Children

18 pages, 2201 KB

Open AccessArticle

Early Risk Stratification for Subsequent Small Airway Dysfunction in Hospitalized Children with Mycoplasma Pneumoniae Pneumonia: A Retrospective Cohort Study

by Ruimeng Ma, Jingrong Song, Yu Fu, Rui Li, Tienan Feng, Zonglang Yu, Mengting Zhang, Shuping Jin and Xiaoying Zhang

Children 2026, 13(5), 713; https://doi.org/10.3390/children13050713 - 21 May 2026

Abstract

Background/Objectives: Small airway dysfunction (SAD) may occur early in children with Mycoplasma pneumoniae pneumonia (MPP), but pulmonary function testing is often deferred until clinical stabilization and may be limited by poor cooperation. Early risk stratification may therefore help identify children who warrant [...] Read more.

Background/Objectives: Small airway dysfunction (SAD) may occur early in children with Mycoplasma pneumoniae pneumonia (MPP), but pulmonary function testing is often deferred until clinical stabilization and may be limited by poor cooperation. Early risk stratification may therefore help identify children who warrant further testing. We aimed to identify early predictors of subsequent spirometry-defined SAD and to develop an internally validated risk-stratification model in hospitalized children with MPP. Methods: In this single-center retrospective cohort study conducted between July 2022 and July 2024, 172 hospitalized children with confirmed MPP were included. Clinical characteristics, immune-inflammatory indices, and chest computed tomography (CT) findings were collected during early hospitalization. Pulmonary function testing was performed after clinical stabilization, and SAD was defined as at least two of forced expiratory flow at 25%, 50%, and 75% of forced vital capacity being <65% of predicted values. Multiple imputation, LASSO selection, and multivariable logistic regression were used for model development and bootstrap internal validation. Results: SAD was identified in 76/172 children (44.2%). Wheezing, CT evidence of small airway involvement, and higher soluble interleukin-2 receptor levels were more common in children with SAD; wheezing remained independently associated with SAD. A model based on routine clinical and chest CT variables showed good discrimination (AUC, 0.885; optimism-corrected AUC, 0.869). Adding interleukin-17 provided limited incremental value. Conclusions: SAD was common in hospitalized children with MPP. An internally validated model based on readily available clinical and chest CT variables may help prioritize children for pulmonary function testing after clinical stabilization, whereas interleukin-17 added limited predictive value. External validation is required before broader clinical application. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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17 pages, 2055 KB

Open AccessCase Report

Pediatric ANCA-Associated Vasculitis: Variable Clinical Course in a Case Series of Three Patients and Literature Review

by Andrei-Ioan Munteanu, Delia-Maria Nicoară, Iulius Jugănaru, Raluca Asproniu, Raluca Vasilescu, Lucian-Ioan Cristun and Otilia Mărginean

Children 2026, 13(5), 712; https://doi.org/10.3390/children13050712 - 21 May 2026

Abstract

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) represents a group of rare systemic autoimmune disorders marked by inflammation and damage to small- and medium-sized blood vessels. The clinical presentation of AAV is highly variable, ranging from isolated organ involvement to severe, life-threatening multisystem [...] Read more.

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) represents a group of rare systemic autoimmune disorders marked by inflammation and damage to small- and medium-sized blood vessels. The clinical presentation of AAV is highly variable, ranging from isolated organ involvement to severe, life-threatening multisystem disease, posing significant challenges in diagnosis, treatment, and prognosis. Objective: To demonstrate the clinical heterogeneity and different outcomes in three pediatric cases of ANCA-positive disease and emphasize the importance of integrating clinical findings with laboratory and imaging investigations for accurate diagnosis. Methods: We present three pediatric patients (ages 12–15 years) with ANCA-positive results but distinct clinical presentations, evaluated at the Children’s Emergency Hospital “Louis Turcanu”, Timisoara, between 2020 and 2024. All cases were investigated according to EULAR/PRINTO/PReS criteria for pediatric vasculitis. Results: Case 1 (PR3-ANCA positive) developed severe multi-organ involvement, including granulomatosis with polyangiitis (GPA) with pulmonary hemorrhage, pericarditis, thrombotic events, and renal impairment, requiring intensive immunosuppression with cyclophosphamide, rituximab, and mycophenolate mofetil, ultimately developing chronic kidney disease stage 3a. Case 2 (BPI-ANCA positive) presented with purpuric lesions and painless joint swelling, responding favorably to corticosteroid therapy with subsequent remission. Case 3 (MPO-ANCA) manifested as polyarticular arthritis without other organ involvement and was ultimately diagnosed as seronegative juvenile idiopathic arthritis (JIA), achieving complete remission with adalimumab therapy. Conclusions: This case series highlights the diverse clinical and biological features of ANCA-positive conditions in children, emphasizing that ANCA positivity requires careful clinical correlation as it may indicate true vasculitis requiring aggressive treatment or alternative diagnoses such as JIA with incidental ANCA positivity. Tailored therapeutic strategies based on clinical presentation and continued research are essential to improve patient outcomes. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Rheumatology: 2nd Edition)

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10 pages, 323 KB

Open AccessArticle

Subclinical Respiratory Involvement in Children with Inflammatory Bowel Disease: FeNO Elevation in Active Disease

by Višnja Tokić Pivac, Sanja Kolaček, Iva Hojsak, Zrinjka Mišak, Oleg Jadrešin and Ivan Pavić

Children 2026, 13(5), 711; https://doi.org/10.3390/children13050711 - 21 May 2026

Abstract

Objectives: We aimed to assess fractional exhaled nitric oxide (FeNO) and spirometry in pediatric patients with inflammatory bowel disease (IBD) and relate these parameters to disease activity, duration, and current treatment. Methods: This prospective case–control study included 161 subjects: children with newly diagnosed, [...] Read more.

Objectives: We aimed to assess fractional exhaled nitric oxide (FeNO) and spirometry in pediatric patients with inflammatory bowel disease (IBD) and relate these parameters to disease activity, duration, and current treatment. Methods: This prospective case–control study included 161 subjects: children with newly diagnosed, active IBD (N = 55), children in clinical remission (N = 53), and healthy controls (N = 53). FeNO was measured using a chemiluminescent analyzer, and pulmonary function was assessed by spirometry. Results: FeNO was higher in patients with IBD than in controls (p = 0.025) and positively correlated with CRP (ρ = 0.22; p = 0.027). Respiratory function measured by spirometry in children with IBD was preserved. No association was found between respiratory parameters, disease activity, and duration. The correlation between FeNO and aminosalicylate treatment was of borderline significance (ρ = 0.28; p = 0.052). Conclusions: Children with IBD, although having normal pulmonary function measured by spirometry, do have increased FeNO, which is positively correlated with CRP. FeNO reflects systemic inflammation, but its role as a clinical marker of disease activity or relapse remains uncertain. Full article

(This article belongs to the Special Issue Improving Respiratory Care for Children)

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12 pages, 208 KB

Open AccessArticle

Severe Asthma Exacerbations in the Pediatric Intensive Care Unit: Clinical Profile, Management, and Outcomes—Retrospective Study

by Amal H. Aljohani, Hamdi Ahmed Alsufiani, Abeer Musaibieh AlSaadi, Nora Abdulrahman Alem, Mamoun AliAbusunoon and Amnah Ibrahim Madkhali

Children 2026, 13(5), 710; https://doi.org/10.3390/children13050710 - 21 May 2026

Abstract

Background: Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood. Objective: To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations. [...] Read more.

Background: Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood. Objective: To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations. Methods: A retrospective descriptive study was conducted of pediatric patients aged 1–14 years with severe acute asthma requiring PICU admission at King Salman Medical City, Madinah, Saudi Arabia (January 2023–October 2024). A total of 73 patients were included. Data included demographics, risk factors, medical history, clinical presentation, management, and outcomes. Results: The mean patient age was 4.6 years, with most (57.5%) aged 1–5 years. Males comprised 56.2% of cases. WHO BMI-for-age z-score assessment revealed a bimodal nutritional distribution: 27.9% of patients were underweight, including 20.6% with severe underweight, while 29.4% were overweight or obese; 42.6% had normal nutritional status. Severe undernutrition was concentrated in the 1–5-year age group, whereas obesity predominated in the 6–10-year age group. A family history of asthma was noted in 54.8% of patients; 16.4% had prior COVID-19 infection. Early symptom onset and delayed diagnosis were common. Poor asthma control was documented in 60.3%, with low medication adherence (9.6%) and limited aerochamber use (13.7%). The most frequent presenting symptoms were dyspnea, cough, and wheezing. Management followed evidence-based protocols: systemic corticosteroids and bronchodilators were first-line therapies. The mean PICU stay was 3.1 days and the mean hospital stay was 8.1 days. No mortality or major complications occurred; 93.2% of patients were discharged in good health. Conclusions: Severe pediatric asthma requiring PICU admission is associated with early symptom onset, a bimodal pattern of nutritional risk encompassing both undernutrition and overweight/obesity, family history of asthma, and inadequate outpatient management. These descriptive findings highlight the need for age-adjusted nutritional screening, enhanced medication adherence support, and targeted outpatient education to reduce avoidable PICU admissions. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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12 pages, 3143 KB

Open AccessArticle

Prevalence of Developmental Dysplasia of the Hip in Japanese Patients with Adolescent Idiopathic Scoliosis: Comparison of Conventional and Age-Adjusted Criteria

by Takahiro Nishimura, Hideaki Watanabe, Naoya Taki and Ichiro Kikkawa

Children 2026, 13(5), 709; https://doi.org/10.3390/children13050709 - 21 May 2026

Abstract

Background/Objectives: The prevalence of developmental dysplasia of the hip (DDH) in adolescent idiopathic scoliosis (AIS) remains unclear, partly because of differences in diagnostic criteria and measurement accuracy. Additionally, spinopelvic alignment and skeletal maturation may affect radiographic assessment of acetabular morphology in patients with [...] Read more.

Background/Objectives: The prevalence of developmental dysplasia of the hip (DDH) in adolescent idiopathic scoliosis (AIS) remains unclear, partly because of differences in diagnostic criteria and measurement accuracy. Additionally, spinopelvic alignment and skeletal maturation may affect radiographic assessment of acetabular morphology in patients with AIS. This study aimed to clarify the prevalence of DDH in Japanese patients with AIS using standardized radiographic assessment and to compare conventional and age-adjusted diagnostic criteria for DDH. Methods: This cross-sectional study included 602 Japanese patients aged 10–18 years with AIS. Patients with inadequate radiographs, including those with pelvic rotation and lateral inclination, were excluded to improve measurement accuracy. DDH was defined using two criteria: (1) conventional (lateral center-edge angle <20°) and (2) age-adjusted thresholds (<15° for <15 years and <18° for ≥15 years). Radiographic parameters were compared between patients with and without DDH. A multivariate logistic regression analysis was performed to identify factors independently associated with DDH. Results: The prevalence of DDH in AIS was 5.6% (34/602) using the conventional criterion and 1.5% (9/602) using the age-adjusted criteria. Patients with DDH showed significantly lower acetabular coverage, with a lower lateral center-edge angle and acetabular head index and higher Sharp and Tönnis angles than those without DDH (all p < 0.01). No significant difference in the main curve Cobb angle was observed between the groups. A younger age was independently associated with DDH, whereas sex and the main curve Cobb angle were not. Conclusions: The prevalence of DDH in Japanese patients with AIS varies substantially depending on the diagnostic criteria. Standardized radiographic evaluation with exclusion of pelvic rotation provides a reliable estimate. These findings highlight the importance of evaluating acetabular morphology on standing whole-spine radiographs in patients with AIS while considering skeletal maturation and spinopelvic alignment. Full article

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

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13 pages, 456 KB

Open AccessArticle

Prevalence, Severity and Treatment Needs of Molar Incisor Hypomineralization Among a Cohort of Lebanese Children: A Cross-Sectional Study

by Ayah Khodor, Ahmad Tarabaih and Mohammad Alkilzy

Children 2026, 13(5), 708; https://doi.org/10.3390/children13050708 - 21 May 2026

Abstract

Objectives: The aim of the study was to assess the prevalence, severity and treatment needs of molar incisor hypomineralization (MIH) among a cohort of children in Lebanon. Methods: A cross-sectional study was performed in Akkar district in northern Lebanon on 1237 school children [...] Read more.

Objectives: The aim of the study was to assess the prevalence, severity and treatment needs of molar incisor hypomineralization (MIH) among a cohort of children in Lebanon. Methods: A cross-sectional study was performed in Akkar district in northern Lebanon on 1237 school children between 10 and 12 years old (mean age 11.11 ± 0.80 years) who were recruited from eight private schools. Clinical evaluations were performed after teeth cleaning and drying using sterile gauze. Examiners assessed all teeth present in the oral cavity using the MIH index of the EAPD. If MIH was diagnosed, a further grading was made according to the MIH-TNI index. Results: In total, 212 children (17.14% [95% CI:15.0, 19.2]) were diagnosed with MIH. Of these, 200 children with completed documentation were included in the further statistical analysis. Out of the affected cases, mild lesions were the most common at 41% (n = 82). Although males exhibited higher cumulative numbers of affected teeth (52.5%, n = 267), with notably greater proportions in moderate (17.7%) and severe (16.7%) cases, the difference between genders was not statistically significant (p = 0.069). Treatment needs increased with severity, in which mild lesions primarily required preventive care (41.0%), while moderate lesions required restorative treatments (34.0%); in contrast, severe lesions (25.0%) often necessitated extensive interventions, such as crowns, pulp therapies or even extractions. Although descriptive patterns suggested an increase in more complex treatment needs in older age groups, the association was not statistically significant (p = 0.26). Conclusions: The prevalence of MIH observed in this cohort study aligns with internationally reported values. Early detection, preventive management, and timely restorative interventions are essential to minimize the long-term impact of MIH. Full article

(This article belongs to the Special Issue Dental Status and Oral Health in Children and Adolescents)

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12 pages, 2461 KB

Open AccessEssay

“What’s in It for the Kid?”: An Approach for the Bedside Ethicist

by Giuliana C. Antolovich, Ingrid Sutherland, Zoe McCallum and Monica S. Cooper

Children 2026, 13(5), 707; https://doi.org/10.3390/children13050707 - 21 May 2026

Abstract

Background/Objectives: Advances in paediatric care have increased the survival of children with severe neurological impairment, often accompanied by complex disability, multimorbidity, and a substantial treatment burden. Determining whether interventions provide meaningful benefit to the child is ethically challenging, particularly when decision-making is shared [...] Read more.

Background/Objectives: Advances in paediatric care have increased the survival of children with severe neurological impairment, often accompanied by complex disability, multimorbidity, and a substantial treatment burden. Determining whether interventions provide meaningful benefit to the child is ethically challenging, particularly when decision-making is shared between parents and clinicians, while the child has limited capacity to participate directly in decision-making. This paper examines the guiding question “what’s in it for the kid?” as a means of strengthening child-centred ethical deliberation alongside established frameworks. Methods: We undertook a conceptual bioethical analysis informed by clinical experience in an inner city tertiary public hospital. The analysis focuses on children with severe neurological impairment and medical complexity. The paper critically examines how the guiding question aligns with and extends key ethical constructs, including shared decision-making, the Zone of Parental Discretion, the Best Interests Standard, and care ethics. Clinical scenarios are used illustratively to demonstrate application in practice. Results: Existing ethical frameworks form an important foundational structure for complex decision-making. The question “what’s in it for the kid” translates ethical principles into a practical moral prompt that centres the child as the subject of decision-making. It facilitates clearer consideration of risks, benefits meaningful to the child and lived experience and helps to distinguish the child’s interests from those of parents and clinicians. Its simplicity enhances accessibility and supports consistent use in complex, high-stakes decisions. Conclusions: “What’s in it for the kid?” is a pragmatic and accessible ethical prompt that complements established frameworks by translating them into clinically usable practice. It promotes explicit, child-focused deliberation and supports a more transparent and child-centred evaluation of benefit and burden, particularly in contexts of uncertainty and medical complexity. Full article

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

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6 pages, 350 KB

Open AccessCase Report

Congenital Esophageal Stenosis Presenting During Weaning in a 5-Month-Old Infant

by Massimo Verdicchio, Cristina Bucci, Sara Isoldi, Laura Aurino, Maria Giovanna Puoti, Serena Marulo, Federica Riccitiello, Rossella Turco, Francesco Cirillo, Giovanni Di Nardo and Paolo Quitadamo

Children 2026, 13(5), 706; https://doi.org/10.3390/children13050706 - 21 May 2026

Abstract

Background/Objectives: Congenital esophageal stenosis (CES) is a rare condition that may present with feeding difficulties in infancy, often becoming evident during weaning. We report a case of CES presenting with progressive dysphagia during the introduction of solid foods. Methods: Clinical evaluation, contrast esophagography, [...] Read more.

Background/Objectives: Congenital esophageal stenosis (CES) is a rare condition that may present with feeding difficulties in infancy, often becoming evident during weaning. We report a case of CES presenting with progressive dysphagia during the introduction of solid foods. Methods: Clinical evaluation, contrast esophagography, endoscopy, and magnetic resonance imaging were performed to characterize the stenosis and guide management. Results: Imaging revealed a fixed narrowing of the mid-distal esophagus with minimal passage of contrast and proximal dilatation. Endoscopy confirmed a non-traversable intrinsic stenosis with macroscopically normal mucosa. The patient underwent three endoscopic dilation sessions under general anesthesia using Savary-Gilliard bougies with progressive diameters (3–5 mm, 3–7 mm, and 7–11 mm). No major procedural complications occurred. At 2-month follow-up after the last dilation, feeding was appropriate for age, dysphagia had improved, and growth was regular. Conclusions: CES should be suspected in infants with feeding difficulties that worsen during weaning, particularly when symptoms are resistant to anti-reflux therapy. Endoscopic dilation can improve feeding tolerance, although repeated and staged sessions may be required. The role of adjunctive therapies such as topical budesonide remains uncertain. Full article

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

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14 pages, 672 KB

Open AccessArticle

Which Bacterial Agent Is More Influential in the Development of Retinopathy of Prematurity: Gram-Positive or Gram-Negative?

by Batuhan Yeke, Mustafa Senol Akin, Seyma Butun Turk, Sarkhan Elbayiyev, Burak Ceran, Ozdemir Ozdemir and Ufuk Cakir

Children 2026, 13(5), 705; https://doi.org/10.3390/children13050705 - 20 May 2026

Abstract

Objective: In addition to hyperoxia, inflammation and infection contribute to the pathogenesis of retinopathy of prematurity (ROP). However, the differential effects of specific bacterial pathogens on ROP development remain unclear. This study aimed to evaluate the association between sepsis due to Gram-positive and [...] Read more.

Objective: In addition to hyperoxia, inflammation and infection contribute to the pathogenesis of retinopathy of prematurity (ROP). However, the differential effects of specific bacterial pathogens on ROP development remain unclear. This study aimed to evaluate the association between sepsis due to Gram-positive and Gram-negative bacteria and the development and severity of ROP. Materials and Methods: Infants at risk for ROP, defined as those with birth weight ≤1500 g or gestational age ≤32 weeks, or those with birth weight >1500 g or gestational age >32 weeks who required cardiorespiratory support, were included in this retrospective study. Patients were categorised into no-ROP and any-stage ROP groups, as well as treatment-requiring and non-treatment-requiring ROP groups. The clinical characteristics, laboratory findings, and microbiological data were compared between the groups. Results: Among the 319 enrolled infants, 193 (60.6%) did not develop ROP, whereas 126 (39.4%) developed any-stage ROP. Clinical early-onset sepsis, clinical and proven late-onset sepsis, and increased frequency of late-onset sepsis episodes were significantly associated with any-stage and treatment-requiring ROP (p < 0.05). In multivariate analysis, both Gram-positive (OR 2.36, 95% CI 1.2–4.6, p = 0.012) and Gram-negative bacterial sepsis (OR 3.56, 95% CI 1.5–8.3, p = 0.004) were independently associated with any-stage ROP. In addition, Gram-positive bacterial sepsis (OR 4.4, 95% CI 1.1–16.9, p = 0.031) was independently associated with treatment-requiring ROP. Conclusions: Gram-positive bacterial sepsis was associated with both any-stage ROP and treatment-requiring ROP, whereas Gram-negative bacterial sepsis was associated with any-stage ROP only. These findings support the potential role of pathogen-specific inflammatory processes in ROP development and progression. Further prospective studies incorporating detailed inflammatory and oxygenation parameters are required to clarify these relationships. Full article

(This article belongs to the Section Pediatric Neonatology)

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10 pages, 520 KB

Open AccessArticle

Is Intravenous Magnesium Sulfate Beneficial in Children with Acute Asthma Exacerbation and Acute Bronchiolitis? A Retrospective Cohort Study

by Yasin Selcuk Yardibi, Begum Baris Cetinkaya, Zeynep Tobcu, Sevim Orum, Dondu Ulker Ustebay and Sefer Ustebay

Children 2026, 13(5), 704; https://doi.org/10.3390/children13050704 - 20 May 2026

Abstract

Background/Objectives: Asthma, one of the most common chronic diseases in childhood, and acute bronchiolitis, a leading cause of hospitalization in early childhood, remain significant contributors to morbidity and mortality. Methods: This retrospective cohort study evaluated the efficacy and safety of intravenous magnesium sulfate [...] Read more.

Background/Objectives: Asthma, one of the most common chronic diseases in childhood, and acute bronchiolitis, a leading cause of hospitalization in early childhood, remain significant contributors to morbidity and mortality. Methods: This retrospective cohort study evaluated the efficacy and safety of intravenous magnesium sulfate (IV MgSO₄) as a secondary treatment in pediatric patients with acute asthma exacerbation unresponsive to first-line therapy and in patients with acute bronchiolitis unresponsive to supportive care. A total of 450 patients aged 6 months to 18 years, including 252 with acute asthma exacerbation and 198 with acute bronchiolitis, were included. Results: Significant improvements in peripheral capillary oxygen saturation were observed after IV MgSO₄ administration in both groups (p < 0.001). In the acute asthma exacerbation group, IV MgSO₄ also significantly reduced tachypnea compared to the acute bronchiolitis group (p < 0.001). No adverse effects related to IV MgSO₄ were observed. Conclusions: These findings suggest that IV MgSO₄ may be both beneficial and safe as an early secondary treatment in acute asthma exacerbations. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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13 pages, 548 KB

Open AccessArticle

Postnatal CMV Infection in Extremely Premature Newborns: A Single-Center Exploratory Study

by Rok Košiček, Vanja Erčulj, Lilijana Kornhauser Cerar, Lev Bregant, Miroslav Petrovec, Marko Pokorn, Ana Spirovska, Tina Uršič, Urška Rahne Potokar and Stefan Grosek

Children 2026, 13(5), 703; https://doi.org/10.3390/children13050703 - 20 May 2026

Abstract

Background/Objectives: The impact of postnatal CMV infection in extremely premature newborns is poorly characterized. We aimed to determine the impact and outcomes of postnatal CMV infection in a population of extremely premature newborns of gestational age of less than 29 weeks hospitalized in [...] Read more.

Background/Objectives: The impact of postnatal CMV infection in extremely premature newborns is poorly characterized. We aimed to determine the impact and outcomes of postnatal CMV infection in a population of extremely premature newborns of gestational age of less than 29 weeks hospitalized in the Department of Perinatology, Division of Gynecology, University Medical Center Ljubljana. Methods: We included all extremely premature newborns of gestational age of less than 29 weeks treated in the Department of Perinatology between December 2022 and December 2024. Newborns were screened for CMV infection at set timepoints and congenital infection was excluded with PCR testing. Additional PCR testing for CMV was performed if newborns developed clinical features suspect for postnatal CMV infection. Clinical characteristics and treatment outcomes of newborns were noted. Mothers of infected newborns had their CMV serostatus determined. Results: In total, 63 extremely premature newborns were included, and 14 newborns had confirmed postnatal CMV infection. Postnatal CMV infection was associated with hepatosplenomegaly and lower platelet and leukocyte counts compared to controls. We found no association between postnatal CMV infection and other neonatal comorbidities. Conclusions: In our study, postnatal CMV infection was associated with a more severe and prolonged clinical course of extremely premature newborns compared to uninfected controls; however, in multivariable analysis, the association with a prolonged length of stay was no longer statistically significant. The results suggest that preventing postnatal CMV infection in this population is important. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 1175 KB

Open AccessArticle

Dental Rehabilitation Improves Oral Health-Related Quality of Life in Children with Molar-Incisor Hypomineralisation: A 12-Month Prospective Controlled Study

by Elif Kandemir Ülker and Seçil Çalışkan

Children 2026, 13(5), 702; https://doi.org/10.3390/children13050702 - 20 May 2026

Abstract

Background/Objectives: This study aims to compare the oral health-related quality of life (OHRQoL) of children with molar incisor hypomineralisation (MIH) and their parents with that of an age- and caries-matched control group, and to evaluate the long-term impact of dental rehabilitation on [...] Read more.

Background/Objectives: This study aims to compare the oral health-related quality of life (OHRQoL) of children with molar incisor hypomineralisation (MIH) and their parents with that of an age- and caries-matched control group, and to evaluate the long-term impact of dental rehabilitation on OHRQoL. Methods: A total of 30 children aged 8–12 years were included, with 15 participants in the MIH group and 15 in the control group. OHRQoL was assessed using the Pediatric Oral Health-Related Quality of Life (POQL) scale. Data were obtained at baseline and at 3, 6, and 12 months after treatment. Statistical analyses included a chi-square test, independent samples t-test, Mann–Whitney U test and Friedman test, according to data distribution. Results: Baseline POQL scores were significantly higher in the MIH group compared with the control group for both children and parents (p = 0.020 and p = 0.036, respectively). Among subscales, emotional functioning scores in children and role and physical functioning scores in parents were significantly higher in the MIH group (p = 0.027 and p = 0.032, respectively). Following dental rehabilitation, POQL scores significantly decreased in both groups (p < 0.001), and this improvement was maintained throughout the 12-month follow-up period. Conclusions: MIH has a negative impact on the OHRQoL of both children and parents, regardless of caries experience. Comprehensive dental rehabilitation results in significant and sustained improvements in OHRQoL, indicating the importance of early and comprehensive management in children with MIH. Full article

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

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9 pages, 181 KB

Open AccessCommunication

Observational Study on the Management of Children with Systemic Diseases During Dental Treatment

by Tatsuya Akitomo, Satoru Kusaka and Ryota Nomura

Children 2026, 13(5), 701; https://doi.org/10.3390/children13050701 - 20 May 2026

Abstract

Background/Aim: While improvements in oral health can sometimes lead to improvements in systemic diseases, certain systemic diseases such as heart disease require consideration during dental treatment. In clinical pediatric dentistry, dental professionals may encounter the pediatric patient with systemic diseases, and should [...] Read more.

Background/Aim: While improvements in oral health can sometimes lead to improvements in systemic diseases, certain systemic diseases such as heart disease require consideration during dental treatment. In clinical pediatric dentistry, dental professionals may encounter the pediatric patient with systemic diseases, and should consult with physicians regarding the overall health status of their patients with systemic diseases before dental procedures. Materials and Methods: We reviewed the responses to letters of inquiry made to external medical institutions regarding the overall physical condition of patients during a 5-year period (2021–2025). The survey items were the gender, age, aim of letter, systemic disease, and physician responses and instructions. Result: A total of 48 letters of inquiry were found, of which 34 were initial confirmations and 14 were reconfirmations. In children aged ≤5 years, the common aim was oral management or caries treatment, and the proportion of surgical procedures increased with age. Among the systemic diseases involved, the diseases of the circulatory system such as congenital heart disease were the most common, with 70% of initial confirmations leading to premedication with antibiotics prior to invasive dental procedures. Although many responses remained unchanged upon reconfirmation, the responses for some patients changed. Conclusions: This study shows the importance of dental professionals consulting with physicians regarding the health condition of patients with systemic diseases before oral management. Furthermore, a single confirmation is insufficient, and the information must be regularly updated. Full article

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

10 pages, 285 KB

Open AccessArticle

Comparison of the Effects of Intraoperative Dexmedetomidine and Fentanyl Infusion on Postoperative Agitation and Analgesia in Pediatric Patients Undergoing Tonsillectomy and Adenoidectomy: A Prospective Randomized Trial

by Yasar Gokhan Gul, Sümeyye Yildiz, Hande Güngör, Burak Omur, Pelin Karaaslan and Bahadir Ciftci

Children 2026, 13(5), 700; https://doi.org/10.3390/children13050700 - 20 May 2026

Abstract

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children [...] Read more.

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time. Full article

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

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11 pages, 2540 KB

Open AccessArticle

Clinical Utility of Rapid-Sequence Magnetic Resonance Imaging (rMRI) in Pediatric Neurosurgery: Enhancing Assessment of Hydrocephalic Changes

by Johanna Krämer, Nieke Ueding, Christian Ott, Angelika Seitz, Malte Ottenhausen, Sandro M. Krieg, Ahmed El Damaty and Mohammed Issa

Children 2026, 13(5), 699; https://doi.org/10.3390/children13050699 - 20 May 2026

Abstract

Objective: Rapid-sequence magnetic resonance imaging (rMRI) has emerged as a radiation-free alternative to computed tomography (CT) in pediatric neuroimaging. This study aimed to evaluate the diagnostic utility, clinical consequences, and subgroup-specific differences in pediatric patients undergoing rMRI for emergency neurosurgical indications. Methods [...] Read more.

Objective: Rapid-sequence magnetic resonance imaging (rMRI) has emerged as a radiation-free alternative to computed tomography (CT) in pediatric neuroimaging. This study aimed to evaluate the diagnostic utility, clinical consequences, and subgroup-specific differences in pediatric patients undergoing rMRI for emergency neurosurgical indications. Methods: We conducted a retrospective, single-center study of 158 rMRIs in 73 pediatric patients who underwent rMRI between January 2017 and December 2023 due to suspected complications of hydrocephalus and brain tumors. A short MRI protocol (195 s) including FLAIR BLADE and T2 HATSE sequences was employed. Patients were categorized into tumor non-related and tumor-related hydrocephalus groups. Results: A total of 158 rMRIs in 73 pediatric patients were included. The mean age was 7.09 ± 4.63 years, with 69.6% male patients. Ventricular size monitoring was the most common rMRI indication (96.2%). Clinical consequences followed in 52.5% of cases, including surgical interventions (21.5%) and shunt valve adjustments (37.3%). Sedation was required in only 5.1% of patients. Only 1.9% required follow-up CT. Statistically significant intergroup differences were found in drainage type (p < 0.001), diagnosis (p < 0.001), and need for follow-up MRI (17.4% in the tumor-related hydrocephalus group vs. 4.5% in the tumor non-related hydrocephalus group; p = 0.014). Conclusions: rMRI is a safe, efficient, and effective alternative to CT for emergency neuroimaging in pediatric patients with hydrocephalus, tumors, or shunts. It facilitates timely clinical decision-making while avoiding radiation exposure. Our findings support broader implementation of rMRI protocols, particularly for patients requiring ongoing tumor surveillance. Full article

(This article belongs to the Section Pediatric Radiology)

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15 pages, 277 KB

Open AccessArticle

Physical Development and Postural Behaviors in Children and Adolescents: A Cross-Sectional Study

by Francesca D’Elia, Rosario Ceruso, Giuseppe Giardullo, Angelica Delfina Picone, Vera Simoes, Tiziana D’Isanto and Giovanni Esposito

Children 2026, 13(5), 698; https://doi.org/10.3390/children13050698 - 19 May 2026

Abstract

Background/Objectives: Musculoskeletal pain represents a frequent and increasingly recognized health issue during adolescence. During this developmental phase, daily habits such as prolonged sitting, sedentary behaviors and the adoption of non-neutral postures may contribute to spinal overload and pain symptoms. This study contributes to [...] Read more.

Background/Objectives: Musculoskeletal pain represents a frequent and increasingly recognized health issue during adolescence. During this developmental phase, daily habits such as prolonged sitting, sedentary behaviors and the adoption of non-neutral postures may contribute to spinal overload and pain symptoms. This study contributes to the existing literature by focusing on concrete postural behaviors in real-life daily situations, an aspect that is still underexplored despite its relevance for musculoskeletal health. The aim of this study was to investigate the associations between daily habits, postural behaviors and the presence of back and neck pain. Methods: A cross-sectional study was conducted on a sample of 70 adolescents aged 10–20 years. Data were collected using the Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA), administered online. Descriptive statistics and chi-square tests with effect sizes (Cramer’s V) were used to examine associations between postural behaviors, lifestyle factors, and pain outcomes, providing an inferential assessment beyond simple descriptive analysis. Results: Significant associations were found between gender and back pain, sitting posture during daily activities (writing at the desk and talking with friends) and back pain, with flexed or asymmetrical postures more frequently reported among participants with pain, and between back and neck pain (p < 0.05). Conclusions: The findings highlight the relevance of gender and daily postural behaviors as factors associated with musculoskeletal pain in adolescents. By identifying posture-specific behaviors linked to pain, this study provides preliminary evidence that can inform targeted preventive strategies and guide future research on modifiable daily habits in youth. Full article

(This article belongs to the Special Issue Physical Fitness and Health in Adolescents)

14 pages, 283 KB

Open AccessReview

Neurotransmitters in Auditory Processing Disorders and Neurodevelopmental Disorders: A Common Neurobiological Substrate?

by Andrea Bianchino, Andrea Migliorelli, Marianna Manuelli, Chiara Bianchini, Francesco Stomeo, Stefano Pelucchi, Andrea Ciorba, Luca Sacchetto, Silvia Palma and Daniele Monzani

Children 2026, 13(5), 697; https://doi.org/10.3390/children13050697 - 19 May 2026

Abstract

Background/Objectives: Auditory processing disorders (APDs), defined as impaired neural processing of acoustic stimuli despite normal peripheral hearing, often co-occur with neurodevelopmental disorders (NDDs) and may contribute to language, attentional, and learning difficulties. Emerging evidence suggests that shared neurotransmitter systems may represent a [...] Read more.

Background/Objectives: Auditory processing disorders (APDs), defined as impaired neural processing of acoustic stimuli despite normal peripheral hearing, often co-occur with neurodevelopmental disorders (NDDs) and may contribute to language, attentional, and learning difficulties. Emerging evidence suggests that shared neurotransmitter systems may represent a common neurobiological substrate underlying these conditions. The aim of this study is to integrate current evidence on glutamatergic, GABAergic, and monoaminergic systems in neurodevelopmental and auditory processing disorders in children and adolescents, and to evaluate the hypothesis that shared neurotransmitter dysregulation may underlie their clinical overlap. Methods: A narrative review of the literature was conducted through electronic searches in PubMed and Embase up to 31 December 2025, using keywords related to neurotransmitters, NDDs and APDs. Results: Available evidence indicates that an imbalance between excitatory glutamatergic and inhibitory GABAergic neurotransmission has been proposed as a central mechanism in NDDs and may also contribute to auditory processing difficulties through altered neural synchrony, sensory gating and temporal auditory coding. Findings collectively suggest the hypothesis of shared neurotransmitter dysregulation across NDDs and APDs. Conclusions: Auditory processing difficulties may represent sensory-level expressions of shared neurochemical vulnerability across neurodevelopmental conditions. Future longitudinal and multimodal studies are needed to clarify causal relationships and to identify clinically useful biomarkers. Full article

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

15 pages, 1091 KB

Open AccessArticle

Hypogammaglobulinemia in Children with Atopic Dermatitis

by Zuhal Karali, Yasin Karali, Zeynep Senocak and Sara Sebnem Kilic

Children 2026, 13(5), 696; https://doi.org/10.3390/children13050696 - 19 May 2026

Abstract

Background and aims: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease among children. Our study aimed to evaluate the prevalence of hypogammaglobulinemia among pediatric patients with AD and to characterize the clinical and laboratory findings of patients diagnosed with AD [...] Read more.

Background and aims: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease among children. Our study aimed to evaluate the prevalence of hypogammaglobulinemia among pediatric patients with AD and to characterize the clinical and laboratory findings of patients diagnosed with AD and hypogammaglobulinemia. Method: The electronic files of 1850 patients aged 0–18 years diagnosed with AD between 2020 and 2022 in the Pediatric Immunology and Allergy Clinic of Bursa Medical Faculty City Hospital were retrospectively analyzed. During this period, all patients newly diagnosed with atopic dermatitis at our clinic were systematically screened for their serum immunoglobulin (Ig) levels (IgG, IgA, and IgM) at the time of initial presentation. We included 200 AD patients with hypogammaglobulinemia. Disease severity was classified using the Scoring Atopic Dermatitis (SCORAD) index. Multivariate logistic and linear regression analyses were performed to identify independent determinants of disease severity, considering age, sex, eosinophil counts, total IgE, food allergies, and baseline immunoglobulin levels. Results: The prevalence of hypogammaglobulinemia among the 1850 screened children with AD was 10.8% (200/1850). Of the 200 patients included in this study, 128 (64%) were male, and 72 (36%) were female. The median age at first clinic presentation was 8 months (interquartile range (IQR) 25–75%: 5–16). According to the Scoring Atopic Dermatitis (SCORAD) index, AD severity was mild in 150 (75%) patients and moderate-to-severe in 50 (25%). Food allergy sensitization was present in 72 (36%) patients. Patients with moderate-to-severe AD had significantly lower IgG (300 vs. 374 mg/dL; p < 0.001; r = −0.346), IgA (10 vs. 14 mg/dL; p = 0.004), and IgM (38 vs. 51 mg/dL; p = 0.001) levels when compared with those with mild disease. Multivariate logistic regression confirmed that lower IgG was the only immunoglobulin independently associated with moderate-to-severe AD (OR = 1.97 per 100 mg/dL decrease; 95% CI: 1.15–3.39; p = 0.013), while food allergy was the strongest independent predictor of the SCORAD index (β = +11.97; p < 0.001). None of the patients received intravenous immunoglobulin (IVIG) treatment. Of the 142 patients who underwent serial serum immunoglobulin measurements, 56 (39%) achieved age-appropriate normal IgG levels, while hypogammaglobulinemia persisted in 86 (61%). Conclusions: We found a higher frequency of hypogammaglobulinemia in patients with AD in our study, as compared with previously reported rates of THI in children from the general pediatric population. Although our study showed an increase in IgG levels during the follow-up period in many patients, it emphasizes the need for long-term immunological monitoring, especially in patients with moderate-to-severe AD. Full article

(This article belongs to the Special Issue Childhood Atopic Dermatitis: Diagnosis, Treatment and Management)

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13 pages, 1160 KB

Open AccessArticle

Anxiety Symptoms in Preschool Children Born Very Preterm: Associations with Cognition and Neonatal Striatal Volumes

by Carmen Rodríguez-Barrios, Natalia Jiménez-Luque, Yolanda Marín Almagro, Irene Gutierrez-Rosa, Manuel Lubián-Gutiérrez, Bahram Jafrasteh, Isabel Benavente-Fernández and Simón Pedro Lubián-López

Children 2026, 13(5), 695; https://doi.org/10.3390/children13050695 - 19 May 2026

Abstract

Background/Objectives: Children born very preterm (VP) are at increased risk of later emotional and cognitive difficulties, including anxiety symptoms during childhood. Altered early brain development, particularly within subcortical circuits involved in emotional regulation, may contribute to this vulnerability. This study aimed to assess [...] Read more.

Background/Objectives: Children born very preterm (VP) are at increased risk of later emotional and cognitive difficulties, including anxiety symptoms during childhood. Altered early brain development, particularly within subcortical circuits involved in emotional regulation, may contribute to this vulnerability. This study aimed to assess anxiety symptoms in preschool-aged children born VP, examine their relationship with cognitive performance, and determine whether neonatal brain volumes at term-equivalent age (TEA) were associated with later anxiety symptoms. We also explored whether cognition mediated the association between neonatal striatal volumes and anxiety. Methods: We conducted a longitudinal cohort study of infants born at ≤32 weeks of gestation and/or with a birth weight ≤1500 g admitted to a tertiary neonatal intensive care unit between 2018 and 2021. At 4–6 years of age, anxiety symptoms were assessed using the Child Behavior Checklist (CBCL) Anxiety Problems subscale, and cognitive performance was evaluated with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Neonatal magnetic resonance imaging performed at TEA was used to obtain regional brain volumetric measures. Associations were analyzed using adjusted linear regression, interaction-based volumetric modeling, path analysis, and receiver operating characteristic analysis. Results: Ninety-five children were included, and 24 (25.3%) showed clinically relevant anxiety symptoms according to the CBCL Anxiety Problems subscale. Higher WPPSI-IV scores were associated with lower anxiety scores (β = −0.183; p = 0.042). The best-fitting MRI model included caudate volume, putamen volume, and their interaction, with a significant association between the putamen–caudate interaction and anxiety symptoms (β = −17.807; p < 0.001). In the path model, both cognition and the putamen–caudate interaction were directly associated with anxiety, whereas the indirect effect through cognition was not significant. The final MRI model showed acceptable discrimination for clinically relevant anxiety (AUC = 0.796). Conclusions: Anxiety symptoms were frequent in preschool-aged children born VP and were associated with lower cognitive performance. Neonatal striatal volumetric organization, particularly the interaction between the putamen and caudate volumes, was independently associated with later anxiety symptoms, suggesting that cognitive and early neural factors may contribute to anxiety risk through parallel rather than mediated pathways. Full article

(This article belongs to the Special Issue Neonatal Brain Injury and Neurodevelopmental Outcomes: Prediction, Assessment, and Interventions)

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