospadias repair is a pediatric surgical procedure associated with relatively pronounced postoperative pain. However, evidence guiding procedure-specific perioperative analgesic strategies remains limited. Although preoperative intravenous ibuprofen has demonstrated analgesic benefits in other pediatric surgical settings, data specific to pediatric urological surgery are scarce. Methods: In this randomized, double-blind, placebo-controlled trial, 104 children (2–7 years old, American Society of Anesthesiologists [ASA] physical status I–II) scheduled for urethroplasty were randomized to receive either intravenous ibuprofen (10 mg/kg; Group I) or saline (Group C) before anesthesia induction. The primary outcome was the proportion of patients requiring rescue opioid analgesia in the postanesthesia care unit (PACU). Secondary outcomes included postoperative FLACC (Face, Legs, Activity, Cry, Consolability), NRS-11 (the numerical rating scale-11 scale), and PAED (Pediatric Anesthesia Emergence Delirium) scores, repeated rescue analgesia, intraoperative opioid use, the LMA (laryngeal mask airway) removal time, and adverse events. Results: Ninety-three patients completed the study (Group I, n = 47; Group C, n = 46). The proportion of patients requiring rescue analgesia in the PACU was significantly lower in the ibuprofen group than in the control group (12.77% vs. 30.43%, p = 0.038, 95% CI: 0.116, 0.968). Moderate-to-severe pain (FLACC ≥ 4) in the PACU occurred less frequently in the ibuprofen group, whereas incidence of emergence delirium was similar between groups. No significant differences were observed in the pain scores on postoperative days 1 and 2, intraoperative opioid use, the LMA removal time, or adverse events. Conclusions: Pre-induction intravenous ibuprofen reduced early postoperative rescue analgesia requirements without increasing adverse events in children undergoing hypospadias repair. Full article

(This article belongs to the Section Pediatric Surgery)

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