Pediatric Reports

6 pages, 762 KB

Open AccessCase Report

Rapid Clinical Response to Omalizumab Treatment in Pediatric Acute Urticaria Associated with Mycoplasma Infection: A Two-Case Report

by Zhen-Li Wu, Yi-Siang Huang, Chien-Ting Chiang and Hong-Ren Yu

Pediatr. Rep. 2026, 18(1), 2; https://doi.org/10.3390/pediatric18010002 - 19 Dec 2025

Abstract

Background and Clinical Significance: Urticaria in children is generally self-limiting, and infections are a significant trigger. While anti-IgE therapy (Omalizumab) is approved for chronic spontaneous urticaria (CSU) in adolescents and adults, its role in treating acute urticaria, particularly in children, is not [...] Read more.

Background and Clinical Significance: Urticaria in children is generally self-limiting, and infections are a significant trigger. While anti-IgE therapy (Omalizumab) is approved for chronic spontaneous urticaria (CSU) in adolescents and adults, its role in treating acute urticaria, particularly in children, is not well defined. Case Presentation: We present two pediatric cases of acute urticaria associated with Mycoplasma pneumoniae infection. Both cases were refractory to antihistamines and corticosteroids but showed rapid response with anti-IgE treatment. Conclusions: This is the first case report in the literature of pediatric acute urticaria treated with Omalizumab. These cases suggest a potential role for IgE-mediated pathways in acute urticaria related to Mycoplasma infection and raise the question of broader applications for Omalizumab beyond CSU. Full article

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16 pages, 1371 KB

Open AccessArticle

A Clinical Prediction Model for Genetic Risk in Children with GDD/ID: A Retrospective Study

by Yunshu Jiang, Ran Chen, Mengyin Chen, Luting Peng, Yuchen Zhao, Rong Li and Xiaonan Li

Pediatr. Rep. 2026, 18(1), 1; https://doi.org/10.3390/pediatric18010001 - 19 Dec 2025

Abstract

Objectives: Global Developmental Delay (GDD) and Intellectual Disability (ID) are prevalent neurodevelopmental disorders with significant disability burden, and genetic factors play a crucial role in their etiology. This study aimed to develop and validate a clinical prediction model for identifying children with GDD/ID [...] Read more.

Objectives: Global Developmental Delay (GDD) and Intellectual Disability (ID) are prevalent neurodevelopmental disorders with significant disability burden, and genetic factors play a crucial role in their etiology. This study aimed to develop and validate a clinical prediction model for identifying children with GDD/ID at high genetic risk, facilitating targeted genetic testing. Methods: We retrospectively analyzed clinical data of children with GDD/ID treated at Nanjing Children’s Hospital from January 2019 to December 2023. Children with comorbid Autism Spectrum Disorder (ASD) were excluded. The dataset was randomly split into training and validation sets (7:3 ratio). Lasso regression was used to identify potential predictive factors for positive genetic test results, followed by multivariable logistic regression to select independent predictors, which were incorporated into a nomogram. Model performance was evaluated by discrimination, calibration, and clinical utility using decision curve analysis in both sets. Results: Four independent predictors—craniofacial abnormalities, visceral abnormalities, physical growth abnormalities, and family history of ID—were identified. The resulting nomogram demonstrated an area under the curve (AUC) of 0.734., with good calibration and positive net benefit on decision curve analysis. Validation confirmed the reliability of the model. Conclusions: We developed a clinically applicable prediction model to identify high genetic risk among children with GDD/ID without ASD. This model may serve as a preliminary screening tool to assist clinicians in prioritizing genetic testing and improving diagnostic efficiency in clinical practice. Full article

(This article belongs to the Special Issue Feature Papers on Child Developmental Disorders and Neurology Research)

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8 pages, 859 KB

Open AccessBrief Report

Feasibility and Early Experience with Pediatric Open Access Endoscopy: A Pilot Study

by Monique T. Barakat, Dorsey M. Bass and Roberto Gugig

Pediatr. Rep. 2025, 17(6), 134; https://doi.org/10.3390/pediatric17060134 - 17 Dec 2025

Abstract

Background: Open access endoscopy (OAE) allows outpatient endoscopic procedures without prior consultation with the endoscopist, a practice common in adult gastroenterology but not part of pediatric gastroenterology practice. Here we evaluate the feasibility and safety of a newly implemented pediatric OAE program. Methods: [...] Read more.

Background: Open access endoscopy (OAE) allows outpatient endoscopic procedures without prior consultation with the endoscopist, a practice common in adult gastroenterology but not part of pediatric gastroenterology practice. Here we evaluate the feasibility and safety of a newly implemented pediatric OAE program. Methods: We identified patients aged 18 and under who underwent OAE in the first year of our program using a prospectively maintained endoscopy database. The program involved three experienced endoscopists and included demographics, indications, interventions, and adverse events. Patients/parents received follow-up calls on day 1 and day 7 to detect adverse events and assess perceptions of the OAE process. Results: A total of 54 outpatient OAE procedures were performed, with a median patient age of 10 years (range 18 months–18 years). This included 33 esophagogastroduodenoscopies (EGDs) and 16 colonoscopies, all with biopsies. ERCPs were performed for stone management (4) and stricture evaluation/stent exchange (1). All procedures were successful with no adverse events reported, and patient/parent feedback indicated that the OAE approach was beneficial in terms of lifestyle, socioeconomic, and psychological aspects. Some challenges were identified through follow-up discussions. Conclusions: Our early experience suggests that pediatric OAE is feasible and appeared safe within this small pilot cohort, with no adverse events observed. Advantages of pediatric OAE include minimizing missed school days and reducing medical anxiety. Feedback has led to refinements in practice at our institution, and further study on OAE is warranted at the endoscopy society level. Larger studies are needed to determine safety, effectiveness, and generalizability. Full article

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11 pages, 944 KB

Open AccessArticle

C-Reactive Protein Levels of Healthy Term Infants Born After Prolonged Rupture of Membranes

by Anders Batman Mjelle, Vilde Solberg, Emma Rød, Eydís Oddsdóttir Stenersen, Håvard Tetlie Garberg, Per Arne Tølløfsrud, Arild Rønnestad and Anne Lee Solevåg

Pediatr. Rep. 2025, 17(6), 133; https://doi.org/10.3390/pediatric17060133 - 5 Dec 2025

Abstract

Background/Objective: Even in the absence of infection, prolonged rupture of membranes (PROM) has been associated with elevated neonatal C-reactive protein (CRP). As both the sensitivity and specificity of CRP in predicting early-onset neonatal sepsis (EOS) may be low, we aimed to describe CRP [...] Read more.

Background/Objective: Even in the absence of infection, prolonged rupture of membranes (PROM) has been associated with elevated neonatal C-reactive protein (CRP). As both the sensitivity and specificity of CRP in predicting early-onset neonatal sepsis (EOS) may be low, we aimed to describe CRP levels during the first 36 h of life in term infants born after PROM ≥ 24 h. Methods: CRP was measured at 1, 12, and 36 h. Descriptive statistics and correlation analyses were performed, taking gestational age, birth weight, sex, delivery mode, and antibiotic treatment into account. Reference CRP values in healthy neonates without sepsis born after PROM were established. Results: Median (range) CRP was 0 (0–62) mg/L, 0 (0–82) mg/L, and 4 (0–92) mg/L at 1, 12, and 36 h, respectively. CRP at 12 and 36 (p < 0.001) but not 1 h was positively correlated with gestational age and birth weight. There was no difference in CRP after C-section vs. vaginal delivery. Among infants without sepsis, CRP was higher at all time points in infants who did vs. those who did not receive antibiotics (p < 0.001). Conclusions: CRP was low in term infants without sepsis born after PROM but with outliers above 60, 80, and 90 mg/L after 1, 12, and 36 h, respectively. Research is needed on the long-term outcomes of infants with inflammation, as evidenced by an elevated CRP after PROM. Full article

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8 pages, 586 KB

Open AccessOpinion

Malignancy Ratio in Pediatric Patients with Hereditary Multiple Exostoses: True Association or Reporting Bias?

by Francesco Fabrizio Comisi, Andrea Maria Comisi, Elena Esposito and Salvatore Savasta

Pediatr. Rep. 2025, 17(6), 132; https://doi.org/10.3390/pediatric17060132 - 3 Dec 2025

Abstract

Background: Hereditary Multiple Exostoses (HME) is a rare autosomal dominant skeletal disorder resulting from loss-of-function variants in the EXT1, EXT2, or EXT3 genes. While malignant transformation into chondrosarcoma is well documented, the incidence and characterization of non-skeletal malignancies in HME remain [...] Read more.

Background: Hereditary Multiple Exostoses (HME) is a rare autosomal dominant skeletal disorder resulting from loss-of-function variants in the EXT1, EXT2, or EXT3 genes. While malignant transformation into chondrosarcoma is well documented, the incidence and characterization of non-skeletal malignancies in HME remain poorly defined. Objective: We aimed to comprehensively review the literature for reported cases of non-skeletal malignancies in individuals with HME and evaluate a potential association with hematologic cancers, particularly in the pediatric population. Methods: An extensive literature search was conducted in the PubMed database up to August 2025 using search terms related to HME and malignancy. Eligible reports included case descriptions of non-skeletal cancers occurring in patients with confirmed or suspected HME. Extracted data included patient age, sex, cancer type, and available genetic or molecular findings. Results: Thirteen cases of non-skeletal malignancies associated with HME were identified. Fewer than half underwent molecular genetic testing. Six cases occurred in pediatric patients, four of which involved hematologic malignancies, three leukemias and one Burkitt lymphoma. In adults, malignancies affected a range of organ systems, including respiratory, gastrointestinal, nervous, and endocrine. A marked male predominance was observed (11 males vs. 2 females). Conclusions: Although a definitive causal relationship cannot be established, hematologic malignancies in pediatric HME patients appear to be disproportionately represented among reported cases. This finding highlights the need for further investigation through large-scale, population-based studies incorporating both clinical and genetic data. Full article

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Graphical abstract

16 pages, 432 KB

Open AccessBrief Report

Early Upper Limb Function in Infants Under Three Months: Associations with Shoulder Biomechanics and General Movement Patterns

by Lucía Fernanda Flores-Santy, Daniela Celi-Lalama and Juan Pablo Hervás-Pérez

Pediatr. Rep. 2025, 17(6), 131; https://doi.org/10.3390/pediatric17060131 - 3 Dec 2025

Abstract

Early identification of neurodevelopmental trajectories is essential for timely intervention in infancy. While joint mobility is often seen as an indicator of motor capacity, its link to early functional performance remains unclear. This study examined whether active shoulder range of motion and the [...] Read more.

Early identification of neurodevelopmental trajectories is essential for timely intervention in infancy. While joint mobility is often seen as an indicator of motor capacity, its link to early functional performance remains unclear. This study examined whether active shoulder range of motion and the quality of spontaneous movement quality relate to early upper limb function in infants under three months. Thirty-two healthy infants participated in a cross-sectional assessment. Video recordings analyzed with the General Movements Assessment classified movements as Fidgety or Writhing. Fine motor performance was evaluated using five items from the Denver II Screening Test. Active shoulder abduction was measured via two-dimensional frontal-plane analysis with Kinovea^®. Data analysis involved t-tests and Pearson correlations. Results showed that infants with Fidgety movements scored higher on fine motor tests than those with Writhing movements. Shoulder range of motion was slightly higher in infants with Writhing movements, but not significantly. No sex differences were found. Weak, nonsignificant correlations existed between shoulder range of motion and fine motor performance. The findings suggest movement quality, rather than limb mobility, is more connected to early motor function. Combining movement quality assessments with simple tests may improve early detection of subtle neuromotor issues and guide early stimulation strategies. Full article

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Graphical abstract

17 pages, 255 KB

Open AccessArticle

Early Childhood Oral Health: Insights into Knowledge, Preventive Practices, and Risk Awareness from a Croatian Cross-Sectional Study

by Marija Matijević, Marija Badrov, Lidia Gavić and Antonija Tadin

Pediatr. Rep. 2025, 17(6), 130; https://doi.org/10.3390/pediatric17060130 - 3 Dec 2025

Abstract

Aim: Early childhood caries (ECC) is a widespread and multifactorial oral disease that affects children globally. Parents’ knowledge, attitudes, and behaviors are crucial in preventing ECC and supporting oral health. This study evaluated Croatian parents’ understanding of children’s oral health, their awareness of [...] Read more.

Aim: Early childhood caries (ECC) is a widespread and multifactorial oral disease that affects children globally. Parents’ knowledge, attitudes, and behaviors are crucial in preventing ECC and supporting oral health. This study evaluated Croatian parents’ understanding of children’s oral health, their awareness of ECC risk factors, and their oral hygiene practices. Materials and methods: A cross-sectional study was conducted using an anonymous and voluntary online questionnaire from October to December 2024 among 948 parents of children aged 1–7 years across Croatia. The study assessed parents’ knowledge of oral health, their understanding of the relationship between risk factors and early childhood caries, habits related to oral hygiene care, children’s experiences with oral health problems, parents’ self-assessment of their knowledge, as well as both their own and their children’s general and oral health and hygiene practices. Data were analyzed using descriptive statistics, Chi-square test, Mann–Whitney U test, and Kruskal–Wallis test. Results: Overall parental knowledge was moderate, with significantly higher scores among older parents, those with university education, healthcare workers, and families with higher incomes (p < 0.05). Parents demonstrated good awareness of the importance of supervising tooth brushing until age seven (93.8%) and fluoride use (81.8%); yet gaps persisted regarding bacterial transmission, tooth eruption, and early orthodontic evaluation. Preventive dental visits were frequently delayed, and only 25.0% of parents reported using interdental cleaning aids. Caries was the most common oral health issue among children (22.3%). Conclusions: Despite moderate awareness and some adherence to preventive measures, significant knowledge and practice gaps remain among Croatian parents. Targeted educational interventions and nationwide preventive strategies are necessary to strengthen oral health literacy and reduce ECC prevalence. Full article

15 pages, 936 KB

Open AccessArticle

Parental Knowledge and Acceptance of Pediatric Lumbar Puncture in Northern Saudi Arabia: Implications for Clinical Practice and Education: A Cross-Sectional Study

by Dana Faez K. Alenezi, Rahaf Maqil T. Alanazi, Fai Fihat S. Almatrafi, Reema Mubarak O. Alanazi, Nouf Swilim K. Alenezy, Dalia Aqeel J. Alanazi, Shahad Wadi A. Alanazi, Rahaf Salman Z. Alanazi, Ayman Hamed Alenezi, Baraah Abu Alsel, Hanaa E. Bayomy, Safya E. Esmaeel and Manal S. Fawzy

Pediatr. Rep. 2025, 17(6), 129; https://doi.org/10.3390/pediatric17060129 - 2 Dec 2025

Abstract

Background/Objectives: Lumbar puncture (LP) remains a vital pediatric procedure for diagnosing neurological and systemic conditions. Despite its clinical significance, parental hesitation to authorize pediatric LP often impedes early diagnosis and care. This study aims to evaluate parental knowledge and attitudes regarding pediatric [...] Read more.

Background/Objectives: Lumbar puncture (LP) remains a vital pediatric procedure for diagnosing neurological and systemic conditions. Despite its clinical significance, parental hesitation to authorize pediatric LP often impedes early diagnosis and care. This study aims to evaluate parental knowledge and attitudes regarding pediatric LP in the Northern Border Region of Saudi Arabia, offering insights to inform targeted education strategies. Methods: A cross-sectional survey was conducted between February and August 2025 using a validated online questionnaire distributed via social media. The survey captured sociodemographic data and assessed awareness and attitudes toward pediatric LP. Univariate and multivariate logistic regression analyses examined factors associated with knowledge and consent. Results: Among 703 respondents, 60.6% were mothers and 95.6% were Saudi nationals. While 64.6% acknowledged the importance of aseptic technique, just 38.1% considered LP a safe practice. Knowledge levels were highest in parents aged 18–25 years (p < 0.001). Physician recommendation was the key factor in parental consent (87.0%), with 59.2% willing to approve the procedure following advice. Parents aged 26–35 years showed greater acceptance (OR = 1.54, 95% CI: 1.02–2.32, p = 0.04), whereas those older than 46 years were less receptive (OR = 0.51, 95% CI: 0.30–0.86, p = 0.01). Conclusions: Overall, parental knowledge regarding pediatric LP is limited. Targeted health education campaigns are needed to improve parental understanding of the procedure’s safety, importance, and benefits. Full article

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16 pages, 1653 KB

Open AccessCase Report

Immunological Profile in Atypical Kawasaki Disease: A Case Report Highlighting the Diagnostic Utility of Cytokine Analysis by qRT-PCR

by Margarita L. Martinez-Fierro, Idalia Garza-Veloz, Felipe D. Marrufo-Garcia, Manuel Gonzalez-Plascencia, Rocio C. Calderon-Zamora, Claudia Sifuentes-Franco and Monica Rodriguez-Borroel

Pediatr. Rep. 2025, 17(6), 128; https://doi.org/10.3390/pediatric17060128 - 1 Dec 2025

Abstract

Background: Kawasaki Disease (KD) is an acute vasculitis affecting children under five years of age, with atypical presentations posing diagnostic challenges and a higher risk of coronary complications when untreated. Methods: We report on a 2-year-old girl with persistent fever, limb edema, erythema, [...] Read more.

Background: Kawasaki Disease (KD) is an acute vasculitis affecting children under five years of age, with atypical presentations posing diagnostic challenges and a higher risk of coronary complications when untreated. Methods: We report on a 2-year-old girl with persistent fever, limb edema, erythema, and non-purulent conjunctivitis, without cervical lymphadenopathy or the typical rash. Inflammatory markers were assessed, and a cytokine expression profile was obtained using qRT-PCR. Results: Laboratory analysis showed elevated C-reactive protein (11.1 mg/dL), high fibrinogen (468 mg/dL), borderline D-dimer (484 ng/mL), and a normal platelet count. The cytokine profile revealed marked upregulation of IFN-α, IFN-β, IFN-γ, IL-1α, IL-1β, IL-5, IL-8, and IL-12, with downregulation of IL-2 and IL-4, as well as low TNF-α levels. These findings, although not pathognomonic, were consistent with an inflammatory profile compatible with atypical KD, in which a preceding viral infection may have played a role, although causality cannot be established. Conclusions: This case highlights the diagnostic utility of cytokine profiling in suspected atypical KD, particularly when clinical criteria are incomplete. The integration of immunological data may aid in earlier recognition and therapeutic intervention, thereby helping to prevent cardiovascular sequelae. Cytokine analysis may serve as a promising adjunct for atypical KD diagnosis, although confirmation in larger cohorts is needed. Full article

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13 pages, 1331 KB

Open AccessCase Report

Two Rare Cases of Bilateral Diaphragmatic Paralysis in Neonates

by Sara Ronci, Chiara Maddaloni, Stefano Caoci, Stefano Pro, Daniela Longo, Andrea Conforti, Andrea Dotta and Francesca Campi

Pediatr. Rep. 2025, 17(6), 127; https://doi.org/10.3390/pediatric17060127 - 1 Dec 2025

Abstract

Diaphragmatic paralysis (DP) in neonates is a rare yet potentially life-threatening cause of respiratory distress, often resulting from obstetric trauma or cardiac surgery. This report presents two distinct cases of bilateral DP: one following a dystocic delivery with associated brachial plexus involvement, and [...] Read more.

Diaphragmatic paralysis (DP) in neonates is a rare yet potentially life-threatening cause of respiratory distress, often resulting from obstetric trauma or cardiac surgery. This report presents two distinct cases of bilateral DP: one following a dystocic delivery with associated brachial plexus involvement, and the other linked to a genetic mutation (SYNGAP1) in a neonate with no birth trauma. Diagnosis was established through imaging, fluoroscopy, electromyography, and genetic testing. In both cases, conservative management was initially pursued; however, due to persistent respiratory failure, invasive interventions were required. The first patient underwent bilateral diaphragmatic plication with favorable outcomes, while the second required tracheostomy due to poor response to non-invasive ventilation with good outcome. These cases highlight the diagnostic and therapeutic challenges of neonatal DP, emphasizing the need for individualized treatment strategies in the absence of standardized guidelines. Early diagnosis and a multidisciplinary approach are crucial to optimize respiratory outcomes and reduce complications from prolonged mechanical ventilation. Full article

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20 pages, 4364 KB

Open AccessArticle

Patterns of Segmental Strain of the Left Ventricle in Extremely Premature Infants

by Tatiana Chumarnaya, Evgeniya Gusarova, Natalya Kosovtsova, Svetlana Koltashova and Olga Solovyova

Pediatr. Rep. 2025, 17(6), 126; https://doi.org/10.3390/pediatric17060126 - 1 Dec 2025

Abstract

Extremely premature newborns are predisposed to cardiovascular complications due to a number of factors, including myocardial immaturity, hemodynamic changes, and iatrogenic effects. There are few studies on myocardial strain in extremely premature infants during the early neonatal period. The objective of study was [...] Read more.

Extremely premature newborns are predisposed to cardiovascular complications due to a number of factors, including myocardial immaturity, hemodynamic changes, and iatrogenic effects. There are few studies on myocardial strain in extremely premature infants during the early neonatal period. The objective of study was to assess the left ventricular (LV) segmental strain in extremely premature newborns during the early neonatal period by employing speckle-tracking echocardiography (STE). This prospective study examined 65 newborns with no signs of hemodynamic impairment during the first 72 h of life. The cohort had a range of birth weights (600–1500 g) and gestational ages (24–35 weeks). The peak strain in 18 LV segments during systole (peak S and time to peak S), and throughout the cardiac cycle (peak G and time to peak G), and during early systolic pre-stretch (peak P and time to peak P) were assessed in the longitudinal, circumferential, and radial directions. We obtained percentile tables of segmental strain characteristics in the longitudinal, circumferential, and radial directions. No dependence of segmental strain on the birth weight, gestational age, or arterial duct closure was found. A positive gradient of the longitudinal strain magnitude was observed from the base to the apex. The highest circumferential and radial strain were observed in LV septum. This study is the first to register and compare the longitudinal, circumferential, and radial LV strain using STE in extremely premature infants with no signs of hemodynamic disturbances during the first 72 h of life. Reference values for segmental strain were established. Full article

(This article belongs to the Special Issue Global Neonatal Screening: Expanding Horizons in Diagnostic Technologies)

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9 pages, 855 KB

Open AccessArticle

Influence of Neonatal Exposure to Hyperoxia on Skeletal Muscle in a Rat Model

by Kentaro Awata, Irena Santosa, Yoshiteru Arai, Mayu Nakagawa, Hiroki Suganuma and Hiromichi Shoji

Pediatr. Rep. 2025, 17(6), 125; https://doi.org/10.3390/pediatric17060125 - 14 Nov 2025

Abstract

Background/Objectives: Premature births below 32 weeks of gestation generally require respiratory oxygen support, leading to a relatively hyperoxic environment compared to in utero conditions. Transient hyperoxia exposure has been linked to an elevated risk of chronic lung disease and retinopathy of prematurity; [...] Read more.

Background/Objectives: Premature births below 32 weeks of gestation generally require respiratory oxygen support, leading to a relatively hyperoxic environment compared to in utero conditions. Transient hyperoxia exposure has been linked to an elevated risk of chronic lung disease and retinopathy of prematurity; however, its effects on skeletal muscles remain elusive. This study aimed to investigate the effects of hyperoxic exposure in rats as a model of premature infants receiving supplemental oxygen (30–60% O₂ for several weeks). We hypothesized that rats exposed to postnatal hyperoxia would exhibit muscle fiber atrophy and alterations in fiber type. Methods: We used a rat model in which newborns were exposed to 80% oxygen from birth until postnatal day 12. We assessed the gastrocnemius muscles of rat legs at 12 weeks. Results: Rats exposed to hyperoxia showed substantially increased protein expression of Atrogin-1, along with elevated levels of adipophilin, myogenic differentiation factor 1, and myogenin. No significant changes were observed in the expression of slow or fast myosin heavy chain proteins. However, myofiber size in the gastrocnemius muscle was reduced in the hyperoxia-exposed group compared to the control group. Conclusions: Thus, transient hyperoxia exposure during early life can impede skeletal muscle development, potentially extending into adulthood. Full article

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16 pages, 1853 KB

Open AccessSystematic Review

Minimally Invasive Versus Open Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis: Insights from an Updated Systematic Review and Meta-Analysis

by Amani N. Al-Ansari, Sagar Ahammed, Ahmed A. Sofy and Somaya Shokry Tawfik

Pediatr. Rep. 2025, 17(6), 124; https://doi.org/10.3390/pediatric17060124 - 10 Nov 2025

Abstract

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and [...] Read more.

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and safe alternative to the open technique. We aimed to compare the surgical outcomes of both approaches and determine which approach is superior to the other. Methods: We searched for relevant articles by searching Scopus, Web of Science, PubMed, and the Cochrane Library until January 2025. The Cochrane risk of bias tool was utilized to assess the quality of the clinical trials, whereas the ROBINS-I tool was used in the observational studies. Our primary outcomes were operation time, length of hospital stay, time needed for full feeding, incidence of incomplete pyloromyotomy, mucosal perforation, wound infection, postoperative vomiting, postoperative incisional hernia, postoperative seroma or hematoma formation, need for reoperation, and rate of conversion to P in the laparoscopic group. Results: We included 12 eligible articles that compared laparoscopic pyloromyotomy with open pyloromyotomy in infants with hypertrophic pyloric stenosis. Our analysis revealed comparable results for both procedures in terms of operation time (p = 0.83), hospitalization duration (p = 0.06), mucosal perforation (p = 0.49), postoperative complications such as vomiting (p = 0.10), incisional hernia (p = 0.60), seroma (p = 0.52), and reoperation rates (p = 0.17). Patients who underwent LP achieved full feeding in less time (p = 0.007) and had fewer wound infections (p = 0.01) compared to OP. However, the incidence of incomplete pyloromyotomy was lower in the OP group than in the LP group (p = 0.03). Conclusions: Both open and laparoscopic pyloromyotomy are effective for treating hypertrophic pyloric stenosis. The laparoscopic approach offers the advantages of a faster return to full feeding and lower wound infection rates but increases the risk of incomplete pyloromyotomy compared to the open technique. Surgeon preference and experience play crucial roles in surgical outcomes, provided that there is a thorough understanding of the benefits and limitations of both techniques. Full article

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12 pages, 994 KB

Open AccessCase Report

Clinical Experience with Inosine Pranobex in Pediatric Acute Respiratory Infections with Comorbidities: A Case Series from a Specialised Centre

by Peter Kunč, Jaroslav Fábry, Katarína Ištvánková, Renata Péčová and Miloš Jeseňák

Pediatr. Rep. 2025, 17(6), 123; https://doi.org/10.3390/pediatric17060123 - 10 Nov 2025

Abstract

Background: Acute respiratory infections (ARIs) pose a significant clinical challenge in paediatric populations, especially in children with comorbidities who may exhibit underlying immune dysregulation. Inosine pranobex (IP) is an immunomodulatory agent that enhances T-lymphocyte and Natural Killer (NK) cell function, offering a targeted [...] Read more.

Background: Acute respiratory infections (ARIs) pose a significant clinical challenge in paediatric populations, especially in children with comorbidities who may exhibit underlying immune dysregulation. Inosine pranobex (IP) is an immunomodulatory agent that enhances T-lymphocyte and Natural Killer (NK) cell function, offering a targeted therapeutic rationale for such cases. Objective: This study aimed to retrospectively describe the clinical characteristics, immunological profiles, and outcomes of paediatric patients with complex, PCR-confirmed viral ARIs and significant comorbidities, for whom adjunctive therapy with IP was initiated based on clinical judgment. Methods: This retrospective case series analysed data from 14 paediatric patients hospitalised at a specialised centre (National Institute of Paediatric Tuberculosis and Respiratory Diseases in Dolny Smokovec, Slovakia). Cases were selected based on PCR-confirmed viral ARI, a history of recurrent infections, significant comorbidities, and initiation of IP therapy. The indication for IP was guided by the treating physician in cases of severe, prolonged, or recurrent disease course, where immune dysregulation was suspected, often supported by prior immunophenotyping. Results: A frequent observation in this cohort was the presence of baseline cellular immune alterations with a frequent observation of baseline cellular immune alterations, most notably the depletion of natural killer (NK) cells. NK cell depletion was identified in half of the patients (7/14). Following the initiation of treatment regimens that included adjunctive IP, clinical stabilisation or improvement was observed in all 14 patients included in the study. The therapy was well tolerated, with no reported adverse events attributable to IP. Conclusions: This case series highlights the common presence of cellular immune alterations in children with complex ARIs. While the observational nature of this study precludes any conclusions about causality, the favourable clinical course, safety profile, and strong immunological rationale support the need for prospective controlled trials to evaluate the role of IP in this specific high-risk paediatric population. Full article

(This article belongs to the Special Issue Infectious Diseases in Children and Adolescents)

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11 pages, 309 KB

Open AccessArticle

Comparison of Serum Sodium Levels Following Intravenous Administration of Isotonic and Hypotonic Solutions in Young Children: A Randomized Controlled Trial

by Nisara Chongcharoen, Yupaporn Amornchaichareonsuk, Suwanna Pornrattanarungsi and Ornatcha Sirimongkolchaiyakul

Pediatr. Rep. 2025, 17(6), 122; https://doi.org/10.3390/pediatric17060122 - 6 Nov 2025

Abstract

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis. Methods: This double-blind, randomized controlled trial involved children aged 3 months to [...] Read more.

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis. Methods: This double-blind, randomized controlled trial involved children aged 3 months to 5 years who were admitted to a general ward between November 2020 and September 2022 and required IVF. We randomly assigned patients (1:1) to receive either an isotonic solution (D₅0.9%NaCl) or hypotonic solution (D₅0.45%NaCl). Serum electrolyte and venous blood gas levels were obtained at the time of IVF administration and 24 and 48 h after IVF administration. During this study, all participants were monitored for vital signs, body weight, fluid intake and output, and clinical symptoms of dysnatremia. Results: Totals of 69 and 68 patients received isotonic and hypotonic solutions, respectively. The mean age was 1.95 ± 1.25 years in the isotonic group and 1.91 ± 1.32 years in the hypotonic group. The initial degrees of dehydration and biochemical indicators were not different. The change in serum sodium level at 24 h was 2.97 (2.32–3.62) mmol/L in the isotonic group and 2.19 (1.54–2.84) mmol/L in the hypotonic group. In both groups, no significant hyponatremia nor hypernatremia occurred. The incidence of hyperchloremic metabolic acidosis was not different between the groups. Neither group showed any complications. Conclusions: Isotonic fluids may be a preferred option for IVFs in pediatric patients under 5 years of age with medical conditions on a general ward, especially within 24 h, due to their potential to better maintain serum sodium levels without increasing the risk of fluid overload or electrolyte complication. Full article

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25 pages, 12887 KB

Open AccessArticle

Spatial Epidemiology of Pediatric Cancer in Romania: A Decade of Persistence, Continuity, and Localized Hotspots (Temporal Trend 2008–2017)

by Iulia Daniela Nedelcu, Ion Andronache, Ioannis Liritzis, Helmut Ahammer, Herbert Franz Jelinek, Andreea Karina Gruia, Daniel Peptenatu and Marko Radulovic

Pediatr. Rep. 2025, 17(6), 121; https://doi.org/10.3390/pediatric17060121 - 5 Nov 2025

Abstract

Objective: Pediatric cancer, though less prevalent than adult malignancies, constitutes a significant public health concern due to its long-term effects on survival, development, and quality of life. This study aimed to investigate spatial patterns and temporal trends of pediatric cancer in Romania over [...] Read more.

Objective: Pediatric cancer, though less prevalent than adult malignancies, constitutes a significant public health concern due to its long-term effects on survival, development, and quality of life. This study aimed to investigate spatial patterns and temporal trends of pediatric cancer in Romania over a ten-year period (2008–2017), identifying persistent and emerging geographic hotspots using Geographic Information Systems (GIS)–based modelling and spatial statistics. Methods: A national pediatric cancer registry provided by the Ministry of Health was analyzed for cases among individuals aged 0–18 years, categorized by administrative-territorial units (ATUs), ICD-10 codes, sex, and year. Spatial indicators of persistence (recurrent prevalence across multiple years) and continuity (uninterrupted recurrence) were computed. Hotspot analysis was conducted using Local Moran’s I, and trend patterns were assessed through temporal modeling. Additionally, fractal and complexity metrics were applied to characterize the spatial structure and heterogeneity of cancer persistence and continuity across regions. Results: Although national pediatric cancer prevalence exhibited a modest decline from 3.57‰ in 2008 to 3.44‰ in 2017, GIS-based spatial modeling revealed stable high-risk clusters in Central and South-Eastern Romania, particularly in historically industrialized counties such as Hunedoara, Prahova, and Galați. These correspond to regions with past heavy industry and chemical pollution. Male children presented a higher frequency of malignant tumors (48,502 cases in males vs. 36,034 in females), while benign and uncertain-behavior neoplasms increased more prominently among females (from 3847 to 4116 cases, compared with 3141 to 3199 in males). Several rural localities showed unexpected prevalence spikes, potentially associated with socioeconomic deprivation, limited health literacy, and reduced access to pediatric oncology services. Regional disparities in diagnostic and reporting capacities were also evident. Conclusion: GIS-based spatial epidemiology proved effective in revealing localized, sex-specific, and persistent disparities in pediatric cancer across Romania. The integration of spatial indicators and complexity metrics into national cancer control programs could strengthen early detection, optimize resource allocation, and reduce health inequities. These findings highlight the value of combining geospatial analysis and fractal modeling to guide evidence-based public health strategies for pediatric oncology. Full article

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13 pages, 898 KB

Open AccessArticle

Healthcare and School Professionals’ Satisfaction with Implementation of Finnish Smart Family Practice in Poland

by Justyna Nowak, Agata Szymczak, Marta Morawska, Heli Kuusipalo, Emma Koivurinta, Kati Kuisma, Päivi Mäki, Taina Sainio, Nella Savolainen and Katarzyna Brukało

Pediatr. Rep. 2025, 17(6), 120; https://doi.org/10.3390/pediatric17060120 - 5 Nov 2025

Abstract

Background: Poland is one of six countries implementing the Finnish Smart Family practice under the Joint Action Health4EUKids, aimed at supporting families in adopting lifestyle counseling methods and preventing childhood obesity across the European Union. Material and method: Since March 2024, Poland has [...] Read more.

Background: Poland is one of six countries implementing the Finnish Smart Family practice under the Joint Action Health4EUKids, aimed at supporting families in adopting lifestyle counseling methods and preventing childhood obesity across the European Union. Material and method: Since March 2024, Poland has implemented Smart Family tools through training sessions for professionals who work or will work with families of children with excess body weight. A total of 295 individuals have been trained, including 52.2% dietitians, 34.9% nurses, and 12.9% school staff such as teachers, school counselors, and psychologists. Before and after the training sessions, participants completed a survey assessing their knowledge of the Smart Family Practice, and familiarity with supportive tools. Results: Among 295 participants, nearly half reported no prior experience with family-based lifestyle change interventions. Post-training, over 70% expressed readiness to implement the SMART FAMILY method, with high interest (80.7%), motivation (76.5%), and satisfaction (83.6%). Most recognized its potential to support healthy lifestyles and parental engagement (>85%). Key barriers included lack of family cooperation (87.8%), staff shortages (81.0%), limited training (78.4%), and insufficient resources (43%). Conclusions: A high level of acceptance and motivation among participants indicates that the SMART FAMILY method has the potential for effective adaptation in Poland. Its implementation requires strengthening specialists’ skills and providing appropriate organizational resources. Overcoming barriers such as lack of experience, limited time, and difficulties in engaging families is crucial to achieving lasting intervention outcomes. Full article

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12 pages, 216 KB

Open AccessArticle

Implementation of an Early Mobility Initiative in a Pediatric Bone Marrow Transplant Unit

by Anne Swanson, Kylie James, Kimberly Fan, Akshay Sharma, Xiaomeng Yuan, Haitao Pan, Gabriela Maron, Hana Hakim and Saad Ghafoor

Pediatr. Rep. 2025, 17(6), 119; https://doi.org/10.3390/pediatric17060119 - 5 Nov 2025

Abstract

Background/Objectives: Children who have received hematopoietic cell transplants (HCTs) often face complex clinical courses and complications that increase their risk of functional impairments. Because of this, pediatric HCT recipients may benefit from early mobilization efforts to reduce long-term functional issues. However, early ambulation [...] Read more.

Background/Objectives: Children who have received hematopoietic cell transplants (HCTs) often face complex clinical courses and complications that increase their risk of functional impairments. Because of this, pediatric HCT recipients may benefit from early mobilization efforts to reduce long-term functional issues. However, early ambulation can be limited by clinical complexity and concerns about infectious transmission in HCT patients. Some patients are under contact precautions due to colonization with bacteria that produce extended-spectrum beta-lactamase (ESBL) enzymes. Our goal was to significantly increase ambulation in pediatric HCT recipients at our institution within three months of the intervention. We aimed to raise the number of ambulation events per day, the number of physical therapy (PT) visits per week, and the distance patients walked with PT per session. Methods: From January to October 2022, data on mobilization, demographics, and clinical characteristics were retrospectively collected from electronic health records. Starting in June 2022, we permitted ESBL-colonized patients to leave their rooms while wearing personal protective equipment (PPE), and we trained clinical staff about this in our QI initiative. Results: In Group 1, the ambulation rate was 1.36 times higher before the intervention than after, with an effect size of 0.3042 (p = 0.004 *). The ambulation rate in Group 2, admitted before the intervention, was 1.33 times higher than in Group 3, admitted after the intervention, with an effect size of 0.2856 (p = 0.016 *). Conclusions: The initiative did not increase ambulation among the targeted group. Patients ambulated more before the intervention, though these results lack statistical power. The lack of success of the intervention may be due to various factors, including the short monitoring period, retrospective data collection, difficulties with PPE use among young patients, and uncollected confounding variables related to clinical status. Full article

12 pages, 247 KB

Open AccessArticle

Exploring the Association Between Medically Assisted Reproduction and Autism Spectrum Disorder: Clinical Correlations from a Retrospective Cohort

by Federica Gigliotti, Maria Eugenia Martelli, Silvia Foglietta, Alessia Balestrini and Carla Sogos

Pediatr. Rep. 2025, 17(6), 118; https://doi.org/10.3390/pediatric17060118 - 4 Nov 2025

Abstract

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. [...] Read more.

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. This study aimed to compare the frequency of ART-conceived children between those diagnosed with ASD and those with other neurodevelopmental disorders (nASD), and to examine differences in prenatal, perinatal and medical histories of ART- and spontaneously (non-ART)-conceived children within an ASD group. Methods: We retrospectively analyzed data from 507 children with a neurodevelopmental disorders (NDDs) diagnosis, classified into ASD (n = 234) and nASD (n = 273) groups. Subsequent analyses focused on the ASD group, further divided into an ART and non-ART group according to the conception mode. Results: ART-conceived children were more frequent in the ASD group than in the nASD group. Moreover, within ASD, ART was significantly associated with potential risk factors such as twin pregnancy, cesarean delivery, low birth weight and parental age. Logistic Binary Regression confirmed these results, suggesting that ART co-occurs with a cluster of perinatal and familial risk factors. Conclusions: Our results indicate that ART is not an independent causal exposure; however, given the retrospective design and the absence of a general population control group, causal inference cannot be drawn. The observed association with ASD appears to be mediated by perinatal and parental variables. These findings underscore the importance of improving obstetric management and care, and ensuring early developmental monitoring for ART-conceived children. Full article

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