Pediatric Reports

14 pages, 967 KB

Open AccessPerspective

Toward Child-Centred Artificial Intelligence in Pediatric Emergency Medicine: A Perspective on Clinical Decision Support, Stakeholder Engagement and Education

by Lorenzo Gasparini, Nicola Gobbi, Daniele Zama and Marcello Lanari

Pediatr. Rep. 2026, 18(4), 91; https://doi.org/10.3390/pediatric18040091 (registering DOI) - 8 Jul 2026

Abstract

Artificial intelligence (AI) is increasingly recognized as a transformative technology in healthcare, with growing evidence supporting its applicability across time-critical clinical environments. This perspective aims to evaluate the integration of AI and machine learning (ML) into pediatric emergency departments (PEDs) across three core [...] Read more.

Artificial intelligence (AI) is increasingly recognized as a transformative technology in healthcare, with growing evidence supporting its applicability across time-critical clinical environments. This perspective aims to evaluate the integration of AI and machine learning (ML) into pediatric emergency departments (PEDs) across three core domains: clinical decision support, stakeholder engagement, and medical education. Within clinical decision support, ML architectures have demonstrated high predictive performance across several high-acuity clinical scenarios, including triage stratification, pediatric traumatic brain injury risk classification, early sepsis detection and clinical deterioration prediction, and dermatological assessment. Model interpretability and real-world implementability remain critical prerequisites for clinical adoption, with explainability methods representing fundamental instruments to enhance transparency and stakeholder trust. Regarding stakeholder engagement, the triadic dynamic among clinicians, caregivers, and patients defines a unique communication challenge in PEDs, with large language models (LLMs) showing preliminary utility; however, stakeholder-inclusive model validation and robust data privacy protections for minors remain key challenges, particularly regarding legal ambiguities of LLM deployment in clinical pipelines. In medical education, AI-driven simulation platforms and LLM-generated adaptive curricula represent promising tools for competency-based training across pediatric emergency scenarios. Future directions emphasize the imperative of prospective multicenter validation in pediatric-specific cohorts, rigorous data quality standards addressing conformance, completeness, and plausibility, and the development of pediatric-tailored governance frameworks. Real-world implementation will require the systematic involvement of all stakeholders—including children, caregivers, clinicians, developers, and institutions—as co-designers of equitable, transparent, and safe AI systems for this uniquely vulnerable population. Full article

(This article belongs to the Special Issue Artificial Intelligence in Pediatric Clinical Practice: Real-World Clinical Applications and Lessons Learned)

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27 pages, 3156 KB

Open AccessSystematic Review

The Effects of Digital Interventions on Language Development in Children with Autism Spectrum Disorder: A Systematic Review and Interdisciplinary Synthesis

by Murat Demirekin and Hatice Yalçın

Pediatr. Rep. 2026, 18(4), 90; https://doi.org/10.3390/pediatric18040090 (registering DOI) - 8 Jul 2026

Abstract

Background/Objectives: Digital technologies are increasingly used in interventions for children with Autism Spectrum Disorder (ASD) to support language development. However, existing evidence remains fragmented due to heterogeneity in intervention types, participant characteristics, and outcome measures. This systematic review aims to synthesize current empirical [...] Read more.

Background/Objectives: Digital technologies are increasingly used in interventions for children with Autism Spectrum Disorder (ASD) to support language development. However, existing evidence remains fragmented due to heterogeneity in intervention types, participant characteristics, and outcome measures. This systematic review aims to synthesize current empirical findings on the effects of digital interventions on language development in children with ASD and to identify key factors influencing intervention effectiveness. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, Web of Science, ERIC, and PsycINFO for studies published between 2010 and 2025. Eligible studies included experimental, quasi-experimental, and intervention-based designs involving children aged 2–18 years with ASD and reporting at least one language-related outcome. Data extraction was performed independently by two reviewers using a structured form. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist and CASP tools. Due to heterogeneity across studies, a narrative synthesis approach was applied. Results: A total of 61 studies met the inclusion criteria. Findings indicate that digital interventions generally have positive effects on language development in children with ASD, with stronger and more consistent outcomes in receptive and expressive language domains. Intervention effectiveness varied according to duration, intensity, content quality, and contextual factors such as family involvement and technological access. Conclusions: The evidence suggests that digital interventions may have positive effects on language development in children with ASD, particularly in receptive and expressive language domains. Among intervention types, video modeling and AI-supported approaches appear to show promising outcomes; however, these findings should be interpreted with caution due to the limited number of AI-focused studies and substantial heterogeneity in study designs, sample characteristics, and outcome measures. Gamified and mobile applications demonstrate moderate effects, especially in vocabulary and pragmatic language skills. Overall, intervention effectiveness varies according to duration, intensity, content quality, and contextual factors such as family involvement and technological access. Future research should prioritize standardized methodologies and longitudinal designs. Full article

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

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14 pages, 320 KB

Open AccessArticle

Children’s Internalizing Symptoms and Well-Being: The Role of Parental Anxiety and Health-Related Quality of Life

by Vasiliki Georgousopoulou, Georgios Manomenidis and Aspasia Serdari

Pediatr. Rep. 2026, 18(4), 89; https://doi.org/10.3390/pediatric18040089 - 6 Jul 2026

Abstract

Background. Children’s health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when [...] Read more.

Background. Children’s health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when parent-proxy reports are used. Methods. A cross-sectional study was conducted among 242 parents of children aged 8–12 years in Northern Greece. Parents completed proxy measures of children’s HRQoL and internalizing symptoms, as well as self-reported measures of their own HRQoL and anxiety. Nonparametric tests were used for bivariate analyses, and multiple linear regression was applied to identify independent predictors of children’s HRQoL. Results. Higher parental mental HRQoL was positively associated with children’s HRQoL (ρ = 0.213, p = 0.031), while parental anxiety (trait anxiety: ρ = −0.204, p = 0.004; state anxiety: ρ = −0.314, p < 0.001) and parent-reported child internalizing symptoms (depression: ρ = −0.369, p < 0.001; anxiety: ρ = −0.322, p < 0.001) were negatively associated with HRQoL; however, in the multivariable model, only parental mental HRQoL (B = 0.344, p = 0.020) and parental education (B = −2.944, p = 0.044) remained significantly associated with parent-proxy child HRQoL, explaining 29.2% of the variance in children’s HRQoL (R² = 0.292). Conclusions. The findings suggest that parent-proxy child HRQoL is associated with parental psychosocial functioning in this community-based sample. Parental mental HRQoL was the strongest independent correlate of parent-proxy child HRQoL. However, given the exclusive use of parent-proxy reports and the convenience-based sample, these findings should be interpreted cautiously, as shared method variance, rater-related effects, and limited generalizability may have contributed to the observed associations. Further multi-informant and longitudinal studies conducted in more diverse populations are warranted. Full article

(This article belongs to the Section Pediatric Psychology)

15 pages, 1161 KB

Open AccessArticle

Utilizing Machine Learning for Diagnostic Assistance of Pediatric Sepsis and Septic Shock in Resource-Limited Settings

by Kaden Bunch, Shamsun Nahar Shaima, Gazi Md. Salahuddin Mamun, Sai Gopal Jarabana, Monique Gainey, Abu Sayem Mirza Md. Hasibur Rahman, Alicia Genisca, Atin Jindal, Nidhi Kadakia, Monira Sarmin, Farzana Afroze, Adam C. Levine, Mohammod Jobayer Chisti and Stephanie Chow Garbern

Pediatr. Rep. 2026, 18(4), 88; https://doi.org/10.3390/pediatric18040088 - 3 Jul 2026

Abstract

Background: Sepsis is a leading cause of pediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries (LMICs). However, timely recognition of potential sepsis and access to healthcare resources needed to diagnose pediatric sepsis according to international guidelines are challenging in LMICs. [...] Read more.

Background: Sepsis is a leading cause of pediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries (LMICs). However, timely recognition of potential sepsis and access to healthcare resources needed to diagnose pediatric sepsis according to international guidelines are challenging in LMICs. This exploratory study aimed to develop machine learning (ML) models to detect pediatric sepsis and septic shock using a simplified set of clinical data contextualized for practical use in resource-limited settings. Methods: This was a secondary analysis of an observational study of 100 children with potential sepsis admitted to a non-profit referral hospital in Dhaka, Bangladesh. The outcomes were sepsis as defined by a Phoenix Sepsis Score (PSS) ≥ 2 and septic shock (sepsis plus PSS cardiovascular sub-score ≥ 1). Models were trained using either clinical + laboratory variables or clinical-only variables. A single 24 h worst-value assessment window was derived per patient; stratified 5-fold cross-validation was used to maintain class proportions across the training and test folds. Model performance was assessed using area under the precision–recall curve (AUPRC) and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CIs) derived from a 2000-resample patient-level bootstrap of out-of-fold classifications. Logistic regression coefficients were used to assess feature contributions. Results: For sepsis classification, the non-laboratory model achieved an AUPRC of 0.942 (95% CI: 0.884–0.979) and an AUROC of 0.945 (95% CI: 0.890–0.983), with comparable performance from the clinical + laboratory model (AUPRC 0.941, 95% CI: 0.880–0.981; AUROC 0.945, 95% CI: 0.881–0.986). For septic shock, AUROCs of 0.870 (95% CI: 0.761–0.952) and 0.878 (95% CI: 0.758–0.967) were observed. However, these estimates should be interpreted cautiously, given the low prevalence (23%) and absence of external validation. SpO₂:FiO₂ ratio, GCS, and systolic blood pressure were consistently strong predictors across models. Conclusions: ML models using pragmatic clinical variables demonstrate preliminary diagnostic performance, with the non-laboratory model showing discrimination comparable to models incorporating laboratory data. Logistic regression demonstrated the most stable performance and may represent an early proof of concept for assistive diagnostic support. However, these models are not clinically usable without external validation. These findings are hypothesis-generating; external validation in larger, independent cohorts is essential before any clinical use, particularly for septic shock. Full article

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10 pages, 492 KB

Open AccessBrief Report

Longitudinal Variability of Fecal Calprotectin in Preterm Newborns: A Prospective Cohort Study

by Mariana A. Polimeni Cavassin Jayme, Cristina Terumi Okamoto, Fernanda Tiemi Takei, Paula Haus de Oliveira, Eloisa Medeiros Nisihara and Renato Nisihara

Pediatr. Rep. 2026, 18(4), 87; https://doi.org/10.3390/pediatric18040087 - 1 Jul 2026

Abstract

Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of [...] Read more.

Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of ≤34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 µg/g in the first week to 65 µg/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population. Full article

(This article belongs to the Section Inborn Errors and Neonatal Screening)

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9 pages, 2051 KB

Open AccessCase Report

Intramural Duodenal Hematoma—A Rare Post-Endoscopy Complication in Pediatric Noonan Syndrome: A Case Report

by Mariusz Olczyk, Anna Socha-Banasiak, Natalia Lwow, Bartosz Waszczyk and Elżbieta Czkwianianc

Pediatr. Rep. 2026, 18(4), 86; https://doi.org/10.3390/pediatric18040086 - 27 Jun 2026

Abstract

Background: Noonan syndrome is a rare genetic disorder from the group of RASopathies, characterized by facial dysmorphism, congenital heart defects, hematologic abnormalities, and growth impairment. Case Presentation: We report the case of an 8-year-old girl with Noonan syndrome admitted for evaluation of abdominal [...] Read more.

Background: Noonan syndrome is a rare genetic disorder from the group of RASopathies, characterized by facial dysmorphism, congenital heart defects, hematologic abnormalities, and growth impairment. Case Presentation: We report the case of an 8-year-old girl with Noonan syndrome admitted for evaluation of abdominal pain and failure to thrive. Hematological evaluation before EGD did not identify contraindications to biopsy, and initial laboratory tests, including coagulation parameters, were normal. Several hours after upper gastrointestinal endoscopy, the patient developed abdominal pain and coffee-ground vomiting. Abdominal ultrasonography revealed an intramural duodenal hematoma (58 × 37 mm), which was confirmed and further characterized by computed tomography as an extensive, long-segment lesion involving the duodenum. Progressive anemia required transfusion of blood products. Conservative management, including nasogastric decompression, parenteral nutrition, and pharmacological treatment, was implemented. Despite the severity and prolonged clinical course, gradual clinical and radiological improvement was achieved, and the patient was discharged in good general condition after one month. Conclusions: Intramural duodenal hematoma is an extremely rare complication of upper gastrointestinal endoscopy with duodenal biopsy. This case highlights the importance of individualized assessment and close monitoring in patients with Noonan syndrome, and indicates that this complication should be considered early when abdominal pain, vomiting, or progressive anemia develops after the procedure, even when hematological evaluation and baseline coagulation parameters are reassuring. Full article

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10 pages, 1806 KB

Open AccessCase Report

Surgical Management of a Large Congenital Melanocytic Nevus of the Face—A Technical Case Report and Comparison with Classic and Novel Approaches

by Kostadin Gigov, Petra Kavradzhieva, Ivan Ginev, Mihaela Prandzheva and Mariya Miteva

Pediatr. Rep. 2026, 18(4), 85; https://doi.org/10.3390/pediatric18040085 - 25 Jun 2026

Abstract

Large congenital melanocytic nevi (LCMN) of the face can pose significant functional, esthetic, and psychosocial challenges in childhood. In selected patients, staged excision offers a practical reconstructive strategy when primary closure is not feasible without distortion of nearby facial landmarks. We report the [...] Read more.

Large congenital melanocytic nevi (LCMN) of the face can pose significant functional, esthetic, and psychosocial challenges in childhood. In selected patients, staged excision offers a practical reconstructive strategy when primary closure is not feasible without distortion of nearby facial landmarks. We report the management of a child with a facial LCMN using a planned multistage surgical approach aimed at lesion removal while preserving contour and minimizing scar burden. The lesion was excised sequentially over three procedures, with careful attention given to relaxed skin tension lines and facial esthetic units. When required, adjunctive reconstruction was performed to optimize closure and support tissue healing. This approach allowed a gradual reduction in the nevus, improved tissue accommodation, and avoidance of excessive tension on the surrounding skin. Postoperative recovery was uncomplicated, and the final esthetic outcome was satisfactory for both the patient and parents. Staged excision was selected over tissue expansion and skin grafting because it allowed progressive lesion reduction while preserving adjacent facial landmarks and minimizing donor-site morbidity. This technical case highlights the importance of individualized surgical planning, preservation of facial esthetic units, and staged scar placement when managing large facial congenital melanocytic nevi in pediatric patients. The educational value of the report lies in illustrating the decision-making process used to balance lesion removal, esthetic outcomes, and long-term surveillance in a challenging facial location. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of the Maxillofacial Region in Pediatric Patients)

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13 pages, 1083 KB

Open AccessArticle

Heterogeneous Renal Trajectories in Pediatric IgA Nephropathy: A Single-Center Experience Highlighting the Dynamic Nature of Early Disease

by John Dotis, Antonia Kondou, Vasiliki Karava, Maria Tsirevelou, Ioannis Koutras, Olympia Dadoudi, George Liapis, Despoina Tramma, Maria Stamou and Nikoleta Printza

Pediatr. Rep. 2026, 18(4), 84; https://doi.org/10.3390/pediatric18040084 - 23 Jun 2026

Abstract

Background/Objectives: Pediatric IgA nephropathy (IgAN) is often considered to have a favorable early course. However, its progression is variable, and the prognostic value of histopathological classifications, such as MEST-C, remains incompletely defined in children. This study aimed to characterize clinicopathological features and the [...] Read more.

Background/Objectives: Pediatric IgA nephropathy (IgAN) is often considered to have a favorable early course. However, its progression is variable, and the prognostic value of histopathological classifications, such as MEST-C, remains incompletely defined in children. This study aimed to characterize clinicopathological features and the early disease course in pediatric IgAN and to descriptively examine histopathological findings and clinical outcomes. Methods: This retrospective, single-center study included children with biopsy-confirmed IgAN diagnosed between 2016 and 2025. Clinical, laboratory, and histopathological data were collected, and biopsies were assessed using the Oxford MEST-C classification. Follow-up data, including estimated glomerular filtration rate (eGFR), were analyzed descriptively, with follow-up extending from diagnosis to early 2026. Results: Fourteen patients were included, showing heterogeneous clinical presentations. Mesangial hypercellularity was observed in all cases (100%), with frequent endocapillary hypercellularity (78.6%) and segmental sclerosis (57.1%), consistent with a predominance of active lesions. Over a median follow-up of approximately five years, renal function remained stable in 57.1% of patients, declined in 21.4%, and improved in 14.3%, indicating variability in renal function during follow-up and potential reversibility in a subset of patients. One patient (7.1%) developed severe acute kidney injury requiring temporary dialysis, followed by full recovery. Given the descriptive design and limited sample size, no conclusions regarding associations between histopathological findings and renal outcomes can be drawn. Conclusions: Within this small cohort, pediatric IgAN showed variable renal function courses ranging from stability to decline or partial recovery. These findings should be considered descriptive and hypothesis-generating, supporting longitudinal monitoring in larger pediatric cohorts. Full article

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19 pages, 1399 KB

Open AccessSystematic Review

Markerless Motion Capture for Human Movement Estimation Using Artificial Intelligence: A Systematic Review

by Georgina Domènech-Garcia, Xavier Marimon, Andoni Carrasco-Urribarren, Alejandro E. Portela and Caritat Bagur-Calafat

Pediatr. Rep. 2026, 18(4), 83; https://doi.org/10.3390/pediatric18040083 - 23 Jun 2026

Abstract

Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, [...] Read more.

Background: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. Objectives: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. Methods: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. Results: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. Conclusions: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice. Full article

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7 pages, 214 KB

Open AccessCommentary

When Platelet Stimulation Becomes Marrow Stress: Rethinking Thrombopoietin Receptor Agonist Intensification in Pediatric Immune Thrombocytopenia

by Maurizio Aricò

Pediatr. Rep. 2026, 18(3), 82; https://doi.org/10.3390/pediatric18030082 - 17 Jun 2026

Abstract

Thrombopoietin receptor agonists (TPO-RAs) have become central second-line treatments for children with persistent or chronic immune thrombocytopenia (ITP). Their efficacy has encouraged broad use, but difficult-to-treat patients who respond suboptimally may be exposed to repeated agent switching, prolonged treatment, or doses exceeding approved [...] Read more.

Thrombopoietin receptor agonists (TPO-RAs) have become central second-line treatments for children with persistent or chronic immune thrombocytopenia (ITP). Their efficacy has encouraged broad use, but difficult-to-treat patients who respond suboptimally may be exposed to repeated agent switching, prolonged treatment, or doses exceeding approved limits. This commentary uses a focused narrative approach to address whether the risk of treatment-associated marrow fibrosis should be interpreted primarily as a consequence of treatment duration or as a risk marker linked to supraphysiological treatment intensity in non-responders. A recent Haematologica report by Ma and colleagues identified clinically significant bone marrow myelofibrosis in a highly selected cohort of children with chronic ITP undergoing marrow re-evaluation after suboptimal response or loss of efficacy during TPO-RA therapy. The most relevant message is not simply that fibrosis can occur, but that it was independently associated with treatment intensification, particularly overdose and frequent switching. The biological plausibility of this association is supported by the known capacity of sustained megakaryocytic stimulation to promote local pro-fibrotic signaling and reticulin deposition. This commentary places this safety concern in the context of pediatric ITP epidemiology, current regulatory indications, expert approaches to refractory disease, and practical surveillance considerations. TPO-RAs should not be viewed as routine treatment for newly diagnosed pediatric ITP; their principal role remains in selected children with persistent or chronic disease who require second-line therapy. Failure to respond at the maximum approved dose should prompt diagnostic and therapeutic reassessment rather than automatic treatment escalation. The emerging lesson is that response-adapted therapy must also be risk-adapted therapy. Full article

13 pages, 490 KB

Open AccessArticle

Effects of White Noise on Academic Skills in Children with ADHD and Specific Learning Disorders: New Perspectives for Personalised Rehabilitation and Educational Intervention

by Elena Cavalieri, Emilia Cascio, Giada Iannone, Loredana Angelini, Giovanni Battista Dell’Isola, Claudio Maura, Raimondo Stefano Maria Torcisi, Elisa Macchione, Simona Lucibello, Alberto Verrotti and Federico Vigevano

Pediatr. Rep. 2026, 18(3), 81; https://doi.org/10.3390/pediatric18030081 - 11 Jun 2026

Abstract

Background/Objectives. This study examined whether exposure to white noise improves reading and writing performance in children with Specific Learning Disorder (SLD), with and without comorbid Attention-Deficit/Hyperactivity Disorder (ADHD). Methods. Thirty children aged 8–13 years (mean age = 9.4) with SLD, 12 of whom [...] Read more.

Background/Objectives. This study examined whether exposure to white noise improves reading and writing performance in children with Specific Learning Disorder (SLD), with and without comorbid Attention-Deficit/Hyperactivity Disorder (ADHD). Methods. Thirty children aged 8–13 years (mean age = 9.4) with SLD, 12 of whom also had ADHD, were recruited from the Centro di Riabilitazione San Raffaele Pisana (Rome). Each child completed two standardized reading and writing assessments, four weeks apart, under two auditory conditions (with vs. without white noise) in randomized order. The primary outcomes were reading speed and accuracy, while the secondary outcome was writing accuracy. Results. Among the 26 completers, white noise significantly improved nonword reading speed and accuracy, showed a trend toward improved passage-reading accuracy, and reduced accuracy in nonword writing. Benefits were different in children with SLD + ADHD compared to those with SLD only. Conclusions. These findings indicate task-specific effects of white noise and suggest potential applications for targeted educational interventions. Full article

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27 pages, 663 KB

Open AccessSystematic Review

Blended and Technology-Enhanced Education in Pediatric Emergency Nursing: A Systematic Review

by Rita Nocerino, Giorgia Cerase, Emma Montella and Albina Simeoli

Pediatr. Rep. 2026, 18(3), 80; https://doi.org/10.3390/pediatric18030080 - 11 Jun 2026

Abstract

Background: Pediatric emergencies are high-risk clinical situations requiring timely, accurate, and coordinated interventions. Nurses play a pivotal role in early recognition and management of acute pediatric conditions; however, the rarity and complexity of these events often limit clinical exposure and preparedness. Continuous professional [...] Read more.

Background: Pediatric emergencies are high-risk clinical situations requiring timely, accurate, and coordinated interventions. Nurses play a pivotal role in early recognition and management of acute pediatric conditions; however, the rarity and complexity of these events often limit clinical exposure and preparedness. Continuous professional education is therefore essential to ensure patient safety and high-quality care. Objective: This systematic review aimed to synthesize evidence on innovative continuing education strategies for nurses involved in pediatric emergency care, with a primary focus on studies evaluating educational effectiveness and a secondary contextual focus on studies describing training needs, perceived barriers, preparedness, and implementation conditions. Methods: The review was conducted according to PRISMA guidelines. The protocol was registered in PROSPERO (ID CRD420251120993). A comprehensive search of PubMed, CINAHL Complete, Scopus, and the Cochrane Library identified studies published between 2015 and August 2025. Primary intervention studies were used to assess educational effectiveness, whereas descriptive, observational, qualitative, and review-based evidence was retained as contextual evidence. Methodological quality was assessed using Joanna Briggs Institute (JBI) tools. Results: Forty-nine studies met the inclusion criteria, including randomized controlled trials, quasi-experimental studies, observational and cohort studies, and integrative or narrative reviews. Educational interventions mainly involved simulation-based training, blended learning, telesimulation, digital education, and structured training programs. Intervention studies suggested improvements in knowledge, technical skills, self-efficacy, and team performance, while contextual studies highlighted training needs, perceived barriers, preparedness, and implementation challenges. However, the evidence was limited by methodological heterogeneity, frequent reliance on self-reported outcomes, and limited long-term follow-up. Conclusions: Simulation-based, blended, and telesimulation-based educational strategies may be associated with short-term improvements in nurses’ preparedness and educational outcomes in pediatric emergency care. However, conclusions regarding effectiveness should be interpreted cautiously because of methodological heterogeneity, reliance on subjective outcomes, and limited evidence on long-term clinical and patient-safety outcomes. Full article

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16 pages, 895 KB

Open AccessCase Report

A Century of Post-Traumatic Appendicitis: A Comprehensive Review with an Illustrative Case

by Mattia Pasquinucci, Irene Marangoni, Veronica Battistella, Maria E. Pinto, Alessandra Pasinato, Fabio S. Chiarenza and Davide Meneghesso

Pediatr. Rep. 2026, 18(3), 79; https://doi.org/10.3390/pediatric18030079 - 10 Jun 2026

Abstract

Background and Clinical Significance: Acute appendicitis following blunt abdominal trauma is a rare and historically debated clinical entity. We present a century-spanning descriptive review of 106 cases of post-traumatic appendicitis, embedded with an illustrative pediatric case initially managed conservatively. Methods: A comprehensive literature [...] Read more.

Background and Clinical Significance: Acute appendicitis following blunt abdominal trauma is a rare and historically debated clinical entity. We present a century-spanning descriptive review of 106 cases of post-traumatic appendicitis, embedded with an illustrative pediatric case initially managed conservatively. Methods: A comprehensive literature review was conducted following PRISMA guidelines across PubMed/MEDLINE, Web of Science, and Google Scholar, encompassing a 100-year period (1925–2025). Clinical variables, trauma mechanisms, and outcomes were extracted and statistically analyzed by age cohort (Pediatric ≤ 18 vs. Adult > 18) and historical medical era. Results: A total of 106 cases were analyzed. High-energy trauma predominated in adults compared to the pediatric cohort (48.8% vs. 18.5%, p = 0.001). The overall complication rate was exceptionally high (66.0%), with no significant difference between pediatric and adult cohorts (61.5% vs. 73.2%, p = 0.293). An epoch-based analysis revealed a significant drop in perforation rates from the historical era (1925–1980) to the modern era (2001–2025) (51.7% to 27.0%, p = 0.033) due to improved diagnostic timelines. Crucially, purely mechanical injuries such as complete appendiceal auto-amputation remained a constant signature of blunt trauma across the century (11.5% overall rate). Conclusions: Our synthesis of historical cases suggests that post-traumatic appendicitis might be a relevant clinical entity where trauma mechanics appear to play a significant role in injury severity, irrespective of patient age. While conservative management could be feasible and safe in the acute setting of uncomplicated cases, we hypothesize that the initial kinetic impact might cause subtle structural changes or alter local appendiceal dynamics, potentially predisposing the organ to recurrent inflammation, warranting close follow-up or elective surgery. Full article

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13 pages, 634 KB

Open AccessArticle

A Coordinated Adhesion-Molecule Activation Profile in Pediatric Sepsis: A Prospective Cohort Study from Vietnam

by Bui Thanh Liem, Chu Van Thien, Nguyen Trong Nghia, Le Anh Phong, Ngo Nhu Dinh, Nguyen Huy Luan and Phung Nguyen The Nguyen

Pediatr. Rep. 2026, 18(3), 78; https://doi.org/10.3390/pediatric18030078 - 9 Jun 2026

Abstract

Background/Objectives: Pediatric sepsis is increasingly recognized as a syndrome involving immune–vascular dysregulation. However, most pediatric biomarker studies focus on individual molecules rather than coordinated patterns of leukocyte–endothelial activation. This study aimed to evaluate whether children diagnosed with sepsis within 48 h of admission [...] Read more.

Background/Objectives: Pediatric sepsis is increasingly recognized as a syndrome involving immune–vascular dysregulation. However, most pediatric biomarker studies focus on individual molecules rather than coordinated patterns of leukocyte–endothelial activation. This study aimed to evaluate whether children diagnosed with sepsis within 48 h of admission showed a coordinated soluble adhesion-molecule activation profile measured at enrollment. Methods: This prospective cohort study included 144 children aged 1–60 months with suspected infection enrolled at Dong Nai Children’s Hospital, Vietnam, from May 2021 to October 2022. Blood samples were collected at enrollment. Sepsis was classified according to the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria within 48 h of admission. Twelve soluble adhesion molecules were measured using a multiplex immunoassay. A composite adhesion activation score was derived by log2 transformation, z-score standardization, and averaging across the 12 markers. Principal component analysis (PCA) was used as an exploratory method to summarize the shared variation across the adhesion-molecule panel. C-reactive protein (CRP) was included as a routinely available inflammatory comparator. Results: Among 144 children, 32 (22.2%) were diagnosed with sepsis within 48 h of admission. Individual marker discrimination was strongest for L-selectin (area under the receiver operating characteristic curve [AUC] 0.883), followed by soluble vascular cell adhesion molecule-1 (sVCAM-1; AUC 0.855), intercellular adhesion molecule-3 (ICAM-3; AUC 0.838), P-selectin glycoprotein ligand-1 (PSGL-1; AUC 0.836), E-selectin (AUC 0.819), and intercellular adhesion molecule-2 (ICAM-2; AUC 0.819). CRP also differed between children with and without sepsis but had a lower AUC than the leading adhesion molecules in descriptive ROC analyses. The composite adhesion activation score was strongly associated with sepsis (odds ratio 7.95 per 1-standard deviation increase; 95% confidence interval 3.44–18.40; p < 0.001) and showed good discrimination (AUC 0.855; 95% confidence interval 0.776–0.931). The first principal component explained 70.0% of biomarker variance, consistent with coordinated elevation of correlated adhesion molecules. Conclusions: In this prospective Vietnamese pediatric cohort, children diagnosed with sepsis within 48 h of admission showed coordinated elevation of soluble adhesion molecules measured at enrollment. These findings support the biological relevance of leukocyte–endothelial activation in pediatric sepsis. However, the adhesion-molecule activation profile should be considered exploratory and hypothesis-generating, requiring external validation and further evaluation against simplified, clinically feasible biomarker approaches. Full article

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22 pages, 3120 KB

Open AccessSystematic Review

Efficacy and Safety of Umifenovir (Arbidol) in Children with Influenza-like Illnesses: A Systematic Review and Meta-Analysis

by Vilya Bulgakova, Artem Poromov, Irina Leneva and Natalia Pshenichnaya

Pediatr. Rep. 2026, 18(3), 77; https://doi.org/10.3390/pediatric18030077 - 9 Jun 2026

Abstract

Background: Pediatric influenza-like illness (ILI) represents a major global health burden. However, international treatment guidelines lack robust evidence specific to children. Umifenovir (Arbidol) is a broad-spectrum antiviral approved for pediatric use in several countries, but clinical data are fragmented and regionally limited. Methods: [...] Read more.

Background: Pediatric influenza-like illness (ILI) represents a major global health burden. However, international treatment guidelines lack robust evidence specific to children. Umifenovir (Arbidol) is a broad-spectrum antiviral approved for pediatric use in several countries, but clinical data are fragmented and regionally limited. Methods: A comprehensive search of PubMed, Russian (RSCI, national archives, regulatory documents), and Chinese (CNKI) databases was conducted for pediatric randomized controlled trials (RCTs) and non-randomized trials comparing umifenovir to symptomatic therapy (ST) or oseltamivir. Risk of bias was assessed using the RoB 2 tool for RCTs, and ROBINS-I for non-RCTs. Outcomes included the duration of fever and other symptoms, prophylactic efficacy, and adverse events. Random-effects models were used (Hartung–Knapp–Sidik–Jonkman approach). The review was not registered. Results: We included 16 therapeutic and eight prophylactic trials enrolling approximately 4700 and 2000 children, respectively. Compared with ST, umifenovir reduced the duration of fever (MD −1.41 days, 95% CI: −1.78 to −1.05), cough (−1.15 days, 95% CI: −1.50 to −0.79), and hospitalization. The complication risk decreased (RR 0.34, 95% CI: 0.23–0.51). For prophylaxis, umifenovir reduced the risk of ILI (RR 0.68, 95% CI: 0.54–0.87) and laboratory-confirmed influenza (RR 0.41, 95% CI: 0.29–0.59). Adverse events were generally mild and did not differ significantly from ST or oseltamivir (RR 0.78, 95% CI: 0.51–1.20). Conclusions: Umifenovir may reduce symptom duration, complications, and infection risk in pediatric ILI, with a favorable safety profile. However, the overall certainty of evidence is limited by the age of the studies, geographic restriction, and methodological quality. Full article

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

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7 pages, 5671 KB

Open AccessCase Report

Neonatal Presentation of 49,XXXXY (Fraccaro) Syndrome with Ventriculomegaly: Expanding the Early Neuroimaging Phenotype

by Gonca Vardar, Giray Girgin, Emel Kabakoglu Unsur and Gulcan Seymen

Pediatr. Rep. 2026, 18(3), 76; https://doi.org/10.3390/pediatric18030076 - 3 Jun 2026

Abstract

49,XXXXY syndrome (Fraccaro syndrome) is a rare sex chromosome pentasomy, historically considered a severe variant within the Klinefelter spectrum. It is characterized by intellectual disability, craniofacial dysmorphism, skeletal anomalies, hypogonadism, and congenital cardiac defects. Although neuroimaging abnormalities have increasingly been recognized in 49,XXXXY [...] Read more.

49,XXXXY syndrome (Fraccaro syndrome) is a rare sex chromosome pentasomy, historically considered a severe variant within the Klinefelter spectrum. It is characterized by intellectual disability, craniofacial dysmorphism, skeletal anomalies, hypogonadism, and congenital cardiac defects. Although neuroimaging abnormalities have increasingly been recognized in 49,XXXXY syndrome, neonatal diagnosis prompted primarily by ventriculomegaly remains rare. We report a neonate with prenatally detected ventriculomegaly in whom postnatal evaluation revealed cleft palate, congenital cardiac defects, bilateral cryptorchidism, and auditory dysfunction. Cranial ultrasonography and brain magnetic resonance imaging demonstrated bilateral ventriculomegaly with colpocephaly and a cavum vergae variant. Cytogenetic analysis confirmed the presence of a 49,XXXXY karyotype. This case highlights ventriculomegaly as a potential early diagnostic clue in 49,XXXXY syndrome and underscores the importance of chromosomal analysis in neonates presenting with structural brain abnormalities associated with multisystem anomalies. Early recognition is important for timely multidisciplinary surveillance and long-term endocrine follow-up. Full article

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14 pages, 856 KB

Open AccessArticle

Epidemiological and Clinical Characteristics of Bronchiolitis and the Impact of RSV Infection: A Five-Year Study in a Tertiary Pediatric Center in Central Romania

by Alexandra-Antonela Obaciu, Veronica Purdel, Laura Bleotu, Vlad Monescu, Mariana-Alexandra Grecu, Ioana Arbanas and Oana Falup-Pecurariu

Pediatr. Rep. 2026, 18(3), 75; https://doi.org/10.3390/pediatric18030075 - 2 Jun 2026

Abstract

Background: Bronchiolitis, due to respiratory syncytial virus, is the most common cause of hospitalization and lower respiratory tract infections in infants and toddlers across the globe. Data on RSV epidemiology in Romania are limited and are mainly derived from national surveillance systems. Understanding [...] Read more.

Background: Bronchiolitis, due to respiratory syncytial virus, is the most common cause of hospitalization and lower respiratory tract infections in infants and toddlers across the globe. Data on RSV epidemiology in Romania are limited and are mainly derived from national surveillance systems. Understanding regional trends in RSV bronchiolitis, its etiology, and its severity is important while assessing the potential impacts of future prevention measures. Methods: We conducted a retrospective cohort study including infants hospitalized with bronchiolitis between 2019 and 2023 in a tertiary pediatric center in Central Romania. Demographic, clinical, and treatment data were analyzed. Comparative analyses between RSV-positive and RSV-negative cases were performed among patients tested for RSV. Disease severity was assessed using oxygen saturation at admission and length of hospital stay. Results: A total of 2967 bronchiolitis hospitalizations were identified during the study period. After exclusion of 167 cases due to hospitalization <24 h or incomplete medical records, 2800 patients were included in the final analysis. The number of admissions decreased in 2020 (n = 301) compared to 2019 (n = 638), followed by an increase in 2021 (n = 463) and a peak in 2022 (n = 745), with a slight decrease in 2023 (n = 653). Among tested patients, RSV positivity increased from 14.4% in 2019 to 37.7% in 2022, then decreased to 27.4% in 2023. RSV-positive cases were more frequent in younger age groups, particularly those under 6 months of age. Compared to RSV-negative cases, RSV-positive bronchiolitis was associated with lower oxygen saturation at admission, and a longer hospital stay (<0.001), indicating a more severe clinical course. Treatment differences were also observed, with higher use of corticosteroids in RSV-positive patients (p < 0.002), while antibiotic use was similar between groups (p = 0.149). Conclusions: RSV infection was associated with a more severe clinical course in our cohort and continues to play a central role in the burden of disease. The variability observed in treatment practices also suggests that further efforts are needed to better align clinical management with current evidence-based recommendations. Full article

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19 pages, 649 KB

Open AccessReview

Self-Limited Focal Epilepsies in Childhood: How Many and How to Treat

by Piero Pavone, Francesca Scrofani, Chiara Caruso, Enrico Parano, Agata Polizzi, Raffaele Falsaperla, Antonio Corsello, Giovanni Battista Dell’Isola and Xena Giada Pappalardo

Pediatr. Rep. 2026, 18(3), 74; https://doi.org/10.3390/pediatric18030074 - 1 Jun 2026

Abstract

Self-limited focal epilepsies in childhood (SELFEs), formerly referred to as “benign epilepsies in childhood”, constitute a heterogeneous group of epileptic conditions with onset predominantly in the neonatal, infantile, and childhood periods. A defining feature of these syndromes is that seizures arise without underlying [...] Read more.

Self-limited focal epilepsies in childhood (SELFEs), formerly referred to as “benign epilepsies in childhood”, constitute a heterogeneous group of epileptic conditions with onset predominantly in the neonatal, infantile, and childhood periods. A defining feature of these syndromes is that seizures arise without underlying structural, metabolic, or other demonstrable cerebral pathology, and the overall clinical trajectory is expected to be favorable, with seizures resolving spontaneously over time. Current nosological frameworks divide SELFEs into two broad categories according to age at onset: (a) neonatal and infantile forms, encompassing self-limited familial and non-familial neonatal, neonatal-infantile, and infantile epilepsies, genetic epilepsy with febrile seizures plus (GEFS+), and myoclonic epilepsy of infancy (MEI); and (b) childhood-onset forms, including self-limited epilepsy with centrotemporal spikes (SeLECTS), self-limited epilepsy with autonomic seizures (SeLEAS), childhood occipital visual epilepsy (COVE), and photosensitive occipital lobe epilepsy (POLE). Despite their historically “benign” label, there is no general agreement to include GEFS + and MEI among the group of SELFEs as both these conditions have been not classified as focal epilepsy in general. Accumulating evidence shows that a subset of affected children subsequently develop additional seizure types, cognitive deterioration, and behavioral or neuropsychiatric difficulties—outcomes that the word “benign” does not adequately communicate. Advances in molecular genetics have identified pathogenic variants affecting ion channels, synaptic transmission, and neuronal excitability, reshaping current understanding of disease mechanisms and phenotypic variability across these syndromes. This review highlights clinically relevant challenges in the diagnosis and management of SELFEs, critically examines emerging genotype–phenotype correlations, and provides evidence-based recommendations for antiseizure medication initiation and withdrawal tailored to individual syndrome characteristics and risk profiles. Full article

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

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13 pages, 250 KB

Open AccessArticle

Mental Wellness and Adherence Self-Efficacy Among Adolescents Living with HIV in the Cape Town Metropole: A Cross-Sectional Survey

by Yolanda Mayman, Charné Petinger and Brian van Wyk

Pediatr. Rep. 2026, 18(3), 73; https://doi.org/10.3390/pediatric18030073 - 29 May 2026

Abstract

Background/Objectives: Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists [...] Read more.

Background/Objectives: Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists on the influence of positive mental wellness on adherence self-efficacy among ALHIV. This study assessed mental wellness among ALHIV and identified key psychosocial predictors of adherence self-efficacy in public healthcare facilities in Cape Town, South Africa. Methods: A cross-sectional survey was conducted among ALHIV (N = 251) aged 10–19 years who were receiving ART at public healthcare facilities across the Cape Town metropole. Participants completed an electronic questionnaire that assessed ten mental wellness domains and adherence self-efficacy. Descriptive statistics were calculated to summarise participant characteristics and mental wellness scores, while Pearson correlations and multiple linear regression were done to identify associations and independent predictors of adherence self-efficacy using SPSS v29. Results: Most participants were aged 15–19 years (76.9%) and diagnosed with HIV at birth (68.9%). Mental wellness scores were high across all domains (M = 3.14–3.71). Hope (M = 3.71), spirituality (M = 3.58), and purpose in life (M = 3.52) were the highest-rated domains. All mental wellness domains were positively correlated with adherence self-efficacy (p < 0.001), with the strongest associations being purpose in life (r = 0.66), self-acceptance (r = 0.66) and resilience (r = 0.66). Hope (p < 0.001), resilience (p = 0.001), purpose in life (p = 0.03) and self-acceptance (p = 0.012) emerged as significant independent predictors. Conclusions: Positive mental wellness and adolescent-centred psychosocial support in routine HIV care may strengthen adherence self-efficacy and support adolescents’ confidence in managing treatment. Full article

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