Children

23 pages, 716 KiB

Open AccessEditor’s ChoiceArticle

Neonatal Drug Formularies—A Global Scope

by Dotan Shaniv, Srinivas Bolisetty, Thomas E. Young, Barry Mangum, Sean Ainsworth, Linda Elbers, Petra Schultz, Melanie Cucchi, Saskia N. de Wildt, Tjitske M. van der Zanden, Neil Caldwell, Anne Smits and Karel Allegaert

Children 2023, 10(5), 848; https://doi.org/10.3390/children10050848 - 8 May 2023

Cited by 13 | Viewed by 4575

Abstract

Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician’s toolbox. Several formularies exist worldwide, but they have never been fully mapped [...] Read more.

Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician’s toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients. Full article

(This article belongs to the Section Pediatric Neonatology)

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20 pages, 9063 KiB

Open AccessEditor’s ChoiceArticle

Exploring the Potential of Three-Dimensional Imaging, Printing, and Modeling in Pediatric Surgical Oncology: A New Era of Precision Surgery

by Arnau Valls-Esteve, Núria Adell-Gómez, Albert Pasten, Ignasi Barber, Josep Munuera and Lucas Krauel

Children 2023, 10(5), 832; https://doi.org/10.3390/children10050832 - 3 May 2023

Cited by 19 | Viewed by 4584

Abstract

Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are [...] Read more.

Pediatric surgical oncology is a technically challenging field that relies on CT and MRI as the primary imaging tools for surgical planning. However, recent advances in 3D reconstructions, including Cinematic Rendering, Volume Rendering, 3D modeling, Virtual Reality, Augmented Reality, and 3D printing, are increasingly being used to plan complex cases bringing new insights into pediatric tumors to guide therapeutic decisions and prognosis in different pediatric surgical oncology areas and locations including thoracic, brain, urology, and abdominal surgery. Despite this, challenges to their adoption remain, especially in soft tissue-based specialties such as pediatric surgical oncology. This work explores the main innovative imaging reconstruction techniques, 3D modeling technologies (CAD, VR, AR), and 3D printing applications through the analysis of three real cases of the most common and surgically challenging pediatric tumors: abdominal neuroblastoma, thoracic inlet neuroblastoma, and a bilateral Wilms tumor candidate for nephron-sparing surgery. The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases. A comprehensive analysis of the advantages and limitations of each technique has been carried out to assist in choosing the optimal approach. Full article

(This article belongs to the Special Issue New Research in Pediatric Surgical Oncology)

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12 pages, 946 KiB

Open AccessEditor’s ChoiceArticle

The Role of Amplitude-Integrated Electroencephalography (aEEG) in Monitoring Infants with Neonatal Seizures and Predicting Their Neurodevelopmental Outcome

by Florina Marinela Doandes, Aniko Maria Manea, Nicoleta Lungu, Timea Brandibur, Daniela Cioboata, Oana Cristina Costescu, Mihaela Zaharie and Marioara Boia

Children 2023, 10(5), 833; https://doi.org/10.3390/children10050833 - 3 May 2023

Cited by 8 | Viewed by 5693

Abstract

Newborn monitoring in neonatal intensive care units (NICU) is mandatory, but neurological and especially electroencephalographic (EEG) monitoring can be overlooked or delayed until the newborn is clinically stable. However, the neonatal period is associated with the highest risk of seizures in humans, and [...] Read more.

Newborn monitoring in neonatal intensive care units (NICU) is mandatory, but neurological and especially electroencephalographic (EEG) monitoring can be overlooked or delayed until the newborn is clinically stable. However, the neonatal period is associated with the highest risk of seizures in humans, and the clinical symptoms may often be discrete, but the evolution and long-term neurodevelopmental disorders in these patients may be important. In response to this issue, we conducted a study to evaluate newborns who experienced neonatal seizures (NS) in the NICU and monitored their long-term neurological development. We enrolled 73 term and preterm newborns who underwent EEG monitoring using amplitude-integrated electroencephalography (aEEG). We then followed their neurological development until around 18 months of age, with 59 patients remaining in the long-term study. A total of 22% of patients with NS developed epilepsy, 12% cerebral palsy, 19% severe neurodevelopmental disabilities, and 8.5% died within the first 18 months of life. Our findings indicate that aEEG background pattern is a strong predictor of unfavorable neurological outcomes, with an odds ratio of 20.4174 (p < 0.05). Additionally, higher Apgar scores were associated with better outcomes (p < 0.05), with the odds of unfavorable neurological outcomes decreasing by 0.7-fold for every point increase in Apgar score. Furthermore, we found a statistically significant association between preterm birth and unfavorable neurological outcomes (p = 0.0104). Our study highlights the importance of early EEG monitoring in the NICU and provides valuable insights into predictors of unfavorable neurological outcomes in newborns who experienced NS. Full article

(This article belongs to the Section Pediatric Neonatology)

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19 pages, 2247 KiB

Open AccessEditor’s ChoiceReview

Short- and Long-Term Outcomes of Preeclampsia in Offspring: Review of the Literature

by Sevasti Koulouraki, Vasileios Paschos, Panagiota Pervanidou, Panagiotis Christopoulos, Angeliki Gerede and Makarios Eleftheriades

Children 2023, 10(5), 826; https://doi.org/10.3390/children10050826 - 1 May 2023

Cited by 20 | Viewed by 9744

Abstract

Preeclampsia is a multisystemic clinical syndrome characterized by the appearance of new-onset hypertension and proteinuria or hypertension and end organ dysfunction even without proteinuria after 20 weeks of pregnancy or postpartum. Residing at the severe end of the spectrum of the hypertensive disorders [...] Read more.

Preeclampsia is a multisystemic clinical syndrome characterized by the appearance of new-onset hypertension and proteinuria or hypertension and end organ dysfunction even without proteinuria after 20 weeks of pregnancy or postpartum. Residing at the severe end of the spectrum of the hypertensive disorders of pregnancy, preeclampsia occurs in 3 to 8% of pregnancies worldwide and is a major cause of maternal and perinatal morbidity and mortality, accounting for 8–10% of all preterm births. The mechanism whereby preeclampsia increases the risk of the neurodevelopmental, cardiovascular, and metabolic morbidity of the mother’s offspring is not well known, but it is possible that the preeclamptic environment induces epigenetic changes that adversely affect developmental plasticity. These developmental changes are crucial for optimal fetal growth and survival but may lead to an increased risk of chronic morbidity in childhood and even later in life. The aim of this review is to summarize both the short- and long-term effects of preeclampsia on offspring based on the current literature. Full article

(This article belongs to the Special Issue Developmental and Behavioral Pediatrics - Volume II)

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15 pages, 351 KiB

Open AccessEditor’s ChoiceArticle

School Burnout after COVID-19, Prevalence and Role of Different Risk and Protective Factors in Preteen Students

by Noémie Lacombe, Maryelle Hey, Verena Hofmann, Céline Pagnotta and Myriam Squillaci

Children 2023, 10(5), 823; https://doi.org/10.3390/children10050823 - 30 Apr 2023

Cited by 8 | Viewed by 3298

Abstract

Background: Current data show an increase in stress among youth since the COVID-19 pandemic, raising the question of the measures to be put in place to limit it. Aim: The aim of this study is to measure the prevalence of burnout and the [...] Read more.

Background: Current data show an increase in stress among youth since the COVID-19 pandemic, raising the question of the measures to be put in place to limit it. Aim: The aim of this study is to measure the prevalence of burnout and the different risk and protective factors of burnout among students and to compare the mean scores obtained with those collected in a similar sample in 2014. Method: Perceived health, school burnout, and the different risk and protective factors among students were measured by self-reported questionnaires among a sample of 184 students (11–13 years old). Results: The results indicate significantly higher burnout scores than in 2014. Different variables were predictive of school burnout: 1. At the individual level, a low academic achievement in mathematics, somatic symptoms, and the expressed stress; 2. At the interpersonal level, lack of support from peers, teachers, and parents and a negative classroom climate; 3. At the pandemic level, the increased workload related to the consequences of COVID-19. The factors with the greatest impact are confidence in the future, perceived stress, parental supports, and mathematics results. Conclusions: An intervention program targeting these four factors among burned out students would be relevant to set up in order to reduce its prevalence. Full article

(This article belongs to the Special Issue Child and Adolescent Psychiatry: A Post-COVID Era?)

25 pages, 1895 KiB

Open AccessEditor’s ChoiceReview

Ultra-Processed Food, Reward System and Childhood Obesity

by Valeria Calcaterra, Hellas Cena, Virginia Rossi, Sara Santero, Alice Bianchi and Gianvincenzo Zuccotti

Children 2023, 10(5), 804; https://doi.org/10.3390/children10050804 - 29 Apr 2023

Cited by 35 | Viewed by 14179

Abstract

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in [...] Read more.

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies. Full article

(This article belongs to the Special Issue Food Intake and Nutrition Assessment in Children: Focus on Healthy Growth)

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9 pages, 250 KiB

Open AccessEditor’s ChoiceReview

Pediatric Conjunctivitis: A Review of Clinical Manifestations, Diagnosis, and Management

by Matthew J. Mahoney, Ruegba Bekibele, Sydney L. Notermann, Thomas G. Reuter and Emily C. Borman-Shoap

Children 2023, 10(5), 808; https://doi.org/10.3390/children10050808 - 29 Apr 2023

Cited by 15 | Viewed by 13011

Abstract

Conjunctivitis is a common pediatric problem and is broadly divided into infectious and non-infectious etiologies. Bacterial conjunctivitis makes up the majority of cases in children and often presents with purulent discharge and mattering of the eyelids. Treatment is supportive with an individual approach [...] Read more.

Conjunctivitis is a common pediatric problem and is broadly divided into infectious and non-infectious etiologies. Bacterial conjunctivitis makes up the majority of cases in children and often presents with purulent discharge and mattering of the eyelids. Treatment is supportive with an individual approach to antibiotic use in uncomplicated cases since it may shorten symptom duration, but is not without risks. Viral conjunctivitis is the other infectious cause and is primarily caused by adenovirus, with a burning, gritty feeling and watery discharge. Treatment is supportive. Allergic conjunctivitis is largely seasonal and presents with bilateral itching and watery discharge. Treatment can include topical lubricants, topical antihistamine agents, or systemic antihistamines. Other causes of conjunctivitis include foreign bodies and non-allergic environmental causes. Contact lens wearers should always be treated for bacterial conjunctivitis and referred to evaluate for corneal ulcers. Neonatal conjunctivitis requires special care with unique pathogens and considerations. This review covers essential information for the primary care pediatric provider as they assess cases of conjunctivitis. Full article

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

14 pages, 824 KiB

Open AccessEditor’s ChoiceReview

COVID-19 and Related Vaccinations in Children: Pathogenic Aspects of Oral Lesions

by Federica Di Spirito, Francesco D’Ambrosio, Maria Pia Di Palo, Francesco Giordano, Nicoletta Coppola and Maria Contaldo

Children 2023, 10(5), 809; https://doi.org/10.3390/children10050809 - 29 Apr 2023

Cited by 6 | Viewed by 3440

Abstract

Various clinical manifestations of SARS-CoV-2 infections and adverse reactions to COVID-19 vaccination have been described in children. The present narrative review aimed to collect and synthesize reported findings on oral lesions detected in SARS-CoV-2-positive subjects following COVID-19 EMA-authorized and WHO Emergency Use Listing-approved [...] Read more.

Various clinical manifestations of SARS-CoV-2 infections and adverse reactions to COVID-19 vaccination have been described in children. The present narrative review aimed to collect and synthesize reported findings on oral lesions detected in SARS-CoV-2-positive subjects following COVID-19 EMA-authorized and WHO Emergency Use Listing-approved vaccine administration in the pediatric population to detail their clinical features and highlight possible pathogenic aspects of those lesions based on current evidence. Few and incomplete reports were retrieved from the literature, probably because most lesions belonged to a broad spectrum of systemic diseases and syndromes and were nonspecific or inaccurately described. The most common oral lesions in pediatric SARS-CoV-2-positive patients were erosive–ulcerative lesions and macules/petechiae, primarily erythematous. In the context of COVID-19 vaccination, oral adverse reactions were rare and typically presented as erosive–ulcerative lesions, with EM-like or unspecified patterns. Future studies should investigate oral lesions in SARS-CoV-2-positive subjects and after COVID-19 vaccination in the pediatric population, taking into account viral variants and newly developed vaccines. Deeper insight into oral lesions detectable in pediatric SARS-CoV-2-positive subjects and after COVID-19 vaccination may increase clinicians’ ability to improve multidisciplinary pediatric oral and general care. Full article

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

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13 pages, 328 KiB

Open AccessEditor’s ChoiceReview

Birth Defects Associated with Prenatal Alcohol Exposure—A Review

by Katarzyna Anna Dyląg, Florencia Anunziata, Gretchen Bandoli and Christina Chambers

Children 2023, 10(5), 811; https://doi.org/10.3390/children10050811 - 29 Apr 2023

Cited by 9 | Viewed by 7978

Abstract

Since the recognition of fetal alcohol syndrome, alcohol has been accepted as a human teratogen. However, little is known about the relation between prenatal alcohol exposure and the spectrum of associated major birth defects. The objective of this review was to summarize data [...] Read more.

Since the recognition of fetal alcohol syndrome, alcohol has been accepted as a human teratogen. However, little is known about the relation between prenatal alcohol exposure and the spectrum of associated major birth defects. The objective of this review was to summarize data on the association of major congenital abnormalities and prenatal alcohol exposure. We included all major birth defects according to ICD-10 classification. We found that the strongest evidence to date lies in the research examining herniation (gastroschisis and omphalocele), oral clefts (cleft lip with or without palate and cleft palate) and cardiac defects. There is less consistent evidence supporting the association between prenatal alcohol exposure and anomalies of gastrointestinal system, diaphragmatic hernia, genitourinary system and neural tube defects. We found no material support for PAE and choanal atresia, biliary atresia or clubfoot. Full article

(This article belongs to the Special Issue Advances in Fetal Alcohol Spectrum Disorders (FASD))

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17 pages, 355 KiB

Open AccessEditor’s ChoiceReview

Genetic Alterations of Transcription Factors and Signaling Molecules Involved in the Development of Congenital Heart Defects—A Narrative Review

by Alexandru Cristian Bolunduț, Cecilia Lazea and Carmen Mihaela Mihu

Children 2023, 10(5), 812; https://doi.org/10.3390/children10050812 - 29 Apr 2023

Cited by 7 | Viewed by 2412

Abstract

Congenital heart defects (CHD) are the most common congenital abnormality, with an overall global birth prevalence of 9.41 per 1000 live births. The etiology of CHDs is complex and still poorly understood. Environmental factors account for about 10% of all cases, while the [...] Read more.

Congenital heart defects (CHD) are the most common congenital abnormality, with an overall global birth prevalence of 9.41 per 1000 live births. The etiology of CHDs is complex and still poorly understood. Environmental factors account for about 10% of all cases, while the rest are likely explained by a genetic component that is still under intense research. Transcription factors and signaling molecules are promising candidates for studies regarding the genetic burden of CHDs. The present narrative review provides an overview of the current knowledge regarding some of the genetic mechanisms involved in the embryological development of the cardiovascular system. In addition, we reviewed the association between the genetic variation in transcription factors and signaling molecules involved in heart development, including TBX5, GATA4, NKX2-5 and CRELD1, and congenital heart defects, providing insight into the complex pathogenesis of this heterogeneous group of diseases. Further research is needed in order to uncover their downstream targets and the complex network of interactions with non-genetic risk factors for a better molecular–phenotype correlation. Full article

(This article belongs to the Section Pediatric Cardiology)

17 pages, 3897 KiB

Open AccessEditor’s ChoiceArticle

Remdesivir Efficacy and Tolerability in Children with COVID-19-Associated Allergic Comorbidities such as Asthma, Allergic Rhinitis, and Atopic Dermatitis

by Gheorghiță Jugulete, Monica Luminos, Carmen Pavelescu and Mădălina Maria Merișescu

Children 2023, 10(5), 810; https://doi.org/10.3390/children10050810 - 29 Apr 2023

Cited by 8 | Viewed by 2299

Abstract

In children, coronavirus disease 2019 (COVID-19) starts as a minor illness compared to adults, but during the ongoing COVID-19 pandemic, distinct SARS-CoV-2 variants and subvariants have changed options for therapies in both adults and children, especially for those with comorbidities such as allergies. [...] Read more.

In children, coronavirus disease 2019 (COVID-19) starts as a minor illness compared to adults, but during the ongoing COVID-19 pandemic, distinct SARS-CoV-2 variants and subvariants have changed options for therapies in both adults and children, especially for those with comorbidities such as allergies. On 25 April 2022, Remdesivir (RDV), a viral RNA-dependent RNA polymerase inhibitor, was approved by the Food and Drug Administration (FDA) for the treatment of pediatric patients 28 days and older, weighing ≥3 kg, hospitalized or non-hospitalized, who are at high risk of progression to severe forms of COVID-19. While RDV has been shown to have favorable effects in numerous types of research conducted on adults, such as shortening hospital stays, and has shown it has antiviral effects on various RNA viruses, there is a lack of findings regarding safety, tolerability, and efficacy of RDV in allergic pediatric patients since its initial FDA approval. This study aims to assess RDV’s efficacy and tolerability in treating pediatric patients with mild and severe forms of COVID-19-associated allergies such as asthma, allergic rhinitis, and atopic dermatitis and how RDV affects the duration of hospitalization, especially for these comorbidities. The most recent pandemic wave among children rose due to the high transmissibility of the Omicron variant, and this study analyzed changes between July 2020 and September 2022 at the National Institute of Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania. Our retrospective study included 250 children <18 years old, 42 (16.8%) had allergies, 132 were males (52.8%), age group 0–5 years old (80%), with a positive viral test for SARS-CoV-2. Severity was categorized as mild (43.6%), moderate (53.2%), and severe (1.6%) COVID-19, and treatment with RDV was administered in 50.4% (126/250) of children included in the study. The presence of comorbidities, asthma (7.2%), allergic rhinitis (4.4%), and atopic dermatitis (4.4%), was associated with an increased risk of developing severe COVID-19 infection in children, p < 0.05. We did not register deaths and severe complications; all cases evolved favorably under the instituted treatment. Laboratory abnormalities in transaminase levels 53.97% (ALT) and 61.9% (AST) were grades 1 or 2 and did not require discontinuation of the antiviral treatment, p < 0.05. RDV in children reduced the duration and evolution of COVID-19 and decreased the length of hospitalization in group-associated allergies; p < 0.05. This article summarizes RDV’s efficacy among children with COVID-19 and allergies when the clinical result was improved and reports positive effects on tolerability and reduced duration of hospitalization, especially in children with asthma, atopic dermatitis, and allergic rhinitis. More studies are needed to confirm our findings. Full article

(This article belongs to the Section Pediatric Allergy and Immunology)

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21 pages, 457 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review

by Audrey Nantel and Véronique Gingras

Children 2023, 10(5), 794; https://doi.org/10.3390/children10050794 - 28 Apr 2023

Cited by 7 | Viewed by 5665

Abstract

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children’s health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in [...] Read more.

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children’s health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics. Full article

(This article belongs to the Special Issue Infant Feeding: Advances and Future Challenges)

10 pages, 255 KiB

Open AccessEditor’s ChoiceArticle

Growing Up with HIV: Experiences of Transition from Adolescence to Adulthood at Selected Primary Health Facilities in Limpopo Province, South Africa

by Azwinndini Cecilia Mukwevho, Maria Sonto Maputle and Dorah Ursula Ramathuba

Children 2023, 10(5), 798; https://doi.org/10.3390/children10050798 - 28 Apr 2023

Cited by 5 | Viewed by 2138

Abstract

Background: Many children who contracted Human Immunodeficiency Virus (HIV) through vertical transmission are now in their adolescent and early adult years. The aim was to explore the experiences of adolescents living with HIV (ALWHIV) during the transition from childhood to adulthood. Methods and [...] Read more.

Background: Many children who contracted Human Immunodeficiency Virus (HIV) through vertical transmission are now in their adolescent and early adult years. The aim was to explore the experiences of adolescents living with HIV (ALWHIV) during the transition from childhood to adulthood. Methods and Material: The study was conducted at selected primary healthcare facilities in the Mopani and Vhembe districts in July 2021. A qualitative research approach that included contextual, descriptive, and exploratory designs was used. The population comprised 27 ALWHIV who were purposively sampled and enrolled for ART care. Data were collected using in-depth interviews, and the question was “How is it for you as you live with a virus and transit from adolescent to adulthood”. The open coding approach was used to analyse the data. Measures to ensure trustworthiness articulated in Lincoln and Guba’s criteria and ethical considerations were adhered to. Findings: The findings revealed four themes: poor understanding of the disease condition, improved physical health when adhering to ARV treatments, challenges related to sexual maturity and intimate relationships, and parents not disclosing their children’s HIV status. Conclusion: Parents’ delayed and non-disclosure of adolescents’ positive HIV status led to a lack of awareness about the course of the disease, non-adherence to ART, and unsafe sex practices that could increase the risk of HIV transmission and re-infection. To address these multiple obstacles associated with ALWHIV, a comprehensive, multi-sectoral approach that is teenager-friendly should be undertaken. Full article

(This article belongs to the Special Issue Addressing Adolescents’ Health Care Needs - Missing Opportunities)

11 pages, 286 KiB

Open AccessEditor’s ChoiceReview

Ethical Dilemmas in Neonatal Care at the Limit of Viability

by Lilijana Kornhauser Cerar and Miha Lucovnik

Children 2023, 10(5), 784; https://doi.org/10.3390/children10050784 - 26 Apr 2023

Cited by 9 | Viewed by 6352

Abstract

Advances in neonatal care have pushed the limit of viability to incrementally lower gestations over the last decades. However, surviving extremely premature neonates are prone to long-term neurodevelopmental handicaps. This makes ethics a crucial dimension of periviable birth management. At 22 weeks, survival [...] Read more.

Advances in neonatal care have pushed the limit of viability to incrementally lower gestations over the last decades. However, surviving extremely premature neonates are prone to long-term neurodevelopmental handicaps. This makes ethics a crucial dimension of periviable birth management. At 22 weeks, survival ranges from 1 to 15%, and profound disabilities in survivors are common. Consequently, there is no beneficence-based obligation to offer any aggressive perinatal management. At 23 weeks, survival ranges from 8 to 54%, and survival without severe handicap ranges from 7 to 23%. If fetal indication for cesarean delivery appears, the procedure may be offered when neonatal resuscitation is planned. At a gestational age ≥24 weeks, up to 51% neonates are expected to survive the neonatal period. Survival without profound neurologic disability ranges from 12 to 38%. Beneficence-based obligation to intervene is reasonable at these gestations. Nevertheless, autonomy of parents should also be respected, and parental consent should be sought prior to any intervention. Optimal counselling of parents involves harmonized cooperation of obstetric and neonatal care providers. Every fetus/neonate and every pregnant woman are different and have the right to be considered individually when treatment decisions are being made. Full article

(This article belongs to the Special Issue Ethical Issues of End of Life Decisions in Pediatrics)

12 pages, 1324 KiB

Open AccessEditor’s ChoiceArticle

Beyond Screen Time: The Different Longitudinal Relations between Adolescents’ Smartphone Use Content and Their Mental Health

by Shunsen Huang, Xiaoxiong Lai, Yajun Li, Yang Cui and Yun Wang

Children 2023, 10(5), 770; https://doi.org/10.3390/children10050770 - 24 Apr 2023

Cited by 9 | Viewed by 8123

Abstract

Purpose: Previous studies focusing on the relationship between adolescents’ screen time and mental health have uncovered contradictory results. By focusing on smartphone use content (SUC), this study uses specification curve analysis to explore the different effects of SUCs on mental health-based on [...] Read more.

Purpose: Previous studies focusing on the relationship between adolescents’ screen time and mental health have uncovered contradictory results. By focusing on smartphone use content (SUC), this study uses specification curve analysis to explore the different effects of SUCs on mental health-based on longitudinal data. Methods: A total of 2552 adolescents were surveyed in the first (July 2020) and second year (April 2021). A total of 2049 eligible participants (average age = 14.39 ± 2.27, female = 1062) are included in the analysis. Participants reported 20 types of content used by them during smartphone use and their mental health (depression, anxiety, and somatization). Specification curve analysis was used to examine the longitudinal relationship between SUCs and their mental health. Results: Smartphone use for listening to music (median β = 0.18, p < 0.001, NSRPD = 25/27, p < 0.05), chatting online (median β = 0.15, p < 0.001, NSRPD = 24/27, p < 0.05), watching TV (median β = 0.14, p < 0.001, NSRPD = 24/27, p < 0.05), and playing games (median β = 0.09, p < 0.001, NSRPD = 19/27, p < 0.05) produce high to medium negative effects on subsequent mental health. Only using smartphones for online courses exerts no effect on their subsequent mental health (median β = 0.01, p > 0.05, NSRPD = 0/27, p > 0.05). The left 15 types of smartphone content showed unstable effects on future mental health. Depending on the types of content used, these effects ranged from high, medium, and small to none. The relatively descending order of effect on mental health is listening to music, chatting online, watching TV, playing games, and types of content (e.g., browsing social media, making payments, reading online novels) with high but unstable effects, types of content with medium (e.g., browsing news and posting/sharing) but unstable effects, types of content (e.g., using the camera, obtaining life information, and making calls) with small but unstable effects, such as finishing homework and taking online courses. Conclusions: This study enlightens researchers and policymakers to update their understanding of adolescents’ technology use, especially to adopt a differentiated attitude towards different media use content. As nutritionists often do, a “nutritionally balanced” digital diet for young people should be recommended to the public, rather than just suggesting limits on the amount of time they can spend using digital media. Full article

(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents)

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19 pages, 3076 KiB

Open AccessEditor’s ChoiceReview

Cardiovascular Magnetic Resonance from Fetal to Adult Life—Indications and Challenges: A State-of-the-Art Review

by Sara Moscatelli, Isabella Leo, Veronica Lisignoli, Siobhan Boyle, Chiara Bucciarelli-Ducci, Aurelio Secinaro and Claudia Montanaro

Children 2023, 10(5), 763; https://doi.org/10.3390/children10050763 - 23 Apr 2023

Cited by 5 | Viewed by 3328

Abstract

Cardiovascular magnetic resonance (CMR) imaging offers a comprehensive, non-invasive, and radiation-free imaging modality, which provides a highly accurate and reproducible assessment of cardiac morphology and functions across a wide spectrum of cardiac conditions spanning from fetal to adult life. It minimises risks to [...] Read more.

Cardiovascular magnetic resonance (CMR) imaging offers a comprehensive, non-invasive, and radiation-free imaging modality, which provides a highly accurate and reproducible assessment of cardiac morphology and functions across a wide spectrum of cardiac conditions spanning from fetal to adult life. It minimises risks to the patient, particularly the risks associated with exposure to ionising radiation and the risk of complications from more invasive haemodynamic assessments. CMR utilises high spatial resolution and provides a detailed assessment of intracardiac and extracardiac anatomy, ventricular and valvular function, and flow haemodynamic and tissue characterisation, which aid in the diagnosis, and, hence, with the management of patients with cardiac disease. This article aims to discuss the role of CMR and the indications for its use throughout the different stages of life, from fetal to adult life. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 2nd Edition)

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12 pages, 794 KiB

Open AccessEditor’s ChoiceArticle

Incidence and Prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C) in Southern Italy

by Francesco La Torre, Maria Pia Elicio, Viviana Anna Monno, Maria Chironna, Fulvio Moramarco, Angelo Campanozzi, Adele Civino, Valerio Cecinati, Ugo Vairo, Mario Giordano, Leonardo Milella, Daniela Loconsole and Fabio Cardinale

Children 2023, 10(5), 766; https://doi.org/10.3390/children10050766 - 23 Apr 2023

Cited by 10 | Viewed by 3130

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a pediatric hyperinflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection whose epidemiology is not very well known at present. The objective of the study was to better understand the incidence of MIS-C [...] Read more.

Multisystem inflammatory syndrome in children (MIS-C) is a pediatric hyperinflammatory syndrome related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection whose epidemiology is not very well known at present. The objective of the study was to better understand the incidence of MIS-C in the Apulia region in southern Italy. Our primary goal was to estimate the incidence of newly identified cases of MIS-C in children aged 0–18 years, during a period of six months, encompassing the second pandemic wave. We also analyzed the characteristics of our cohort in terms of clinical features, treatment, and outcomes. The cumulative incidence of MIS-C was 3.27 per 100,000 residents between 0 and 18 years of age. In our cohort, gastrointestinal, mucocutaneous, and cardiac involvement were the most common clinical features. With our step-up approach to therapy, no patients required intensive care unit (ICU) admission and no cardiac sequelae after 6 months of onset were found in echocardiograms. Conclusion: Our epidemiological study of MIS-C in southern Italy showed unexpectedly overlapping figures with other US studies. Full article

(This article belongs to the Section Global Pediatric Health)

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7 pages, 564 KiB

Open AccessEditor’s ChoiceBrief Report

Clinical Hematochemical Parameters in Differential Diagnosis between Pediatric SARS-CoV-2 and Influenza Virus Infection: An Automated Machine Learning Approach

by Dejan Dobrijević, Jelena Antić, Goran Rakić, Jasmina Katanić, Ljiljana Andrijević and Kristian Pastor

Children 2023, 10(5), 761; https://doi.org/10.3390/children10050761 - 22 Apr 2023

Cited by 10 | Viewed by 2293

Abstract

Background: The influenza virus and the novel beta coronavirus (SARS-CoV-2) have similar transmission characteristics, and it is very difficult to distinguish them clinically. With the development of information technologies, novel opportunities have arisen for the application of intelligent software systems in disease diagnosis [...] Read more.

Background: The influenza virus and the novel beta coronavirus (SARS-CoV-2) have similar transmission characteristics, and it is very difficult to distinguish them clinically. With the development of information technologies, novel opportunities have arisen for the application of intelligent software systems in disease diagnosis and patient triage. Methods: A cross-sectional study was conducted on 268 infants: 133 infants with a SARS-CoV-2 infection and 135 infants with an influenza virus infection. In total, 10 hematochemical variables were used to construct an automated machine learning model. Results: An accuracy range from 53.8% to 60.7% was obtained by applying support vector machine, random forest, k-nearest neighbors, logistic regression, and neural network models. Alternatively, an automated model convincingly outperformed other models with an accuracy of 98.4%. The proposed automated algorithm recommended a random tree model, a randomization-based ensemble method, as the most appropriate for the given dataset. Conclusions: The application of automated machine learning in clinical practice can contribute to more objective, accurate, and rapid diagnosis of SARS-CoV-2 and influenza virus infections in children. Full article

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

12 pages, 265 KiB

Open AccessEditor’s ChoiceArticle

Association of In-School and Electronic Bullying with Suicidality and Feelings of Hopelessness among Adolescents in the United States

by Tran H. Nguyen, Gulzar Shah, Maham Muzamil, Osaremhen Ikhile, Elizabeth Ayangunna and Ravneet Kaur

Children 2023, 10(4), 755; https://doi.org/10.3390/children10040755 - 21 Apr 2023

Cited by 11 | Viewed by 4612

Abstract

Background: Suicide-related behaviors increasingly contribute to behavioral health crises in the United States (U.S.) and worldwide. The problem was worsened during the COVID-19 pandemic, especially for youth and young adults. Existing research suggests suicide-related behaviors are a consequence of bullying, while hopelessness is [...] Read more.

Background: Suicide-related behaviors increasingly contribute to behavioral health crises in the United States (U.S.) and worldwide. The problem was worsened during the COVID-19 pandemic, especially for youth and young adults. Existing research suggests suicide-related behaviors are a consequence of bullying, while hopelessness is a more distal consequence. This study examines the association of in-school and electronic bullying with suicide-related behavior and feelings of despair among adolescents, adjusted for sociodemographic characteristics, abuse experience, risk-taking behaviors, and physical appearance/lifestyles. Method: Using Chi-square, logistic regression, and multinomial logistic regression, we analyzed the US 2019 Youth Risk Behavior Surveillance System (YRBSS) national component. The YRBSS includes federal, state, territorial, and freely associated state, tribal government, and local school-based surveys of representative sample middle and high school students in the US. The 2019 YRBSS participants comprised 13,605 students aged 12 to 18 years and roughly equal proportions of males and females (50.63% and 49.37%, respectively). Results: We observed a significant association (p < 0.05) between being bullied and depressive symptoms, and the association was more vital for youth bullied at school and electronically. Being bullied either at school or electronically was associated with suicidality, with a stronger association for youth who experienced being bullied in both settings. Conclusion: Our findings shed light on assessing early signs of depression to prevent the formation of suicidality among bullied youth. Full article

(This article belongs to the Special Issue Child Abuse and Neglect)

9 pages, 256 KiB

Open AccessEditor’s ChoiceArticle

Prevalence of Dental Anomalies and Its Role in Sex Estimation among Children of Jazan Region, Saudi Arabia

by Apathsakayan Renugalakshmi, Thilla Sekar Vinothkumar, Ahmed M. Bokhari, Samaher Almahdi, Abdulrahman Almalki, Sudheer Babu Balla, Santosh Kumar Tadakamadla and Zaki Hakami

Children 2023, 10(4), 759; https://doi.org/10.3390/children10040759 - 21 Apr 2023

Cited by 8 | Viewed by 2029

Abstract

Background: This study aimed to ascertain the prevalence of dental anomalies and their ability to estimate sex status. Material and Methods: This cross-sectional radiographic study was based on the evaluation of dental anomalies of Saudi children aged between 5 and 17 years. A [...] Read more.

Background: This study aimed to ascertain the prevalence of dental anomalies and their ability to estimate sex status. Material and Methods: This cross-sectional radiographic study was based on the evaluation of dental anomalies of Saudi children aged between 5 and 17 years. A total of 1940 orthopantomograms (OPG) were screened, of which 1442 were included. All the OPGs were digitally evaluated with ImageJ software. The demographic variables and dental anomaly findings were subjected to descriptive and comparative statistical analysis. Discriminant function analysis was conducted for sex estimation. p value < 0.05 was considered as significant. Results: The mean age of the children in this study was 11.35 ± 0.28 years. At least one dental anomaly was detected in 161 children (11.17%), including 71 males and 90 females. Only 13 children (8.07%) presented with more than one anomaly. The most common dental anomaly detected was root dilaceration (47.83%) followed by hypodontia (31.68%). The least common dental anomaly was infraocclusion (1.86%). The sex prediction accuracy using discriminant function analysis was 62.9% (p < 0.01). Conclusion: The prevalence of dental anomalies was 11.17% with root dilaceration and hypodontia being the most common. The role of dental anomalies in sex estimation was found to be ineffective. Full article

(This article belongs to the Special Issue Oral Health Behaviours and Their Predictors in Children)

13 pages, 2233 KiB

Open AccessEditor’s ChoiceArticle

Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children

by Zenon Pogorelić, Ivana Janković Marendić, Tin Čohadžić and Miro Jukić

Children 2023, 10(4), 750; https://doi.org/10.3390/children10040750 - 20 Apr 2023

Cited by 11 | Viewed by 3091

Abstract

Aim of the study: To evaluate the clinical outcomes and complication rate of laparoscopic appendectomy in children operated on during the daytime versus nighttime. Methods: A total of 303 children who underwent laparoscopic appendectomy for acute appendicitis between 1 January 2020 [...] Read more.

Aim of the study: To evaluate the clinical outcomes and complication rate of laparoscopic appendectomy in children operated on during the daytime versus nighttime. Methods: A total of 303 children who underwent laparoscopic appendectomy for acute appendicitis between 1 January 2020 and 31 December 2022 were enrolled in this retrospective study. The patients were divided into two study groups. The first group consisted of the patients who underwent laparoscopic appendectomy during the day shift from 07:00–21:00 (n = 171), while the patients in the second group underwent laparoscopic appendectomy during the night shift from 21:00–07:00 (n = 132). The groups were compared for baseline clinical and laboratory data, treatment outcomes, and complications. The Mann–Whitney U test was used to compare continuous variables, while the Chi-square test was used to compare categorical variables. A two-sided Fisher’s exact test was used when the frequency of events in a certain cell was low. All p values less than 0.05 were considered significant. Results: The proportion of complicated appendicitis was almost the same in both patient groups (n = 63, 36.8% vs. n = 49, 37.1%, p = 0.960). Out of the total number of patients presenting during the daytime and nighttime, 11 (6.4%) and 10 (7.6%) developed a postoperative complication, respectively (p = 0.697). Additionally, rates of readmission (n = 5 (2.9%) vs. n = 2 (1.5%); p = 0.703), redo-surgery (n = 3 (1.7%) vs. n = 0; p = 0.260), conversion to open surgery (n = 0 vs. n = 1 (0.8%); p = 0.435) and length of hospital stay (n = 3 (IQR 1, 5) vs. n = 3 (IQR 2, 5); p = 0.368) did not differ significantly between daytime and nighttime appendectomies. The duration of the surgery was significantly shorter in patients presenting during the day than in those presenting at night (26 min (IQR 22, 40) vs. 37 min (31, 46); p < 0.001). Conclusions: Different shift times did not affect the treatment outcomes or complication rates for children receiving laparoscopic appendectomy. Full article

(This article belongs to the Special Issue New Aspects in the Diagnosis and Treatment of Acute Surgical Conditions in Children)

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31 pages, 713 KiB

Open AccessEditor’s ChoiceReview

Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity

by Malgorzata Wasniewska, Giorgia Pepe, Tommaso Aversa, Simonetta Bellone, Luisa de Sanctis, Procolo Di Bonito, Maria Felicia Faienza, Nicola Improda, Maria Rosaria Licenziati, Claudio Maffeis, Alice Maguolo, Giuseppina Patti, Barbara Predieri, Mariacarolina Salerno, Stefano Stagi, Maria Elisabeth Street, Giuliana Valerio, Domenico Corica and Valeria Calcaterra

Children 2023, 10(4), 735; https://doi.org/10.3390/children10040735 - 17 Apr 2023

Cited by 12 | Viewed by 4480

Abstract

Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative [...] Read more.

Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity. Full article

(This article belongs to the Special Issue State-of-Art in Metabolic Syndrome in Childhood)

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12 pages, 1292 KiB

Open AccessEditor’s ChoiceArticle

Appropriate Use of Antibiotic and Principles of Antimicrobial Stewardship in Children

by Melodie O. Aricò, Enrico Valletta and Désirée Caselli

Children 2023, 10(4), 740; https://doi.org/10.3390/children10040740 - 17 Apr 2023

Cited by 9 | Viewed by 3853

Abstract

Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic [...] Read more.

Antibiotics account for over 10% of the overall drug expense of the National Health System in Italy in 2021. Their use in children is of particular interest on one side, because acute infections are very common in children, while they build their immunologic library of competence; on the other side, although many acute infections are expected and turn out to be of viral origin, caregivers will often ask the family doctor or primary care attending to reassure them by prescribing antibiotic treatment, although it may often be unnecessary. The inappropriate prescription of antibiotics in children may likely be a source not only of undue economic burden for the public health system but also of increasing development of antimicrobial resistance (AMR). Based on those issues, the inappropriate use of antibiotics in children should be avoided to reduce the risks of unnecessary toxicity, increase in health costs, lifelong effects, and selection of resistant organisms causing undue deaths. Antimicrobial stewardship (AMS) describes a coherent set of actions that ensure an optimal use of antimicrobials to improve patient outcomes while limiting the risk of adverse events including AMR. The aim of this paper is to spread some concept of good use of antibiotics for pediatricians or every other physician involved in the choice to prescribe, or not, antibiotics in children. Several actions could be of help in this process, including the following: (1) identify patients with high probability of bacterial infection; (2) collect samples for culture study before starting antibiotic treatment if invasive bacterial infection is suspected; (3) select the appropriate antibiotic molecule based on local resistance and narrow spectrum for the suspected pathogen(s); avoid multi-antibiotic association; prescribe correct dosage; (4) choose the best route of administration (oral vs. parenteral) and the best schedule of administration for every prescription (i.e., multiple administration for beta lactam); (5) schedule clinical and laboratory re-evaluation with the aim to consider therapeutic de-escalation; (6) stop antibiotic administration as soon as possible, avoiding the application of “antibiotic course”. Full article

(This article belongs to the Special Issue Focus on Children 2021: Challenges and Opportunities towards the Future)

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11 pages, 266 KiB

Open AccessEditor’s ChoiceArticle

Self-Harm Behaviors, Suicide Attempts, and Suicidal Ideation in a Clinical Sample of Children and Adolescents with Psychiatric Disorders

by Elena Predescu and Roxana Sipos

Children 2023, 10(4), 725; https://doi.org/10.3390/children10040725 - 14 Apr 2023

Cited by 11 | Viewed by 3966

Abstract

Suicidal ideation and self-harm behaviors have been found to be important risk factors for suicide. The aim of this study was to explore the rates of psychiatric disorders among different groups of patients with suicidal ideation, suicide attempts, and non-suicidal self-harm behaviors and [...] Read more.

Suicidal ideation and self-harm behaviors have been found to be important risk factors for suicide. The aim of this study was to explore the rates of psychiatric disorders among different groups of patients with suicidal ideation, suicide attempts, and non-suicidal self-harm behaviors and to identify the associated socio-demographic and clinical variables. We conducted a cross-sectional study with emergency-admitted patients presenting with non-suicidal self-harm behaviors, suicide attempts, or suicidal ideation to the emergency room of the Child and Adolescent Psychiatry Clinic in Cluj-Napoca, Romania. Data were collected from the patients’ charts using a questionnaire that contained socio-demographic and clinical variables. A total of 95 patients aged between 6 and 18 years were included in the study. Ingesting medication and cutting were the most frequently used methods to attempt suicide. Depression and mixed affective and conduct disorders were the diagnoses most commonly associated with suicidal behavior. Girls with depressive symptoms were more probable to have suicide attempts than boys, and girls with depressive symptoms and behavioral problems registered more self-harm behaviors. Further research should systematically examine the relationship between self-harm behaviors and suicide attempts and the profile of patients at risk of future suicide attempts. Full article

(This article belongs to the Special Issue Child and Adolescent Psychiatry and Mental Health)

10 pages, 572 KiB

Open AccessEditor’s ChoiceArticle

by Denis Čaušević, Babina Rani, Qais Gasibat, Nedim Čović, Cristina Ioana Alexe, Silviu Ioan Pavel, Lucian Ovidiu Burchel and Dan Iulian Alexe

Children 2023, 10(4), 721; https://doi.org/10.3390/children10040721 - 13 Apr 2023

Cited by 9 | Viewed by 3320

Abstract

The study aimed to investigate differences in anthropometry, body composition (BC), and somatotype in young football players of the same chronological age according to the maturity stage. Overall, 64 elite players (age: 14.28 ± 0.46 years) were evaluated for standing and sitting body [...] Read more.

The study aimed to investigate differences in anthropometry, body composition (BC), and somatotype in young football players of the same chronological age according to the maturity stage. Overall, 64 elite players (age: 14.28 ± 0.46 years) were evaluated for standing and sitting body height, girth measures, and BC using the bioelectric impedance scale and skinfold thickness. In total, two-thirds (73.44%, n = 47) of football players were classified as on-time maturers, 12.50% (n = 8) were early maturing, and 14.06% (n = 9) were late maturing. Standing and sitting height, leg length, fat-free mass, and muscle mass were significantly different (p < 0.001) across maturity groups. A significant decrease (p < 0.05) with maturity progression was seen for subscapular and suprailiac skinfolds along with a girth increase at all sites (p < 0.05). Early maturers were balanced ectomorphs, while on-time and late maturers featured mesomorph–ectomorph characteristics. The obtained results suggested that mature players have better BC presented as a lower fat percentage along with higher muscle mass, advantages in circumferences, and longitudinal dimensions of the body with highlighted mesomorph features. Maturity can have a substantial influence on body measures, thereby affecting sport-specific performance. Early maturers can use their anthropometric advantages and compensate for a lack of talent, consequently preventing even participation of physically undeveloped players in training. A better understanding of maturity, BC, and somatotypes can help in the selection of young talented players. Full article

(This article belongs to the Special Issue Sustainability in Team Sports for Young Athletes)

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11 pages, 304 KiB

Open AccessEditor’s ChoiceArticle

Perceived Physical Literacy Is Associated with Cardiorespiratory Fitness, Body Composition and Physical Activity Levels in Secondary School Students

by Charlie Nezondet, Joseph Gandrieau, Philippe Nguyen and Gautier Zunquin

Children 2023, 10(4), 712; https://doi.org/10.3390/children10040712 - 12 Apr 2023

Cited by 19 | Viewed by 3098

Abstract

Background: Overweight and obese adolescents are often associated with lower Physical Activity (PA) levels and low Cardiorespiratory Fitness (CRF). Recently, the concept of Physical Literacy (PL), has been suggested to be associated with higher levels of active behavior and better health in adolescents. [...] Read more.

Background: Overweight and obese adolescents are often associated with lower Physical Activity (PA) levels and low Cardiorespiratory Fitness (CRF). Recently, the concept of Physical Literacy (PL), has been suggested to be associated with higher levels of active behavior and better health in adolescents. The purpose of this study is to investigate the relationships between PL, body composition, cardiorespiratory fitness and physical activity levels in French secondary school students. Methods: The level of PL was assessed in 85 French adolescents using a French version of the Perceived Physical Literacy Instrument (F-PPLI). Cardiorespiratory fitness was measured by the “20 m adapted walk/shuttle run test”. The PA level was assessed by the Youth Risk Behavior Surveillance System questionnaire. Weight status was measured by the Body Mass Index (BMI) and the body composition data. Results: We find a significant association between the PL and the percentage Fat Mass (%FM) (r = −0.43; p ≤ 0.01), between the PL and moderate to vigorous PA (MVPA) per week (r = 0.38; p ≤ 0.01). The PL was associated (r = 0.36; p ≤ 0.01) with the percentage of Skeletal Muscle Mass (%SMM) and cardiorespiratory fitness (r = 0.40; p ≤ 0.05). Conclusions: Developing the PL for the most disadvantaged secondary school students in a PA program could be a suitable strategy to increase their PA level, reduce their adiposity, and promote better long-term health. Full article

(This article belongs to the Section Global Pediatric Health)

23 pages, 673 KiB

Open AccessEditor’s ChoiceReview

Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review

by Zahra Zhu, Daniela Dluzynski, Nouran Hammad, Deepika Pugalenthi, Sarah A. Walser, Rea Mittal, Debopam Samanta, Melanie L. Brown, Ali A. Asadi-Pooya, Angelina Kakooza-Mwesige, Alberto Spalice, Martina Capponi, Alain Lekoubou, Ashutosh Kumar, Sita Paudel, Paul R. Carney, Gayatra Mainali and Sunil Naik

Children 2023, 10(4), 713; https://doi.org/10.3390/children10040713 - 12 Apr 2023

Cited by 9 | Viewed by 5893

Abstract

(1) Background: Epilepsy is one of the most common chronic neurological disorders in childhood. Complementary and alternative medicine (CAM) use is highly prevalent in patients with epilepsy. Despite CAM’s widespread and increasing popularity, its prevalence, forms, perceived benefits, and potential risks in pediatric [...] Read more.

(1) Background: Epilepsy is one of the most common chronic neurological disorders in childhood. Complementary and alternative medicine (CAM) use is highly prevalent in patients with epilepsy. Despite CAM’s widespread and increasing popularity, its prevalence, forms, perceived benefits, and potential risks in pediatric epilepsy are rarely explored. (2) Methods: We performed a scoping review of the available literature on the use of CAM in pediatric epilepsy. (3) Results: Overall, global cross-sectional studies showed a variable degree of CAM usage among children with epilepsy, ranging from 13 to 44% in prevalence. Popular types of CAMs reported were supplements, cannabis products, aromatherapy, herbal remedies, dietary therapy, massage therapy, and prayer. Families often report that CAM is effective, although there are limited objective measures of this. Potential risks lie in the use of CAM, such as herbal remedies, and/or unregulated, contaminated, or unpurified products. Studies also underscored inadequate patient–physician discussions regarding CAM. (4) Conclusions: A better understanding of this topic would aid clinicians in guiding patients/families on the use of CAM. Further studies on the efficacy of the different types of CAM used, as well as potential side effects and drug interactions are needed. Full article

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

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11 pages, 400 KiB

Open AccessEditor’s ChoiceArticle

The Interaction Effect of Birth Spacing and Maternal Healthcare Services on Child Mortality in Pakistan

by Muhammad Farhan Asif, Saima Ishtiaq, Nishat Ishfaq Abbasi, Iffat Tahir, Ghulam Abid and Zohra S. Lassi

Children 2023, 10(4), 710; https://doi.org/10.3390/children10040710 - 12 Apr 2023

Cited by 6 | Viewed by 3262

Abstract

There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society’s level of development. [...] Read more.

There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society’s level of development. A variety of factors influences child mortality. This study investigated the causes of child death and the interaction effect of birth spacing (B.S.) and maternal health care services (MHCS) on child mortality. Using SPSS version 20, we used the Pakistan Demographic and Health Survey (PDHS) 2017–2018 data set to investigate the associated factors of child mortality and the moderating influence of birth spacing using binary logistic regression. The outcome variable is categorical with two categories. The findings indicated that the risk of infant death decreased with adequate B.S. between two pregnancies and access to maternal health care services. Birth spacing was found to moderate the link between access to maternal health care services (MHCS) and child mortality. Our research leads us to conclude that the amount of time between children’s births significantly reduces infant mortality. When the birth spacing is at least 33 months, the relationship between maternal health care services and child mortality becomes more evident and negative. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 295 KiB

Open AccessEditor’s ChoiceArticle

Promoting Resilience in Early Childhood Education and Care to Prepare Children for a World of Change: A Critical Analysis of National and International Policy Documents

by Ann-Christin Furu, Angel Chan, Jonna Larsson, Ingrid Engdahl, Sarah Klaus, Anna May Navarrete and Barbara Turk Niskač

Children 2023, 10(4), 716; https://doi.org/10.3390/children10040716 - 12 Apr 2023

Cited by 6 | Viewed by 6708

Abstract

In recent years, the sustainability crisis has raised interest in the concept of resilience, i.e., the capacity to persist, adapt, or transform in the face of change and challenge. However, to date, resilience has only been studied to a limited extent within early [...] Read more.

In recent years, the sustainability crisis has raised interest in the concept of resilience, i.e., the capacity to persist, adapt, or transform in the face of change and challenge. However, to date, resilience has only been studied to a limited extent within early childhood education and care (ECEC). This paper reports on a study that used critical document analysis of national and international policies to explore if and how the concept of resilience within ECEC could contribute to sustainability in a world of rapid change. Five national and four international documents were analysed through the theoretical lenses of childism and place-based education. The results show that resilience is implicitly expressed in ECEC policies yet is rarely linked to sustainability issues. Instead, policies mainly limit resilience to the psychological dimension and the individual child. The conclusion is that ECEC is an apt context for supporting resilience in multiple ways. It suggests using a holistic understanding of resilience to advocate for ECEC policies that include diverse perspectives of families and local communities, incorporate indigenous voices, and recognise the interconnectedness between humans and the more-than-human world. Full article

(This article belongs to the Special Issue Early Childhood Education in a World of Change)

20 pages, 324 KiB

Open AccessEditor’s ChoiceArticle

Father–Mother Co-Involvement in Child Maltreatment: Associations of Prior Perpetration, Parental Substance Use, Parental Medical Conditions, Inadequate Housing, and Intimate Partner Violence with Different Maltreatment Types

by Joyce Y. Lee, Susan Yoon, Keunhye Park, Angelise Radney, Stacey L. Shipe and Garrett T. Pace

Children 2023, 10(4), 707; https://doi.org/10.3390/children10040707 - 11 Apr 2023

Cited by 9 | Viewed by 5288

Abstract

The current study applied a family systems approach to examine dyadic parental risk factors linked with mother–father co-involved physical abuse, neglect, sexual abuse, and emotional abuse. Parental substance use, mental health problems, disability and medical conditions, inadequate housing, economic insecurity, intimate partner violence, [...] Read more.

The current study applied a family systems approach to examine dyadic parental risk factors linked with mother–father co-involved physical abuse, neglect, sexual abuse, and emotional abuse. Parental substance use, mental health problems, disability and medical conditions, inadequate housing, economic insecurity, intimate partner violence, and prior maltreatment history were investigated as key risk factors at the dyadic parental level. Logistic regression analysis was conducted using national child welfare administrative data from the National Child Abuse and Neglect Data System. The results showed differential associations between risk factors and four child maltreatment types: physical abuse, neglect, emotional abuse, and sexual abuse. Intimate partner violence was associated with higher odds of mother–father co-involved neglect and emotional abuse. Parental substance use, inadequate housing, and prior maltreatment history were all associated with higher odds of mother–father co-involved neglect, but lower odds of physical abuse. Parental disability and medical conditions were associated with higher odds of mother-father co-involved sexual abuse, whereas parental substance use was associated with lower odds of sexual abuse. Implications include more nuanced ways of addressing multiple risk factors within the family to prevent future occurrences of child maltreatment involving both mothers and fathers. Full article

(This article belongs to the Special Issue Child Abuse and Neglect)

17 pages, 981 KiB

Open AccessEditor’s ChoiceArticle

School Children’s Physical Activity and Preferred Activities during Outdoor Recess in Estonia: Using Accelerometers, Recess Observation, and Schoolyard Mapping

by Getter Marie Lemberg, Eva-Maria Riso, Ingunn Fjørtoft, Lise Kjønniksen, Merike Kull and Evelin Mäestu

Children 2023, 10(4), 702; https://doi.org/10.3390/children10040702 - 10 Apr 2023

Cited by 15 | Viewed by 3811

Abstract

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess [...] Read more.

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess PA in two urban and two rural primary schools in Estonia. Schoolyards were described with the geographical mapping method, children’s activities during outdoor recess were registered by using observations, and PA levels were measured with accelerometers. Students from grades two to six (8–13-year-olds) were included in the study. All observed schoolyards had different spaces including various ball game areas, climbing facilities, and slacklines. The natural environment dominated in the rural schools, and artificial surfaces dominated in the urban schools. Boys in the study tended to enjoy more sport-related activities, whereas girls preferred more social and less active activities. Students participating in outdoor recess spent about twice as much time (20.4%) on moderate-to-vigorous PA (MVPA) compared to indoor recess (9.5%), although boys were more active than girls (22.9% vs. 17.3%). All schoolyards afforded more MVPA during outdoor recess compared to indoor recess, whereas schoolyards with more space per child and natural environment elements generated more varied PA and higher MVPA. These findings confirm the importance of schoolyard design and quality for the variety and intensity of students’ PA during outdoor recess. Full article

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

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15 pages, 621 KiB

Open AccessEditor’s ChoiceArticle

The Emotional Experience of Caring for Children in Pediatric Palliative Care: A Qualitative Study among a Home-Based Interdisciplinary Care Team

by Patricia Rico-Mena, Javier Güeita-Rodríguez, Ricardo Martino-Alba, Marina Castel-Sánchez and Domingo Palacios-Ceña

Children 2023, 10(4), 700; https://doi.org/10.3390/children10040700 - 9 Apr 2023

Cited by 15 | Viewed by 4508

Abstract

The healthcare providers caring for children with life-threatening illnesses experience considerable compassion fatigue. The purpose of this study was to describe the feelings and emotions of professionals working in an interdisciplinary pediatric palliative home care team. A qualitative case study was conducted, comprising [...] Read more.

The healthcare providers caring for children with life-threatening illnesses experience considerable compassion fatigue. The purpose of this study was to describe the feelings and emotions of professionals working in an interdisciplinary pediatric palliative home care team. A qualitative case study was conducted, comprising 18 participants. A purposeful sampling technique approach was used including the home-based interdisciplinary pediatric palliative team. Data were collected via semi-structured interviews and researchers’ field notes. A thematic analysis was performed. Two themes emerged: (a) changing life for the better, which described how professionals value life more and helping children and families provides compassion satisfaction, which is comforting and explains their dedication to care; (b) adverse effects of work highlighted the emotional burden of caring for children with life-limiting or life-threatening illnesses, which can affect their job satisfaction and may lead to burnout, showing how experiencing in-hospital child deaths with suffering leads professionals to develop an interest in specializing in pediatric palliative care. Our study provides information on possible causes of emotional distress in professionals caring for children with life-threatening illnesses and highlights strategies that can help them to reduce their distress. Full article

(This article belongs to the Special Issue Advances in Rehabilitation of Children with Disabilities)

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13 pages, 1183 KiB

Open AccessEditor’s ChoiceArticle

The Influence of Smartphone Use on Tweens’ Capacity for Complex Critical Thinking

by Rosa Angela Fabio and Rossella Suriano

Children 2023, 10(4), 698; https://doi.org/10.3390/children10040698 - 8 Apr 2023

Cited by 6 | Viewed by 4896

Abstract

The spread of modern technologies exposes many people to a high level of ambiguous and misleading information that can impact people’s judgments and worldviews. This happens especially in a phase of life such as preadolescence when children are particularly sensitive to external conditioning. [...] Read more.

The spread of modern technologies exposes many people to a high level of ambiguous and misleading information that can impact people’s judgments and worldviews. This happens especially in a phase of life such as preadolescence when children are particularly sensitive to external conditioning. Critical thinking can be seen as the first line of defense against misleading information. However, little is known about the consequences of media use on the critical thinking skills of tweens. In this study, we evaluated the effects of problematic smartphone use on the various stages of critical thinking, comparing high and low tween smartphone users. The results confirm the main hypothesis, namely, that problematic smartphone use is related to the ability to think critically. There was a significant difference between high and low users in the third phase of critical thinking: evaluation of sources. Full article

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16 pages, 1336 KiB

Open AccessEditor’s ChoiceReview

Micronutrient Deficiency in Children and Adolescents with Obesity—A Narrative Review

by Valeria Calcaterra, Elvira Verduci, Chiara Milanta, Marta Agostinelli, Carolina Federica Todisco, Federica Bona, Jonabel Dolor, Alice La Mendola, Martina Tosi and Gianvincenzo Zuccotti

Children 2023, 10(4), 695; https://doi.org/10.3390/children10040695 - 7 Apr 2023

Cited by 20 | Viewed by 7798

Abstract

Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative [...] Read more.

Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary. Full article

(This article belongs to the Special Issue Advances in Research on Nutrition and Childhood Obesity: 2nd Edition)

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13 pages, 322 KiB

Open AccessEditor’s ChoiceArticle

Overweight and Obesity: Its Impact on Foot Type, Flexibility, Foot Strength, Plantar Pressure and Stability in Children from 5 to 10 Years of Age: Descriptive Observational Study

by Cristina Molina-García, José Daniel Jiménez-García, Daniel Velázquez-Díaz, Laura Ramos-Petersen, Andrés López-del-Amo-Lorente, Carlos Martínez-Sebastián and Francisco Álvarez-Salvago

Children 2023, 10(4), 696; https://doi.org/10.3390/children10040696 - 7 Apr 2023

Cited by 9 | Viewed by 2551

Abstract

Background: Overweight (OW) and childhood obesity (OB) may cause foot problems and affect one’s ability to perform physical activities. The study aimed to analyze the differences in descriptive characteristics, foot type, laxity, foot strength, and baropodometric variables by body mass status and age [...] Read more.

Background: Overweight (OW) and childhood obesity (OB) may cause foot problems and affect one’s ability to perform physical activities. The study aimed to analyze the differences in descriptive characteristics, foot type, laxity, foot strength, and baropodometric variables by body mass status and age groups in children and, secondly, to analyze the associations of the BMI with different physical variables by age groups in children. Methods: A descriptive observational study involving 196 children aged 5–10 years was conducted. The variables used were: type of foot, flexibility, foot strength and baropodometric analysis of plantar pressures, and stability by pressure platform. Results: Most of the foot strength variables showed significant differences between the normal weight (NW), OW and OB groups in children aged between 5 and 8. The OW and OB groups showed the highest level of foot strength. In addition, the linear regression analyses showed, in children aged 5 to 8 years, a positive association between BMI and foot strength (the higher the BMI, the greater the strength) and negative association between BMI and stability (lower BMI, greater instability). Conclusions: Children from 5 to 8 years of age with OW and OB show greater levels of foot strength, and OW and OB children from 7 to 8 years are more stable in terms of static stabilometrics. Furthermore, between 5 and 8 years, having OW and OB implies having more strength and static stability. Full article

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

19 pages, 872 KiB

Open AccessEditor’s ChoiceReview

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework

by Alessandra Preziosi, Irene Paraboschi and Stefano Giuliani

Children 2023, 10(4), 689; https://doi.org/10.3390/children10040689 - 5 Apr 2023

Cited by 8 | Viewed by 2436

Abstract

Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers [...] Read more.

Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers on FGS in children published from January 2000 to December 2022 were systematically reviewed. The stage of research development was measured considering seven fields of application: biliary tree imaging, vascular perfusion for gastrointestinal procedures, lymphatic flow imaging, tumor resection, urogenital surgery, plastic surgery, and miscellaneous procedures. Fifty-nine articles were selected. For each field of application, the overall IDEAL stage was determined to be 2a for biliary tree imaging (10 publications, 102 cases), 1 for vascular perfusion for gastrointestinal procedures (8 publications, 28 cases), 1 for lymphatic flow imaging (12 publications, 33 cases), 2a for tumor resection (20 publications, 238 cases), 2a for urogenital surgery (9 publications, 197 cases), and 1-2a for plastic surgery (4 publications, 26 cases). One report did not belong to any categories. FGS in children is still in an early phase of adoption and development. We recommend using the IDEAL framework as a guide and suggest developing multicenter studies to define the standard guidelines, effectiveness, and outcomes. Full article

(This article belongs to the Section Pediatric Surgery)

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12 pages, 286 KiB

Open AccessEditor’s ChoiceArticle

Effectiveness of Video Modeling in Improving Technical Skills in Young Novice Basketball Players: A Quasi-Experimental Study

by Amayra Tannoubi, Ibrahim Ouergui, Medina Srem-Sai, John Elvis Hagan, Frank Quansah and Fairouz Azaiez

Children 2023, 10(4), 687; https://doi.org/10.3390/children10040687 - 4 Apr 2023

Cited by 9 | Viewed by 3713

Abstract

(1) Objective: This is a quasi-experimental study that investigated the effect of four weeks of training sessions using video modeling (VM) on individual and collective technical skills in young novice basketball players. (2) Method: 20 players were equally assigned to either a control [...] Read more.

(1) Objective: This is a quasi-experimental study that investigated the effect of four weeks of training sessions using video modeling (VM) on individual and collective technical skills in young novice basketball players. (2) Method: 20 players were equally assigned to either a control group (CG, n = 10; 12 ± 0.7 years) or a video modeling group (VMG, n = 10; 12.5 ± 0.5 years; visualizing videos before each session) were assessed before and after the four-week training period using the Basketball Skill Test of the American Alliance for Health, Physical Education, Recreation and Dance for individual techniques and three vs. three small-sided games for collective aspects. (3) Results: For the passing test, VMG induced higher performance than CG (p = 0.021; d = 0.87). For offensive balls post-intervention, higher values were recorded for VMG compared to CG (p = 0.003; d = 1.81). In addition, the number of attack balls index post-intervention was higher for VMG compared to CG (p = 0.001; d = 0.28). For losing the ball, VMG induced lower values than CG after the training intervention (p < 0.001; d = −3.23). The efficiency index was higher post-training compared to pre-training for VMG (p = 0.013; d = 1.24). (4) Conclusion: The study highlighted the importance of using video modeling as an effective strategy to improve technical skills and collective performance in novice young basketball players. Full article

(This article belongs to the Special Issue Sports Science in Children)

13 pages, 715 KiB

Open AccessEditor’s ChoiceReview

Direct 3D-Printed Orthodontic Retainers. A Systematic Review

by Efthimia Tsoukala, Ioannis Lyros, Apostolos I. Tsolakis, Michael P. Maroulakos and Ioannis A. Tsolakis

Children 2023, 10(4), 676; https://doi.org/10.3390/children10040676 - 3 Apr 2023

Cited by 9 | Viewed by 4608

Abstract

Three-dimensional (3D) printing technology has shed light on many fields in medicine and dentistry, including orthodontics. Direct 3D-printed prosthetics, implants or surgical devices are well-documented. The fabrication of orthodontic retainers using CAD technology and additive manufacturing is an emerging trend but the available [...] Read more.

Three-dimensional (3D) printing technology has shed light on many fields in medicine and dentistry, including orthodontics. Direct 3D-printed prosthetics, implants or surgical devices are well-documented. The fabrication of orthodontic retainers using CAD technology and additive manufacturing is an emerging trend but the available data are scarce. The research approach of the present review included keywords in Medline, Scopus, Cochrane Library and Google Scholar up to December 2022. The searching process concluded with five studies eligible for our project. Three of them investigated directly 3D-printed clear retainers in vitro. The other two studies investigated directly 3D-printed fixed retainers. Among them, one study was in vitro and the second was a prospective clinical trial. Directly 3D-printed retainers can be evolved over time as a good alternative to all the conventional materials for retention. Devices that are 3D-printed are more time and cost efficient, offer more comfortable procedures for both practitioners and patients and the materials used in additive manufacturing can solve aesthetic problems, periodontal issues or problems with the interference of these materials with magnetic resonance imaging (MRI). More well-designed prospective clinical trials are necessary for more evaluable results. Full article

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

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16 pages, 1229 KiB

Open AccessEditor’s ChoiceArticle

Improvement of Diet after an Early Nutritional Intervention in Pediatric Oncology

by Mélanie Napartuk, Véronique Bélanger, Isabelle Bouchard, Caroline Meloche, Daniel Curnier, Serge Sultan, Caroline Laverdière, Daniel Sinnett and Valérie Marcil

Children 2023, 10(4), 667; https://doi.org/10.3390/children10040667 - 31 Mar 2023

Cited by 5 | Viewed by 3004

Abstract

Pediatric cancer survivors may experience cardiometabolic sequelae over the course of their lives as a result of the treatments they have received. While nutrition consists of an actionable target for cardiometabolic health, few nutritional interventions have been documented in this population. This study [...] Read more.

Pediatric cancer survivors may experience cardiometabolic sequelae over the course of their lives as a result of the treatments they have received. While nutrition consists of an actionable target for cardiometabolic health, few nutritional interventions have been documented in this population. This study assessed the changes in diet during a one-year nutritional intervention for children and adolescents undergoing cancer treatments and the participants’ anthropometric and cardiometabolic profiles. A total of 36 children and adolescents (mean age: 7.9 years, 52.8% male) newly diagnosed with cancer (50% leukemia) and their parents underwent a one-year individualized nutrition intervention. The mean number of follow-up visits with the dietitian during the intervention was 4.72 ± 1.06. Between the initial and one-year assessments, there was an improvement in diet quality reflected by the Diet Quality Index (5.22 ± 9.95, p = 0.003). Similarly, the proportion of participants with moderate and good adherence (vs. low adherence) to the Healthy Diet Index score almost tripled after one year of intervention (14% vs. 39%, p = 0.012). In parallel, there was an increase in the mean z-scores for weight (0.29 ± 0.70, p = 0.019) and BMI (0.50 ± 0.88, p = 0.002), and in the mean levels of HDL-C (0.27 ± 0.37 mmol/L, p = 0.002) and 25-hydroxy vitamin D (14.5 ± 28.1 mmol/L, p = 0.03). Overall, this study supports that a one-year nutritional intervention deployed early after a pediatric cancer diagnosis is associated with an improvement in the diets of children and adolescents. Full article

(This article belongs to the Special Issue Nutrition to Improve Child and Adolescent Health)

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13 pages, 700 KiB

Open AccessEditor’s ChoiceReview

PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein–Barr Virus Reactivation as Trigger Agents?

by Stefano Pallanti and Michele Di Ponzio

Children 2023, 10(4), 648; https://doi.org/10.3390/children10040648 - 30 Mar 2023

Cited by 9 | Viewed by 8454

Abstract

COVID-19 impacted the entire world’s population, frequently resulting in long-lasting neuropsychiatric complications. Furthermore, social distancing, lockdowns and fear for one’s personal health worsen individual psychological wellbeing, especially in children and adolescents. Herein, we discuss the results of studies that specifically reported data about [...] Read more.

COVID-19 impacted the entire world’s population, frequently resulting in long-lasting neuropsychiatric complications. Furthermore, social distancing, lockdowns and fear for one’s personal health worsen individual psychological wellbeing, especially in children and adolescents. Herein, we discuss the results of studies that specifically reported data about the impact of the COVID-19 pandemic or infection on children with Pediatric Acute-Onset Neuropsychiatric Disorders (PANS). Furthermore, we present the cases of five adolescents with PANS whose symptomatology increased following SARS-CoV-2 infection. What emerged from this study was that COVID-19 resulted in the exacerbation of obsessions, tics, anxiety and mood symptoms and decreased wellbeing. Moreover, new symptoms, as well as new PANS cases, are reported to have arisen after COVID-19 infection. Here, we hypothesize that the pathogenic mechanisms of silent viruses, such as the Epstein–Barr virus, are related to neuroinflammation, immune responses and reactivation, with additional roles played by social-isolation-related inflammatory processes. The discussion of PANS, which represents a model of immune-mediated neuropsychiatric manifestations, is particularly relevant, with the aim of uncovering the mechanisms that lead to neuropsychiatric Post-Acute COVID-19 Syndrome (PACS). Prospects for future studies and treatment implications are discussed. Full article

(This article belongs to the Special Issue Focus on Children 2021: Challenges and Opportunities towards the Future)

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16 pages, 4361 KiB

Open AccessEditor’s ChoiceReview

Holoprosencephaly: Review of Embryology, Clinical Phenotypes, Etiology and Management

by Maísa Malta, Rowim AlMutiri, Christine Saint Martin and Myriam Srour

Children 2023, 10(4), 647; https://doi.org/10.3390/children10040647 - 30 Mar 2023

Cited by 13 | Viewed by 11426

Abstract

Holoprosencephaly (HPE) is the most common malformation of the prosencephalon in humans. It is characterized by a continuum of structural brain anomalies resulting from the failure of midline cleavage of the prosencephalon. The three classic subtypes of HPE are alobar, semilobar and lobar, [...] Read more.

Holoprosencephaly (HPE) is the most common malformation of the prosencephalon in humans. It is characterized by a continuum of structural brain anomalies resulting from the failure of midline cleavage of the prosencephalon. The three classic subtypes of HPE are alobar, semilobar and lobar, although a few additional categories have been added to this original classification. The severity of the clinical phenotype is broad and usually mirrors the radiologic and associated facial features. The etiology of HPE includes both environmental and genetic factors. Disruption of sonic hedgehog (SHH) signaling is the main pathophysiologic mechanism underlying HPE. Aneuploidies, chromosomal copy number variants and monogenic disorders are identified in a large proportion of HPE patients. Despite the high postnatal mortality and the invariable presence of developmental delay, recent advances in diagnostic methods and improvements in patient management over the years have helped to increase survival rates. In this review, we provide an overview of the current knowledge related to HPE, and discuss the classification, clinical features, genetic and environmental etiologies and management. Full article

(This article belongs to the Special Issue Genetic Diagnosis in Children with Developmental Delay)

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17 pages, 553 KiB

Open AccessEditor’s ChoiceSystematic Review

Motivation toward Physical Activity and Healthy Habits of Adolescents: A Systematic Review

by Javier Cachón-Zagalaz, Hanrriette Carrasco-Venturelli, María Sánchez-Zafra and María Luisa Zagalaz-Sánchez

Children 2023, 10(4), 659; https://doi.org/10.3390/children10040659 - 30 Mar 2023

Cited by 16 | Viewed by 7275

Abstract

Adolescence is a transformative period in which rapid physical, cognitive and psychosocial growth takes place. Laying the foundation for healthy behaviors is paramount during these formative years. The aim of this review is to determine which countries are leading in research on adolescents’ [...] Read more.

Adolescence is a transformative period in which rapid physical, cognitive and psychosocial growth takes place. Laying the foundation for healthy behaviors is paramount during these formative years. The aim of this review is to determine which countries are leading in research on adolescents’ motivation towards physical activity and healthy habits and their main findings. A systematic review was conducted following the PRISMA statement using the Web of Science and Scopus databases during the months of September to December 2022. The search terms used were: “Physical activity”, “Motivation” and “Adolescents”, in the following research areas: Education, Educational Research and Sport Sciences. A total of 5594 articles were identified, but only those that met the established criteria were included (32 articles). It is concluded that most of the research is led in Spain with 16 articles, followed by 3 in Chile, 2 in Portugal, 2 in Norway and the rest of the countries with 1. Likewise, most of the works include very similar aspects regarding the incidence of motivation towards the adherence to the practice of Physical Activity and healthy habits. Full article

(This article belongs to the Special Issue Early Childhood Education Development)

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12 pages, 509 KiB

Open AccessEditor’s ChoiceArticle

Atherogenic Index of Plasma (AIP) and Its Association with Fatty Liver in Obese Adolescents

by Hüseyin Dağ, Fatih İncirkuş and Okan Dikker

Children 2023, 10(4), 641; https://doi.org/10.3390/children10040641 - 29 Mar 2023

Cited by 13 | Viewed by 2764

Abstract

Background: The atherogenic index of plasma (AIP) is the base-10 logarithmic conversion of the triglyceride to high-density lipoprotein cholesterol ratio [AIP = log10 (triglyceride/HDL cholesterol)]. Some studies have found a link between low serum vitamin D levels, AIP, and fatty liver. This study [...] Read more.

Background: The atherogenic index of plasma (AIP) is the base-10 logarithmic conversion of the triglyceride to high-density lipoprotein cholesterol ratio [AIP = log10 (triglyceride/HDL cholesterol)]. Some studies have found a link between low serum vitamin D levels, AIP, and fatty liver. This study was conducted to evaluate the relationship between AIP levels, fatty liver, and vitamin D levels in obese adolescents aged 10–17 years. Methods: This study included 136 adolescents, including 83 obese and 53 healthy controls, in the age range of 10–17 years. Thirty-nine of the obese adolescents had fatty livers. Those with ultrasonography grades 2 or 3 of fat were in the fatty liver group. The AIP value was calculated as the logarithmic conversion of the ratio (triglyceride/HDL cholesterol) at the base of 10. Vitamin D and other laboratory tests were analyzed biochemically. Statistical evaluations were made with the SPSS program. Results: The AIP, body mass index (BMI), homeostatic model assessment for insulin resistance (HOMA-IR), and insulin averages of obese adolescents with fatty liver were significantly higher than those of obese adolescents without fatty liver and the healthy control group (p < 0.05). Again, the mean AIP of obese patients without fatty liver was pointedly higher than that of the healthy control group (p < 0.05). There was a positive, moderate relationship between AIP and BMI, AIP and HOMA-IR, and AIP and insulin levels (p < 0.05), whereas there was a negative, moderate (37.3%) relationship between AIP and vitamin D (p = 0.019). Conclusion: AIP levels were higher in obese adolescents, and this increase was higher in obese adolescents with fatty liver in this study. Moreover, we detected a negative correlation between AIP and vitamin D levels and a positive correlation with BMI, insulin resistance, and insulin levels. Based on our data, we concluded that AIP can be a useful predictor of fatty liver in obese adolescents. Full article

(This article belongs to the Special Issue State-of-Art in Metabolic Syndrome in Childhood)

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14 pages, 1202 KiB

Open AccessEditor’s ChoiceReview

Pediatric Bowel Management Options and Organizational Aspects

by Elizaveta Bokova, Wendy Jo Svetanoff, Marc Aaron Levitt and Rebecca Maria Rentea

Children 2023, 10(4), 633; https://doi.org/10.3390/children10040633 - 28 Mar 2023

Cited by 12 | Viewed by 3740

Abstract

A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript [...] Read more.

A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age. Full article

(This article belongs to the Special Issue Advance in Pediatric Surgery)

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10 pages, 653 KiB

Open AccessEditor’s ChoiceArticle

Effects of a 12-Week Functional Training Program on the Strength and Power of Chinese Adolescent Tennis Players

by Wensheng Xiao, Xiaorong Bai, Soh Kim Geok, Dawei Yu and Yang Zhang

Children 2023, 10(4), 635; https://doi.org/10.3390/children10040635 - 28 Mar 2023

Cited by 9 | Viewed by 4058

Abstract

Background: Functional training is any type of training designed to improve a specific movement or activity for fitness or high performance sports. This study examined the effect of functional training on the strength and power of young tennis players. Methods: 40 male tennis [...] Read more.

Background: Functional training is any type of training designed to improve a specific movement or activity for fitness or high performance sports. This study examined the effect of functional training on the strength and power of young tennis players. Methods: 40 male tennis players were assigned to the functional training group (n = 20; age, 16.7 ± 0.4 years) or the conventional training group (n = 20; age, 16.5 ± 0.6 years). The functional training group received three 60 min sessions per week for 12 weeks, while the conventional training group participated in three sessions per week of mono-strength exercise for 12 weeks. Strength and power were measured according to the International Tennis Federation protocol at baseline, 6 weeks after the intervention, and 12 weeks after the intervention. Results: Both forms of training increased (p < 0.05) push-ups, wall squat test, over medicine ball throw, and standing long jump after 6 weeks of training, and the effect improved further as the 12-week mark approached. Except for the wall squat test (left) at 6 weeks, functional training showed no advantage over conventional training. After an additional 6 weeks of training, all measures of strength and power were better (p < 0.05) in the functional training group. Conclusions: Improvements in strength and power could occur after as little as 6 weeks of functional training, and 12-week functional training could outperform conventional training in male adolescent tennis players. Full article

(This article belongs to the Special Issue Sports Science in Children)

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16 pages, 712 KiB

Open AccessEditor’s ChoiceReview

Effects of Sepsis on Immune Response, Microbiome and Oxidative Metabolism in Preterm Infants

by Anna Parra-Llorca, Alejandro Pinilla-Gonzlez, Laura Torrejón-Rodríguez, Inmaculada Lara-Cantón, Julia Kuligowski, María Carmen Collado, María Gormaz, Marta Aguar, Máximo Vento, Eva Serna and María Cernada

Children 2023, 10(3), 602; https://doi.org/10.3390/children10030602 - 22 Mar 2023

Cited by 8 | Viewed by 3314

Abstract

This is a narrative review about the mechanisms involved in bacterial sepsis in preterm infants, which is an illness with a high incidence, morbidity, and mortality. The role of the innate immune response and its relationship with oxidative stress in the pathogenesis are [...] Read more.

This is a narrative review about the mechanisms involved in bacterial sepsis in preterm infants, which is an illness with a high incidence, morbidity, and mortality. The role of the innate immune response and its relationship with oxidative stress in the pathogenesis are described as well as their potential implementation as early biomarkers. Moreover, we address the impact that all the mechanisms triggered by sepsis have on the dysbiosis and the changes on neonatal microbiota. Full article

(This article belongs to the Special Issue Allergic Diseases and Type 2 Inflammation in Children)

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13 pages, 10456 KiB

Open AccessEditor’s ChoiceArticle

Permanent Tooth Agenesis and Associated Dental Anomalies among Orthodontically Treated Children

by Shirley Schonberger, Rana Kadry, Yehoshua Shapira and Tamar Finkelstein

Children 2023, 10(3), 596; https://doi.org/10.3390/children10030596 - 21 Mar 2023

Cited by 12 | Viewed by 5467

Abstract

(1) Background: Tooth agenesis is one of the most common developmental dental anomalies often affecting the maxillary incisors area and premolar regions. (2) Purpose: The aim of this study was to assess the prevalence and distribution of permanent tooth agenesis and the associated [...] Read more.

(1) Background: Tooth agenesis is one of the most common developmental dental anomalies often affecting the maxillary incisors area and premolar regions. (2) Purpose: The aim of this study was to assess the prevalence and distribution of permanent tooth agenesis and the associated dental abnormalities among orthodontically treated children. (3) Materials and Methods: This study was carried out utilizing 3000 pretreatment records of children who underwent orthodontic treatment, 1780 (59%) females and 1220 (41%) males, aged 10–25 years (mean age 15 years). Tooth agenesis and other dental anomalies were surveyed using their panoramic radiographs, according to gender, pattern, and location. The level of statistical significance was set at p < 0.05 using t-test or Chi-Square tests. (4) Results: The total number of missing teeth, excluding third molars, was 518 (17%) found in 326 (11%) children. The majority were the maxillary lateral incisors, which was 176 teeth (34%) (p < 0.05). Of them, 111 (63%) were in females, and 65 (37%) were in males. The second most common missing tooth was mandibular second premolars, which was 137 teeth (26%), followed by missing 73 (14%) maxillary second premolars. Impacted teeth had the highest associated dental anomaly prevalence (14.3%), while transposition showed the lowest anomaly prevalence (0.5%). (5) Conclusions: A prevalence of 11% for tooth agenesis was detected in this study. More teeth were missing in the maxilla compare with the mandible. A significant association was found between missing maxillary lateral incisors and missing premolars (p < 0.05). Associated dental anomalies included an increased number of peg-shaped maxillary lateral incisors, palatally displaced and impacted maxillary canines, ectopic teeth, and infra-occluded (submerged) primary second molars. Full article

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

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16 pages, 518 KiB

Open AccessEditor’s ChoiceArticle

Risk Factors for Persistent Anosmia and Dysgeusia in Children with SARS-CoV-2 Infection: A Retrospective Study

by Francesco Mariani, Rosa Morello, Daniele Omar Traini, Anna La Rocca, Cristina De Rose, Piero Valentini and Danilo Buonsenso

Children 2023, 10(3), 597; https://doi.org/10.3390/children10030597 - 21 Mar 2023

Cited by 9 | Viewed by 2603

Abstract

Background: Olfactory and gustative dysfunctions are two of the most common post-acute sequelae of SARS-CoV-2 infection in children, which can have a negative impact on the routines of children and families. As several children have had COVID-19 since the Omicron variant, it is [...] Read more.

Background: Olfactory and gustative dysfunctions are two of the most common post-acute sequelae of SARS-CoV-2 infection in children, which can have a negative impact on the routines of children and families. As several children have had COVID-19 since the Omicron variant, it is important to investigate if this increase in infections is reflected in higher olfactory/taste disfunctions. The primary aim of this study was to characterize the presence of olfactory/gustative problems in a cohort of children, its evolution, and its association with risk factors such as COVID-19 variant, hospitalization, presence of olfactory/gustative dysfunction during the acute phase, and vaccination. Methods: This was a retrospective analysis of children with microbiologically confirmed SARS-CoV-2 infection evaluated in person at a referral pediatric post-COVID-19 clinic in Rome, Italy. We included children younger than 19 years old, evaluated from the beginning of the pandemic up to October 2022. At specific timepoints, we investigated the presence of olfactory/taste disfunctions and evaluated them according to the SARS-CoV-2 variants circulating at the time of infection. Results: A total of 1250 children (650 females; 52.0%) with a mean age of 6.77 (±4.12) years were included in the study. At 3, 6, 12, and 18 months, 12 (9.6%), 7 (5.6%), 2 (1.6%), and 1 (0.8%) of the children reported anosmia and dysgeusia post-COVID-19 infection, respectively. The presence of anosmia and dysgeusia during the acute phase of infection and being infected with a pre-Omicron variant were found to be significant risk factors for persistent olfactory and gustatory dysfunction during all follow-up periods. Conclusions: anosmia and dysgeusia symptoms tended to decrease gradually over time, but not all children recovered quickly. Full article

(This article belongs to the Special Issue Long COVID or Post-COVID-19 Syndrome in Children: What Do We Know So Far?)

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13 pages, 824 KiB

Open AccessEditor’s ChoiceArticle

Does Problematic Use of Social Network Mediate the Association between Bullying Victimization and Loneliness among Lebanese Adolescents?

by Elia Eid, Feten Fekih-Romdhane, Abir Sarray El Dine, Diana Malaeb, Souheil Hallit and Sahar Obeid

Children 2023, 10(3), 599; https://doi.org/10.3390/children10030599 - 21 Mar 2023

Cited by 8 | Viewed by 3169

Abstract

(1) Background: Bullying victimization has been associated with several behavioral outcomes, particularly loneliness. Similarly, an increase in social network use has been identified in recent years, particularly during the COVID-19 pandemic, and has been shown to be associated with bullying and loneliness. Investigating [...] Read more.

(1) Background: Bullying victimization has been associated with several behavioral outcomes, particularly loneliness. Similarly, an increase in social network use has been identified in recent years, particularly during the COVID-19 pandemic, and has been shown to be associated with bullying and loneliness. Investigating the mediating factors of loneliness among bullied adolescents is useful for taking preventive measures in the Lebanese population. This study aims to examine the association between bullying victimization and loneliness among Lebanese adolescents while considering the indirect effect of problematic social network use. (2) Methods: We carried out a cross-sectional study, between January and April 2022, that enrolled 379 adolescent Lebanese students (64.9% females, mean age 16.07 ± 1.19 years) who were current residents of Lebanon (15 to 18 years), and were from the five governorates of Lebanon (Beirut, Mount Lebanon, North, South and Bekaa). The snowball method was applied to select our sample; an electronic copy of the questionnaire was created using the Google Forms software and an online strategy was designed to collect the data. (3) Results: Negative social comparison and addictive consequences of problematic use of social network mediated the association between bullying victimization and loneliness. Higher bullying victimization was significantly associated with higher negative social comparison and addictive consequences of problematic use of social network, which in turn were significantly associated with more loneliness. Finally, higher bullying victimization was directly significantly associated with more loneliness. (4) Conclusions: Studying the mediating factors of loneliness in bullied adolescents can improve our understanding of this topic, allowing us to propose new interventions to prevent psychological problems in adolescents. Future studies are needed to further clarify the physiological processes that underlie the associations between social triggers and loneliness during adolescence. Full article

(This article belongs to the Special Issue Child Abuse and Neglect)

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21 pages, 2397 KiB

Open AccessEditor’s ChoiceArticle

Association between Bullying Victimization and Aggression in Lebanese Adolescents: The Indirect Effect of Repetitive Negative Thinking—A Path Analysis Approach and Scales Validation

by Feten Fekih-Romdhane, Diana Malaeb, Abir Sarray El Dine, Ecem Yakın, Souheil Hallit and Sahar Obeid

Children 2023, 10(3), 598; https://doi.org/10.3390/children10030598 - 21 Mar 2023

Cited by 13 | Viewed by 4528

Abstract

(1) Background: The purpose of the present study was to validate the Perseverative Thinking Questionnaire (PTQ) and the Buss–Perry Aggression Questionnaire-Short Form (BPAQ-SF) and test whether repetitive negative thinking plays an indirect role in the relationship between bullying victimization and aggression among Lebanese [...] Read more.

(1) Background: The purpose of the present study was to validate the Perseverative Thinking Questionnaire (PTQ) and the Buss–Perry Aggression Questionnaire-Short Form (BPAQ-SF) and test whether repetitive negative thinking plays an indirect role in the relationship between bullying victimization and aggression among Lebanese adolescents. (2) Methods: This cross-sectional study was conducted between January and May 2022 and included 379 Lebanese adolescent students (64.9% females, mean age 16.07 years). (3) Results: The three-factor solution of the PTQ and the four-factor solution of the BPAQ-SF showed excellent model fit. PTQ mediated the association between bullying victimization and physical aggression, verbal aggression, hostility, and anger. (4) Conclusions: This study expands on previous research by showing that repetitive negative thinking, an impactful socio-cognitive factor for students’ mental health, has a mediating (indirect) effect on the cross-sectional relationship between bullying victimization and aggression. This suggests that interventions aiming to prevent aggressive behaviors among adolescent students may be more effective if focused on repetitive negative thinking. Full article

(This article belongs to the Section Pediatric Mental Health)

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