Children

10 pages, 5654 KB

Open AccessArticle

Safety and Effectiveness of ERCP in the Pediatric Population: A Tertiary Care Center Experience

by Dario Ligresti, Dario Quintini, Lucio Carrozza, Gabriele Rancatore, Margherita Pizzicannella, Marco Giacchetto, Maria Vittoria Grassini, Giacomo Emanuele Maria Rizzo, Gaetano Burgio, Gennaro Martucci, Giusy Ranucci, Davide Cintorino, Fabio Tuzzolino, Mario Traina and Ilaria Tarantino

Children 2026, 13(8), 1073; https://doi.org/10.3390/children13081073 - 13 Aug 2026

Abstract

Background and Aim: Pediatric ERCP remains significantly less studied compared to its application in adults, particularly in infants, due to the limited procedural volume. This study aims to evaluate the indications, procedural specifics, technical success rates, and adverse events associated with pediatric [...] Read more.

Background and Aim: Pediatric ERCP remains significantly less studied compared to its application in adults, particularly in infants, due to the limited procedural volume. This study aims to evaluate the indications, procedural specifics, technical success rates, and adverse events associated with pediatric ERCP at a tertiary care center over an 18-year period, with specific attention to patients weighing less than 10 kg. Methods: A retrospective analysis of all ERCPs performed on patients under 18 years of age at ISMETT between 2005 and 2023. Demographic data, indications, procedural specifics, outcomes, and adverse events were collected and reported. Subgroup analyses focusing on initial ERCP procedures were performed and stratified by weight and indication type. Results: 194 ERCPs were performed on 84 patients. Acute or chronic pancreatitis was the most common indication. Technical success was high across weight groups. Adverse events occurred only in patients ≥ 10 kg (7%), predominantly post-ERCP pancreatitis. No adverse events were reported in the <10 kg group. In the “first-ERCP” subgroup, pancreatic indications were associated with a higher adverse event rate than biliary indications, although the estimate was imprecise owing to the small number of events. Conclusions: In our experience as a specialized center, pediatric ERCPs have proven to be safe and effective, even in infants < 10 kg. Pancreatic indications appeared to carry a higher risk for adverse events than biliary indications, although this estimate was imprecise. Full article

(This article belongs to the Topic Evolving Role of Endoscopy in Adult and Pediatric Gastrointestinal Disorders)

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14 pages, 251 KB

Open AccessArticle

Inpatient Palliative Care for Pediatric Neurologic and Neuromuscular Illnesses in the U.S.—A National Perspective

by Zahra Mojtahedi, Pearl C. Kim, Yonsu Kim, Ji W. Yoo and Jay J. Shen

Children 2026, 13(8), 1072; https://doi.org/10.3390/children13081072 - 13 Aug 2026

Abstract

Background: Pediatric neurologic and neuromuscular illnesses, often progressive and debilitating, require comprehensive medical management focused on enhancing quality of life. Despite the benefits of palliative care in managing symptoms and providing psychological support, there is limited knowledge on its associated factors and utilization [...] Read more.

Background: Pediatric neurologic and neuromuscular illnesses, often progressive and debilitating, require comprehensive medical management focused on enhancing quality of life. Despite the benefits of palliative care in managing symptoms and providing psychological support, there is limited knowledge on its associated factors and utilization for pediatric neurologic and neuromuscular illnesses in hospital settings. Methods: This study analyzed the National Inpatient Sample (NIS) database, covering hospitalizations of children under 18 years with neurologic and neuromuscular diagnoses from 2016 to 2020, to examine associations of palliative care with sociodemographic, clinical, and hospital factors. Results: Out of 139,598 pediatric patients, 4273 (3.1%) received palliative care. Palliative care recipients were younger (mean age 5.3 vs. 6.4 years), had more diagnoses (17.8 vs. 10.9) and procedures (4.0 vs. 2.4), higher illness severity scores (3.4 vs. 2.6), longer LOS (18.7 vs. 9.9 days), and higher hospital charges ($332,559 vs. $150,727). In-hospital mortality was significantly higher among palliative care recipients (32.9% vs. 2.4%). The utilization of palliative care increased annually (OR = 1.08, 95% CI [1.05, 1.11]). Black patients had lower odds (OR = 0.90, 95% CI [0.81, 1.00]). Higher severity scores (OR = 2.09, 95% CI [1.99, 2.20]) were positively associated with palliative care. Smaller hospitals and urban nonteaching hospitals were inversely associated with palliative care utilization. Conclusions: Palliative care utilization for pediatric neurologic and neuromuscular illnesses remains low, with significant disparities based on sociodemographic and hospital-related factors. Enhanced awareness and integration of palliative care in pediatric practice, especially in underutilized settings, are crucial for improving outcomes and quality of life for these patients. Full article

21 pages, 532 KB

Open AccessSystematic Review

Psychological Interventions for Children with Neurodevelopmental Disabilities in the Context of Neurodiversity: A Systematic Review

by Kalliopi Megari, Dimitra V. Katsarou, Evangelos Mantsos, Soultana Papadopoulou, Efthymia Efthymiou, Maria Theodoratou, Maria Sofologi and Evgenia Toki

Children 2026, 13(8), 1071; https://doi.org/10.3390/children13081071 - 12 Aug 2026

Abstract

Background/Objectives: This systematic review examines psychological interventions for children with neurodevelopmental disabilities within a neurodiversity framework, emphasizing that variations in cognition, behavior, and neurological functioning represent natural forms of human diversity rather than deficits. Methods: A systematic literature search was conducted across the [...] Read more.

Background/Objectives: This systematic review examines psychological interventions for children with neurodevelopmental disabilities within a neurodiversity framework, emphasizing that variations in cognition, behavior, and neurological functioning represent natural forms of human diversity rather than deficits. Methods: A systematic literature search was conducted across the PubMed, PsycINFO, and Google Scholar databases for studies published between 2010 and 2025. Studies were included if they focused on children with autism spectrum disorder (ASD), learning or intellectual disabilities (LD/ID), or specific learning disabilities (SpLD), and evaluated psychological or behavioral interventions. Results: A total of 34 studies met the inclusion criteria after screening and full-text review. The findings indicate that traditional interventions, such as Applied Behavior Analysis (ABA) and Cognitive Behavioral Therapy (CBT), demonstrate effectiveness in improving adaptive behavior, emotional regulation, and cognitive functioning. However, more recent approaches, including Naturalistic Developmental Behavioral Interventions (NDBI), person-centered therapies, and gamified interventions, show greater alignment with neurodiversity principles by emphasizing individual strengths, autonomy, and environmental adaptation. Conclusions: Despite promising outcomes, the evidence base remains uneven, with a predominant focus on autism and limited high-quality studies addressing other neurodevelopmental conditions. The review highlights the need for more rigorous, inclusive, and longitudinal research, as well as the integration of neurodivergent perspectives in intervention design. Overall, the findings suggest that interventions incorporating individualized, strengths-based, and context-sensitive adaptations are associated with more consistent improvements in both functional outcomes and quality of life. Full article

(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention (3rd Edition))

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14 pages, 45227 KB

Open AccessCase Report

An Extensive Lymphatic Malformation of the Parotid and Parotideo-Masseteric Region in an Adolescent: Nerve-Preserving Surgical Management and Postoperative Imaging Follow-Up: A Case Report

by Michał Gontarz, Krzysztof Gąsiorowski, Krystyna Gałązka, Tomasz Marecik, Jakub Bargiel, Paweł Szczurowski, Katarzyna Rusek and Grażyna Wyszyńska-Pawelec

Children 2026, 13(8), 1070; https://doi.org/10.3390/children13081070 - 12 Aug 2026

Abstract

Background: Lymphatic malformations of the parotid gland and of the adjacent parotideo-masseteric region are rare and technically demanding, because the malformation infiltrates the glandular parenchyma and grows around the branches of the facial nerve rather than displacing them, and published experience consists almost [...] Read more.

Background: Lymphatic malformations of the parotid gland and of the adjacent parotideo-masseteric region are rare and technically demanding, because the malformation infiltrates the glandular parenchyma and grows around the branches of the facial nerve rather than displacing them, and published experience consists almost entirely of isolated case reports. Case Presentation: A 16-year-old boy was treated for an extensive lymphatic malformation of the left parotid and parotideo-masseteric region, present since childhood and progressive over three years, with facial asymmetry, no pain and normal facial nerve function. Magnetic resonance imaging showed a mixed lesion of 47 × 20 × 55 mm involving the superficial and deep lobe with parapharyngeal extension. Facial nerve-preserving partial parotidectomy of European Salivary Gland Society levels I, II and IV was performed under continuous nerve monitoring. Histology confirmed a cavernous lymphangioma (CD31 and D2-40 positive). A postoperative sialocele was managed after a single revision. Conclusions: Level-classified nerve-preserving parotidectomy with monitoring was associated with stable residual disease and preserved facial nerve function during 19 months of follow-up. The radial resection margin was focally involved and a thin residual lesion persisted on imaging. Stability at follow-up does not establish the absence of future progression, and longer follow-up is required. Full article

(This article belongs to the Section Pediatric Surgery)

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20 pages, 923 KB

Open AccessArticle

Nationwide Trends in Newborn Anthropometric Indicators in Kazakhstan, 2013–2022: A Population-Level Time-Trend Analysis

by Marat Shoranov, Anel Ibrayeva, Yerlan Ismoldayev, Bolat Sadykov, Dimash Davletov, Shynar Tanabayeva and Ildar Fakhradiyev

Children 2026, 13(8), 1069; https://doi.org/10.3390/children13081069 - 12 Aug 2026

Abstract

Background/Objectives: Birth size is a population-level marker of fetal growth, maternal health, and perinatal care. In Kazakhstan, long-term national and regional patterns in newborn anthropometry have not been jointly examined across birth weight, birth length, the Rohrer index, low birth weight (LBW), and [...] Read more.

Background/Objectives: Birth size is a population-level marker of fetal growth, maternal health, and perinatal care. In Kazakhstan, long-term national and regional patterns in newborn anthropometry have not been jointly examined across birth weight, birth length, the Rohrer index, low birth weight (LBW), and macrosomia. This study aimed to quantify national annual trends in these five indicators for 2013–2022, compare region-specific trajectories, and examine whether the two ends of the birth-weight distribution changed in different directions. Methods: This retrospective ecological time-trend study used de-identified individual newborn records (birth weight, birth length, sex, birth date, and region; 3,483,810 live births, 2013–2022) from the Electronic Register of Inpatients of the Ministry of Health of the Republic of Kazakhstan. These individual-level records were used to calculate the Rohrer index and to apply exclusion criteria at the newborn level, but national trend models were deliberately fitted on the 10 annual observations, and regional heterogeneity was tested with a single region × year interaction model rather than individual births or independent per-region regressions to avoid pseudoreplication. Results: Mean birth weight increased from 3429.5 g (2013) to 3518.4 g (2022), and mean birth length increased from 52.5 to 53.3 cm. Recorded LBW prevalence declined from 3.09% to 1.46%, while macrosomia increased from 12.59% to 16.02%. Pooled regional birth weight ranged from 3392.6 g to 3548.6 g, LBW from 0.9% to 5.3%, and macrosomia from 11.7% to 18.1%; region-specific trends after false-discovery-rate correction showed that only North Kazakhstan Region had a statistically robust increase in LBW. Conclusions: Official registry data for Kazakhstan, analyzed at the individual level and aggregated for trend modeling, showed a decade-long increase in mean birth weight and length, an observed decline in recorded LBW prevalence, and an increase in macrosomia prevalence, with statistically confirmed heterogeneity in regional trajectories. Because this study lacked gestational age or maternal characteristics, these findings should be interpreted as ecological surveillance patterns that support continued monitoring of both ends of the birth-weight distribution, rather than as evidence of individual-level changes in fetal growth or maternal metabolic risk. Full article

(This article belongs to the Section Pediatric Neonatology)

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22 pages, 1588 KB

Open AccessReview

Modern Determinants of Earlier Menarche and Mental Health: A Translational Review for Clinicians

by Giuseppe Marano, Claudia d’Abate, Giuseppe Sorrenti, Gianandrea Traversi, Osvaldo Mazza and Marianna Mazza

Children 2026, 13(8), 1068; https://doi.org/10.3390/children13081068 - 12 Aug 2026

Abstract

Background: Over the past decades, the global onset of menarche has progressively advanced, driven by complex interactions between metabolic, psychosocial, and environmental factors. Beyond its reproductive significance, menarche represents a critical developmental milestone that coincides with increased vulnerability to mental health difficulties. Contemporary [...] Read more.

Background: Over the past decades, the global onset of menarche has progressively advanced, driven by complex interactions between metabolic, psychosocial, and environmental factors. Beyond its reproductive significance, menarche represents a critical developmental milestone that coincides with increased vulnerability to mental health difficulties. Contemporary determinants such as childhood obesity, early-life adversity, and exposure to endocrine-disrupting chemicals (EDCs) may accelerate pubertal timing while simultaneously shaping adverse psychological trajectories during adolescence. Objectives: This review aims to provide a translational and clinically oriented synthesis of modern determinants of earlier menarche and their associations with mental health outcomes in girls and adolescents, highlighting implications for early identification, prevention, and integrated clinical care. Methods: We conducted a narrative review mapping a scoping literature search conducted using PubMed/Medline, Scopus, and PsycINFO, focusing on literature from the last decade (2016–2026), with emphasis on systematic reviews, meta-analyses, and longitudinal cohort studies. Evidence was synthesized across biological, psychosocial, and environmental domains. Results: Accumulating evidence indicates that higher childhood adiposity, psychosocial stress, and EDC exposure are consistently associated with advanced pubertal timing. Earlier menarche correlates with an elevated risk of depressive symptoms, anxiety, self-harm, and body image-related distress, although effect sizes vary across populations. Emerging longitudinal data suggest that the peri-menarcheal period represents a critical window for symptom exacerbation. These associations appear to be mediated by biological mechanisms (e.g., hormonal shifts, hypothalamic–pituitary–adrenal (HPA) axis reactivity) and social processes including peer-comparison dynamics and premature sexualization. Conclusions: Earlier menarche acts as a biopsychosocial sentinel event rather than an isolated gynecological milestone. Integrating mental health screening and anticipatory guidance into pediatric and gynecological care is essential for early risk detection. A multidisciplinary, equity-oriented approach is required to address both individual vulnerability and broader environmental determinants. Full article

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

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15 pages, 902 KB

Open AccessArticle

Premedication of Pediatric Cardiac Population with Midazolam: Comparison of Oral and Sublingual Administration Regarding Plasma Midazolam Concentration, Clinical Effectiveness, Hemodynamic and Behavioral Outcomes

by Theofili Kousi, Afroditi Karafotia, Vlasios Karageorgos, Georgios Gkantinas, Ioanna Sofianidou, Meletios Kanakis, Alexandra Smina, Ioanna Zergioti, Constantin Tamvakopoulos and Theofani Antoniou

Children 2026, 13(8), 1067; https://doi.org/10.3390/children13081067 - 11 Aug 2026

Abstract

Background: Midazolam is widely used as a pediatric premedication, but evidence from direct comparisons of oral and sublingual administration in children with congenital heart disease remains limited, particularly that from pharmacokinetic and physiologic data analyzed together. Methods: We conducted a single-center prospective randomized [...] Read more.

Background: Midazolam is widely used as a pediatric premedication, but evidence from direct comparisons of oral and sublingual administration in children with congenital heart disease remains limited, particularly that from pharmacokinetic and physiologic data analyzed together. Methods: We conducted a single-center prospective randomized study comparing oral midazolam 0.5 mg/kg with sublingual midazolam 0.3 mg/kg in children undergoing cardiac surgery or catheterization procedures under general anesthesia. Plasma midazolam and 1-hydroxymidazolam concentrations were measured approximately 30 min after administration. Log-transformed concentrations were compared using regression/ANCOVA models adjusted for dose and age. Changes in mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO₂) were analyzed from baseline to 15 and 30 min. Behavioral outcomes included the sedation score, separation from parents, and mask acceptance. Results: Sixty-eight children were randomized; 65 had evaluable pharmacokinetic samples and formed the complete-case pharmacokinetic cohort. Adjusted plasma midazolam concentrations did not differ significantly between the groups, with an adjusted geometric mean ratio for sublingual versus oral administration of 0.98 (95% CI 0.53–1.79; unadjusted p = 0.940; Holm-adjusted p = 1.000). The corresponding ratio for 1-hydroxymidazolam was 1.37 (95% CI 0.55–3.41; unadjusted p = 0.494; Holm-adjusted p = 1.000). HR and SpO₂ changes were non-significant between the groups. At 30 min, sublingual administration was associated with a lower adjusted change in MAP compared with oral administration (adjusted difference −12.08 mmHg, 95% CI −19.74 to −4.42; unadjusted p = 0.002, Holm-adjusted p = 0.012). Behavioral outcomes did not differ significantly between the groups. Conclusions: In this prospective randomized pediatric cardiac cohort, oral midazolam 0.5 mg/kg and sublingual midazolam 0.3 mg/kg produced comparable plasma concentrations and similar behavioral outcomes. Sublingual administration was not associated with worse HR or SpO₂ responses, although an isolated lower MAP change at 30 min warrants confirmation in larger studies. Sublingual midazolam may represent a feasible lower-dose alternative for premedication in this population. Full article

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

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21 pages, 978 KB

Open AccessArticle

Bullying Victimization and Mattering: An Analysis of Adolescent Gender Identity and Sexual Orientation

by Sarah Hobson, Amanda Krygsman, Heather Brittain, Anjalika Khanna Roy and Tracy Vaillancourt

Children 2026, 13(8), 1066; https://doi.org/10.3390/children13081066 - 11 Aug 2026

Abstract

Background/Objectives: Youth who experience bullying victimization often report lower mattering, the perception of being valued by others; yet this association remains underexplored across intersections of gender and sexual identities. Methods: Using Spring 2025 data from the Health and Peer Relations Study, we examined [...] Read more.

Background/Objectives: Youth who experience bullying victimization often report lower mattering, the perception of being valued by others; yet this association remains underexplored across intersections of gender and sexual identities. Methods: Using Spring 2025 data from the Health and Peer Relations Study, we examined whether gender identity and sexual orientation moderated the association between bullying and mattering among Canadian youth in Grades 7–12 (N = 54,181; racially/ethnically diverse = 65.2%, sexually diverse = 14.8%, gender diverse = 3.5%), controlling for grade and race/ethnicity. Results: After controlling for covariates, the three-way interaction between bullying, gender identity, and sexual orientation was statistically significant (p = 0.042). Bullying was negatively associated with mattering across most groups, and the association was strongest among straight girls, while associations were largely similar across other groups. In contrast, average mattering followed a clear social gradient wherein straight girls and boys reported the highest levels, and sexually and/or gender diverse youth reported the lowest. Conclusions: Bullying is associated with lower mattering among most youth. However, socially advantaged youth reported stronger associations between bullying and mattering, while socially marginalized youth reported lower mattering regardless of bullying exposure. Findings highlight the importance of addressing youth bullying and underlying drivers of social inequities in mattering. Full article

(This article belongs to the Section Global Pediatric Health)

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15 pages, 1049 KB

Open AccessArticle

The Impact of 40 Years of Data Collection: The Victoria Cerebral Palsy Register

by Dinah S. Reddihough, Gina Hinwood, Angela Guzys, Erich Rutz and Susan M. Reid

Children 2026, 13(8), 1065; https://doi.org/10.3390/children13081065 - 10 Aug 2026

Abstract

Background: The Victorian Cerebral Palsy Register (VCPR) project collects information on all individuals born or living in Victoria since 1970. It is one of the largest cerebral palsy (CP) registers internationally, with over 6800 participants. Methods: This paper will explain how the VCPR [...] Read more.

Background: The Victorian Cerebral Palsy Register (VCPR) project collects information on all individuals born or living in Victoria since 1970. It is one of the largest cerebral palsy (CP) registers internationally, with over 6800 participants. Methods: This paper will explain how the VCPR was established, how data are collected and the main outcomes from its use over an extended period of time. Results: The knowledge generated through the VCPR has contributed to information about epidemiology including trends in prevalence over time, and rates and causes of death; the VCPR has been used to investigate causal pathways and potential avenues for prevention or amelioration. It has been valuable in identifying cohorts for multidisciplinary studies resulting in improved understanding of the management of associated problems. The VCPR has also been used in the development of measurement tools and has enabled data linkage studies contributing to knowledge about CP. Conclusion: The Register not only provides an efficient means of identifying eligible cohorts, but the population basis of the VCPR provides the ability to assess the generalisability of research cohorts and a means of adjusting for selection bias and potential misinterpretation of study results. The project has gained international recognition for the knowledge generated on prevalence, risk factors, mortality, clinical profiles, neuroimaging patterns, health service use, assessment tools, participation, epidemiology in paediatric orthopaedics, and quality of life. It has underpinned significant improvements in clinical care for children with CP by enabling researchers from diverse disciplines to complete 157 studies. Full article

(This article belongs to the Special Issue Advances in Early Detection and Intervention in Children with Cerebral Palsy)

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22 pages, 1333 KB

Open AccessSystematic Review

Neonatal Interfacility Transport to Tertiary and Quaternary Centres: Clinical Outcomes and System-Level Determinants—A Systematic Review

by Roni Octavian Damian, Lidia Boldeanu, Mihai Gabriel Cucu, Mirela Anişoara Siminel, Mihai Alexandru Butoi, Vlad Ionuț Belghiru, Silvia Nica, Vlad Pădureanu, Mohamed-Zakaria Assani, Virginia Maria Rădulescu, Cristiana Geormaneanu, Mihail Virgil Boldeanu and Luciana Teodora Rotaru

Children 2026, 13(8), 1064; https://doi.org/10.3390/children13081064 - 10 Aug 2026

Abstract

Background/Objectives: Outborn neonates—those born outside tertiary perinatal centres and transferred postnatally—may experience higher mortality and morbidity than inborn infants. This systematic review without meta-analysis synthesised contemporary evidence on neonatal interfacility transfer to tertiary and quaternary neonatal centres, focusing on mortality, major morbidity, [...] Read more.

Background/Objectives: Outborn neonates—those born outside tertiary perinatal centres and transferred postnatally—may experience higher mortality and morbidity than inborn infants. This systematic review without meta-analysis synthesised contemporary evidence on neonatal interfacility transfer to tertiary and quaternary neonatal centres, focusing on mortality, major morbidity, physiological instability, prognostic tools, and organisational determinants. Methods: Four electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library) were searched for English-language publications from January 2010 to December 2025. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by consensus. Narrative synthesis followed PRISMA 2020 and SWiM principles. Of the 2456 records identified, 44 publications were retained: 31 primary studies and 13 contextual or methodological sources. Results: Across the primary evidence, outborn status was generally associated with higher mortality and major morbidity, particularly among very preterm infants, although effect magnitude varied across healthcare systems. Hypothermia, respiratory deterioration, and haemodynamic instability were recurrent transport-related complications. Specialised teams, standardised stabilisation, and thermal-management bundles were associated with better physiological stability. TRIPS and TRIPS-II showed prognostic utility. Conclusions: Predominantly observational evidence suggests that neonatal transport outcomes reflect interactions between biological vulnerability, transport-related stress, and system organisation. Strengthening regionalised transport pathways and standardising stabilisation practices may improve outcomes, but causal inference remains limited. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine (2nd Edition))

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18 pages, 2488 KB

Open AccessArticle

Modified Medial Para-Olecranon Pinning Versus Conventional Crossed Pinning for Displaced Pediatric Supracondylar Humerus Fractures: A Retrospective Comparative Cohort Study

by Hassan Salah Ibrahim, Abdulla Abdelwahab, Girgis Saad and Habib Al Ismaily

Children 2026, 13(8), 1063; https://doi.org/10.3390/children13081063 - 10 Aug 2026

Abstract

Background/Objectives: Closed reduction and percutaneous pinning is the standard surgical treatment for displaced pediatric supracondylar humerus fractures. Although crossed-pin fixation provides excellent biomechanical stability, medial pin insertion remains associated with the risk of iatrogenic ulnar nerve injury. The modified medial para-olecranon technique [...] Read more.

Background/Objectives: Closed reduction and percutaneous pinning is the standard surgical treatment for displaced pediatric supracondylar humerus fractures. Although crossed-pin fixation provides excellent biomechanical stability, medial pin insertion remains associated with the risk of iatrogenic ulnar nerve injury. The modified medial para-olecranon technique has been introduced as an alternative medial wire insertion strategy while preserving the principles of crossed-pin fixation. This study compared its clinical performance with conventional crossed pinning. Methods: A retrospective comparative cohort study was conducted at a tertiary referral trauma center between January 2017 and December 2024. Seventy children younger than 14 years with Gartland type II–IV supracondylar humerus fractures met the inclusion criteria. All patients treated with the modified medial para-olecranon technique (n = 35) were included. A comparison cohort of 35 patients treated with conventional crossed pinning was selected from 68 eligible conventionally treated patients by computer-generated random sampling stratified by Gartland type (frequency matching), after application of identical eligibility criteria. The primary outcome was functional outcome assessed using the Flynn criteria. Secondary outcomes included operative time, radiographic alignment, fracture union, and postoperative complications. Results: Baseline demographic and fracture characteristics were comparable between groups. Mean age was 6.7 ± 2.8 years in the modified medial para-olecranon group and 6.9 ± 2.6 years in the conventional crossed-pin group. The modified medial para-olecranon group had a lower mean Flynn score (6.80 ± 3.31 vs. 10.74 ± 3.70; mean difference, −3.94; 95% CI, −5.61 to −2.27; p < 0.001) and a higher proportion of excellent Flynn outcomes (77.1% vs. 28.6%). Operative time was shorter in the modified medial para-olecranon group (47.49 ± 7.50 vs. 66.00 ± 8.19 min; mean difference, −18.51 min; 95% CI, −22.26 to −14.76; p < 0.001). Fracture union occurred at a comparable time in both groups (27.71 ± 3.94 vs. 28.34 ± 4.12 days; mean difference, −0.63 days; 95% CI, −2.55 to 1.29), and postoperative Baumann angles were similar. No postoperative iatrogenic ulnar nerve injuries occurred in the modified medial para-olecranon group, whereas two occurred in the conventional crossed-pin group; both were transient sensory paraesthesia that resolved without exploration within six months. Overall complications occurred in 1 patient (2.9%) and 7 patients (20.0%), respectively (odds ratio, 0.17; 95% CI, 0.03 to 1.02; Fisher exact p = 0.055). Conclusions: In this retrospective comparative cohort, the modified medial para-olecranon technique was associated with favorable functional outcomes, shorter operative time, and fewer observed postoperative ulnar nerve injuries, although the difference in complications did not reach statistical significance, while maintaining comparable radiographic alignment and fracture healing. Because treatment was not randomized and potential confounders could not be adjusted for, these between-group differences should be interpreted as associations rather than as evidence of a causal treatment effect. Further prospective multicenter studies and dedicated anatomical investigations are required before broader recommendations can be made. Full article

(This article belongs to the Special Issue Pediatric Orthopaedic Trauma: Evolving Surgical Indications and Techniques)

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13 pages, 765 KB

Open AccessArticle

Assessing the Relationship Between Multidimensional Area-Level Indicators and Lupus Disease Activity in Children

by Chelsea Reynolds, Paul J. Nietert, Mileka Gilbert, Emily Vara, Natasha Ruth and Joyce Chang

Children 2026, 13(8), 1062; https://doi.org/10.3390/children13081062 - 10 Aug 2026

Abstract

Background/Objectives: Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease that is associated with more severe organ involvement, more intensive drug therapy, and increased long-term organ damage compared with adult-onset disease. The objectives of this study were to evaluate the performance [...] Read more.

Background/Objectives: Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease that is associated with more severe organ involvement, more intensive drug therapy, and increased long-term organ damage compared with adult-onset disease. The objectives of this study were to evaluate the performance of widely used small area-level multidimensional indicators of neighborhood disadvantage in a mixed urban–rural cSLE cohort against disease outcomes. Methods: This retrospective cohort study utilized electronic health records to identify and evaluate pediatric patients with cSLE across a single center in South Carolina between 1 January 2020 and 31 December 2024. Primary outcomes included disease activity at diagnosis, measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); the achievement of a low lupus disease activity state (LLDAS) by the last visit; the development of major organ involvement; and the rates of unplanned hospitalizations and emergency department visits. The associations of the census tract-level Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Childhood Opportunity Index (COI) with clinical presentation and outcomes were estimated using generalized linear models and logistic regression. Results: A total of 85 patients with cSLE were included, of which 76% reported being of Black race, and 28% lived in rural areas. Lupus disease severity was inconsistent across the metrics of area-level social vulnerability, neighborhood deprivation, child opportunity, and rurality. Patients who lived in more socially vulnerable communities were more likely to attain LLDAS during follow-up, while those who lived in lower-opportunity areas were more likely to develop CNS lupus. Baseline disease activity, renal involvement, and healthcare use were not significantly associated with area-level social disadvantages or rurality. Conclusions: In this single-center, mixed urban–rural cohort of children with cSLE, indicators of neighborhood-level disadvantage and rurality alone explained little variation in disease severity and disease control overall. The utility of available small area-level metrics is likely context-dependent and influenced by regional features, population characteristics, and the outcomes being studied. Future work should integrate individual- and area-level factors across diverse settings to better understand the drivers of health disparities. Full article

(This article belongs to the Special Issue Beyond Juvenile Idiopathic Arthritis, Lupus and Juvenile Dermatomyositis: The Spectrum of Pediatric Rheumatic Disease)

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15 pages, 2345 KB

Open AccessArticle

The Effect of Antenatal Paracetamol on Breathing Effort of Premature Infants at Birth: A Feasibility Trial

by Timothy J. R. Panneflek, Janneke Dekker, Kristel L. A. M. Kuypers, Douglas P. Derleth, Graeme R. Polglase, Lotte E. van der Meeren, Merlijn Wind, Remco Visser, Stuart B. Hooper, Thomas van den Akker and Arjan B. te Pas

Children 2026, 13(8), 1061; https://doi.org/10.3390/children13081061 - 10 Aug 2026

Abstract

Background: Prostaglandin E₂ (PGE₂) suppresses perinatal breathing. Reducing antenatal PGE₂ concentrations with paracetamol could stimulate spontaneous breathing in premature infants at birth. We aimed to assess feasibility and potential effects of antenatal paracetamol. Methods: In this randomised, placebo-controlled, triple-blind [...] Read more.

Background: Prostaglandin E₂ (PGE₂) suppresses perinatal breathing. Reducing antenatal PGE₂ concentrations with paracetamol could stimulate spontaneous breathing in premature infants at birth. We aimed to assess feasibility and potential effects of antenatal paracetamol. Methods: In this randomised, placebo-controlled, triple-blind feasibility trial, pregnant women <31 weeks’ gestation were randomised to receive either intravenous paracetamol (intervention) or placebo (control). Multiple pregnancies were also eligible, and the number of infants could exceed the number of enrolled women. The primary outcome was feasibility of administering study medication within 30–120 min prior to birth. Secondary exploratory outcomes included measures of breathing and other physiological parameters of infants during the first 1–10 min after birth and were compared between infants from mothers who received paracetamol and infants from mothers who received a placebo irrespective of timing of administration. Planned enrolment was 40 women. Results: The trial enrolled 23 women before termination due to low recruitment. Five women did not receive study medication, while 18 did (9 per group). Overall, 11 of the 23 enrolled women (48%) received study medication within the specified timeframe. The nine women in the intervention group gave birth to 13 infants, while the nine women in the control group gave birth to 12 infants. Among infants, average minute volume did not differ significantly between groups (intervention (n = 13) vs. control (n = 12); mean ± SEM; 147 ± 12 vs. 114 ± 14 mL/kg/min, p = 0.093). However, the intervention group had a significantly higher area under the curve for minute volume, greater inspiratory drive, and a higher heart rate (1120 ± 410 vs. 707 ± 346 mL/kg, p = 0.020; 11.8 ± 1.0 vs. 8.4 ± 1.3 mL/kg/breath/s, p = 0.046; 137 ± 5 vs. 121 ± 5 beats/min, p = 0.037). Conclusions: Antenatal paracetamol administration 30–120 min prior to birth was feasible in only half of the women, below the pre-specified threshold of 80%, but the exploratory findings suggest that it may improve the breathing effort of premature infants. Full article

(This article belongs to the Special Issue Neonatal Cardiopulmonary Support and Challenges in Extreme Prematurity)

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18 pages, 969 KB

Open AccessArticle

Age-Stratified Association Between CPI Screening Categories and Caries Experience in the Permanent Dentition of Children and Adolescents from Southwest Romania: A Multicenter Cross-Sectional Clinical Study

by Narcis Mihaiță Bugălă, Adelina Smaranda Bugălă, Mihaela Jana Țuculină, Dana Maria Albulescu, Alina Nicoleta Căpitănescu, Dragoș Cadea, Adrian Macovei, Dragoș Alexandru, Ana Maria Rîcă and Ancuța Ramona Camen

Children 2026, 13(8), 1060; https://doi.org/10.3390/children13081060 - 10 Aug 2026

Abstract

Background/Objectives: Dental caries and gingival inflammation share several biofilm-related determinants. This study evaluated the association between Community Periodontal Index (CPI) screening categories and permanent-dentition caries experience in a consecutively recruited clinical sample of children and adolescents from Southwest Romania. Methods: The multicenter cross-sectional [...] Read more.

Background/Objectives: Dental caries and gingival inflammation share several biofilm-related determinants. This study evaluated the association between Community Periodontal Index (CPI) screening categories and permanent-dentition caries experience in a consecutively recruited clinical sample of children and adolescents from Southwest Romania. Methods: The multicenter cross-sectional study included 638 participants aged 6–19 years, analyzed as 6–12 years (n = 407) and 13–19 years (n = 231). Analyses included nonparametric comparisons, adjusted Poisson models, a formal CPI-by-age-stratum interaction, continuous-age sensitivity analyses, and generalized Poisson models allowing underdispersion. Results: Mean DMF-T was 4.71 ± 2.55 and 4.93 ± 2.58 in the younger and older strata, respectively. CPI correlated strongly with DMF-T (rho = 0.743 and 0.749; both p < 0.001). Adjusted expected DMF-T counts were higher for CPI 1 and CPI 2 than for CPI 0 in both strata. There was no statistical evidence that the CPI–DMF-T association differed by age stratum (global interaction p = 0.749) or continuous age (p = 0.552). Plaque Index adjustment markedly attenuated CPI estimates; the extent of residual CPI association was sensitive to count-model specification. Conclusions: Higher CPI categories were associated with greater cumulative caries experience in this clinical sample, but the findings do not establish temporality, causality, or predictive validity. Unequal numbers of erupted permanent teeth and CPI-eligible sextants may have contributed to the observed gradient because these quantities were not retained analytically. Full article

(This article belongs to the Special Issue Oral Health Disparities in Children and Adolescents: Determinants and Challenges (2nd Edition))

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13 pages, 762 KB

Open AccessArticle

Probiotic Supplementation to Prevent Diaper Dermatitis in Antibiotic-Treated Neonates: Secondary Analysis of a Randomised Controlled Trial

by Mojca Železnik, Petra Bratina, Andreja Valcl, Katja Lozar Manfreda, Evgen Benedik, Tanja Obermajer, Bojana Bogovič Matijašić, Aleksander Mahnič, Darja Paro-Panjan and Jana Lozar Krivec

Children 2026, 13(8), 1059; https://doi.org/10.3390/children13081059 - 9 Aug 2026

Abstract

Background/Objectives: Diaper dermatitis (DD) is a common dermatological condition that is often exacerbated by antibiotics. Probiotics may restore microbiota balance and influence the incidence of DD. This study aimed to evaluate whether 6 weeks of Limosilactobacillus (L.) reuteri DSM 17938 supplementation [...] Read more.

Background/Objectives: Diaper dermatitis (DD) is a common dermatological condition that is often exacerbated by antibiotics. Probiotics may restore microbiota balance and influence the incidence of DD. This study aimed to evaluate whether 6 weeks of Limosilactobacillus (L.) reuteri DSM 17938 supplementation during and after antibiotic treatment affects the incidence of DD. Methods: A secondary analysis of a randomised, double-blind, placebo-controlled trial that included 89 term neonates treated with antibiotics during the first 3 weeks of life was conducted. Neonates were assigned to receive either a probiotic supplement or a placebo for a total of 6 weeks. DD incidence, onset of DD, and skin care data were collected for 87 infants. Faecal samples were collected 6 weeks after study enrolment to analyse the composition of gut microbiota. Results: Twenty-four (28%) infants developed DD, of whom six (25%) had fungal DD. There was no significant difference in the incidence of DD or fungal DD between the probiotic and placebo groups (30% vs. 25% and 7% in both groups, respectively). Probiotic supplementation had no significant effect on the gut microbiota composition or diversity. In an exploratory binary logistic regression analysis based on six fungal DD events, probiotic supplementation was not associated with fungal DD, whereas breastfeeding was associated with lower odds of fungal DD; however, the overall model was not statistically significant, and this finding should be interpreted with caution because of the small number of events. Conclusions: In this exploratory secondary analysis, supplementation with L. reuteri DSM 17938 was not associated with a reduced incidence of DD or alterations in gut microbiota composition in antibiotic-treated neonates. Breastfeeding was associated with lower odds of fungal DD; however, this finding should be confirmed in larger, adequately powered studies. Full article

(This article belongs to the Section Pediatric Neonatology)

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Graphical abstract

13 pages, 659 KB

Open AccessArticle

Factors Associated with Major PICU Interventions in Adolescents Hospitalized for Intentional Pharmaceutical Poisoning

by Ebru Guney Sahin and Cansu Durak

Children 2026, 13(8), 1058; https://doi.org/10.3390/children13081058 - 8 Aug 2026

Abstract

Objective: Intentional pharmaceutical poisoning is one of the most common methods of self-harm among adolescents and frequently results in pediatric intensive care unit (PICU) admission because of the potential for severe pharmaceutical-related toxicity. Although mortality is generally low, a subset of patients may [...] Read more.

Objective: Intentional pharmaceutical poisoning is one of the most common methods of self-harm among adolescents and frequently results in pediatric intensive care unit (PICU) admission because of the potential for severe pharmaceutical-related toxicity. Although mortality is generally low, a subset of patients may require advanced intensive care interventions. Methods: This retrospective observational cohort study was conducted in the pediatric intensive care unit of a tertiary referral hospital between January 2022 and January 2026 and included adolescents admitted to the PICU due to intentional pharmaceutical poisoning. Demographic characteristics, psychiatric history, clinical findings, laboratory parameters, administered treatments, and clinical outcomes were evaluated. The primary outcome measure was defined as the requirement for a major PICU intervention, including invasive or noninvasive mechanical ventilation, vasoactive support, continuous renal replacement therapy (CRRT), therapeutic plasma exchange, extracorporeal membrane oxygenation (ECMO), intensive care-level seizure management, or clinically significant arrhythmia requiring intensive care support. Patients with and without major PICU intervention requirements were compared. Results: A total of 125 adolescent patients were included in the study, and the majority were female. Multiple-pharmaceutical ingestion and a history of psychiatric diagnoses were common comorbidities. Although the clinical course was stable in most patients, 15 patients (12%) required major pediatric intensive care interventions. Patients requiring major interventions had lower Glasgow Coma Scale scores, higher lactate levels, more frequent symptomatic presentation, and higher rates of Poisoning Severity Score (PSS) ≥ 3. Overall mortality in the cohort was low. Conclusions: Although most adolescents admitted to the PICU due to intentional pharmaceutical poisoning experienced mild-to-moderate toxicity, a subgroup required advanced intensive care support. Neurological impairment at presentation, symptomatic clinical presentation, and markers of increased physiologic stress appeared to be associated with more severe clinical courses. In pediatric poisonings, evaluating the need for advanced intensive care support rather than focusing solely on mortality may better reflect clinical severity. Full article

(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)

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23 pages, 728 KB

Open AccessSystematic Review

Skeletal and Dentoalveolar Components of Maxillary Expansion: A Systematic Review of Post-Treatment Stability

by Niccolò Cenzato, Alessia Tremolada, Alessandra Comparini, Fausto Zamparini and Cinzia Maspero

Children 2026, 13(8), 1057; https://doi.org/10.3390/children13081057 - 8 Aug 2026

Abstract

Background: Maxillary transverse deficiency is a common skeletal discrepancy in orthodontic patients that often requires expansion therapy for correction. Failure to address this condition during growth may compromise the orthopedic prognosis, frequently necessitating surgically assisted rapid palatal expansion (SARPE) or other orthognathic surgical [...] Read more.

Background: Maxillary transverse deficiency is a common skeletal discrepancy in orthodontic patients that often requires expansion therapy for correction. Failure to address this condition during growth may compromise the orthopedic prognosis, frequently necessitating surgically assisted rapid palatal expansion (SARPE) or other orthognathic surgical procedures after skeletal maturity. Methods: The studies in this systematic review were selected according to predefined inclusion criteria. Randomized controlled trials, controlled clinical studies, and cohort studies published within the last 10 years with a follow-up ≥ 6 months were included. The databases PubMed, Scopus, and Embase were searched. Orthodontic outcomes included midpalatal suture opening, skeletal transverse changes, intermolar width variations, dental tipping, and long-term stability. Thirteen studies met the eligibility criteria. Risk of bias was assessed using the RoB 2 and the Newcastle–Ottawa Scale. Results: All orthodontic devices produced significant transverse expansion in the short term. Bone-borne and hybrid systems showed a greater initial skeletal component, with greater expansion at the maxillary and nasal basal levels and limited relapse over time. Tooth-borne expansion was associated with greater dental tipping and reduction in buccal bone thickness, with partial recovery during retention. Over time, loss of expansion mainly affected the dentoalveolar component, whereas the skeletal component remained more stable. Long-term data (≥3–5 years) remain limited but suggest that relapse is predominantly related to dental uprighting rather than a true loss of skeletal base width. Conclusions: Long-term transverse stability improves when expansion is predominantly skeletal. Bone-supported and hybrid appliances may produce a greater initial skeletal contribution and reduce dental tipping in some clinical settings; however, current evidence does not demonstrate superior long-term stability compared with tooth-borne expansion. Additional prospective orthodontic studies with extended follow-up, particularly without prolonged retention, are required. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, and Long-Term Prognosis of Pediatric Oral Surgical Diseases)

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12 pages, 696 KB

Open AccessArticle

Remimazolam–Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm Randomized Trial

by Liming Cai, Zhengzheng Gao, Zeyang Wang, Xiaoxue Wang, Jing Hu, Lei Hua, Wenya Fu, Lanxin Qiao, Jianmin Zhang, Lijing Li, Fang Wang and Xiumin Qin

Children 2026, 13(8), 1056; https://doi.org/10.3390/children13081056 - 8 Aug 2026

Abstract

Background/Objectives: Propofol is effective for pediatric endoscopy but can depress ventilation. We compared three induction regimens in school-aged children undergoing bidirectional gastrointestinal endoscopy. Methods: This single-center, assessor-blinded randomized trial allocated children aged 6–12 years (1:1:1) to propofol 3 mg/kg (P), remimazolam 0.2 mg/kg [...] Read more.

Background/Objectives: Propofol is effective for pediatric endoscopy but can depress ventilation. We compared three induction regimens in school-aged children undergoing bidirectional gastrointestinal endoscopy. Methods: This single-center, assessor-blinded randomized trial allocated children aged 6–12 years (1:1:1) to propofol 3 mg/kg (P), remimazolam 0.2 mg/kg plus propofol 1 mg/kg (R1), or remimazolam 0.4 mg/kg plus propofol 1 mg/kg (R2). All groups received sufentanil and standardized propofol maintenance. Respiratory depression was a respiratory rate < 10 breaths/min or peripheral oxygen saturation < 90% for >1 min. The trial was prospectively registered (ChiCTR2500096218), and analysis followed assigned groups. Results: The analysis included 120 children (40 per group). Respiratory depression occurred in 32/40 (80.0%) in P, 6/40 (15.0%) in R1, and 14/40 (35.0%) in R2 (overall p < 0.001). Compared with P, the risk difference was −65.0 percentage points for R1 (95% confidence interval [CI], −77.4 to −44.6; risk ratio, 0.19; 95% CI, 0.09–0.37) and −45.0 percentage points for R2 (95% CI, −61.0 to −23.6; risk ratio, 0.44; 95% CI, 0.27–0.66); both Holm-adjusted p values were <0.001. Mean time to eye opening was 12.7, 11.2, and 16.9 min, respectively. In the exploratory R1-versus-R2 comparison, time to eye opening was 5.75 min shorter with R1 (95% CI, 4.28–7.20). Conclusions: Both remimazolam–propofol regimens reduced monitor-defined respiratory depression compared with propofol 3 mg/kg. The 0.2 mg/kg remimazolam–propofol regimen combined this respiratory benefit with faster recovery than the 0.4 mg/kg regimen in exploratory analysis, supporting its further evaluation as an induction strategy for pediatric bidirectional endoscopy. Full article

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9 pages, 463 KB

Open AccessArticle

The Impact of Earthquake-Induced Healthcare Disruption on an Established Developmental Hip Dysplasia Screening Program in an Earthquake Zone

by Okan Aslantürk, Sultan Nisa Çabuk, Emre Ergen, Hüseyin Utku Özdeş, Fırat Al, Tahsin Sarıbas, Murat Kılıç, Hakan Ertem, Mustafa Karakaplan, Sevgi Demiröz Taşolar, Hüseyin Ayvaz, Aybars Kıvrak and Şenol Bekmez

Children 2026, 13(8), 1055; https://doi.org/10.3390/children13081055 - 7 Aug 2026

Abstract

Background/Objectives: Pandemics and natural disasters may delay the diagnosis and treatment of developmental dysplasia of the hip (DDH). In this study, we evaluated the effect of 2023 Kahramanmaraş earthquake-induced healthcare disruption on the DDH screening program. Methods: Medical records of infants [...] Read more.

Background/Objectives: Pandemics and natural disasters may delay the diagnosis and treatment of developmental dysplasia of the hip (DDH). In this study, we evaluated the effect of 2023 Kahramanmaraş earthquake-induced healthcare disruption on the DDH screening program. Methods: Medical records of infants referred for DDH screening between February 2022 and February 2025 were retrospectively reviewed. Three consecutive twelve-month intervals: the pre-earthquake year (February 2022 to February 2023), the earthquake year (February 2023 to February 2024), and the post-earthquake year (February 2024 to February 2025) were evaluated to detect early and late effects of the earthquake on the DDH screening. Results: A thousand infants in the pre-earthquake year, 404 in the earthquake year, and 824 in the post-earthquake year were evaluated. A 60% reduction in referrals was detected during the earthquake year. DDH incidence in late presentations during pre-earthquake, earthquake, and post-earthquake years was 18.6%, 45.8%, and 22.2%, respectively. Pairwise analysis revealed a statistically significant increase in the post-earthquake year compared with the pre-earthquake period (Yates-corrected chi-square = 4.119, p = 0.042). No significant difference was found between the pre-earthquake year and the earthquake year (Yates chi-square = 1.362, p = 0.243), nor between the post-earthquake years (Yates chi-square = 0.084, p = 0.772). Conclusions: The earthquake caused significant disruption in healthcare and DDH screening. Health authorities planning post-disaster service recovery should proactively augment DDH screening capacity for infants who missed screening during the acute phase. Full article

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

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