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Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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9 pages, 2597 KiB  
Article
Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?
by Adelina Ionescu, Mihai-Codrut Dragomirescu, Alexandru Herdea and Alexandru Ulici
Children 2023, 10(6), 968; https://doi.org/10.3390/children10060968 - 30 May 2023
Cited by 11 | Viewed by 3578
Abstract
Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. While some advocate for universal screening, others recommend using risk factors as landmarks. In this study, we aimed to assess the risk [...] Read more.
Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. While some advocate for universal screening, others recommend using risk factors as landmarks. In this study, we aimed to assess the risk factors associated with DDH incidence among a large population. We conducted a retrospective single-center multifactorial study between January 2019 and March 2022, including 3720 children who were investigated anamnestically, clinically, and through an ultrasound scan. We classified them into two groups: the control group with 3300 healthy children and the study group with 420 newborns diagnosed with DDH. Our analysis identified several risk factors associated with DDH, including gender, prematurity, non-vertex birth presentation, oligohydramnios, gestational diabetes, maternal hypertension, family history, associated deformities, and swaddling. We found that every DDH patient had at least two risk factors. Based on our findings, we recommend that children who present two or more risk factors for DDH be mandatorily evaluated sonographically, as well as children with clinical signs. DDH screening is recommended for each newborn for the long-term benefits of early detection and treatment. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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10 pages, 437 KiB  
Article
Bacterial Pathogens and Antimicrobial Susceptibility Patterns of Urinary Tract Infections in Children during COVID-19 2019–2020: A Large Tertiary Care Center in Saudi Arabia
by Ibraheem Altamimi, Abeer Almazyed, Sami Alshammary, Abdulaziz Altamimi, Abdullah Alhumimidi, Raed Alnutaifi, Mohammed Malhis and Abdullah Altamimi
Children 2023, 10(6), 971; https://doi.org/10.3390/children10060971 - 30 May 2023
Cited by 9 | Viewed by 2847
Abstract
Background: One of the most prevalent bacterial infections in children is urinary tract infection (UTI), which has become a major concern with increasing resistance of the pathogens to the routinely used antimicrobial agents. The aim of the study is to determine the antimicrobial [...] Read more.
Background: One of the most prevalent bacterial infections in children is urinary tract infection (UTI), which has become a major concern with increasing resistance of the pathogens to the routinely used antimicrobial agents. The aim of the study is to determine the antimicrobial susceptibility patterns of pediatric UTI-causing pathogens, including ESBL-producing bacteria, in Saudi Arabia. Methods: This cross-sectional retrospective study was conducted to ascertain the frequency of isolation and the antimicrobial resistance pattern of uropathogens among children aged 0–15 years. The data from the urine cultures was collected during 2019–2020 at the King Fahad Medical City, a major tertiary hospital in Riyadh, Saudi Arabia. A total of 1022 urine samples from patients diagnosed with urinary tract infections (UTIs) were collected for this study. Microbial species present in the samples were cultured and identified using standard biochemical techniques. To assess the resistance of these strains to antimicrobial drugs, an in vitro method was employed, and the criteria set by the Clinical Laboratory Standard Institute (CLSI) were followed. In addition, a double-disc synergy test was conducted to identify strains of E. coli that produce extended-spectrum beta-lactamase (ESBL). Results: The predominant pathogens were E. coli (58.6%), followed by Klebsiella sp. (23.9%). E. coli isolates were more sensitive to meropenem and ertapenem in 99.2% of cases, followed by amikacin (99%). Klebsiella sp. were sensitive to amikacin in 97.1% of cases, followed by meropenem and ertapenem (92.2% in both). The highest sensitivities of antimicrobials toward ESBL were for meropenem and ertapenem (100% in both), followed by amikacin (99%). Conclusions: Our study recommends using local antibiotic sensitivity data for empirical UTI treatment. Amikacin, ertapenem, and meropenem are effective intravenous options. Cephalosporin, cefuroxime, amoxicillin/clavulanic acid, and nitrofurantoin are suitable oral choices. No significant changes in antimicrobial susceptibility were observed during the COVID-19 pandemic. Further research is needed to assess potential pandemic-related alterations. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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13 pages, 277 KiB  
Article
Supporting and Enhancing NICU Sensory Experiences (SENSE), 2nd Edition: An Update on Developmentally Appropriate Interventions for Preterm Infants
by Roberta Pineda, Polly Kellner, Carolyn Ibrahim, SENSE Advisory Team Working Group and Joan Smith
Children 2023, 10(6), 961; https://doi.org/10.3390/children10060961 - 28 May 2023
Cited by 9 | Viewed by 7383
Abstract
The Supporting and Enhancing NICU Sensory Experiences (SENSE) program promotes consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for preterm infants each day of NICU hospitalization to optimize infant and parent outcomes. The initial development included an integrative review, stakeholder input (NICU parents [...] Read more.
The Supporting and Enhancing NICU Sensory Experiences (SENSE) program promotes consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for preterm infants each day of NICU hospitalization to optimize infant and parent outcomes. The initial development included an integrative review, stakeholder input (NICU parents and healthcare professionals), and feasibility focus groups. To keep the program updated and evidence-based, a review of the recent evidence and engagement with an advisory team will occur every 5 years to inform changes to the SENSE program. Prior to the launch of the 2nd edition of the SENSE program in 2022, information from a new integrative review of 57 articles, clinician feedback, and a survey identifying the barriers and facilitators to the SENSE program’s implementation in a real-world context were combined to inform initial changes. Subsequently, 27 stakeholders (neonatologists, nurse practitioners, clinical nurse specialists, bedside nurses, occupational therapists, physical therapists, speech-language pathologists, and parents) carefully considered the suggested changes, and refinements were made until near consensus was achieved. While the 2nd edition is largely the same as the original SENSE program, the refinements include the following: more inclusive language, clarification on recommended minimum doses, adaptations to allow for variability in how hospitals achieve different levels of light, the addition of visual tracking in the visual domain, and the addition of position changes in the kinesthetic domain. Full article
(This article belongs to the Special Issue Family Centered Neonatal and Maternity Care)
14 pages, 1272 KiB  
Review
Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials—Systematic Review of Methods and Recommendations for Future Research
by Sanja Schreiber, Daniel Whibley and Emily C Somers
Children 2023, 10(6), 954; https://doi.org/10.3390/children10060954 - 27 May 2023
Cited by 10 | Viewed by 9229
Abstract
The Schroth method is a non-operative treatment for scoliosis and kyphosis, used standalone or as an adjunct to bracing. While supporting evidence for its effectiveness is emerging, methodologic standardization and rigor are equivocal. Thus, we aimed to systematically review methods of published Schroth [...] Read more.
The Schroth method is a non-operative treatment for scoliosis and kyphosis, used standalone or as an adjunct to bracing. While supporting evidence for its effectiveness is emerging, methodologic standardization and rigor are equivocal. Thus, we aimed to systematically review methods of published Schroth physiotherapeutic scoliosis-specific exercise (PSSE) trials and provide guidance for future research. We searched six databases for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSIs) investigating the effect of Schroth in children and adults with scoliosis or kyphosis. General characteristics, methodological approaches, treatment protocols, and outcomes reporting were analyzed. Risk of bias (RoB) was assessed using an adapted Cochrane RoB2 tool for RCTs and ROBINS-I for NRSI. Eligible studies (n = 7) were conducted in six countries and included patients with Scheuermann’s kyphosis (n = 1) and adolescent idiopathic scoliosis (n = 6). Though all seven studies used the term Schroth to describe their interventions, the Schroth method was used in four of seven studies, of which only one used Schroth classification, three used Schroth therapists, and none prospectively registered the study protocol. Overall, methodological rigor was suboptimal, potentially invalidating evidence synthesis. Authors should follow minimum standards for reporting, including prospectively registering detailed protocols; using appropriate exercise labeling, Schroth classification and certified therapists; naming and describing exercises per classification; and providing therapy dosages, prescription methods, and adherence. Full article
(This article belongs to the Special Issue Evidence on Conservative Treatment and Assessment of Idiopathic Scoliosis and Other Spinal Deformities)
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16 pages, 653 KiB  
Review
Pediatric Sleep Respiratory Disorders: A Narrative Review of Epidemiology and Risk Factors
by Marta Piotto, Antonella Gambadauro, Alessia Rocchi, Mara Lelii, Barbara Madini, Lucia Cerrato, Federica Chironi, Youssra Belhaj and Maria Francesca Patria
Children 2023, 10(6), 955; https://doi.org/10.3390/children10060955 - 27 May 2023
Cited by 24 | Viewed by 6349
Abstract
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase “sleep-disordered breathing (SDB)” indicates a wide array of conditions characterized by snoring and/or respiratory distress due to [...] Read more.
Sleep is a fundamental biological necessity, the lack of which has severe repercussions on the mental and physical well-being in individuals of all ages. The phrase “sleep-disordered breathing (SDB)” indicates a wide array of conditions characterized by snoring and/or respiratory distress due to increased upper airway resistance and pharyngeal collapsibility; these range from primary snoring to obstructive sleep apnea (OSA) and occur in all age groups. In the general pediatric population, the prevalence of OSA varies between 2% and 5%, but in some particular clinical conditions, it can be much higher. While adenotonsillar hypertrophy (“classic phenotype”) is the main cause of OSA in preschool age (3–5 years), obesity (“adult phenotype”) is the most common cause in adolescence. There is also a “congenital–structural” phenotype that is characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes and associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities. Full article
(This article belongs to the Special Issue Advances in Sleep Respiratory Disorders in Children and Adolescents)
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9 pages, 508 KiB  
Review
The Psychological Burden of Families with Diabetic Children: A Literature Review Focusing on Quality of Life and Stress
by Paraskevi Theofilou and Dimitris D. Vlastos
Children 2023, 10(6), 937; https://doi.org/10.3390/children10060937 - 26 May 2023
Cited by 12 | Viewed by 4152
Abstract
Chronic diseases, such as childhood diabetes mellitus (DM), are a complex and continuous struggle as well as a great challenge both for the children who face the disease and for their parents. DM is characterized by the complex management of therapeutic treatments, thus [...] Read more.
Chronic diseases, such as childhood diabetes mellitus (DM), are a complex and continuous struggle as well as a great challenge both for the children who face the disease and for their parents. DM is characterized by the complex management of therapeutic treatments, thus causing physical and psychological complications infamily members. There are many families who, upon hearing the diagnosis of their child with DM, stand still in front of these new facts as their lives change. All these unprecedented conditions cause parents intense stress and discomfort, leading them to a mental burden, as the only thing that concerns them upon diagnosis is how the family will survive in the face of the current conditions they are experiencing as well as the future of the sick child. The purpose of this brief literature review is to present the research findings related to the psychological burden of families withchildren with DM, focusing on the quality of life and stress. Full article
(This article belongs to the Section Global Pediatric Health)
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10 pages, 828 KiB  
Article
Human Milk Fatty Acid Composition and Its Effect on Preterm Infants’ Growth Velocity
by Batool Ahmed, Afnan Freije, Amina Omran, Mariangela Rondanelli, Mirko Marino and Simone Perna
Children 2023, 10(6), 939; https://doi.org/10.3390/children10060939 - 26 May 2023
Cited by 8 | Viewed by 2532
Abstract
This study aimed to analyze the fatty acid content in human milk and to find its relationship with the growth velocity of preterm infants. Mature milk samples from 15 mothers of preterm infants were collected from three different hospitals, followed by lipid extraction, [...] Read more.
This study aimed to analyze the fatty acid content in human milk and to find its relationship with the growth velocity of preterm infants. Mature milk samples from 15 mothers of preterm infants were collected from three different hospitals, followed by lipid extraction, fatty acid methylation, and finally gas chromatography analysis to determine the fatty acids composition. The average total lipid content was 3.61 ± 1.57 g/100 mL with the following classes of fatty acids: saturated fatty acids 43.54 ± 11.16%, unsaturated fatty acids 52.22 ± 10.89%, in which monounsaturated fatty acids were 36.52 ± 13.90%, and polyunsaturated fatty acids were 15.70 ± 7.10%. Polyunsaturated fatty acid sub-class n-6 was 15.23 ± 8.23% and n-3 was 0.46 ± 0.18%. Oleic acid, palmitic acid, and linoleic acid were the most abundant fatty acids. The n-6/n-3 ratio was 32.83:1. EPA and DHA fatty acids were not detected. As gestational age and birth weight increase, C20:2n6 content increases. The growth velocity increases with the decrement in C16 and increment in C20:2n6. The lipid profile of preterm human milk was found to be low in some essential fatty acids, which may affect the quality of preterm infants’ nutrition. Full article
(This article belongs to the Special Issue 10th Anniversary of Children: Feature Papers in Neonatology)
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15 pages, 2505 KiB  
Review
Post-Traumatic Stress Disorder in Unaccompanied Refugee Minors: Prevalence, Contributing and Protective Factors, and Effective Interventions: A Scoping Review
by Charles Oberg and Hayley Sharma
Children 2023, 10(6), 941; https://doi.org/10.3390/children10060941 - 26 May 2023
Cited by 8 | Viewed by 4911
Abstract
In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review [...] Read more.
In 2021, there were close to 37 million children displaced worldwide. There were 13.7 million refugees and an additional 22.8 million internally displaced. In Europe, this included 23,255 unaccompanied minors seeking asylum, up 72% compared with 2020 (13,550). The objective was to review the current literature regarding PTSD in unaccompanied refugee minors (URM). The authors searched Ovid Medline, Embase, and Cochrane Library from 1 January 2008 through 15 January 2019. Thirty full texts were chosen that specifically studied unaccompanied refugee minors (URM). The results showed that URM had a prevalence of post-traumatic stress disorder (PTSD of 17–85% across the studies reviewed. There were numerous factors that contributed to PTSD, including cumulative stress and trauma, guilt, shame, and uncertainty about legal status. Protective factors included resilience, a trusted mentor, belonging to a social network, religion, having an adult mentor, and having a family (even if far away). Immigrant youth can thrive most easily in multiculturally affirming countries. Five interventions demonstrated effectiveness, comprising trauma-focused cognitive behavioral therapy (TF-CBT); “Mein Weg”, a TF-CBT combined with a group-processing mixed therapy approach; teaching recovery techniques (TRT), narrative exposure therapy for children (KIDNET), and expressive arts intervention (EXIT). The significant mental health conditions include depression, anxiety, internalizing and externalizing behaviors, and frequently PTSD. It is fair to conclude that the high levels of mental health problems experienced in URM are due to exposure to traumatic experiences, separation from parents, and lack of social support. Full article
(This article belongs to the Special Issue Research on Child Trauma and Protection)
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14 pages, 673 KiB  
Review
D-Lactate: Implications for Gastrointestinal Diseases
by Barblin Remund, Bahtiyar Yilmaz and Christiane Sokollik
Children 2023, 10(6), 945; https://doi.org/10.3390/children10060945 - 26 May 2023
Cited by 40 | Viewed by 9193
Abstract
D-lactate is produced in very low amounts in human tissues. However, certain bacteria in the human intestine produce D-lactate. In some gastrointestinal diseases, increased bacterial D-lactate production and uptake from the gut into the bloodstream take place. In its extreme, excessive accumulation of [...] Read more.
D-lactate is produced in very low amounts in human tissues. However, certain bacteria in the human intestine produce D-lactate. In some gastrointestinal diseases, increased bacterial D-lactate production and uptake from the gut into the bloodstream take place. In its extreme, excessive accumulation of D-lactate in humans can lead to potentially life-threatening D-lactic acidosis. This metabolic phenomenon is well described in pediatric patients with short bowel syndrome. Less is known about a subclinical rise in D-lactate. We discuss in this review the pathophysiology of D-lactate in the human body. We cover D-lactic acidosis in patients with short bowel syndrome as well as subclinical elevations of D-lactate in other diseases affecting the gastrointestinal tract. Furthermore, we argue for the potential of D-lactate as a marker of intestinal barrier integrity in the context of dysbiosis. Subsequently, we conclude that there is a research need to establish D-lactate as a minimally invasive biomarker in gastrointestinal diseases. Full article
(This article belongs to the Special Issue Cutting Edge Research on Pediatric Gastroenterology)
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12 pages, 959 KiB  
Article
Investigation of the Relationship of Impacted Maxillary Canines with Orthodontic Malocclusion: A Retrospective Study
by Orhan Cicek, Turhan Gurel and Busra Demir Cicek
Children 2023, 10(6), 950; https://doi.org/10.3390/children10060950 - 26 May 2023
Cited by 15 | Viewed by 3756
Abstract
Impacted canines, which play an important role in smile aesthetics and functional occlusion, can lead to dental and skeletal malocclusions. In this study the aim was to evaluate the relationship between impacted maxillary canines and malocclusion. A total of 151 patients comprising 101 [...] Read more.
Impacted canines, which play an important role in smile aesthetics and functional occlusion, can lead to dental and skeletal malocclusions. In this study the aim was to evaluate the relationship between impacted maxillary canines and malocclusion. A total of 151 patients comprising 101 females and 50 males aged between 13 and 33 years were included. The groups were divided based on age, gender, skeletal and dental classification, and sector classification. Angular and linear measurements were performed on lateral cephalometric and panoramic radiographs. In panoramic radiographs, the vertical distance of the impacted canine to the occlusal plane and the angle between it and the bicondylar plane were measured and sector classification was performed according to its relationship with the root of the lateral incisor. Skeletal classification was performed according to the ANB angle on lateral cephalometric radiographs and dental classification by molar relationship via the intraoral photographs. The Chi-square test analyzed independent qualitative and quantitative data using Kruskal–Wallis and Man–Whitney U tests. The statistical significance level was accepted as p < 0.05. According to the intraclass correlation test, an excellent positive correlation was found with 0.985 for canine distance and 0.993 for canine angle between the repeated measurements. The impaction of the maxillary right canine was significantly highest in females and lowest in males. The impacted canine angle was significantly highest in sector 1 and lowest in sector 4. Distance to the occlusal plane was significantly higher in dental Class II and sector 4. It was observed that there was a considerable relationship between impacted maxillary canines and malocclusion; bilateral impacted canines were more frequent in skeletal Class III, and the distance of impacted canines to the occlusal plane increased while their angles decreased both in dental Class II and from sectors 1 to 4. Full article
(This article belongs to the Special Issue New Clinical Evidences in Pediatric Orthodontics and Pediatric Dentistry)
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20 pages, 799 KiB  
Review
Association between Dentofacial Features and Bullying from Childhood to Adulthood: A Systematic Review
by Alice Broutin, Isabelle Blanchet, Thibault Canceill and Emmanuelle Noirrit-Esclassan
Children 2023, 10(6), 934; https://doi.org/10.3390/children10060934 - 25 May 2023
Cited by 10 | Viewed by 2834
Abstract
Bullying occurs when an individual is repeatedly victimised by negative actions performed by peers. As oral features, like malocclusion and dental structural defects, can promote psychological distress, which is also found in those who are bullied, we aimed to study the association between [...] Read more.
Bullying occurs when an individual is repeatedly victimised by negative actions performed by peers. As oral features, like malocclusion and dental structural defects, can promote psychological distress, which is also found in those who are bullied, we aimed to study the association between orofacial conditions and bullying. A systematic review (PROSPERO CRD42022331693), including articles dealing with bullying and dentofacial traits, was performed following the PRISMA chart. The iterative search of eligible publications was carried out on 27 March 2023 on four databases (PubMed, PubPsych, Web of Science and Cochrane Reviews) and in the grey literature. Among the 25 articles included, 4 referred to qualitative studies, which analysed 632 interviews with children, 8 interviews with parents, 292 letters, and 321 Twitter posts. The other 21 were cross-sectional studies, which included 10,026 patients from 7 to 61 years old. Two of the qualitative studies and seven of the cross-sectional studies rated a low risk of bias, according to Joanna Briggs Institute’s Critical Appraisal Tools. The majority of studies (88%) reported a relationship between malocclusion or structural defects and exposure to bullying among young adolescents. Structural dental abnormalities and severe malocclusion should be managed, among others, for psychological questions because they crystallise the loss of self-confidence and increase the risk of bullying. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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20 pages, 1002 KiB  
Review
Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity
by Valeria Calcaterra, Matteo Vandoni, Luca Marin, Vittoria Carnevale Pellino, Virginia Rossi, Alessandro Gatti, Pamela Patanè, Caterina Cavallo, Fabio Re, Ilaria Albanese, Dario Silvestri, Alessandro De Nunzio and Gianvincenzo Zuccotti
Children 2023, 10(6), 928; https://doi.org/10.3390/children10060928 - 24 May 2023
Cited by 14 | Viewed by 4779
Abstract
Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in [...] Read more.
Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children’s poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention. Full article
(This article belongs to the Special Issue New Trends in Adolescent Health and Development)
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16 pages, 649 KiB  
Review
Sports Games and Motor Skills in Children, Adolescents and Youth with Intellectual Disabilities
by Nikola Aksović, Tatiana Dobrescu, Saša Bubanj, Bojan Bjelica, Filip Milanović, Miodrag Kocić, Milan Zelenović, Marko Radenković, Filip Nurkić, Dejan Nikolić, Jovan Marković, Milena Tomović and Ana-Maria Vulpe
Children 2023, 10(6), 912; https://doi.org/10.3390/children10060912 - 23 May 2023
Cited by 14 | Viewed by 4519
Abstract
(1) Background: Sports games are one of the best ways of engaging in physical activity for individuals with intellectual disabilities (ID) and Down syndrome (DS). This systematic review of the current literature aims to identify and sum relevant data on motor skills and [...] Read more.
(1) Background: Sports games are one of the best ways of engaging in physical activity for individuals with intellectual disabilities (ID) and Down syndrome (DS). This systematic review of the current literature aims to identify and sum relevant data on motor skills and clarify whether there are positive effects of sports programs in motor skills games in children, adolescents, and youth with ID and DS. (2) Methods: The systematic review of the papers was carried out following the methodological guidelines and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus. The following electronic databases were researched: PubMed, MEDLINE, Google Scholar, ScienceDirect, and ERIC from 2001 to 2023. (3) Results: The basketball test battery can be used to improve and monitor basketball training. Basketball players with lower levels of ID achieved better results, especially those with disabilities of the II and III degrees. Futsal has a positive impact on the coordination, and the differences between the test results of the vertical jump with and without an arm swing, that can be seen indirectly as a coordination factor, were statistically significant. (4) Conclusions: Basketball is recommended as an effective and practical rehabilitation program for children, adolescents, and youth with ID and DS. Futsal is an interesting and helpful activity for individuals with ID as well. Full article
(This article belongs to the Special Issue Childhood Physical Activity and Health)
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13 pages, 1698 KiB  
Article
Machine Learning Detects Intraventricular Haemorrhage in Extremely Preterm Infants
by Minoo Ashoori, John M. O’Toole, Ken D. O’Halloran, Gunnar Naulaers, Liesbeth Thewissen, Jan Miletin, Po-Yin Cheung, Afif EL-Khuffash, David Van Laere, Zbyněk Straňák, Eugene M. Dempsey and Fiona B. McDonald
Children 2023, 10(6), 917; https://doi.org/10.3390/children10060917 - 23 May 2023
Cited by 8 | Viewed by 2826
Abstract
Objective: To test the potential utility of applying machine learning methods to regional cerebral (rcSO2) and peripheral oxygen saturation (SpO2) signals to detect brain injury in extremely preterm infants. Study design: A subset of infants enrolled in the Management [...] Read more.
Objective: To test the potential utility of applying machine learning methods to regional cerebral (rcSO2) and peripheral oxygen saturation (SpO2) signals to detect brain injury in extremely preterm infants. Study design: A subset of infants enrolled in the Management of Hypotension in Preterm infants (HIP) trial were analysed (n = 46). All eligible infants were <28 weeks’ gestational age and had continuous rcSO2 measurements performed over the first 72 h and cranial ultrasounds performed during the first week after birth. SpO2 data were available for 32 infants. The rcSO2 and SpO2 signals were preprocessed, and prolonged relative desaturations (PRDs; data-driven desaturation in the 2-to-15-min range) were extracted. Numerous quantitative features were extracted from the biosignals before and after the exclusion of the PRDs within the signals. PRDs were also evaluated as a stand-alone feature. A machine learning model was used to detect brain injury (intraventricular haemorrhage-IVH grade II–IV) using a leave-one-out cross-validation approach. Results: The area under the receiver operating characteristic curve (AUC) for the PRD rcSO2 was 0.846 (95% CI: 0.720–0.948), outperforming the rcSO2 threshold approach (AUC 0.593 95% CI 0.399–0.775). Neither the clinical model nor any of the SpO2 models were significantly associated with brain injury. Conclusion: There was a significant association between the data-driven definition of PRDs in rcSO2 and brain injury. Automated analysis of PRDs of the cerebral NIRS signal in extremely preterm infants may aid in better prediction of IVH compared with a threshold-based approach. Further investigation of the definition of the extracted PRDs and an understanding of the physiology underlying these events are required. Full article
(This article belongs to the Special Issue Application of Near-Infrared Spectroscopy in Pediatrics)
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17 pages, 838 KiB  
Review
Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications
by George Daskalakis, Alexandros Psarris, Antonios Koutras, Zacharias Fasoulakis, Ioannis Prokopakis, Antonia Varthaliti, Christina Karasmani, Thomas Ntounis, Ekaterini Domali, Marianna Theodora, Panos Antsaklis, Kalliopi I. Pappa and Angeliki Papapanagiotou
Children 2023, 10(5), 907; https://doi.org/10.3390/children10050907 - 22 May 2023
Cited by 40 | Viewed by 11281
Abstract
As the leading cause of neonatal morbidity and mortality, preterm birth is recognized as a major public health concern around the world. The purpose of this review is to analyze the connection between infections and premature birth. Spontaneous preterm birth is commonly associated [...] Read more.
As the leading cause of neonatal morbidity and mortality, preterm birth is recognized as a major public health concern around the world. The purpose of this review is to analyze the connection between infections and premature birth. Spontaneous preterm birth is commonly associated with intrauterine infection/inflammation. The overproduction of prostaglandins caused by the inflammation associated with an infection could lead to uterine contractions, contributing to preterm delivery. Many pathogens, particularly Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Actinomyces, Candida spp., and Streptococcus spp. have been related with premature delivery, chorioamnionitis, and sepsis of the neonate. Further research regarding the prevention of preterm delivery is required in order to develop effective preventive methods with the aim of reducing neonatal morbidity. Full article
(This article belongs to the Section Global Pediatric Health)
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13 pages, 648 KiB  
Article
Clinical and Functional Characteristics of a New Phenotype of SMA Type I among a National Sample of Spanish Children: A Cross-Sectional Study
by Beatriz de-Andrés-Beltrán, Javier Güeita-Rodríguez, Domingo Palacios-Ceña and Ángel Luis Rodríguez-Fernández
Children 2023, 10(5), 892; https://doi.org/10.3390/children10050892 - 16 May 2023
Cited by 9 | Viewed by 3607
Abstract
Spinal Muscular Atrophy (SMA) type I has classically presented extremely severe clinical features. New pharmacological treatments have led to a new phenotype of SMA. The aim of this study was to describe the current health and functional status of children with SMA. A [...] Read more.
Spinal Muscular Atrophy (SMA) type I has classically presented extremely severe clinical features. New pharmacological treatments have led to a new phenotype of SMA. The aim of this study was to describe the current health and functional status of children with SMA. A cross-sectional study was conducted based on the STROBE guidelines. Patient questionnaires and standardized tools were used. A descriptive analysis was conducted establishing the proportions of subjects for each of the characteristics of interest. In total, 51 genetically confirmed SMA type I subjects were included. Fifty-seven percent received oral feeding, 33% received tube feeding and 10% combined both. Moreover, 21.6% had tracheostomies, and 9.8% needed more than 16 h/d ventilatory support. Regarding orthopedic status, 66.7% had scoliosis, and 68.6% had hip subluxation or dislocation. Up to 67% were able to sit independently, 23.5% walked with support and one child walked independently. Current SMA type I is a different entity from the classic phenotype but also from types II and III. In addition, no differences were found between SMA type I subgroups. These findings may enable the professionals involved in the care of these patients to improve their interventions in terms of prevention and rehabilitation measures for these children. Full article
(This article belongs to the Special Issue Advances in Rehabilitation of Children with Disabilities)
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12 pages, 995 KiB  
Article
Trends and Predictors of Pediatric Negative Appendectomy Rates: A Single-Centre Retrospective Study
by Miro Jukić, Petra Nizeteo, Jakov Matas and Zenon Pogorelić
Children 2023, 10(5), 887; https://doi.org/10.3390/children10050887 - 15 May 2023
Cited by 7 | Viewed by 3393
Abstract
Background: Appendectomy is still the standard treatment for acute appendicitis in the majority of centers. Despite all available diagnostic tools, the rates of negative appendectomies are still relatively high. This study aimed to determine negative appendectomy rates and to analyze the demographic and [...] Read more.
Background: Appendectomy is still the standard treatment for acute appendicitis in the majority of centers. Despite all available diagnostic tools, the rates of negative appendectomies are still relatively high. This study aimed to determine negative appendectomy rates and to analyze the demographic and clinical data of the patients whose histopathology report was negative. Methods: All patients younger than 18 years who underwent appendectomy for suspected acute appendicitis in the period from 1 January 2012 to 31 December 2021 were included in the single-center retrospective study. Electronic records and archives of histopathology reports were reviewed for patients with negative appendectomy. The primary outcome of this study was a negative appendectomy rate. Secondary outcomes comprehended the rate of appendectomies and the association of age, sex, body mass index (BMI), values of laboratory markers, scoring systems, and ultrasound reports with negative histopathology reports. Results: During the study period, a total of 1646 appendectomies for suspected acute appendicitis were performed. In 244 patients, negative appendectomy was reported regarding the patients’ pathohistology. In 39 of 244 patients, other pathologies were found, of which ovarian pathology (torsion and cysts) torsion of greater omentum and Meckel’s diverticulitis were the most frequent. Finally, the ten-year negative appendectomy rate was 12.4% (205/1646). The median age was 12 years (interquartile range, IQR 9, 15). A slight female predominance was noted (52.5%). A significantly higher incidence of negative appendectomies was noted in girls, with a peak incidence between the ages of 10 and 15 years (p < 0.0001). Male children whose appendectomy was negative had significantly higher BMI values compared to female patients (p = 0.0004). The median values of white blood cell count, neutrophil count, and CRP in the patients with negative appendectomy were 10.4 × 109/L, 75.9%, and 11 mg/dL, respectively. The median of Alvarado’s score was 6 (IQR 4; 7.5), while the median of the AIR score was 5 (IQR 4, 7). The rate of children with negative appendectomy who underwent ultrasound was 34.4% (84/244), among which 47 (55.95%) concluded negative reports. The rates of negative appendectomies were not homogenous in terms of distribution regarding the season. The incidence of negative appendectomies was more frequent during the cold period of the year (55.3% vs. 44.7%; p = 0.042). Conclusions: The majority of negative appendectomies were performed in children older than 9 years and most frequently in female children aged 10 to 15 years. In addition, female children have significantly lower BMI values compared to male children with negative appendectomy. An increase in the utilization of auxiliary diagnostic methods such as computed tomography could affect the reduction in the pediatric negative appendectomy rate. 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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13 pages, 2689 KiB  
Article
Redefining Neurodevelopmental Impairment: Perspectives of Very Preterm Birth Stakeholders
by Anne Synnes, Amarpreet Chera, Lindsay L. Richter, Jeffrey N. Bone, Claude Julie Bourque, Sofia Zhang-Jiang, Rebecca Pearce, Annie Janvier and Thuy Mai Luu
Children 2023, 10(5), 880; https://doi.org/10.3390/children10050880 - 14 May 2023
Cited by 12 | Viewed by 2902
Abstract
Children born very preterm are at risk of severe neurodevelopmental impairment, a composite endpoint that includes cerebral palsy, developmental delay, and hearing and visual impairment defined by medical professionals. We aimed to describe preterm birth stakeholders’ perspectives on this classification. Ten clinical scenarios [...] Read more.
Children born very preterm are at risk of severe neurodevelopmental impairment, a composite endpoint that includes cerebral palsy, developmental delay, and hearing and visual impairment defined by medical professionals. We aimed to describe preterm birth stakeholders’ perspectives on this classification. Ten clinical scenarios describing 18-month-old children with different components of severe neurodevelopmental impairment and one scenario of a typically developing child (control) were distributed to parents and stakeholders using a snowball sampling technique. For each scenario, participants rated health on a scale from 0 to 10 and whether the scenario represented a severe condition. Results were analyzed descriptively and mean differences from the control scenario were compared using a linear mixed-effects model. Stakeholders (number = 827) completed 4553 scenarios. Median health scores for each scenario varied from 6 to 10. The rating for the cerebral palsy and language delay scenario was significantly lower (mean difference −4.3; 95% confidence interval: −4.4, −4.1) than the control. The proportion of respondents rating a scenario as “severe” ranged from 5% for cognitive delay to 55% for cerebral palsy and language delay. Most participants disagreed with the rating used in research to describe severe neurodevelopmental impairment in preterm children. The term should be redefined to align with stakeholder perceptions. Full article
(This article belongs to the Special Issue Family-Oriented Research to Improve Care of Preterm Infants)
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11 pages, 782 KiB  
Article
Elevated Urinary Hepcidin Level and Hypoferremia in Infants with Febrile Urinary Tract Infection: A Prospective Cohort Study
by Yu-Chen Hsu, Hsin-Chun Huang, Kuo-Su Tang, Li-Ting Su, Ying-Hsien Huang, Hui-Chen Huang and I-Lun Chen
Children 2023, 10(5), 870; https://doi.org/10.3390/children10050870 - 12 May 2023
Cited by 6 | Viewed by 2311
Abstract
To evaluate the kinetics of serum and urinary hepcidin levels along with anemia-related parameters during the infection course of infants with febrile urinary tract infection (UTI), we enrolled febrile infants aged one to four months in this prospective study. Febrile patients with UTI [...] Read more.
To evaluate the kinetics of serum and urinary hepcidin levels along with anemia-related parameters during the infection course of infants with febrile urinary tract infection (UTI), we enrolled febrile infants aged one to four months in this prospective study. Febrile patients with UTI were allocated into Escherichia coli (E. coli) or non-E. coli groups according to urine culture results. Septic workup, blood hepcidin, iron profile, urinalysis, and urinary hepcidin–creatinine ratio were collected upon admission and 3 days after antibiotic treatment. In total, 118 infants were included. On admission, the febrile UTI group showed a significant reduction in serum iron level and a significant elevation of urinary hepcidin–creatinine ratio compared to the febrile control counterpart. Moreover, urinary hepcidin–creatinine ratio had the highest odds ratio, 2.01, in logistics regression analysis. After 3 days of antibiotic treatment, hemoglobin and the urinary hepcidin–creatinine ratio were significantly decreased. Patients with an E. coli UTI had a significantly decreased urinary hepcidin–creatinine ratio after 3 days of antibiotics treatment, whereas the non-E. coli group showed insignificant changes. Our study suggested that the urinary hepcidin–creatinine ratio elevated during acute febrile urinary tract infection and significantly decreased after 3 days of antibiotics treatment, especially in E. coli UTI. Full article
(This article belongs to the Section Pediatric Neonatology)
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32 pages, 1344 KiB  
Review
School Mindfulness-Based Interventions for Youth, and Considerations for Anxiety, Depression, and a Positive School Climate—A Systematic Literature Review
by Jessica Monsillion, Rafika Zebdi and Lucia Romo-Desprez
Children 2023, 10(5), 861; https://doi.org/10.3390/children10050861 - 11 May 2023
Cited by 17 | Viewed by 10555
Abstract
Mindfulness-based interventions (MBIs) are growing in popularity, with research concerning their efficacy with youth populations. Following a preliminary analysis of the existing literature, and given the positive effects of such programs, we felt it relevant to assess whether research has considered the implications [...] Read more.
Mindfulness-based interventions (MBIs) are growing in popularity, with research concerning their efficacy with youth populations. Following a preliminary analysis of the existing literature, and given the positive effects of such programs, we felt it relevant to assess whether research has considered the implications for MBIs on children and adolescents, with regard to depression, anxiety, and school climate. Objectives: We aim to estimate the effect of MBIs as innovative interventions addressing youths in school settings, with special consideration for anxiety, depression, and school climate outcomes. Method: This review investigates the existing literature in the field of mindfulness, using quasi-experimental and randomized control trial (RCT) models, targeted at youth (5–18 years) in school settings. A search was carried out in four databases—WebofScience, Google Scholar, PubMed, and PsycARTICLES. This resulted in 39 articles, which were sorted based on predetermined inclusion criteria; 12 articles qualified. Results: The results show discrepancies in terms of methodological and implementation variables, types of interventions, instructor trainings, assessment measures, and choice of practices and exercises, which make the effects of existing school MBIs difficult to compare. Consistencies were observed in emotional and behavioral regulation, prosocial behaviors, and reducing stress and anxiety in students. The results of this systematic review also suggest that MBIs could be potential mediators in improving student well-being and environmental factors, such as school and class climates. Specifically, children’s sense of safety and community can be improved by an improved quality of relationships between students, their peers, and teachers. Future research should consider incorporating school climate perspectives, such as implementing whole-school MBI approaches and using replicable and comparable study designs and methods, whilst considering the capacities and limitations of the academic and institutional context. Full article
(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents)
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23 pages, 716 KiB  
Article
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 14 | Viewed by 4861
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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13 pages, 2225 KiB  
Review
State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations
by Elizaveta Bokova, Wendy Jo Svetanoff, Joseph J. Lopez, Marc A. Levitt and Rebecca M. Rentea
Children 2023, 10(5), 846; https://doi.org/10.3390/children10050846 - 8 May 2023
Cited by 11 | Viewed by 4442
Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part [...] Read more.
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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20 pages, 9063 KiB  
Article
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 20 | Viewed by 4827
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  
Article
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 6264
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  
Review
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 22 | Viewed by 10549
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  
Article
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 11 | Viewed by 3519
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  
Review
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 41 | Viewed by 15923
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  
Review
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 18 | Viewed by 14539
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  
Review
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 7 | Viewed by 3547
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  
Review
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 11 | Viewed by 8876
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, 3897 KiB  
Article
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 9 | Viewed by 2402
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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17 pages, 355 KiB  
Review
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 2601
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)
21 pages, 457 KiB  
Review
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 5930
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  
Article
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 2294
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)
18 pages, 350 KiB  
Review
The Association between Music and Language in Children: A State-of-the-Art Review
by Maria Chiara Pino, Marco Giancola and Simonetta D’Amico
Children 2023, 10(5), 801; https://doi.org/10.3390/children10050801 - 28 Apr 2023
Cited by 8 | Viewed by 10157
Abstract
Music and language are two complex systems that specifically characterize the human communication toolkit. There has been a heated debate in the literature on whether music was an evolutionary precursor to language or a byproduct of cognitive faculties that developed to support language. [...] Read more.
Music and language are two complex systems that specifically characterize the human communication toolkit. There has been a heated debate in the literature on whether music was an evolutionary precursor to language or a byproduct of cognitive faculties that developed to support language. The present review of existing literature about the relationship between music and language highlights that music plays a critical role in language development in early life. Our findings revealed that musical properties, such as rhythm and melody, could affect language acquisition in semantic processing and grammar, including syntactic aspects and phonological awareness. Overall, the results of the current review shed further light on the complex mechanisms involving the music-language link, highlighting that music plays a central role in the comprehension of language development from the early stages of life. Full article
(This article belongs to the Special Issue How to Contribute to the Language and Communication Development of Children and Adolescents)
13 pages, 940 KiB  
Article
Optimizing Fine Motor Coordination, Selective Attention and Reaction Time in Children: Effect of Combined Accuracy Exercises and Visual Art Activities
by Mohamed Frikha and Raghad Saad Alharbi
Children 2023, 10(5), 786; https://doi.org/10.3390/children10050786 - 27 Apr 2023
Cited by 8 | Viewed by 6255
Abstract
Optimizing fine motor coordination and cognitive abilities in middle childhood through new intervention programs remains one of the most essential orientations in motor development and skills proficiency. The present study aims to identify the effect of a structure-based program intervention, combining motor accuracy [...] Read more.
Optimizing fine motor coordination and cognitive abilities in middle childhood through new intervention programs remains one of the most essential orientations in motor development and skills proficiency. The present study aims to identify the effect of a structure-based program intervention, combining motor accuracy exercises with visual art activities (ceramics, pottery, and creations using raw materials), on fine motor coordination, selective attention, and reaction time in middle childhood. Sixty, right-handed typically developed male schoolchildren (age = 8.29 ± 0.74 years; body height = 130.25 ± 0.05 cm and body mass = 29.83 ± 4.68 kg; mean ± SD) volunteered to participate in the study. They were randomly assigned to a combined group intervention (MG) receiving a mixed program integrating visual art activities and motor accuracy exercises; an accuracy group intervention (AG) receiving oriented motor accuracy exercises; and a control group (CG). Selective attention, reaction time, and fine motor coordination skills (accuracy: darts throw; manual dexterity: grooved pegboard test) were measured. Repeated measure ANOVA, one-way ANOVA, and Kruskal–Wallis ANOVA were performed for analysis. The results showed higher changes in MG compared to AG in manual dexterity (p < 0.001), in motor accuracy (p < 0.001), and in reaction time (p < 0.01), but not in selective attention (p = 0.379). In addition, higher changes were recorded in AG compared to CG in motor accuracy (p < 0.05), reaction time (p < 0.05), and in selective attention (p < 0.01), but not in manual dexterity (p = 0.082). The structured combined program best assists accuracy, manual dexterity, reaction time, and selective attention. Therefore, instructors in sports academies and teachers at schools are advised to use the combined program in the training sessions and in the non-curricular activities, respectively, to improve fine motor coordination, selective attention, and reaction time in middle childhood. Full article
(This article belongs to the Special Issue Childhood Physical Activity and Health)
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11 pages, 286 KiB  
Review
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 6942
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  
Article
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 10 | Viewed by 8711
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  
Review
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 3483
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  
Article
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 11 | Viewed by 3266
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  
Brief 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 11 | Viewed by 2415
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  
Article
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 12 | Viewed by 4838
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  
Article
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 9 | Viewed by 2138
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  
Article
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 13 | Viewed by 3323
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  
Review
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 15 | Viewed by 4741
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  
Article
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 10 | Viewed by 4073
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  
Article
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 13 | Viewed by 4248
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  
Article
Maturity-Related Variations in Morphology, Body Composition, and Somatotype Features among Young Male Football Players
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 10 | Viewed by 3500
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  
Article
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 20 | Viewed by 3290
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  
Review
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 6392
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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