Children doi: 10.3390/children13050672

Authors: Rachel Batchelor Natasha Cogings Christopher McCormack Matthew Hotton

Background/Objectives: Children and young people (CYP) with long-term physical health conditions (LTCs) are at greater risk of psychosocial difficulties. Systematic reviews on adults with LTCs have supported acceptance and commitment therapy (ACT) in improving several psychosocial outcomes. This systematic review aimed to investigate the effectiveness of ACT for CYP-reported psychosocial outcomes among CYP with LTCs. It also examined the factors associated with the effects and the quantitative acceptability of the included ACT interventions. Methods: Eligible studies used a quantitative experimental design to evaluate ACT for CYP-reported psychosocial outcomes in CYP (≤18 years old) with LTCs. Only studies published in English in peer-reviewed journals, from any year, were included. CINAHL (EBSCO), Cochrane Library, Embase (Ovid), MEDLINE (Ovid) and PsycInfo (Ovid) were systematically searched. Google Scholar and Web of Science were also searched, and forward and backward citation searching was completed for included papers. Research quality was appraised using Cochrane risk-of-bias tools. Results were narratively synthesised. Results: Sixteen studies (nine randomised controlled trials (RCTs) and seven non-RCTs) from 19 reports met inclusion criteria, with 777 participants and five LTCs (chronic pain, diabetes, cancer, obesity and visual impairment). Findings provided preliminary support for the effectiveness of ACT on most CYP-reported psychosocial outcomes studied. Seven studies considered factors associated with intervention effects, with mixed findings. Acceptability was supported in the three studies that assessed it quantitatively. However, almost all studies had overall high/serious risk-of-bias ratings. Conclusions: There is preliminary evidence supporting potential benefits of ACT for improving psychosocial outcomes in CYP with LTCs, with limited but supportive findings for its acceptability. However, findings are constrained by high/serious risk of bias and small sample sizes. Larger, high-quality trials with active controls and longer follow-ups are needed to inform future care pathways. Registration: This systematic review was pre-registered (PROSPERO registration number: CRD42023425918).

Children doi: 10.3390/children13050671

Authors: Shanshan Zhang Zhengzheng Gao Jing Hu Yi Ren Xiaohuan Cui Lijing Li Jianmin Zhang Fang Wang

Background: To investigate the risk factors for and prognostic implications of massive blood loss during posterior spinal instrumentation and fusion (PSIF) in pediatric patients with scoliosis. Methods: We retrospectively analyzed the electronic medical records of 460 children who underwent scheduled PSIF under general anesthesia between June 2021 and January 2024. Patients were grouped based on intraoperative blood loss: massive (estimated blood loss [EBL]/estimated blood volume [EBV] ≥ 30%) and nonmassive (EBL/EBV < 30%). Perioperative parameters were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for massive intraoperative blood loss. Results: Among the 460 patients with scoliosis who underwent PSIF, 188 were male and 272 were female (mean age 9.4 ± 4.1 years). Massive intraoperative blood loss occurred in 126 (27%) patients. Factors associated with massive blood loss included age, preoperative Cobb angle, history of heart disease or neurofibromatosis, number of previous scoliosis surgeries, operative time, number of fused levels, number of pedicle screws inserted, and whether osteotomy was performed. Multivariate analysis identified younger age (odds ratios [OR] = 0.829, 95% confidence interval [CI], 0.751–0.914, p < 0.001), history of heart disease (OR = 4.338, 95% CI: 1.637–11.498, p = 0.003), greater number of fused levels (OR = 1.118, 95% CI: 1.014–1.233, p = 0.025), and longer operative time (OR = 1.008, 95% CI: 1.005–1.012, p < 0.001) as independent risk factors. Additionally, the massive blood loss group had a longer postoperative hospital stay (p = 0.008) and a higher rate of postoperative allogeneic blood transfusion (7.1% vs. 1.2%, p = 0.002) than the nonmassive blood loss group. Conclusions: Younger age, preexisting heart disease, a greater number of fused levels, and longer operation duration are independent risk factors for massive intraoperative blood loss in children undergoing PSIF for scoliosis.

Children doi: 10.3390/children13050670

Authors: Veronica Ramirez Jules Mercier-Ross

Acute chest syndrome (ACS) is a common pulmonary complication in children with sickle cell disease, defined by a new pulmonary infiltrate on imaging accompanied by fever and/or respiratory symptoms. ACS pathophysiology is multifactorial and incompletely understood, involving vaso-occlusion, pulmonary infarction, inflammation, hypoventilation, and infection—the latter being a frequent trigger in children. While most pediatric cases are mild, ACS can be life-threatening and requires prompt diagnosis and management to prevent progression into respiratory failure. Mild cases are managed with pain control, IV hydration, empiric antibiotics, incentive spirometry and supplemental oxygen when needed. More severe cases may require simple or exchange transfusion to reduce hemoglobin S levels and limit further vaso-occlusion. ACS is associated with neurologic events and long-term pulmonary complications, making prevention a clinical priority. Disease-modifying therapies include hydroxyurea and chronic transfusion. This review summarizes current evidence on the pathophysiology, risk factors, clinical presentation, diagnosis, acute management and preventative therapies for ACS in children.

Children doi: 10.3390/children13050669

Authors: Funda Aytekin Güvenir Senem Özgür

Background: Cardiac channelopathies are rare but potentially life-threatening disorders that may present with syncope or seizure-like episodes in children, often leading to misdiagnosis and delayed recognition. Other arrhythmia-associated cardiac conditions may also present with similar clinical manifestations and require careful cardiac evaluation. Objective: To evaluate the prevalence of cardiac channelopathies and inherited arrhythmogenic cardiac disorders in pediatric patients presenting with syncope and seizure-like events and to identify associated clinical and electrocardiographic features. Methods: This retrospective cross-sectional study included pediatric patients presenting with syncope, presyncope, seizures, or seizure-like episodes who underwent cardiac evaluation at Ankara Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital between January 2015 and April 2019. Cardiac evaluation was performed using a standard 12-lead electrocardiogram and was complemented by additional investigations, including 24 h Holter monitoring, exercise testing, pharmacological provocation, electrophysiological studies, and genetic analysis, when clinically indicated. Demographic, clinical, and diagnostic parameters were systematically evaluated. Results: A total of 363 patients were included in the final analysis. The mean age was 12.2 ± 4.7 years, and 58.7% were female. The most common diagnosis was vasovagal syncope (n = 160, 44.1%), followed by epilepsy (n = 53, 14.6%). Cardiac channelopathies, and arrhythmogenic right ventricular dysplasia (ARVD) were identified in 18 patients, corresponding to 4.9% of the pediatric cardiology-evaluated patients and 0.82% of the initial screened population. These diagnoses included long QT syndrome (n = 8), Brugada syndrome (n = 3), short QT syndrome (n = 3), catecholaminergic polymorphic ventricular tachycardia (n = 2), ARVD (n = 1), and malignant-type early repolarization (n = 1). Compared with other patients, those with cardiac channelopathies, malignant-type early repolarization, and ARVD more frequently had exercise-related triggers (p < 0.001), ventricular extrasystoles and ventricular tachycardia (p < 0.001), and abnormal exercise test findings (p < 0.001). Conclusions: Cardiac channelopathies are not uncommon in pediatric patients presenting with syncope and seizure-like events and should be considered in the differential diagnosis. Clinical triggers, family history, and electrocardiographic abnormalities may serve as important clues for early identification. A multidisciplinary approach, including detailed cardiac evaluation, is essential to prevent misdiagnosis and reduce the risk of sudden cardiac death.

Children doi: 10.3390/children13050668

Authors: Alina-Costina Luca Dana Elena Mindru Solange Tamara Rosu Cosmin Diaconescu Eduard Vasile Rosu Elena Țarcă Heidrun Adumitrăchioaiei Dana-Teodora Anton-Paduraru

Congenital heart disease (CHD) is the most common congenital anomaly worldwide and is associated with substantial infant morbidity and mortality. This narrative review synthesizes evidence linking CHD to alterations in the gut microbiome across neonatal, perioperative, and chronic stages and highlights a gut–heart–immune framework in which microbial imbalance, intestinal barrier dysfunction, and systemic inflammation may interact to influence clinical outcomes. Early infancy represents a potential window for microbiome and immune development, shaped by delivery mode and feeding, with many breastfed infants developing a Bifidobacterium-dominant community supported by human milk oligosaccharides. In CHD, abnormal splanchnic perfusion and hypoxemia, together with intensive care and perioperative exposures (fasting, delayed enteral feeding, antibiotics, acid suppression), may predispose to dysbiosis and impaired barrier function. Cardiac surgery with cardiopulmonary bypass can act as a “second hit,” with evidence of increased gut permeability, endotoxemia, inflammatory activation, and biomarker signals of enterocyte injury and tight-junction disruption. Clinically, these mechanisms align with gut-sensitive outcomes including necrotizing enterocolitis (especially in ductal-dependent lesions), feeding intolerance, and postoperative infection-risk phenotypes. Interventions show mixed evidence: human milk exposure appears protective for NEC risk, synbiotics demonstrated outcome benefits in a randomized trial of cyanotic CHD infants, while probiotics may modify dysbiosis without consistently preventing intestinal injury and require careful safety frameworks. Key research gaps include the need for longitudinal stage-based cohorts, integration of microbiome profiling with barrier injury and perfusion markers, and standardized safety monitoring in intervention trials.

Children doi: 10.3390/children13050667

Authors: Hilmi Onur Kabukçu Pelin Köşger Ayşe Sülü Birsen Uçar

Background/Objectives: While premature ventricular contraction (PVC) burden is clearly linked to cardiomyopathy in adults, its association with ventricular dysfunction in children remains less well established. This study investigated the myocardial effects of a PVC burden greater than 5% and its potential predictive factors in a pediatric population. Methods: The study enrolled 23 children aged 5–18 years with a PVC burden >5% on 24 h Holter monitoring, who had no chronic systemic illness, congenital or acquired heart disease, or known family history of cardiomyopathy or sudden cardiac death, along with 33 age-matched healthy controls. Data on demographic characteristics, anthropometric measures, clinical findings, and laboratory results were obtained. Twelve-lead electrocardiography, exercise testing using the Bruce protocol, 24 h Holter monitoring, and echocardiographic assessments—including conventional, tissue Doppler, and both segmental and global strain analyses—were performed and compared between the patient and control groups. Results: In the patient group, left ventricular isovolumetric relaxation time (IVRT) was prolonged, and the myocardial performance index (MPI) was higher compared with the controls (p < 0.001, p = 0.004). Longitudinal strain analysis revealed a significant reduction in global longitudinal strain (GLS) (p = 0.035). In addition, significantly lower segmental longitudinal strain values were observed in the basal anterolateral, basal inferolateral, and basal anterior segments, as well as a reduction in apical two-chamber GLS (p = 0.002, p = 0.002, p = 0.003, and p = 0.014, respectively). Circumferential strain was also significantly reduced in the basal anteroseptal, basal anterior, basal inferolateral, and mid anteroseptal segments, as well as in the basal, mid, and global averages (p = 0.003, p = 0.003, p = 0.026, p = 0.003, p = 0.006, p = 0.022, and p = 0.017, respectively). PVC burden on Holter monitoring was positively correlated with the global strain values, indicating less negative strain with increasing PVC burden. Conclusions: In children with structurally normal hearts and a PVC burden exceeding 5%, TDI and strain imaging revealed subtle alterations in diastolic function and myocardial deformation despite preserved ejection fraction. These findings suggest that frequent PVCs may be associated with early myocardial alterations and highlight the potential utility of advanced echocardiographic techniques in this population.

Children doi: 10.3390/children13050666

Authors: Manh Cuong Nguyen Thi Viet Ha Nguyen Loi Nguyen Thuy Ha Dang Tam Tran Thi Van Anh Nguyen Ngoc Thach Hoang Ngoc Quynh Le Nguyen Thi Minh Phuong Do Van Tinh Nguyen Hai Yen Vu Thi Ngoc Hong Nguyen Thi Thu Trang Nguyen Thi Cam Van Le Thi Khanh Ngoc Bui Thi Thuy Hang Le Minh Dien Tran

Background/Objectives: Very early onset inflammatory bowel disease (VEO-IBD), frequently associated with monogenic defects, is increasingly recognized worldwide but remains poorly characterized in Vietnam. This study aimed to characterize the clinical phenotypes and genetic spectrum of Vietnamese children with VEO-IBD. Methods: We conducted a retrospective cohort study at a tertiary pediatric referral center in Vietnam from July 2016 to January 2026. Clinical, laboratory, endoscopic, histopathological, genetic, and treatment data were systematically collected and analyzed. Monogenic variants were identified using next-generation sequencing and classified according to ACMG criteria. Results: Thirty-six children were included, with a median age at onset of 7.5 months, and 72.2% presenting before 24 months. Crohn’s disease predominated (72.2%). Disease burden was high, with growth impairment in 75.0% and anemia in 91.7%. Extraintestinal manifestations were frequent, particularly recurrent infections (72.2%), dermatitis (44.4%), and oral ulcers (44.4%). Perianal disease occurred in 58.3%, with early complications including perianal ulcer (44.4%), perianal abscess (30.6%) and fistulas (33.3%). Inflammatory markers were markedly elevated, and disease activity indices indicated moderate-to-severe disease at diagnosis. Genetic testing was performed in 91.7% of patients, identifying monogenic etiologies in 30.3%. Identified variants involved genes related to immune regulation (IL10RA/IL10RB, FOXP3, XIAP), autoinflammation (TNFAIP3), host defense (CYBB), and epithelial function (MYO5B). Conclusions: Monogenic etiologies account for a substantial proportion of VEO-IBD and are associated with distinct clinical phenotypes and therapeutic implications. Early integration of genomic testing with clinical phenotyping is essential to improve diagnostic precision and enable pathway-based treatment, supporting precision medicine in pediatric IBD.

Children doi: 10.3390/children13050665

Authors: Vercancy Wu Myla E. Moretti Kayla Esser Natasha Henriques Jennifer D. Zwicker Julia Orkin Eyal Cohen Nathalie Major Wendy J. Ungar

Background: Infants discharged home from a neonatal intensive care unit (NICU) often have multiple ongoing medical needs. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program provides nurse navigator-led support for caregivers of high-risk infants through their first year after transitioning from the NICU to home. The objective was to compare health care resource use and costs between CCENT and standard care control groups post-discharge. Methods: Resource use and costs were collected at 4 months and 12 months post-discharge from families enrolled in the CCENT randomized controlled trial across Canada. Infant healthcare utilization and parent mental health service use and costs were analyzed from public health care system and family payer perspectives and were compared statistically between groups and within groups over time. Results: A total of 97 and 105 infants were randomized to the intervention and control groups, respectively. Significant reductions in use of medications and equipment were observed over time in both groups while use of allied health professionals decreased and emergency department (ED) visits increased for CCENT. Annual total healthcare costs per child to the public payer were $4135 (95% CI $2825, $5709) for the CCENT group and $4578 (95% CI $2246, $8356) for controls. The cost of delivering CCENT was $669 per family (SD $362). The average annual out-of-pocket cost per family was $724 (95% CI $467, $1024) for CCENT and $728 (95% CI $479, $1007) for controls. Conclusions: This study indicates the importance of considering patterns of healthcare utilization, program costs and costs to families when implementing NICU to home care interventions. Excluding the cost of a nurse navigator, costs to the healthcare system were not increased in the intervention group. Such a program may help families access appropriate care.

Children doi: 10.3390/children13050663

Authors: Elena Theodorou Marousa Kyritsi Rouzana Komesidou

Background/Objectives: Developmental Language Disorder (DLD) affects approximately two children in every classroom and significantly impacts literacy development and academic achievement. Given the central role of language in learning, teachers are well-positioned to identify, support, and advocate for children with DLD through referrals, interventions, and inclusive curriculum delivery. However, evidence consistently indicates that teachers lack fundamental knowledge of DLD, highlighting an urgent need for targeted professional training. This study, conducted in Cyprus, aimed to (1) explore pre-school and primary school teachers’ knowledge and views regarding DLD and (2) synthesize an evidence-based checklist of essential topics for DLD teacher training. Methods: A total of 133 teachers completed an online questionnaire addressing three research questions: teachers’ knowledge of DLD and its characteristics; their attitudes toward DLD; and their perceptions of their role in supporting children with DLD. Results: Findings aligned with international trends, showing limited confidence in supporting students with DLD despite reasonable familiarity with the label and its core features. Teachers demonstrated a broad understanding of their supportive role but acknowledged knowledge limitations and requested structured professional development. Based on these findings and existing literature, the Basic-DLD Guide was created for researchers, practitioners, and continuing education providers, to inform the development of basic trainings. Conclusions: The study’s findings and the guide can have direct clinical significance, providing an evidence-informed foundation for designing structured professional training to improve identification and support for children with DLD in educational settings.

Children doi: 10.3390/children13050662

Authors: Abby P. M. Katz Madelyn Dewitt Naomi Zeltzer Bethel Daniel Brooke Ury Zoe Maxwell Aliana Rodriguez Acevedo Huy Tran Isha Thakkar Diana S. Grigsby-Toussaint

Background: High quality pediatric sleep is shaped by multiple factors, including duration, restoration, and continuity. Multiple socio-ecological factors that are typically enforced by caregivers (e.g., bedtime routines) also determine the likelihood of attaining optimal pediatric sleep health. Consistent with the extant sleep literature on pre-pubertal children, this qualitative study targeted caregivers to identify factors influencing children’s sleep quality. Methods: Participants were recruited from Project G-SPACE, a US-based study exploring the influence of greenspace on sleep and mental health among elementary school-aged children. A racial, ethnic, and socio-economically diverse sample of caregivers (n = 21) participated in virtual semi-structured interviews about their perceptions of determinants of child sleep quality and behavior. Template-style thematic analysis was employed to synthesize the interviews. Results: Caregivers report that busy days for their children, especially characterized by high levels of physical activity, facilitate sleep continuity and good sleep quality. Sibling dynamics can be disruptive, resulting in poor sleep quality. To promote sleep health, parents employ rules regarding screentime, food/drink, and bed/wake time schedules, though the latter seems to be more flexible when children are not in school (e.g., weekends). Conclusions: Caregivers demonstrated great variability regarding implementing strategies to enhance their children’s sleep quality, suggesting that parents may be unsure of how to optimize the strategies they employ, which are most effective, or how to manage resistance from their children. Clinicians should discuss how to address these practical challenges with caregivers. Future research investigating the developmentally unique differences in determinants of sleep quality among elementary school-aged children is prudent.

Children doi: 10.3390/children13050664

Authors: Marius Zoltan Rezumeș Liliana Catan Elena Constanta Amaricai Ada Maria Codreanu Andreea Ancuța Vataman Vlad Laurentiu David

Background: Pectus excavatum (PE) is the most common anterior chest wall deformity in children and adolescents. It may lead to postural adaptations of the trunk and spine and can influence the distribution of the center of gravity. Methods: A total of 35 patients with PE, with a Haller index < 3.25, aged 5–17 years, followed a structured exercise program including postural correction exercises, thoracic mobility exercises, breathing retraining, and trunk extensor strengthening for three months after proper instruction by a specialist. Patients were assessed before and after the intervention. Postural alignment was evaluated laterally (right and left) using the GaitON Posture Analysis System, and static balance was assessed using the PoDATA 2.0 stabilometric platform (Chinesport, Italy), which analyzes plantar pressure distribution and center of pressure (COP) displacement during orthostatic stance. Statistical analysis was performed using paired t-tests and Pearson correlation coefficients. Results: Stabilometric analysis demonstrated a reduction in COP trajectory length, confidence ellipse area, and maximum velocity, indicating improved postural control and reduced sway. Postural analysis revealed statistically significant improvements in head and shoulder girdle alignment. Correlations suggest a potential relationship between segmental alignment and stabilometric parameters and a possible reduction in thoracic hyperkyphosis associated with PE. Conclusions: Postural and stabilometric assessment in PE highlights changes in the analyzed parameters and suggest that a structured exercise program may be associated with improvements in biomechanical function and neuromuscular control. These methods can be integrated into conservative management and therapeutic strategies.

Children doi: 10.3390/children13050661

Authors: Sarah Yale Jeffrey Engelmann Michelle Loman DaJhnae Gambrell Sanders Mohit Maheshwari Theresa Mikhailov

Introduction: Electronic nicotine delivery systems (ENDSs), also known as e-cigarettes or vapes, have shown popularity among the adolescent population. Compared to adults, less is known regarding the impacts of ENDS and nicotine on the adolescent brain. Adolescent research related to nicotine and other illicit substances can be difficult due to the requirement of parent/guardian consent, adolescent hesitancy for disclosure of product use, and the continually evolving vaping and nicotine products on the market. Despite these challenges, further research is needed to explore the impact of ENDS on the developing adolescent brain. The objective of the study was to evaluate reward sensitivity and cognitive flexibility in the adolescent population using functional magnetic resonance imaging (fMRI) through a probabilistic reversal learning task. Methods: This pilot study recruited participants aged 13–19 years old to complete fMRI testing. We specifically adapted a probabilistic reversal learning task that was previously used to measure reward sensitivity and cognitive flexibility in adults (including nicotine users). We were unable to recruit enough ENDS users to complete the planned analysis; therefore, we evaluated non-users as proof of concept for the use of the probabilistic reversal learning task in adolescents to support future research. Participants completed four blocks of a probabilistic reversal learning task, each lasting 6 min. During each block of the task, blood-oxygenation-level-dependent (BOLD) fMRI images were collected. The reward sensitivity and cognitive flexibility contrasts of parameter estimates were entered into a group analysis model. Due to the small sample size and exploratory nature of the study, we were interested in computing population-level estimates of brain activation that could be attributed to reward sensitivity (win-stay minus lose-stay trials) and cognitive flexibility (lose-shift trials minus lose-stay trials). Results: A total of twelve participants completed fMRI testing—ten non-users, one intermittent user, one regular user. Four of these participants (three non-users and one intermittent user) were excluded from the fMRI analysis due to excessive head movement and/or poor task performance. With the seven remaining non-users, we found no evidence of significant BOLD activation when strictly controlling the Type I error rate. Using a more liberal statistical threshold that did not control the Type I error rate, both contrasts resulted in suprathreshold clusters in occipital and posterior parietal regions, and the reward sensitivity contrast also resulted in suprathreshold clusters in the prefrontal cortex (bilateral middle occipital gyrus). Discussion/Conclusions: We did not find statistically significant BOLD activation, which is likely due to the small sample size. Suprathreshold clusters using the liberal statistical threshold may be feasible for use as regions of interest in future studies using this task. Notably, the prefrontal regions where the reward sensitivity contrast exceeded the liberal statistical threshold in our study were similar to those observed in previous studies of reward sensitivity in adults (including nicotine users) and adolescents. This pilot study explores the use of an fMRI reward-learning paradigm in the adolescent population, which can serve as a catalyst for future research related to nicotine use.

Children doi: 10.3390/children13050660

Authors: Wisam Muhsen Joanne Hosking Jos M. Latour Eirik Nestaas

Background/Objectives: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity, yet no prediction model incorporating echocardiographic assessment of right ventricle (RV) function and pulmonary haemodynamics exists. This study aimed to identify clinical and echocardiographic candidate variables of BPD to inform the design of a future multicentre study for BPD prediction model construction. Methods: This prospective observational feasibility study recruited preterm infants born before 32 weeks of gestation. Echocardiographic scans were performed at Day 5 and Day 9 postnatally. Candidate variables across six domains, clinical, RV systolic, diastolic, and global function, pulmonary-haemodynamics, and patent ductus arteriosus (PDA) variables, were evaluated using Mann–Whitney U tests and univariable logistic regression. Results: Of 40 preterm infants enrolled, 27 (68%) developed BPD. The BPD group had lower gestational age (median 26 vs. 30 weeks, OR 0.50, p < 0.001), lower current weight (median 763 vs. 1200 g, OR 0.54, p = 0.002), and higher mean airway pressure (OR 1.86, p = 0.002). By Day 5, significant differences included higher normalised RV s’ (OR 2.26, p = 0.042), shorter RVET (OR 0.49, p = 0.018), elevated RV-MPI-PW (OR 2.28, p = 0.019), shorter PAAT (OR 0.72, p = 0.047), and larger normalised PDA diameter (OR 1.70, p = 0.002). By Day 9, normalised RV a’ (OR 1.93, p = 0.015), RV E/e’ ratio (OR 2.03, p = 0.033), and RV e’/a’ ratio (OR 0.54, p = 0.019) additionally emerged. All infants with reversed anterior–cerebral–artery diastolic flow subsequently developed BPD. Conclusions: Clinical and echocardiographic variables across multiple RV-function, PDA and pulmonary vascular domains were identified as candidate variables for BPD, providing a conceptual framework for a future multicentre prediction model study.

Children doi: 10.3390/children13050659

Authors: Alena Bagkaki John Papagiannis Aris Anastasakis Fragiskos Parthenakis Gregory Chlouverakis Emmanuil Galanakis Ioannis Germanakis

Background: Channelopathies represent a heterogeneous group of rare inherited cardiac diseases associated with life-threatening arrhythmias. Our knowledge of their epidemiology in childhood is limited. The aim of this study is to evaluate the epidemiology of pediatric channelopathies on a Mediterranean island (Crete, Greece). Methods: Retrospective study of children < 18 years followed in the Regional Tertiary Pediatric Cardiology Unit during a 24-year period (2002–2025) and meeting the disease-specific diagnostic criteria. Results: A total of 43 children (32 families) were enrolled, corresponding to an average annual incidence of 1.43 (95% C.I.: 1.03–1.92) and a cumulative prevalence of 31.1 (95% C.I.: 22.1–42.5) cases per 100, 000 children, with significant regional incidence differences. Long QT syndrome (n = 38) was predominant; rare cases of Brugada syndrome (n = 3) and Catecholaminergic polymorphic tachycardia (n = 2) were recorded. The diagnosis was based on symptomatic presentation (n = 15, 35%), while asymptomatic patients (n = 28, 65%) were diagnosed during cascade family screening (n = 22, 51%) and preparticipation screening (n = 6, 14%). They represented the first diagnosis within affected families (index cases) in 21/43 (49%) of cases. Genetic testing was performed in 35/43 (81%) channelopathy cases and it was positive in 33/43 (77%) of them, specifically in 30 out of 38 (79%) LQT cases with a genotype of LQT2 in 15 (39%), LQT1 in 10 (26%), LQT3 in one (3%) and LQT5 in two (5%) cases. Conclusions: The incidence of pediatric channelopathies on the Mediterranean island of Crete seems comparable to that reported in the literature, with regional clusters of significantly increased incidence. Further study of the epidemiology of pediatric channelopathies is needed, to document any regional or ethnic differences and for the best design of large-scale screening programs.

Children doi: 10.3390/children13050658

Authors: Callie Goodman Nicole Neiman Ashley Dunn Ann Ming Yeh Rachel Bensen Claudia Mueller Anava Wren

Background/Objectives: Adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) experience persistent physical symptoms and psychosocial challenges that can impair functioning and quality of life. Health mindset, beliefs about whether health is fixed versus malleable and responsive to effort, is linked to positive health outcomes but has not been examined in AYAs with IBD. This study evaluated the internal reliability of a health mindset measure in AYAs with IBD and examined associations between health mindset and depressive symptoms, peer relationships, global health, pain interference, fatigue, and disease activity. Methods: Participants were 101 AYAs with IBD (M = 18.4 years; 54.4% ulcerative colitis; 63.4% female) recruited from an outpatient pediatric IBD clinic and a national IBD network. Participants completed a one-time online survey consisting of the Health Mindset Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) measures for physical, psychosocial, and global health outcomes, and IBD disease activity indices. Results: The Health Mindset Scale demonstrated good internal reliability in this sample. Additionally, a growth health mindset was significantly associated with lower pain interference, lower Crohn’s disease activity, and better global health. No significant associations were observed between health mindset and depressive symptoms, peer relationship quality, fatigue, or ulcerative colitis disease activity. Conclusions: This novel study provides initial evidence that health mindset is associated with clinically meaningful outcomes in AYAs with IBD. These findings highlight that health mindset may be an important psychological construct in chronic illness adjustment and management, extending mindset theory and research to a young clinical population with IBD.

Children doi: 10.3390/children13050657

Authors: Koray Tumuklu Behcet Gunsoy

Introduction: The present study aimed to compare cortical auditory maturation, as reflected by P1 latency of cortical auditory evoked potentials (CAEPs), in children with congenital severe-to-profound sensorineural hearing loss rehabilitated with unilateral cochlear implants (CIs) or bilateral conventional hearing aids (HAs). Materials and Methods: Eighty-five children with congenital severe-to-profound sensorineural hearing loss were included in this retrospective comparative study. Participants were divided into two groups: unilateral CI users (n = 42) and bilateral HA users (n = 43). All children were fitted with their devices before 48 months of age and achieved aided free-field thresholds between 30 and 50 dB HL. CAEPs were recorded using the Fonix® HEARLab System with speech stimuli (/m/, /g/, /t/) presented at 55 dB SPL. P1 latency values were measured and compared between groups using independent samples t-tests. Correlation analyses were performed to assess the relationship between duration of device use and P1 latency. Results: Eighty-five children were included (CI: n = 42; HA: n = 43). Mean P1 latency values did not differ significantly between groups for the /m/ stimulus (126.4 ± 29.13 ms vs. 126.4 ± 29.28 ms, p = 1.00), /g/ stimulus (106.5 ± 26.46 ms vs. 110.1 ± 29.49 ms, p = 0.55), or /t/ stimulus (114.7 ± 22.93 ms vs. 118.5 ± 27.19 ms, p = 0.48). Age at device fitting was comparable between groups (27.95 ± 9.10 vs. 26.88 ± 14.15 months, p = 0.68). The duration of device use was significantly longer in the HA group (48.02 ± 28.39 months) compared to the CI group (26.00 ± 15.92 months) (p < 0.001). Correlation analysis revealed no significant association between duration of device use and P1 latency for any stimulus (/m/: p = 0.28; /g/: p = 0.17; /t/: p = 0.09). Conclusions: When devices were fitted before 48 months of age and aided thresholds were optimized, unilateral cochlear implantation and bilateral conventional hearing aids showed comparable P1 latency values as an index of cortical auditory maturation. These findings suggest that early and adequate auditory stimulation may play an important role in supporting cortical auditory development in children with congenital hearing loss, although results should be interpreted within the context of individualized clinical management.

Children doi: 10.3390/children13050656

Authors: Stephanie J. Glover Josh Tiller-Ormord Kelly Anderson Jessica Busse Laura Dorneman Lori Knowles Susan Lindemulder Melinda D. Wu W. Michael Vanderlind

Background/Objectives: Pediatric hematology and oncology patients are at increased risk for psychosocial and neurocognitive difficulties following treatment. Survivorship programs monitor late effects associated with disease and treatment history, with most programs focusing on screening and referring. Relatively less focus is placed on psychoeducation and intervention. The current paper describes the process of creating a novel psychology trainee-led consultation service embedded within a multidisciplinary survivorship clinic. Methods: A psychology intern collaborated with clinic staff and reviewed existing literature to inform the nature of the service. Patients seen in clinic met with the psychology intern for a 20-min visit focused on an area of concern identified during existing neuropsychology and/or social work assessment visits. Topics addressed included coping with stress, anxiety management, improving mood, sleep hygiene, parenting responses to common behavioral issues, and the acquisition of academic support. Pilot patient satisfaction data were collected via a questionnaire at the end of the visit, without any patient-identifiable factors attached to response data. Results: Most patients and families (90%) found the service helpful. Moreover, the majority of families (90%) found a 20-min service delivery to be adequate. The most common topic area addressed was anxiety management. Conclusions: Results demonstrate high patient satisfaction. Advantages of this service include rapid access to a no-fee support addressing common mental health and neurocognitive sequelae of childhood cancer and the expansion of psychology training opportunities. Future research should evaluate the service using validated outcome measures and examine its long-term effects.

Children doi: 10.3390/children13050655

Authors: Amayra Tannoubi Noura Ahmed John Elvis Hagan Medina Srem-Sai Vlad Adrian Geantă Fairouz Azaiez

Background/Objectives: Emotional intelligence (EI) is a modifiable psychological competency associated with athletic performance, yet controlled interventions targeting EI in youth sport remain scarce. Pre-session video observational modeling (VOM) is effective for motor skill acquisition, but its potential to enhance EI has not been examined in a randomized design. This study aimed to evaluate the effects of a 6-week pre-session VOM program on EI and 9 m shooting performance in U14 male handball players, and to examine whether changes in EI were associated with performance improvements. Methods: Thirty-three male U14 handball players (M = 13.2 ± 0.4 years) were randomly assigned to a VOM group (n = 17) or a control group (n = 16). Before each training session, the VOM group viewed a standardized 3–5 min video demonstrating the 9 m shooting technique, while both groups completed identical training. EI was assessed using the Arabic Emotional Intelligence Scale (A-EIS), and performance as successful shots per five attempts. Data were analyzed using mixed ANOVA, between-group comparisons of change scores, and linear regression. Outcome assessment was conducted by an evaluator blinded to group allocation. Results: Groups did not differ at baseline (p > 0.05). The VOM group improved significantly across all EI dimensions and performance (p ≤ 0.005, η2p ≥ 0.176), whereas the control group showed statistically significant declines in most EI variables (p ≤ 0.019, d ≥ 0.66). Between-group differences were significant for all outcomes, with large effect sizes (d = 0.90–3.08, 95% CI [0.32, 3.85]). Significant Group × Time interactions were observed across variables (p ≤ 0.015, ω2p = 0.078–0.539). Improvements in EI was significantly associated with performance gains (β = 0.517, p = 0.002), and post-intervention EI was significantly associated with performance variance at post-test (R2 = 0.437, p < 0.001). Conclusions: Pre-session VOM was associated with concurrent improvements in emotional intelligence and 9 m shooting performance in youth handball players, with findings requiring replication in larger and more diverse samples before generalizable conclusions can be drawn. The observed relationship between EI and performance suggests that emotional processes may contribute to skill acquisition. These findings support the inclusion of brief observational strategies in youth training programs, while requiring replication in broader samples.

Children doi: 10.3390/children13050654

Authors: James Best Peter S. W. Davies Laura Hunt Andrew Leech Helen McCarthy Tim Warnock

Background: Poor or rapid growth velocity in early childhood can have negative long-term health consequences. Early identification of children at risk of growth problems facilitates timely intervention to change growth trajectories and health parameters, but barriers exist to routine screening in primary care. Methods: Experts from general practice, primary care nursing, pediatrics, dietetics, and academic research convened to develop a practical algorithm to support routine growth screening and intervention in children aged 1 to 5 years in primary care. Results: Using a single initial measurement of weight and height in conjunction with risk factor assessment, the algorithm presented here identifies children at risk of poor or rapid growth velocity and provides guidance for intervention and follow-up frameworks. Conclusions: This tool helps to define children in the community setting who are at risk of poor or rapid growth velocity and supports primary care providers in promoting healthy growth trajectories through timely intervention and continued routine growth monitoring.

Children doi: 10.3390/children13050653

Authors: Kazım Okan Dolu İdan Fırat Unay Yasemin Tepe Hande Üçler Çınar Çağla Karavaizoğlu Himmet Haluk Akar

Background/Objectives: We aimed to evaluate the etiologic distribution of markedly elevated IgE (≥2000 IU/mL) and the association of parasitic infections with longitudinal IgE dynamics and National Institutes of Health Hyper-IgE Syndrome (NIH-HIES) score trajectories in pediatric patients. Methods: We retrospectively enrolled 127 pediatric patients with IgE ≥2000 IU/mL and ≥1 year of longitudinal follow-up at a tertiary allergy clinic (2019–2024). The primary outcome was the IgE reduction percentage difference between parasitic and non-parasitic groups. Results: Atopic sensitization was identified in 81.0% of tested patients; genetic evaluation was performed in 40 patients (31.5%), with confirmed IEI in one patient (0.8% of the cohort; 2.5% of those evaluated). Parasitic infections were present in 24.4% of patients (n = 31; intestinal parasites 15.7%, scabies 8.7%, hydatid cyst 1.6%; two patients had concurrent intestinal parasitosis and scabies). Median IgE reduction was 63.8% vs. 27.0% in parasitic versus non-parasitic groups (p < 0.001), persisting after multivariable adjustment (p < 0.001). Parasitic infection independently predicted IgE normalization below 2000 IU/mL (OR = 8.26; 95% CI: 2.76–24.68; p < 0.001). All three NIH-HIES inflammatory components (IgE, eosinophilia, eczema) regressed more often in the parasitic group (all p ≤ 0.01); no patient reached the ≥40-point HIES threshold. Conclusions: Parasitic infections produce a clinical phenotype overlapping with hyper-IgE syndrome, constituting a reversible phenocopy of primary immune dysregulation. In populations with substantial parasitic prevalence, parasitological evaluation may be a useful consideration in children with markedly elevated IgE and indeterminate clinical scores; however, this approach should complement rather than replace comprehensive clinical assessment.

Children doi: 10.3390/children13050652

Authors: Alexandra B. Gibson Courtney P. D. Goldenberg Malinda J. Colwell Amelia E. Talley Joaquín Borrego Adam T. Schmidt

Background: Children participating in the Head Start program in the United States are predominantly from underserved groups, have increased rates of child adversity, and are at risk for externalizing behavior problems in the classroom. The Good Behavior Game (GBG) is an effective classroom management strategy for reducing disruptive and off-task classroom behaviors. However, previous research has not examined the GBG within the Head Start context. Methods: The current case–controlled study evaluated the effectiveness of the GBG in six Head Start children aged 3–5. Researchers conducted daily classroom behavioral observations of disruptive behaviors, and teachers completed pre- and post-treatment assessments of externalizing behaviors and social skills. Results: Study results showed the majority of target children exhibited reductions in at least one observed externalizing behavior and clinically significant improvements in teacher-reported externalizing behaviors, although most participants did not exhibit significant changes in social skills. Findings illustrate the effectiveness of structured classroom interventions, such as the GBG, for improving classroom behavioral compliance. Results have implications for teacher training and highlight the capacity for low-intensity interventions such as the GBG to have substantial impacts on classroom management within settings such as Head Start. Future research should endeavor to determine the optimal dosage and duration of the GBG, assess the effectiveness of teacher training to administer the GBG in their own classrooms, and evaluate if the current findings generalize to other contexts.

Children doi: 10.3390/children13050651

Authors: Lida Zeinali Evan Giusto Heather Knych Amy Lesneski Morgan Hardie Houssam Joudi Deepika Sankaran Satyan Lakshminrusimha Payam Vali

Background: Preterm infants with bradycardia at birth often undergo immediate cord clamping (ICC) followed by resuscitation with positive pressure ventilation (PPV), chest compressions (CCs) and umbilical venous catheter (UVC) epinephrine. Resuscitation with an intact cord (PPV during delayed umbilical cord clamping—DCC) stabilizes cardiac output but delays UVC placement. Objective: To evaluate the feasibility of direct epinephrine injection into the umbilical vein during DCC (DCC + direct-epinephrine) compared with ICC and epinephrine administered through a UVC (ICC + cath-epinephrine), and to explore differences in return of spontaneous circulation (ROSC) and need for CCs between these approaches. Methods: Eleven preterm lambs (125–127 d gestation) were asphyxiated by cord compression to decrease heart rate (HR) to <30/min. In the ICC + cath-epinephrine group, the cord was immediately cut, lambs received PPV followed by CCs if HR < 60/min, and epinephrine was administered after UVC placement. In the DCC + direct-epinephrine group, cord compression was released when HR < 30/min and PPV was initiated. If HR remained <60/min, epinephrine was injected into the UV using a 25G needle. If ROSC was achieved, DCC was continued for 2 min. If HR < 100/min, the cord was cut and resuscitation was continued as outlined above. Plasma epinephrine concentrations were analyzed. Results: All lambs required epinephrine. Time to epinephrine was shorter with DCC + direct-epinephrine, 1.0 (0.7, 1.6) vs. 3.7 min (3.2, 5.2). Fewer lambs with DCC + direct-epinephrine needed CC (2/6 vs. 5/5, p = 0.06). ROSC success and plasma epinephrine concentrations were similar. Post-ROSC, heart rates and mean blood pressures tended to be higher in the ICC + cath-epinephrine group. Conclusions: In this perinatal lamb model of asphyxial bradycardia, resuscitation with an intact cord with direct umbilical venous epinephrine injection is feasible. Larger studies are required to determine whether this approach reduces the need for CC or improves clinically meaningful outcomes.

Children doi: 10.3390/children13050650

Authors: Arzu Eroglu

Background: Developmental and benign movement disorders (DBMD) are a common but often under-recognized cause of referral in children with suspected seizures, frequently leading to misdiagnosis and unnecessary treatment. Methods: This retrospective cohort study included 453 children evaluated for suspected seizures between January 2019 and January 2024. Patients with epilepsy, cerebral palsy, metabolic disorders, significant developmental delay, psychiatric conditions, or structural brain abnormalities were excluded. DBMD was diagnosed in 113 patients based on clinical evaluation by experienced pediatric neurologists and established diagnostic criteria. Demographic characteristics, diagnostic distribution, age at presentation, and electroencephalography (EEG) findings were analyzed. Prevalence was calculated with 95% confidence intervals (CIs). Group comparisons were performed using chi-square tests and one-way ANOVA with Tukey post hoc analysis. Results: The prevalence of DBMD was 24.9% (95% CI: 21.2–29.1), corresponding to nearly one in four children referred with suspected seizures. Breath-holding spells were the most common diagnosis (6.6% of the total cohort; 26.5% of DBMD cases), followed by Sandifer syndrome and non-epileptic staring episodes. Age at presentation differed significantly between diagnostic groups (p = 0.001), with breath-holding spells occurring at younger ages and staring episodes at older ages. EEG findings were normal in 80.5% of patients, and no diagnosis-specific epileptiform patterns were identified. No patients were observed to develop epilepsy during the follow-up period. Conclusions: DBMD accounts for a substantial proportion of children referred for suspected seizures. Recognition of age-specific clinical patterns and predominantly normal EEG findings may improve diagnostic accuracy and help avoid unnecessary investigations and antiepileptic treatment.

Children doi: 10.3390/children13050649

Authors: Erin Chung Najla Tabbara Winnie Seto Vibhuti Shah

Background/Objectives: Vancomycin dosing in neonates is challenging due to high pharmacokinetic variability and immature renal function. This study evaluated current therapeutic drug monitoring (TDM) practices, the association between vancomycin concentration and clinical outcomes, and the predictive performance of a locally developed population pharmacokinetic (popPK) model compared to the published models. Methods: This was a retrospective cohort study of neonates admitted to a tertiary neonatal intensive care unit (NICU). We assessed the persistent positive culture, infection recurrence, mortality and acute kidney injury (AKI) stratified by initial vancomycin trough concentrations (<10 mg/L, 10–15 mg/L, >15 mg/L). The locally developed popPK model was externally validated and compared with 32 other published neonatal vancomycin popPK models (with a total of 33 models evaluated). Results: A total of 366 neonates were included (mean postmenstrual age of 28.9 ± 3.81 weeks; 191 received at least 5 days of vancomycin). Only 28% of neonates achieved initial vancomycin trough concentrations within the 10–15 mg/L using standard vancomycin dosing. Higher vancomycin trough concentrations (>15 mg/L) were not associated with improved efficacy but were significantly associated with a higher incidence of AKI. The locally derived popPK model demonstrated superior predictive accuracy, meeting all predefined performance criteria, whereas none of the 32 other published models met all the criteria. Conclusions: Current vancomycin dosing strategies often result in suboptimal exposure and increased nephrotoxicity without added efficacy. Model-informed precision dosing using the locally developed popPK model may offer a safer, more effective approach for neonatal vancomycin therapy.

Children doi: 10.3390/children13050648

Authors: Giulia Montanari Andrea Zanaroli Egidio Candela Giacomo Biasucci Federico Baronio Rita Ortolano Marcello Lanari

Background/Objectives: Glycogen storage disease type IX (GSD IX) is an inherited metabolic disorder characterized by marked clinical heterogeneity and variable severity. Dietary therapy is considered the cornerstone of management, but evidence on treatment strategies, efficacy, and safety remains limited. This study aimed to systematically synthesize available data on therapeutic approaches and clinical outcomes in GSD IX. Methods: A focused analysis of treatment-related data was conducted from a previously performed PRISMA-based systematic review. Clinical studies reporting treatment and follow-up data in genetically confirmed GSD IX patients were included. Results: Among 400 patients identified in the original review, 129 from 26 studies had treatment and follow-up data available. Dietary management combined with uncooked cornstarch (UCCS) was the most common approach (96.1%), with highly heterogeneous protocols. Hepatic manifestations improved in 59/129 (45.7%) of patients, and hypoglycemia in 45/129 (34.9%). Growth outcomes were variable, with catch-up growth in 14.0% and persistent impairment in 19.4%, although data were often missing. Muscle involvement was rarely assessed. No treatment-related adverse events were reported. However, disease-related complications were described, including liver cirrhosis, neurological involvement, osteopenia/osteoporosis, and two deaths in GSD IXa patients. Conclusions: Dietary therapy combined with UCCS remains the mainstay of treatment in GSD IX and is associated with improvement in key clinical domains. However, evidence is limited, heterogeneous, and largely based on small studies. Data on modified cornstarch formulations, such as Glycosade®, are scarce. Prospective studies and standardized treatment protocols are needed to support evidence-based management.

Children doi: 10.3390/children13050647

Authors: Yahui Zhang Yanxia You Jianqiu Huang Yunfeng Liu Tongyan Han

Background/Objective: Preterm birth poses notable neurodevelopmental risks, with cerebral microcirculatory disturbances potentially contributing to long-term impairment. Existing monitoring modalities lack bedside capacity to evaluate these microvascular changes during critical brain development. We characterized cerebral microperfusion and functional maturation patterns in preterm versus full-term neonates using combined ultra-micro angiography (UMA) and an amplitude-integrated electroencephalogram (aEEG). Methods: In this prospective study, 76 neonates (23 extremely/very preterm [EP/VPT], 27 moderate-late preterm, and 26 term controls) were assessed at term-equivalent age. UMA helped quantify regional microperfusion (color pixel percentage, abbreviated as CPP in this context to differentiate from cerebral perfusion pressure), whereas aEEG (Burdjalov scores) helped evaluate functional maturation at 37–38 and 40 weeks’ postmenstrual age. Results: EP/VPT infants demonstrated significant cerebral hyperperfusion with distinct cortex–white matter perfusion gradients. Although preterm infants showed advanced aEEG maturation at 37–38 weeks, this difference normalized by 40 weeks. Conclusion: Gestation-dependent cerebral hyperperfusion and transient EEG maturation differences in EP/VPT infants at term-equivalent age support the value of UMA–aEEG integration for neurovascular assessment. The observed perfusion–EEG patterns suggest prematurity-specific neuroadaptation, warranting further investigation of long-term functional correlates.

Children doi: 10.3390/children13050646

Authors: Shilpa Vyas-Read Shazia Bhombal Roopa Siddaiah Clifford L. Cua Amulya Buddhavarapu Robin L. McKinney Philip T. Levy Amanda L. Hauck Nicolas F. M. Porta Kathleen A. Gibbs Krithika Lingappan Matthew S. Douglass Eric D. Austin Steven H. Abman Ronald W. Day

Background: Echocardiography is a non-invasive test that is readily used to detect pulmonary hypertension associated with bronchopulmonary dysplasia (BPD-PH) and right ventricular failure (RVF). However, the most feasible, reproducible and accurate parameters to measure and use for guidance in addressing patient care have not been established and may differ between subspecialties. Methods: We surveyed members of the BPD Collaborative to determine how different care providers clinically evaluate infants for BPD-PH and RVF. Perceived challenges and obstacles that limit the utility of echocardiography are also reported. Results: Of the 108 survey respondents from ~45 centers, 55.6% were neonatologists, 18.5% were pediatric pulmonologists or pediatric intensive care physicians, 15.7% were pediatric cardiologists or pulmonary hypertension specialists, and 10.2% were other providers. Responses revealed discrepancies between specialists concerning the use of standard echocardiographic protocols and parameters that can be measured serially with relative ease, metrics that should be used to best define and distinguish the severity of BPD-PH or RVF, and parameter values that should be used to determine whether changes in PH-targeted medical therapies, hemodynamic or respiratory support are needed. Free text responses identified patient-, protocol-, cardiology-, technician-, and BPD-PH definition-related obstacles that may limit the reliable utility of echocardiography. Conclusions: Although most providers agree that echocardiography is feasible and of value, variability exists between subspecialists and centers, suggesting the need for improved standardization of imaging protocols and BPD-PH definition, consistent test interpretation, and effective communication of results to improve the reproducibility and accuracy of echocardiography in infants with BPD.

Children doi: 10.3390/children13050645

Authors: Irene Coll Campayo Pablo Estebala Alández Daniela Vallejos Rojas Raúl Cuesta Román María Luisa Bonet Piña Nora López-Safont

Background/Objectives: Adolescence is a critical developmental stage during which lifestyle and dietary habits are established, influencing both general and oral health outcomes. Territorial disparities between rural and urban environments may contribute to nutritional inequalities and health vulnerabilities. The aim of this study was to analyze differences between rural and urban environments in terms of lifestyle behaviors, dietary patterns, and oral health outcomes among adolescents in Mallorca, Spain. Methods: A cross-sectional study was conducted among 463 adolescents corresponding to the WHO index ages (12 and 15 years). Data were collected through questionnaires assessing dietary habits, oral hygiene behaviors and lifestyle characteristics. Clinical oral examinations were performed following the World Health Organization Pathfinder methodology. Statistical analyses included descriptive statistics and comparative analyses between rural and urban populations. Results: Urban adolescents reported higher consumption of sugar-sweetened beverages and ultra-processed foods (p < 0.001), whereas rural adolescents showed higher weekly physical activity (4.45 ± 2.34 vs. 3.62 ± 2.41 h/week; p < 0.001). Caries prevalence was higher in rural students (45.0% vs. 28.6%; p < 0.001), who however demonstrated better periodontal indicators. Conclusions: Geographic environment is associated with differences in dietary patterns, physical activity levels, lifestyle behaviors, and oral health outcomes among adolescents. These findings highlight the importance of targeted public health interventions adapted to geographic context and support the role of broader social and environmental determinants in adolescent oral health.

Children doi: 10.3390/children13050644

Authors: Sophia Charitou Emmanouil Skordilis

Background: Early motor milestones play a critical role in shaping developmental trajectories across motor, cognitive, social, and functional domains. Increasing evidence indicates that motor competence facilitates environmental exploration, learning opportunities, and social engagement during infancy and early childhood. Methods: The present scoping review aimed to map and synthesize the existing evidence on early motor interventions in children aged 0–6 years across diverse pediatric populations. A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science. Studies were selected based on predefined inclusion criteria, and data were extracted and synthesized using a descriptive and thematic approach. Results: A total of 30 studies were included, encompassing a wide range of populations, including preterm infants, children at risk of cerebral palsy, and typically developing children. Across studies, early motor interventions were associated with improvements in motor outcomes and, in many cases, broader developmental domains such as cognition and social interaction. Intervention effectiveness appeared to be influenced by factors such as timing, intensity, task specificity, and caregiver involvement. Conclusions: The review provides a cross-population synthesis of early motor interventions and proposes a conceptual framework that integrates shared mechanisms underlying effective intervention across diverse pediatric groups. This approach offers a more unified understanding of how early motor interventions influence developmental trajectories beyond diagnosis-specific perspectives.

Children doi: 10.3390/children13050643

Authors: Clive Friedman David A. Tesini Adithya Kethu

Background: Daily, perhaps for hours at a time, pacifiers are put in baby’s mouths for the primary purpose of soothing. A causal relationship exists between the use of pacifiers and the development of malocclusions and disturbances to the cranio-facial-respiratory complex (CFRC). Finite element analysis (FEA) has enabled us to understand how pacifier bulbs behave under negative pressure and tongue movement in the mouth. It is now realized that the design and size of pacifiers should be based on infant and toddler biometrics of the maxillary palatal width and should contribute to proper oral function and development. Attention has shifted toward the interaction between the pacifier shield, the lips, chin and developing tempro-mandibular joint (TMJ). Free mandibular motion is essential to normal TMJ development, essential to maintaining airway space and promoting forward mandibular growth. This is especially relevant in infants with retrognathia, when shield pressure may restrict free movement of the jaw and anterior mandibular advancement. Conclusions: When the pacifier shield interacts with the chin, it impacts the growth and development of the infant mandible and airway physiology. Interference with free movement of the mandible must be made a functional concern in design of the pacifier shield. Technological advances in smartphone photogrammetry now make development of non-invasive diagnostic tools that can advantage the future oral health of children.

Children doi: 10.3390/children13050641

Authors: Letteria Anna Morabito Malgorzata Wasniewska Cecilia Lugarà Emanuela Pignatone Domenico Corica Renato Vaiasuso Alessandra Cipriani Giovanni Luppino Roberto Coco Giorgia Pepe Tiziana Abbate Stefano Stagi Tommaso Aversa

Background: Treatment with recombinant human growth hormone (rhGH) is approved for children born small for gestational age (SGA) who fail to show postnatal catch-up growth; however, optimizing its efficacy remains a challenge. Aim: to evaluate the impact of rhGH therapy on growth trajectory (GT) and adult height (AH) in SGA children and to identify factors influencing height gain (HG). Methods: A total of 49 SGA children (24 males, 25 females) without postnatal growth recovery and treated with rhGH were enrolled. Clinical and anthropometric data were collected at treatment initiation (T0), after 1 (T1) and 2 years (T2) of therapy, at pubertal onset (P0), during the first (P1) and second year (P2) of puberty, and at attainment of AH. Parameters included age, bone age, H, weight, BMI (all expressed as SDS), HG, and the difference between H and target height (Δ H-TH). Results: a significant increase in HG at all evaluated stages was observed (p < 0.05). The H–TH difference progressively decreased from T0, particularly until the first two years of puberty. Nevertheless, mean AH was −1.75 ± 0.63 SDS, and it was found to fall within the TH range in 86% of cases. Univariate and multivariate regression analysis revealed that age and H at T0 were independent predictors of HG. Conclusions: rhGH treatment has a positive impact on GT in children born SGA. Pubertal growth has a limited contribution in influencing AH of these patients. H and timing of treatment initiation significantly influence HG in SGA children. Early selection of patients for rhGH therapy could further improve their GT.

Children doi: 10.3390/children13050642

Authors: Andreea Teodora Constantin Ioana Roșca Leonard Năstase Alexandru Dinulescu Alina Turenschi Gabriel-Petre Gorecki Ciprian Andrei Coroleuca Elena Poenaru Daniela Eugenia Popescu

Background/Objectives: Exclusive breastfeeding offers optimal benefits for infant nutrition and health and increases maternal involvement, bonding and interactions. This study aimed to explore breastfeeding practices among mothers in Romania and identify risk factors associated with low exclusive breastfeeding rates. Methods: A cross-sectional online survey was conducted between September and December 2025, targeting mothers in Romania via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographic characteristics, birth and neonatology variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. Responses were analyzed using Fisher’s exact tests and multivariable logistic regression. Results: A total of 357 complete questionnaires were analyzed. Cesarean section was the most frequent mode of delivery (54.6%), while immediate mother–infant contact after birth was reported by only 35.6% of mothers, and breastfeeding initiation within the first hour occurred in 10.6% of cases. Overall, 49.3% of mothers reported exclusive breastfeeding, 35.3% mixed feeding, and 15.4% exclusive formula feeding. Women who delivered in private hospitals reported earlier mother–infant contact, more frequent encouragement to initiate breastfeeding, and earlier breastfeeding initiation compared with those delivering in public hospitals. Preterm birth was associated with delayed breastfeeding initiation, reduced rooming-in, and lower rates of exclusive breastfeeding up to six months. In multivariable logistic regression, rooming-in was independently associated with higher odds of exclusive breastfeeding (aOR = 2.798, 95% CI: 1.779–4.401), while lack of lactation support was associated with lower odds (aOR = 0.546, 95% CI: 0.302–0.987). No significant associations were observed for timing of initial maternal–infant contact (aOR = 1.084, 95% CI: 0.679–1.733) or encouragement from medical staff to initiate breastfeeding (aOR = 1.207, 95% CI: 0.721–2.020). Conclusions: Our study highlights current breastfeeding practices and associated hospital factors in Romania. However, significant challenges remain in supporting and encouraging mothers to optimally feed their infants. Additional investment and bold policy action are needed to promote and support breastfeeding from the first hour of life, for both term and preterm infants, in all maternity hospitals in Romania.

Children doi: 10.3390/children13050640

Authors: Anuța Bilașco Anca Cristina Drăgănescu Victor Daniel Miron Cristina Ramona Rădulescu Diana Maria Băncilă Ana-Maria Tudor Angelica Constanța Vișan Doina-Anca Pleșca

Background: Herpes zoster (HZ) is uncommon in children and is typically considered a mild disease. However, hospitalized cases may be associated with complications. Data on herpes zoster in children in Eastern Europe are limited. This study aimed to describe the clinical features, complications, and factors associated with severity in hospitalized pediatric HZ. Methods: We conducted a retrospective cohort study including children (<18 years) hospitalized with HZ between January 2015 and December 2025, at a tertiary infectious diseases center in Bucharest, Romania. Demographic, clinical, laboratory, and outcome data were extracted from medical records. Univariable and multivariable analyses were performed to identify factors associated with complications and prolonged hospital stay. Results: Among 612 pediatric HZ cases, 92 (15.0%) required hospitalization. The median age was 8.8 years (IQR 4.8–13.2), and 52.2% were male. Overall, 43.5% developed complications, most commonly bacterial superinfection (30.4%), followed by neurological and ophthalmological involvement. Herpes zoster sine herpete was identified in 4.3% of cases and was associated with central nervous system involvement. Headache (OR = 4.34, p = 0.025) and lymphopenia (OR = 3.01, p = 0.020) were independently associated with complications. Patients with complications had longer hospital stays (median of 6 vs. 4 days, p = 0.002). In multivariable analysis, complications, immunocompromised status, and chronic conditions were associated with prolonged hospitalization. Conclusions: Herpes zoster in children is generally mild and has a favorable prognosis; however, hospitalized cases are often associated with complications, especially bacterial superinfections and neurological involvement. These findings derive from a selected population and highlight the role of clinical and host-related factors in shaping outcomes in hospitalized pediatric herpes zoster.

Children doi: 10.3390/children13050639

Authors: Anna Damatopoulou Michail Matalliotakis Fani Ladomenou Christina Thomou Marina Koropouli Maria Polychronaki

Background/Objectives: Neonatal sepsis remains a major contributor to neonatal morbidity and mortality worldwide, yet diagnostic uncertainty and heterogeneous clinical presentation continue to challenge early recognition and management. Early-onset sepsis (EOS), typically arising within the first 72 h of life, is strongly influenced by maternal and perinatal factors. Limited data exist on the temporal evolution of clinical system involvement during the first week of life. This study aimed to identify the predominant clinical systems involved in preterm and term neonates with suspected or confirmed sepsis and to determine maternal and neonatal risk factors associated with early disease severity, persistent sepsis, and adverse outcomes. Methods: A total of 297 neonates met the inclusion criteria. Most infants (99.3%) were admitted before 72 h of life. Clinical system involvement was recorded daily, and maternal–neonatal risk factors were analyzed to identify predictors of advanced sepsis at presentation, persistent sepsis at Day 7, and mortality. Results: Respiratory involvement was the predominant clinical system affected on Day 1 (57.2%) and remained common through Day 3. CNS, gastrointestinal, and skin involvement were infrequent. Lower gestational age (p = 0.035) and prolonged rupture of membranes >18 h (p = 0.043) independently predicted sepsis at Day 1. Advanced sepsis at admission was associated with lower birth weight, lower gestational age, older maternal age, and absence of intrapartum antibiotics (all p ≤ 0.001). Persistent sepsis at Day 7 was linked to prematurity (p = 0.008), higher mortality (p < 0.001), and prolonged hospitalization (p = 0.001). Conclusions: Respiratory involvement was the most common clinical system affected in neonates with EOS. Prematurity, low birth weight, prolonged rupture of membranes, and maternal intrapartum infection significantly increased the risk of severe disease. Understanding the evolution of clinical system involvement during the first days of life may support more precise risk stratification and reduce unnecessary antibiotic exposure.

Children doi: 10.3390/children13050638

Authors: Silvia D’Agostino Vanja Granberg Giulia Valentini Massimo Corsalini Luisa Limongelli

Background/Objectives: Mycoplasma pneumoniae (MP) is a frequent cause of community-acquired pneumonia, but it is increasingly recognized for extrapulmonary complications, specifically Mycoplasma pneumoniae-induced rash and mucositis (MIRM). This systematic review aims to comprehensively assess the frequency of clinical features, diagnostic criteria and outcomes of oral mucositis in patients with confirmed MP infection. Methods: A systematic review was conducted following PRISMA guidelines across PubMed, Web of Science and Scopus, covering the period 2015–2025. Inclusion criteria encompassed in vivo studies, case reports, and case series in English focusing on MP-associated mucositis. Methodological quality was assessed using JBI checklists for case-based evidence and the Newcastle–Ottawa Scale for cohort studies. Two clinical cases were reported. Results: Out of 242 identified records, 42 studies were included, involving 140 patients with a notable male predominance (62%). Oral involvement was reported in 92.9% of cases, often characterized by severe ulcerations, hemorrhagic crusting, and debilitating pain. Intensive Care Unit admission was required in 21.5% of cases due to severe systemic or mucosal disease, with 14.3% necessitating parenteral nutrition. Quality assessment indicated moderate-to-high methodological rigor across most included studies. Conclusions: MIRM represents a significant clinical entity where oral mucositis is a dominant feature, often preceding or overshadowing respiratory symptoms. Early recognition by oral health professionals is crucial to avoid misdiagnosis, ensure appropriate multidisciplinary care, and implement supportive or immunomodulatory therapies that reduce morbidity and hospitalization length.

Children doi: 10.3390/children13050637

Authors: Theodore A. Petti Paulette Forbes Richard Drachtman

Background/Objectives: Sickle cell disease (SCD) is the most prevalent inherited pediatric hematologic disease. Pain is the most common complaint and primary reason for emergency care. Effective coping is critical to improved quality of life for individuals with SCD and other chronic illnesses. Hope, engendered by provision of comprehensive care, may explain the positive impact of effective coping and improved health outcomes. The relevance of effective coping skills and hope’s impact on repeated hospitalizations and/or length of hospitalization stay (LOS) among adolescents with SCD is considered. A regional, comprehensive pediatric sickle cell center (RCPSCC) provided the services. Methods: Patients with SCD, ages 13 through 21 years seen in a university RCPSCC (URCPCC-SCD), completed surveys: a general scale providing a broad range of positive and maladaptive coping-related issues, and KIDCOPE, a standardized scale measuring pediatric coping strategies. Medical records were reviewed for frequency of hospitalization and length of stay (LOS) for the eight months before study entry. Results: Thirty-four URCPCC-SCD outpatients, mean/median age of 16 years, entered the study, and data were analyzed for 33. All reported some sense of future hopefulness, and almost half reported feeling “tense or wound up” most of the time. Use of avoidant or negative coping strategies in response to daily stress correlated positively with increased LOS. Conclusions: Youths with SCD require effective coping strategies to improve self-efficacy and related hope for brighter futures. Individualized, comprehensive treatment and support to families and individuals at risk for sickle cell crisis are uniquely offered in a URCPCC-SCD. Their contributions to service delivery and clinical outcome are expected to enhance hope, mitigate prolonged hospitalizations, and improve adherence to treatment (N = 268).

Children doi: 10.3390/children13050636

Authors: Paula Sevilla Hermoso Mireia Mor Conejo Carme Alejandre Laia Roig Cortes Omar Rodriguez Francisco José Cambra Lasaosa Iolanda Jordan Mònica Balaguer

Introduction. Bronchiolitis is the leading cause of Pediatric Intensive Care Unit (PICU) admission for lower respiratory tract infection in infants. Although survival has improved, concerns remain regarding potential long-term functional impairments, including alterations in psychomotor development, learning, and behavior. This study aimed to describe the epidemiological and clinical characteristics of children admitted to the PICU for bronchiolitis and to evaluate their functional outcomes at 12-month follow-up. Methods. A retrospective descriptive cohort study was conducted, including all patients admitted to the PICU for bronchiolitis during the 2021–2022 period. Epidemiological, clinical, microbiological, and laboratory data were collected. Functional health status was assessed using the Pediatric Overall Performance Category (POPC), Pediatric Cerebral Performance Category (PCPC), and Functional Status Scale (FSS) at PICU discharge and 12 months. Changes in functional status were categorized as improved, stable, or worsened. Exploratory unadjusted analyses were performed to describe differences between outcome groups. Results. A total of 164 patients were included (43.9% female), with a median age of 51 days (IQR 26.25–118.5). Respiratory syncytial virus was identified in 79.7% of cases. Invasive mechanical ventilation was required in 31.1% of patients, and 45.7% developed complications during PICU admission. Mortality was 0.6%. At 12 months, functional deterioration was observed in 14.6% of patients according to POPC, 16.5% according to PCPC, and 3.6% according to FSS. Higher proportions of functional deterioration were observed among patients with underlying medical conditions, those requiring invasive mechanical ventilation, those with complications, and those with longer PICU and hospital stays, particularly in the PCPC scale. Conclusions. Most children admitted to the PICU for bronchiolitis showed stable or improved functional status at 12 months. However, a subset experienced functional deterioration, more frequently observed in patients with greater clinical severity and complexity during admission. These results support the need for further studies to better characterize long-term outcomes and to identify children who may benefit from closer follow-up.

Children doi: 10.3390/children13050635

Authors: Yeonju Kim Insu Choi Kyung Soon Choi In Seok Jeong Hwa Jin Cho

Background and Objectives: Kawasaki disease (KD) is an acute systemic vasculitis in children, and approximately 10–20% of patients develop resistance to intravenous immunoglobulin (IVIG), which is associated with an increased risk of coronary artery complications. Natural killer (NK) cells play an important role in innate immune regulation, but the temporal dynamics of NK-cell regulatory receptors during KD and their relationship with IVIG response remain unclear. Materials and Methods: In this prospective observational study, we performed longitudinal immunophenotyping in children with KD treated at a tertiary referral center. Peripheral blood samples were obtained before IVIG administration (D0) and at three follow-up timepoints after treatment (D2, D14, and D56). NK-cell subsets and receptor expression—including the activating receptor NKG2D and inhibitory receptor NKG2A—were analyzed using multiparameter flow cytometry. Associations with IVIG response were evaluated using Firth penalized logistic regression for baseline predictors and linear mixed-effects models to assess longitudinal immune trajectories. Results: A total of 69 patients with KD were included, of whom 17 (24.6%) were classified as IVIG resistant. Baseline NK-cell subsets and receptor expression did not differ significantly between IVIG-sensitive and IVIG-resistant patients, although the NKG2D/NKG2A ratio tended to be lower in resistant patients (median 2.51 vs. 3.34, p = 0.054). Longitudinal mixed-effects analysis demonstrated significant temporal changes in NK-cell regulatory signaling following IVIG therapy. Both NKG2A (P(time) = 0.019) and NKG2D (P(time) < 0.001) expression showed significant time effects across the disease course. Importantly, the NKG2D/NKG2A ratio demonstrated a significant time-by-group interaction (P(interaction) = 0.030), indicating divergent trajectories of activating and inhibitory NK-cell signaling according to IVIG response. At the convalescent phase (D56), IVIG-resistant patients showed significantly higher NKG2A expression (p = 0.038) and a lower NKG2D/NKG2A ratio (p = 0.023) than IVIG-sensitive patients. Conclusions: While baseline NK-cell immunophenotypes were not associated with IVIG response, longitudinal analysis revealed that IVIG-resistant patients exhibited a distinct immune trajectory, characterized by increased NKG2A expression and a lower NKG2D/NKG2A ratio during the convalescent phase. These findings suggest that differences in IVIG responsiveness may be related to alterations in immune regulatory processes during the resolution phase of inflammation. However, the clinical implications of these findings remain to be established and require validation in larger, multicenter studies with longitudinal outcome data.

Children doi: 10.3390/children13050634

Authors: Domenico Monacis Giacomo Pascali Dario Colella

Background: The integration of active breaks during the school day has been widely demonstrated to be effective in counteracting sedentary behaviors. The present study assessed the efficacy of a structured active breaks (ABs) intervention implemented during recess on multiple domains of Physical Literacy (PL) in primary-school children. Methods: A single-blind randomized controlled trial was conducted with 139 children (aged 9–10 years). Classes were randomized into an Experimental Group (EG, n = 66) and a Control Group (CG, n = 73). The EG participated in an 8-week intervention (six sessions/week, ~10 min) consisting of coordinative and interdisciplinary motor tasks during recess. Pre- and post-intervention assessments included physical fitness (SLJ, 4 × 10 m SR, 6MWT, MBT), gross motor skills (TGMD-2), selective attention (Bell Test), physical activity levels (PAQ-C), physical self-perception (PSP), and enjoyment (PACES). Results: A mixed-design MANOVA revealed a significant multivariate Time × Group interaction (p < 0.001). Univariate analyses showed significant improvements in the EG compared to the CG for explosive strength (p < 0.001), agility (p < 0.001), Gross Motor Quotient (p = 0.003), and selective attention (p < 0.001). Furthermore, the EG demonstrated significant increases in physical activity levels, self-perception, and enjoyment (p < 0.05). No significant gender interaction was found, indicating equal effectiveness for boys and girls. Conclusions: Transforming recess into a structured opportunity for movement through ABs effectively enhances physical, cognitive, and affective domains. This intervention represents a sustainable strategy for Health-Promoting Schools to foster PL and psychophysical well-being without reducing curricular instruction time.

Children doi: 10.3390/children13050633

Authors: Marko Bašković Jana Buzuk Bianka Dujić Danijela Jurić Kristina Jurković Karla Pehar Sara Vuković Davor Ježek Dubravko Habek Ivan Milas

Cryptorchidism is the most prevalent congenital anomaly of the male genitourinary tract, with an incidence of approximately 1 to 9 percent in full-term male infants, decreasing with age due to spontaneous descent. It encompasses testes that fail to descend into the scrotum, which may be intra-abdominal, inguinal, or ectopic, and can be associated with syndromic, genetic, or environmental factors. The descent process occurs in two phases: intra-abdominal, driven by gubernacular development and androgen-independent mechanisms, and inguinoscrotal, regulated by hormonal and mechanical factors including androgens and the gubernaculum. Clinically, cryptorchidism manifests as absent or hypoplastic scrotal testes, often with inguinal fullness. Palpation and physical examination are primary diagnostic tools, with imaging such as ultrasound or MRI reserved for specific cases. Surgical exploration remains the definitive diagnostic modality, especially for nonpalpable testes. Early referral, ideally before 12 months of age, is essential for timely orchidopexy, which aims to position the testes within the scrotum to reduce risks of torsion, trauma, subfertility, and malignancy. Hormonal therapy shows limited efficacy and is generally not recommended as a primary treatment modality. Long-term outcomes indicate that early orchidopexy improves spermatogenic potential and fertility. Men with a history of cryptorchidism exhibit elevated risks of subfertility and testicular germ cell tumors, with the risk being higher if surgical correction is delayed or if testes remain intra-abdominal. The increased malignancy risk persists even after orchidopexy, underscoring the importance of vigilant surveillance. Management strategies emphasize a multidisciplinary approach, combining surgical intervention with ongoing monitoring, to optimize functional and oncological outcomes. Early diagnosis, appropriate surgical treatment, and patient education are critical components in minimizing long-term complications associated with cryptorchidism.

Children doi: 10.3390/children13050632

Authors: Sergio De Salvatore Costanzo Testa Silvia Salera Amos Cocola Leonardo Oggiano Edoardo Costici Fabrizio Donati Laura Ruzzini Fabio Pascarella Paolo Brigato Pier Francesco Costici

Background/Objectives: Subtalar arthroereisis (STA) is widely used for symptomatic pediatric flexible flatfoot and provides consistent radiographic correction. However, return to sport (RTS) after STA is less well defined, and the relative role of early postoperative pain versus radiographic correction remains unclear. Methods: We performed a retrospective observational cohort study of consecutive skeletally immature patients treated with STA using a non-absorbable endosinotarsal screw at a single tertiary center. Inclusion criteria were symptomatic flexible flatfoot refractory to >6 months of conservative treatment, complete pre-/postoperative weight-bearing radiographs, complete functional data, and minimum follow-up of 6 months. The primary endpoint was RTS to the pre-symptom primary sport at final follow-up. Secondary outcomes were UCLA Activity Score, FAAM Sport subscale, and postoperative VAS. Radiographic correction was quantified as delta change (Δ) in Meary, Costa–Bertani, and Kite angles. Group comparisons used nonparametric tests. A parsimonious multivariable logistic regression model (EPV-constrained) included UCLA at 3 months, VAS pain, and ΔMeary. Results: Fifty patients were included (mean follow-up 9.2 ± 2.5 months; range 6–14); 27/50 (54%) resumed their primary sport. Baseline characteristics were comparable between Returners and Non-Returners. Returners showed higher early postoperative UCLA scores than Non-Returners (8.0 [7.0–8.5] vs. 6.0 [5.0–7.0], p = 0.005). FAAM Sport and VAS pain did not differ significantly between groups (p = 0.224 and p = 0.493, respectively). Radiographic correction magnitude was similar between groups (ΔMeary p = 0.938; ΔCosta–Bertani p = 0.984; ΔKite p = 0.108). In multivariable analysis, UCLA at 3 months was the only independent correlate of RTS (OR 2.65 per point, 95% CI 1.34–6.15; p = 0.009), whereas VAS pain (OR 0.98, 95% CI 0.76–1.25; p = 0.892) and ΔMeary (OR 1.01, 95% CI 0.91–1.13; p = 0.875) were not significant. Conclusions: In this cohort, STA achieved substantial radiographic correction, but neither correction magnitude nor early postoperative pain independently correlated with RTS at short-term follow-up. Early postoperative activity level was the strongest independent correlate of sport resumption, supporting a function-centered postoperative assessment beyond radiographic alignment alone.

Children doi: 10.3390/children13050631

Authors: Haritomane Brillakis Xiaoran Tong John S. Lyons

Background/Objectives: Sleep disturbance is common among youth in the child welfare system, yet the role of placement instability and placement setting in shaping sleep outcomes remains understudied. This study examined the association between placement instability, time spent in different care settings, and sleep disturbance among children in foster care. Methods: We conducted a retrospective cohort study using longitudinal administrative child welfare data from a Midwestern U.S. state, including 20,888 youth aged 5–18 years who entered foster care between 2010 and 2020. Sleep disturbance was assessed using the Child and Adolescent Needs and Strengths (CANS) sleep item. Baseline was defined as the first CANS assessment within one month of entry into care, and follow-up as the assessment closest to discharge or the end of a three-year observation window, whichever occurred first. We estimated association using a time-lagged linear mixed-effects model predicting sleep disturbance after each placement episode, including placement instability: 1 (reference), 2, 3, or ≥4 placement(s), time since placement, time spent in care settings (kinship, foster home, treatment foster home, congregate care, institutional care), and baseline trait factor scores derived from non-sleep CANS items, while controlling for sleep at the time of placement and demographics. Results: At baseline, 2016 children had actionable sleep disturbance (CANS sleep = 2 or 3; 1701 moderate and 315 severe). By the end of follow-up, this increased to 2884 children (2372 moderate and 512 severe). In linear mixed-effects models, placement instability demonstrated a dose–response association with higher subsequent sleep disturbance relative to one placement (2 placements: β = 0.025; 3 placements: β = 0.045; ≥4 placements: β = 0.067; all p ≤ 0.02). Time spent in kinship care was associated with lower sleep disturbance (β = −0.049; p < 0.001), whereas time spent in treatment foster homes was associated with higher sleep disturbance (β = 0.035; p < 0.001). Trauma in the family, medical/developmental needs, and internalizing/sexual issues were positively associated with sleep disturbance. Time and instability interactions showed modest attenuations of instability-associated sleep disturbance over time for higher placement counts. Conclusions: Placement instability is associated with progressively worse sleep disturbance over time among youth in foster care, even after controlling for sleep status at placement and baseline functioning. Sleep disturbance may represent an actionable indicator for the child welfare system, highlighting opportunities for targeted screening and support during placement transitions.

Children doi: 10.3390/children13050629

Authors: Ziad D. Baghdadi

Silver diamine fluoride (SDF) is a key preservation-based intervention in pediatric dentistry. It can arrest many cavitated lesions, reduce treatment burden, and expand access for children who cannot receive conventional restorative care. This viewpoint article offers a reasoned, heuristic framework for calibrating SDF guidance to the strength of the underlying evidence. It does not present a systematic review or formal policy standards. Foundational trials support the clinical usefulness of 38% SDF. The 2017 AAPD guidelines provided conditional recommendations based on low-quality evidence. The current challenge is no longer whether to endorse SDF but how to calibrate guidance on its implementation. Later studies addressing intervals and implementation often have open-label designs, small samples, single centers, or overlapping data sources. Mechanistic and microbiome studies support biological plausibility, but policy should not treat them as definitive evidence. We propose a hypothesis-generating framework that separates claims about the existence of an effect (for which there is stronger directional support) from claims about its optimal conditions (which remain more uncertain), highlights dataset overlap, and matches recommendation strength to study quality. The framework supplements GRADE and provides illustrative upgrade pathways. The goal is to preserve SDF access while making guidelines more transparent, credible, and precise.

Children doi: 10.3390/children13050630

Authors: Ronella Marom Laurence Mangel Addy S. BrandStetter Jacky Herzlich Dror Mandel Yuval Bar-Yosef

Objective: Prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) has been associated with altered neonatal adaptation, but its relationship with early elimination patterns remains unclear. Given the role of serotonin in gastrointestinal and urinary physiology, we aimed to evaluate the association between maternal SSRI use during pregnancy and time to first stool and time to first void in healthy neonates. Methods: In this retrospective matched cohort study, neonates exposed to SSRIs in utero were matched 1:1 with unexposed controls by gestational age (GA) and weight-for-gestational-age category. The primary outcomes were time to first void and time to first stool. Multivariable linear regression was performed using log10-transformed time to first stool, adjusting for maternal age, GA, and neonatal sex. Sensitivity analyses included size-for-gestational-age and time to first feeding. Results: A total of 266 neonates were included (133 SSRI-exposed, 133 unexposed). Time to first stool was shorter in SSRI-exposed neonates compared with unexposed neonates (median 7.4 vs. 8.6 h, p = 0.023), while the time to first void did not differ. In adjusted analysis, SSRI exposure remained associated with shorter time to first stool (β = −0.08, 95% CI −0.16 to −0.001, p = 0.035), corresponding to an approximate 17% reduction. The association was consistent across sensitivity analyses. Meconium-stained amniotic fluid was associated with shorter time to first stool among SSRI-exposed neonates but not in unexposed neonates. The overall model explained a limited proportion of variance. Conclusions Prenatal SSRI exposure was associated with modest but consistent reduction in time to first stool, without affecting time to first void. While the clinical significance remains uncertain, these findings suggest a potential influence of in utero SSRI exposure on early neonatal gastrointestinal adaptation, which may be influenced by intrapartum conditions.

Children doi: 10.3390/children13050628

Authors: Hee-Beom Yang

Background: Although various laparoscopic techniques are available for pediatric hernia repair, the learning curve for laparoscopic intracorporeal sac transection with purse-string suture (LIST-PS) has not yet been established. Considering that intracorporeal suturing is technically more challenging than extracorporeal knotting, an objective assessment of surgical competence is crucial. The study aimed to evaluate the learning curve and safety profile of LIST-PS performed by a single surgeon in a large series of pediatric patients. Methods: A retrospective analysis of 469 pediatric patients treated between March 2019 and December 2025 was conducted. The learning curve was assessed using the cumulative sum (CUSUM) analysis of operative times. The cohort was divided into phases 1 (learning) and 2 (proficiency) based on the CUSUM peak. Additionally, a high-risk subgroup (preterm infants aged < 1 year) was compared with a control group to evaluate the impact of patient complexity on surgical progress. Results: The mean patient age was 3.4 ± 3.5 years, and 29.4% were born prematurely. The CUSUM analysis identified a peak at case 233, marking the transition to proficiency. The mean operative time decreased significantly from 70.6 ± 26.3 min in phase 1 to 52.0 ± 16.5 min in phase 2 (p < 0.001). Despite the reduction in operative time, the recurrence rate remained stable at 1.7% in both phases (p > 0.999). In a subgroup analysis, the high-risk group (preterm infants and infants < 1 year) required longer operative times (73.5 ± 32.8 min vs. 57.7 ± 19.2 min; p < 0.001) but showed no significant difference in recurrence compared to the control group (0.96% vs. 1.92%; p = 0.691). Conclusions: Technical proficiency in LIST-PS was achieved after 233 cases. Although high-risk patients consistently required more time, the surgeon’s improvement followed a parallel trajectory across all risk levels, maintaining high surgical safety throughout the learning process.

Children doi: 10.3390/children13050627

Authors: Velisha Thompson Joyce Shirinde Masilu D. Masekameni Thokozani P. Mbonane

Background: Asthma is one of the leading chronic inflammatory respiratory conditions affecting children under 5 years of age, especially those who reside in socio-economically disadvantaged and densely populated low- and middle-income communities. Methods: A cross-sectional analytical study was conducted to ascertain the prevalence of factors influencing asthma and wheeze among young children attending early childhood development centres in Alexandra Township. Data were collected using a self-administered modified International Study of Asthma and Allergies in Childhood questionnaire. The analysis was performed utilising STATA version 19. The study sample comprised 3265 young children and their parents or guardians. Results: The findings reveal that the prevalence of asthma and current wheeze was 17.52% and 35.56%, respectively, while the prevalence of a history of wheeze was 64.36%. In the multivariate analysis, a family history of asthma was identified as a risk factor for asthma (p < 0.001) and for current wheeze (p < 0.001) and historical wheeze (p < 0.001). Additionally, the use of pain medication and passing of public transport were seldom identified as risk factors for both asthma and wheeze. Furthermore, exposure to second-hand tobacco smoke (p = 0.025) was found to influence the occurrence of asthma. Conclusions: This study highlights the impact of individual, household, and environmental factors on asthma. The findings are critical for the implementation of preventive environmental health measures to address this issue, particularly in low- and middle-income countries with limited curative resources.

Children doi: 10.3390/children13050626

Authors: Anna Riva Gabriele Arienti Simona Di Guardo Eleonora Brasola Giovanna Zuin Laura Spini Naire Sansotta Andrea Eugenio Cavanna Renata Nacinovich

Background/Objectives: Inflammatory bowel diseases (IBDs) are relapsing–remitting gastrointestinal disorders often emerging in adolescence and frequently associated with psychiatric co-morbidities, including eating disorders (EDs). Deficiency in interoception—awareness of internal bodily sensations—is a transdiagnostic feature in EDs, with emerging evidence suggesting its relevance also in IBDs. This study aimed to assess interoceptive abilities in adolescents with IBDs compared to healthy adolescents. Methods: A total of 76 patients with IBDs and 90 healthy controls were enrolled in the study. All participants completed a comprehensive psychometric assessment, including measures of interoceptive sensibility (MAIA-2) and eating-related symptomatology (EDI-3). Results: Up to one in six (15.8%) patients with IBDs were found to be at high risk of developing EDs (EDI-3 Eating Disorder Risk Composite scale >70th percentile). Mean MAIA-2 scores were largely comparable, with the exception of the MAIA-2 Trusting subscale, which assesses whether the experience of one’s body is rated as safe and trustworthy. Specifically, patients with IBDs at high risk of developing EDs reported lower scores than both healthy controls and patients with IBDs at low risk of developing EDs, with a statistically significant difference emerging in the comparison with the latter group (p = 0.044). Conclusions: Adolescents with IBDs who report an elevated risk of developing eating disorders have a psychological profile characterised by increased disordered eating symptomatology, accompanied by selective impairment in interoceptive trust, as evidenced by reduced trust in internal bodily signal. These findings highlight the clinical relevance of thorough clinical assessment and early psychological intervention in this vulnerable population.

Children doi: 10.3390/children13050625

Authors: Jill L. Findley Anna L. Trebilcock Jeffrey A. Kasparek Melody M. Gordon John T. Reets Stephen P. Beals Timothy R. Littlefield

Background/objectives: This comprehensive study of infants with combinational deformational plagiocephaly with brachycephaly (cDPB) and combinational deformational brachycephaly with plagiocephaly (cDBP) examined the effectiveness of a custom, thermoplastic vacuum-formed cranial remolding orthosis and identified clinical predictive factors that affect treatment outcomes. In addition, a standardized classification scale for babies with combinational head shapes was developed for this study. Methods: This was a retrospective study of patients who were treated by Cranial Technologies between January 2014 and March 2025 and met the following inclusion criteria: (a) presented with a Cranial Vault Asymmetry Index (CVAI(S)) > 3.5 AND Cephalic Index (CI) > 90, (b) were compliant with the treatment protocol, (c) were nonsyndromic, and (d) did not have craniosynostosis. Infants with isolated plagiocephaly or isolated brachycephaly were excluded. Multiple linear regression (MLR) analyses and paired t-tests were used to model the effects of clinical predictive factors on CVAI(S) and CI outcomes and determine the change between pre- and post-treatment cranial anthropometric measurements, respectively. Results: N = 82,326 infants met the inclusion criteria for this study. The mean overall reduction in CVAI(S) was −3.64 (p < 0.001) and for specific age groups it was as follows: 3–4 months −5.274 (p < 0.001), 4–6 months −4.074 (p < 0.001), 6–8 months −3.262 (p < 0.001), 8–11 months −2.692 (p < 0.001), and >11 months −2.247 (p < 0.001). The mean overall reduction for CI was −3.84 (p < 0.001) and was not related to age. In terms of clinician-rated outcomes, 95–100% of babies who entered treatment at less than 6 months of age had a “good” or “great” outcome, while the “good” or “great” success rate dropped to less than 19% for babies who started treatment after 11 months of age. MLR (Adj. R2: 0.582) identified the following factors as significant predictors (p < 0.001) for change in CVAI(S): entry age (β = 0.008), left-sided plagiocephaly (β = −0.420), initial cephalic index (β = −0.056), initial CVAI(S) (β = −0.479), prematurity (β = −0.189), and the presence of torticollis or neck muscle involvement (β = 0.053). A second MLR for change in CI (Adj. R2: 0.217) observed significance (p < 0.001) for the following predictors: initial CI (β = −0.335), left-sided plagiocephaly (β = −0.332), multiple birth (β = −0.290), male sex (β = −0.158), initial CVAI(S) (β = −0.049), premature (β = −0.086), and neck muscle involvement (β = −0.106). Conclusions: CRO treatment for cDPB/cDBP resulted in highly significant improvement in both CVAI(S) and CI across all age groups with the youngest babies requiring the shortest treatment durations and demonstrating more favorable results, especially in correcting asymmetry. Overall, the mean reduction in CVAI(S) varied significantly between age groups, with younger babies experiencing greater change in CVAI(S) scores, whereas CI did not demonstrate the same relationship with entry age. This study proposed new terminology for infants who present with elements of both plagiocephaly and brachycephaly. The use of standardized terms such as cDPB/cDBP to describe a combinational head shape will enhance comparability across future studies, thus enabling better outcome reporting.

Children doi: 10.3390/children13050624

Authors: Jianji Xu Jinshan Zhang Chihuan Kong

Background: Portal hypertension is a major cause of esophagogastric variceal bleeding in children. Endoscopic therapy is widely used for acute hemostasis; however, it primarily controls the bleeding episode rather than the underlying portal hypertensive physiology, and definitive management often requires surgical portal decompression. Evidence regarding the outcomes of a staged endoscopic–surgical management strategy in pediatric patients remains limited. This study aimed to evaluate the clinical outcomes of children with portal hypertensive bleeding managed with endoscopic hemostasis as a bridging therapy followed by definitive portal decompression surgery. Methods: We conducted a retrospective consecutive cohort study including 12 children presenting with portal hypertension-related variceal bleeding at our tertiary pediatric center between January 2021 and December 2024. All patients underwent endoscopic hemostasis, followed by evaluation for portal decompression surgery when anatomically feasible. Clinical outcomes including hemostasis success, rebleeding, shunt patency, and survival were analyzed. An age-stratified exploratory analysis was performed to examine the association with early dysfunction after Rex shunt reconstruction. Results: Endoscopic hemostasis was successfully achieved in all patients, with no early rebleeding prior to surgery. Ten patients underwent portal decompression surgery within 7 days (Rex shunt, n = 8; splenorenal shunt, n = 2). During a median follow-up of 18 months, early Rex shunt dysfunction (<3 months) was observed in 2 of 8 patients (25%), both of whom were younger than 3 years, whereas no dysfunction was observed in older children. Given the small sample size, this observation should be interpreted descriptively. Rebleeding and mortality occurred exclusively in association with shunt dysfunction. Conclusions: A staged endoscopic–surgical strategy appears feasible for stabilizing children with acute portal hypertensive bleeding and enabling timely definitive portal decompression. In this small cohort (n = 12), an age-related signal in early Rex shunt dysfunction was observed in very young children; however, this finding should be interpreted cautiously and requires further validation in larger studies.

Children doi: 10.3390/children13050623

Authors: Myra Maghasi Koech Njie Albertine Enjema Juddy Wachira

Background: Rheumatic heart disease (RHD) remains a significant public health problem in low- and middle-income countries. Beyond its clinical consequences, RHD adversely affects the health-related quality of life (HRQoL) of affected children and adolescents, their families, and healthcare systems. Addressing the HRQoL of children and adolescents with RHD will contribute to strengthening patient-centered care and policy development. Objective: To determine the health-related quality of life of children and adolescents with rheumatic heart disease attending follow-up at the pediatric cardiology clinic of Moi Teaching and Referral Hospital (MTRH), Kenya. Methods: This was a hospital-based cross-sectional study conducted between January and July 2024. A total of 171 children and adolescents aged 5–18 years were consecutively enrolled while attending follow-up at the pediatric cardiology clinic of MTRH. The EuroQol EQ-5D-Y and EQ-5D-L questionnaires were used to assess HRQoL across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Overall HRQoL was evaluated using the EQ visual analog scale (EQ-VAS) and categorized as optimal (≥80%), suboptimal (70–79%), or poor (≤70%). Results: Overall HRQoL was optimal in 70.8% (n = 121) of participants, suboptimal in 8.2% (n = 14), and poor in 21.1% (n = 36). Impaired HRQoL was significantly associated with poor self-care (95% CI: 0.066–0.853; p = 0.028), anxiety/depression (95% CI: 0.111–0.678; p = 0.005), pain/discomfort (95% CI: 0.142–0.758; p = 0.009) and missing more than five school days (95% CI: 0.109–0.584; p = 0.001). Caregiver characteristics (age, education level, and income), surgical correction, RHD-related hospital admissions, comorbidities, and Ross classification were not significantly associated with HRQoL. Conclusion: Health-related quality of life among children and adolescents with RHD was most adversely affected in the mental health and mobility domains. Routine assessment of HRQoL should be incorporated into the clinical care of children and adolescents with RHD to reduce disease-related morbidity and support holistic management.

Children doi: 10.3390/children13050622

Authors: Efrossini Briassouli George Briassoulis

Background: Pediatric septic shock remains a major cause of morbidity and mortality and requires timely recognition and management across multiple hospital settings. Although intensive care support is critical, outcomes are also influenced by earlier phases of care, including emergency department recognition, first-hour treatment, inpatient monitoring, and timely escalation to the pediatric intensive care unit (PICU). Objective: We aimed to review pediatric septic shock across the full hospital trajectory, from emergency department recognition to PICU management and outcomes, with emphasis on diagnostic challenges, early treatment, escalation of care, and prognostic assessment. Methods: This narrative review was based on a structured literature search of PubMed/MEDLINE, Scopus, and the Cochrane Library, with emphasis on international guidelines, consensus statements, systematic reviews, and clinically relevant pediatric studies addressing recognition, resuscitation, escalation, intensive care management, and outcomes in pediatric septic shock. Results: Pediatric septic shock is best approached as a dynamic continuum rather than a single event. Early recognition is complicated by age-dependent physiology, nonspecific presentation, and delayed hypotension. Timely antimicrobial therapy, individualized fluid resuscitation, early vasoactive support, and repeated reassessment during the first hours are central to management. Ward surveillance and prompt escalation to PICU are critical, as delayed recognition of deterioration may worsen organ dysfunction and resource use. In the PICU, phenotype-informed hemodynamic support, fluid stewardship, respiratory support, and organ support are essential. Outcomes should be evaluated beyond mortality to include organ dysfunction burden, duration of support, length of stay, and longer-term functional recovery. Conclusions: Pediatric septic shock outcomes are shaped by the entire hospital care pathway rather than PICU treatment alone. A trajectory-based, continuum-of-care approach may improve timely diagnosis, escalation, and short- and longer-term outcomes.

Children doi: 10.3390/children13050621

Authors: Andreea Mihaela Kiș Dan Iovanescu Liana Todor Ramona Amina Popovici Laria-Maria Trusculescu Dana Emanuela Pitic Andreea Salcudean Adina Feher Andrada Ioana Dumitru Porumb Anca Iustin Olariu

Background/Objectives: Neglect of children’s oral health is a major concern at international, national, and regional levels. Of all the health problems that can occur in childhood, dental ones are among the most common. Tooth decay, for example, is a chronic condition in children and can have long-term consequences, especially in otorhinolaryngology and pediatric diseases if not treated properly. Methods: The data collection method was questionnaire. Questionnaires were administered to parents regarding oral hygiene habits and access to dental services; data were collected in dental offices across Timiș County, encompassing urban, peri-urban, and rural settings. Children enrolled in the study underwent clinical dental examinations to assess their oral health status (dental caries, gingival diseases, developmental anomalies). Results: Parental education level was not significantly associated with the habit of annual dental check-ups (χ2, p = 0.092); however, a directional trend was observed. Total monthly family income was significantly associated with the stated reason for not attending dental check-ups (one-way ANOVA, p = 0.043): families with lower incomes more frequently cited financial and logistical barriers, whereas higher-income families cited lack of time or perceived lack of necessity. Parental education level (p < 0.001) and family income (p < 0.001) were both significantly associated with daily tooth-brushing frequency. Conclusions: The efforts of specialists must be increased through coherent policies, adapted education, and real support for vulnerable groups. An informed child, with supported parents, is a child with a real chance at a healthy life. This is not just a professional opinion, but a collective responsibility.

Children doi: 10.3390/children13050620

Authors: Torun Marie Vatne Elise Olsen Pedersen Hanne Cathrine Lie

Background/Objectives: Siblings of children with the life-limiting disease Metachromatic Leukodystrophy (MLD) are growing up witnessing rapid disease progression and death, affecting development and psychological wellbeing. Family-centred palliative care should include sibling support, but research on sibling needs is scarce. This semi-structured interview study aims to describe parents’ perceptions of siblings’ behavioural adaptation, emotional reactions, and support needs. Methods: Seven parents recruited from a national resource centre for rare disorders participated in semi-structured interviews that were audiotaped and transcribed. Content analysis was used to identify recurrent themes. Results: Siblings were described as more mature, patient, caring, appreciative, and sociable than other children due to life with the ill child. Expressions of love and concern, fear, sadness and sorrow, anger, and hope were described. Parents described how sibling support implies strengthening close family relations and providing resources at home, external support, and information. Conclusion: This study shows that sibling support involves all instances surrounding the family and ill child, and that a family-centred, trauma-sensitive approach is needed.

Children doi: 10.3390/children13050619

Authors: Min-Muh Sheu Hsi-Pao Hsieh Chao-An Chi You-De Shen Ching-Ying Cheng

Purpose: This study investigated the effects of visual rehabilitation on binocular visual function in kindergarten children with developmental delay. Methods: This study comprised a case series tracking changes in binocular visual function in three children with developmental delay during rehabilitation. The rehabilitation schedule was tailored to the specific circumstances of each child and was divided into three phases—baseline, intervention, and maintenance—aiming to observe the impact of rehabilitation on visual performance. Results: All three children presented with pre-existing visual deficits—including amblyopia, strabismus, and oculomotor dysfunction—which were associated with functional challenges such as frequent falls, postural instability, and reading difficulties. Following the multidisciplinary rehabilitation program, marked improvements were observed in visual acuity, accommodative facility, and stereopsis. Furthermore, parents reported a decrease in daily functional challenges, with these gains being sustained during the post-intervention follow-up. Conclusions: This case series suggests that structured visual rehabilitation may improve binocular function and daily performance in children with developmental delays. These findings underscore that visual ability extends beyond mere visual acuity, highlighting the necessity of assessing multidimensional visual functions in special education and rehabilitative practice.

Children doi: 10.3390/children13050618

Authors: Ada Maria Carstea Alexandra Borda Raluca Morosan Adriana Elena Pittner Estera Boeriu Cristina Ionasiu Rebreanu Stanciu-Lelcu Theia Vulcanescu Dan Dumitru Maria Mirabela Mihailescu Marin

Background: Chronic pain in children with cancer is a major challenge in pediatric palliative care. It results from the interaction of disease-related and treatment-related factors, psychological distress, and the child’s family and social environment. When poorly controlled, it can impair quality of life, emotional development, social functioning, and family well-being. This narrative review examines the challenges and management strategies for chronic pain in children with cancer from a pediatric palliative care perspective, with attention to pain mechanisms, assessment difficulties, and psycho-emotional influences. Methods: This narrative review was based on a structured literature search conducted in PubMed/MEDLINE, Scopus, and Web of Science for English-language articles published between January 2000 and October 2025. Of 135 records identified, 15 studies judged most relevant to the thematic scope of the review were included in the final synthesis. A PRISMA-based flowchart was used to illustrate study identification and selection without implying a formal systematic review. Results: Chronic pain in children with cancer emerged as a multidimensional problem requiring an integrated approach to assessment and management, and some studies suggest that 20–26% of childhood cancer survivors experience persistent pain. Pharmacological strategies, including opioids and adjuvant medications, remain central, while psychological, supportive, and non-pharmacological interventions may complement multimodal care. Conclusions: Chronic pain in children with cancer should be managed through an integrated, individualized, and child-centered approach that addresses the physical, emotional, social, and relational dimensions of suffering and may improve quality of life for both children and their families.

Children doi: 10.3390/children13050617

Authors: Petra Klanjšek Petra Povalej Bržan Nataša Marčun Varda Mirjam Močnik Sonja Golob Jančič Miha Kovačič Majda Pajnkihar

Background/Objectives: Child malnutrition is a global health challenge linked to poor growth, impaired development, weakened immunity, and adverse outcomes. Early risk detection is essential, but current screening tools differ in accuracy and feasibility. This study aimed to develop and validate new bedside pediatric malnutrition screening models based on machine learning and evolutionary computation methods that can capture complex patterns in non-invasive clinical indicators while remaining practical for routine ward use. Methods: We conducted a cross-sectional study including 180 hospitalized children (1 month–18 years) recruited consecutively from six pediatric wards. The required sample size (minimum 138 participants) was calculated a priori using national prevalence estimates of pediatric undernutrition (4–9.5%) to ensure adequate precision at a 95% confidence level. Data collection included a questionnaire, anthropometry, subjective malnutrition risk assessment, and the Subjective Global Nutritional Assessment (SGNA) tool. Screening models were developed using decision trees, random forests, XGBoost, lasso regression, artificial neural networks, ANFIS, and genetic programming. Their performance was evaluated against the SGNA tool and physician-based subjective malnutrition risk assessment using sensitivity, specificity, AUC, and Cohen’s κ. Results: Machine learning and intelligent evolutionary models (GP, ANN, and ANFIS) showed the best performance in this sample, with substantial to high agreement (κ = 0.81–1.00) and high diagnostic accuracy (AUC = 0.92–1.00) with the subjective malnutrition risk assessment. The GP model demonstrated the highest apparent accuracy in this dataset, but also higher complexity, whereas simpler models such as decision trees showed lower accuracy but greater interpretability and feasibility for routine clinical use. However, validation was performed on a relatively small independent sample, and no external validation was conducted, which may limit the generalizability of the findings. Conclusions: While complex models may serve as digital assessment instruments, simpler models are rapid and more suitable for bedside screening. All developed models are non-invasive and cost-effective and show potential for supportive approaches for early detection of malnutrition risk at hospital admission. However, given the limited validation sample and the absence of external validation, these findings should be interpreted with caution, and further large-scale, multicenter studies are required to confirm generalizability and clinical applicability.

Children doi: 10.3390/children13050615

Authors: Christian J. Wiedermann Verena Barbieri Giuliano Piccoliori Doris Hager von Strobele Prainsack

Background/Objectives: Adolescence is a critical period in terms of mental health, with the family environment being a key determinant. Parental resilience, the ability to adapt and recover from stress, is a parental psychological resource that may shape the family context of adolescent development but population-based evidence is scarce. This study examined if parental resilience is linked to adolescent mental well-being, mediated by perceived family support, and whether it varies by sex or developmental stage. Methods: This population-based cross-sectional study analyzed data from 2004 adolescents aged 11–19 years from the COP-S Wave 4 survey in Italy. Parental resilience was assessed using a Brief Resilience Scale. Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), and mental well-being was assessed across five outcomes: health-related quality of life (KIDSCREEN-10), emotional difficulties (SDQ), depressive symptoms (PHQ-2), anxiety symptoms (SCARED), and psychosomatic complaints (HBSC-SCL). Regression models were used to examine associations, and mediation analyses were conducted using the PROCESS macro with bootstrap confidence intervals (5000 resamples). Results: Parental resilience was independently associated with better health-related quality of life, lower emotional and behavioral difficulties, fewer depressive and anxiety symptoms, and fewer psychosomatic complaints, after adjusting for adolescent social support and demographics. Parental resilience showed weak positive associations with the MSPSS subscales; the hypothesis of the strongest family support association was unsupported. The analyses did not support family support as a mediator and no moderation by sex or development was found. Conclusions: In this population-based sample, parental resilience was associated with multiple dimensions of adolescent mental well-being that were distinct from adolescents’ perceptions of social support. These findings suggest that strengthening parental resilience may promote adolescent mental health at the population level.

Children doi: 10.3390/children13050616

Authors: Kenan Cantekin Fahrettin Kalabalık Mihriban Güner Münevver Kılıç

Background: Primary teeth play a crucial role in guiding permanent dentition; however, data regarding root apex closure in primary molars remain limited. The aim of this study was to evaluate the age-related root apex closure status of primary second molars in children aged 2–7 years using panoramic radiographs and to obtain clinically guiding data for pediatric dental treatment planning. Materials and Methods: This cross-sectional, descriptive, and retrospective study evaluated panoramic radiographs. A total of 1628 panoramic radiographs obtained from 1628 patients were evaluated, each representing one individual with primary second molars. The relationships between age groups, gender, and root apex closure status were analyzed statistically with a significance level set at p < 0.05. Results: No root apex closure was observed in either maxillary or mandibular primary second molars in the 2–2.99-year age group. In the 3–3.99-year group, a limited number of closed apices were detected only in mandibular primary second molars. A marked increase in the proportion of closed apices was observed in both jaws in the 4–4.99-year group. In the 5–5.99- and 6–6.99-year groups, root apex closure was completed in the majority of maxillary and mandibular primary second molars. Although statistically significant gender-related differences were detected in certain age groups, these differences were not consistent across all age categories. Conclusions: Root apex closure in primary second molars demonstrates a clear age-dependent pattern between 2 and 7 years of age. The findings are expected to provide clinically relevant guidance for pediatric endodontic treatment planning and contribute to the limited literature regarding root development in primary teeth.

Children doi: 10.3390/children13050614

Authors: Anita Yeconia Bukhay Hanne Pike Joar Eilevstjønn Raphael Mduma Ladislaus Blacy Estomih Mduma Robert Moshiro Jackie K. Patterson Siren Rettedal Hege Ersdal

Background: Birth asphyxia is a leading cause of neonatal mortality. More than half of these deaths are due to low-quality care. Objectives: To describe the frequency, sequence, timing, and duration of interventions after birth and newborn outcomes. Methods: This prospective observational study in rural Tanzania included newborns ≥28 weeks gestation. Trained research assistants observed and recorded all deliveries and resuscitations 24 h a day, 7 days a week, logging interventions in real time using the Liveborn Observation app. Results: Of 2564 newborns born, 2431 (94.9%) were enrolled in the study. Macerated stillbirth (n = 52), newborns with no parental consent (n = 67) or incomplete Liveborn data (n = 14) were excluded. Additionally, 2193/2431 (90.2%) newborns did not receive bag-mask ventilation (BMV), and 1755/2431 (72.2%) started breathing before 30 s from birth at median (quartiles) 6 (3, 13) s, 438/2431 (18.0%) started breathing beyond 30 s at 49 (38, 67) s. Moreover, 238/2431 (9.8%) received BMV at 82 (54, 120) s after birth, 1/3 within the first min. Finally, 159/238 (66.8%) were suctioned for 26 (17, 40) s. The first suction sequence was initiated at 44 (24, 78) s after birth. In 24/238 (10.1%) newborns, BMV continued for more than 10 min, with an increased risk of dying within 24 h (RR = 4.26, 95% CI; 1.3–10.0, p = 0.016) and seven days (RR = 8.14, 95% CI; 3.5–17.6, p < 0.001) compared to those ventilated for less than 10 min. Conclusions: Almost 10% of newborns received BMV at birth, but only one-third were ventilated within the first recommended minute. Excessive use of suctioning likely delayed the start of BMV, and prolonged ventilation beyond 10 min was associated with higher mortality.

Children doi: 10.3390/children13050613

Authors: Walid Al-Qerem Anan Jarab Fawaz Alasmari Alaa Hammad Khalda Smairan Judith Eberhardt

Background/Objectives: The Global Lung Initiative (GLI) 2022 race-neutral spirometry reference equations were introduced to improve interpretability across populations; however, their performance in Middle Eastern adolescents remains insufficiently validated. This study evaluated the applicability of GLI-2022 among healthy Jordanian adolescents. Methods: Healthy adolescents were recruited from secondary schools across multiple Jordanian cities (July–November 2025). Spirometry was performed according to ATS/ERS standards using a single device and standardized procedures. GLI-2022 predicted values and z-scores were derived for forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC. Calibration was assessed using mean (SD) z-scores and the proportion below the lower limit of normal (LLN; z < −1.645). Agreement between measured and predicted values was examined using Bland–Altman methods. LLN-based pattern classifications were compared with those obtained using the local reference equation and GLI-2012. Results: A total of 921 adolescents (482 males, 439 females; mean age 15.7–16.0 years) were included. GLI-2022 produced positive mean z-scores for FEV1 (0.51–0.73) and FVC (0.51–0.69), with low proportions below LLN for both indices (<2% in each sex), indicating underestimation of predicted lung volumes. Exact binomial testing confirmed that the observed proportions below LLN for FEV1 and FVC were significantly lower than the expected 5% in both sexes (all p < 0.001). The FEV1/FVC ratio showed smaller deviations (mean z 0.07–0.19), with 4.1% of females and 5.8% of males below LLN, and these proportions did not differ significantly from 5% (female p = 0.444; male p = 0.402). Mean observed-minus-predicted biases for FEV1 were +0.185 L in females and +0.306 L in males, and for FVC were +0.224 L and +0.351 L, respectively; FEV1/FVC bias was −0.15 percentage points in females and +0.60 percentage points in males. LLN-based pattern classification showed 98.7% overall agreement with the local equation and 99.7% with GLI-2012; concordance for obstructive and possible restrictive patterns was 93.5% and 100.0%, respectively. Conclusions: In healthy Jordanian adolescents, GLI-2022 appears to underestimate predicted FEV1 and FVC, yielding upward-shifted z-scores and fewer volume indices below LLN, while the ratio is less affected. Although LLN-based pattern classification was largely preserved, population-specific validation remains necessary before routine clinical adoption of GLI-2022 in Jordanian adolescents; extrapolation to other Middle Eastern adolescent populations should await additional regional validation.

Children doi: 10.3390/children13050612

Authors: Stephanie L. Santoro Chance Alvarado Stephen A. Hart Thomas Casto Clifford L. Cua

We evaluated the birth rate of Down syndrome (DS) in the CDC birth certificate online database. From 2016 to 2025, live birth incidence could range greatly (depending on the proportion of unknown cases that are counted as DS+) due to relatively high numbers of unknown/not stated status. The annual live birth incidence of DS in live-born infants using CDC birth certificate data from 2016 to 2025 shows a wide range of potential birth rates as calculated here, due to relatively high numbers of unknown/not stated DS status. Although our findings overlap with published data, future studies are needed to further evaluate the current birth rate of DS in the US.

Children doi: 10.3390/children13050611

Authors: Freya Morris Alexandra Carlisle Penny A. Cook Lucy Deeprose Bethany Dubbey Louise Fox Alexandra Livesey Raja A. S. Mukherjee

Background/Objectives: Language difficulties have been recognised as common in people with FASD. Assessment of the language domain is important, and the CELF, CCC, and VABS are three commonly used language assessment tools. The CCC and VABS are both informant-report questionnaires, whilst the CELF is completed in person by a Speech and Language Therapist (SaLT). As many neurodevelopmental assessment clinics may not have access to a SaLT, the aim of this paper was to establish potential correlations between these measures in individuals with FASD, as well as to establish the clinical utility of questionnaire-based measures for assessment of communication in FASD in the absence of a multidisciplinary team. Methods: Data was drawn from the UK National FASD Clinic database containing 385 patient assessments. Sample size varied between 77 and 274 completed assessments depending on the measure due to change in clinical practice over several years. A two-tailed Spearman’s Correlations between CCC subscales and CELF domains were carried out. Two-tailed Spearman’s Correlations between the Communication domain of the VABS and the CELF were also conducted. Results: Significant correlations were found between all assessed CELF domains and the CCC Semantics and Coherence subdomains and GCC, as well as between the CCC Syntax subdomain and 3 of the CELF domains. No significant correlations were found between CCC Speech and any CELF domains. A mix of significant correlations between the VABS domain and subdomains and the CELF domains were found. Conclusions: These results suggest the potential clinical utility of using the CCC as a measure of an individual’s language functioning as part of an FASD assessment, particularly in the absence of access to direct assessment carried out by a SaLT. Future research should focus on the development of a questionnaire-based assessment battery for an FASD population to increase access to diagnosis.

Children doi: 10.3390/children13050609

Authors: Lea Berger Eva Möhler

The objective of this state-of-the-art review was to ascertain whether bullying should be regarded as an ACE. To that end, a systematic search of the extant literature was conducted. A comprehensive search of three databases yielded 27 studies that met the inclusion criteria. The papers that were identified were sorted into the following categories: expanded ACE, associations between ACEs and bullying, latent class analysis, biological stress markers and negative health outcomes associated with ACEs and bullying. The extant evidence indicates that bullying falls within the ambit of the ACE concept. Moreover, bullying contributes independently and as part of the cumulative score to the prediction of negative health outcomes. However, minor discrepancies to other ACEs were identified, for example in the different path of embodiment regarding changes in BMI. It is recommended that subsequent studies incorporate bullying as an element of their ACE measurements. One approach to doing so would be to utilize the ACE-IQ. Further research is necessary to elucidate the embodiment of the consequences of ACEs and bullying.

Children doi: 10.3390/children13050610

Authors: Martha Caterina Faraguna Viola Crescitelli Roberta Pretese Maria Valvassori Bolgè Vera Marchetti Giusi Sgroi Stefania Sala Silvia Gigante Cristina Bonfanti Adriana Balduzzi Serena Gasperini

Background: Arginase 1 deficiency (ARG1-D) is an ultra-rare urea cycle disorder characterized by hyperargininemia and progressive neurological impairment, including spasticity, loss of motor function, and reduced quality of life. Conventional management based on dietary protein restriction and ammonia scavengers rarely achieves adequate metabolic control or prevents neurological deterioration. Pegzilarginase, a recombinant human arginase 1 enzyme, is the first disease-modifying therapy for ARG1-D. Methods: We report the first Italian real-world experience with pegzilarginase in three pediatric patients with genetically confirmed ARG1-D enrolled in the phase 3 PEACE trial. Clinical, biochemical, functional, nutritional and quality-of-life data were retrospectively collected over a long-term follow-up (2003–2025). Outcomes were evaluated across three phases: treatment initiation (Start), a 13-month treatment interruption due to trial closure (Stop), and therapy re-initiation through an early access program (Restart). Results: Pegzilarginase rapidly normalized plasma arginine levels and was associated with improvements in motor function, spasticity, walking endurance, dietary protein tolerance, bone mineral density, and quality of life. During treatment interruption, all patients experienced biochemical worsening and clinical deterioration, including increased spasticity, reduced mobility, and emotional distress. Re-initiation of pegzilarginase restored metabolic control and led to progressive neurological and functional recovery, including partial reversal of long-standing motor deficits. Conclusions: This real-world experience supports pegzilarginase as a disease-modifying therapy for ARG1-D. Sustained normalization of plasma arginine, rather than subthreshold biochemical control, correlates with functional and neurological improvement and may partially reverse non-lesional metabolic brain injury. Early initiation of pegzilarginase, including in newborn-screened patients, may further modify the natural history of ARG1-D.

Children doi: 10.3390/children13050608

Authors: Hussein Zaitoon Aimee D. Wauters Luisa M. Rodriguez Jane L. Lynch

Dear Editor, [...]

Children doi: 10.3390/children13050607

Authors: Nicola Improda Giada Ballarin

Dear Editor, [...]

Children doi: 10.3390/children13050606

Authors: Flora Bacopoulou Dimitrios Dimitriou Diana L. Robins Antonios I. Christou Theodora Xenopoulou Christos Prapas Vasiliki Efthymiou

Background/Objectives: The aim of this study was to translate, culturally adapt, and validate the updated (March 2025) version of the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) in Greek by examining its reliability, validity, and screening efficacy in a Greek sample. Methods: The M-CHAT-R/F was administered to Greek parents/primary caregivers of children aged 16–48 months, with no prior diagnosis of autism spectrum disorder (ASD), severe sensory impairments, or other chronic conditions causing neurodevelopmental delay. Parents/primary caregivers were invited to participate in the nationwide Program “Child and Family Health Promotion through the Paediatric Framework” of the Greek Ministry of Health in collaboration with UNICEF, implemented by the National and Kapodistrian University of Athens. Results: The final sample comprised 280 parents of children 16 to 48 months old (mean age ± SD 24.64 ± 7.75 months) with an almost equal sex distribution. Mean (±SD) parental age was 35.31 (±3.14) years, ranging from 30 to 48 years, and most respondents were mothers (94.3%). The Greek M-CHAT-R/F demonstrated acceptable reliability (KR-20 = 0.789) and acceptable scalability (monotonicity). Conclusions: The present study provides compelling evidence that the Greek M-CHAT-R/F is a reliable, valid, culturally appropriate instrument for screening children for the presence of ASD. The psychometric properties of the Greek version are consistent with previous international reports and warrant its use in routine pediatric practice in Greece.

Children doi: 10.3390/children13050605

Authors: Makama Andries Monyeki Anita Elizabeth Pienaar Carli Gericke Barry Gerber

Background: Physical activity (PA), physical fitness (PF), and motor skills (MS) play crucial roles in overall health and well-being, particularly in early childhood, when habits that affect future health are formed. Methods: This study, involving 299 children (150 boys, 149 girls, mean age 6.9 ± 0.96 years), explored the variance explained by external factors such as socioeconomic status (SES), body composition (BC), sex, and geographical location on motor-related physical fitness (MRPF) and health-related physical fitness (HRPF) in children. Using a variety of assessments, including demographics, anthropometric data, BIA, ActiGraphs, the 20 m shuttle run, 10 and 20 m speed tests, and test items from the Körperkoordinations test für Kinder (KTK) and the TGMD-2, a multiple stepwise regression analysis using SPSS (v 28.0) identified the associated factors. Results: The variables tested show modest explained variance for HRPF, MRPF, and MS, with the largest cumulative explained variance of 26.4%. The explained variances for MRPF and MS were lower (medium to small) than the significant, medium-to-large, explained variances for HRPF. Body fat percentage (BF%), moderate-to-vigorous physical activity (MVPA), parental education and income, and BMI emerged as substantial contributors to HRPF, explaining 12.1% to 26.4% of the variance. Sex, BF%, and quintile status were the most influential associated factors for MRPF, and for MS, BMI and sex emerged as the strongest contributors. Conclusions: These findings underscore the importance of holistic approaches that consider individual factors, such as MVPA, body composition (BC), PA levels, sex, and broader social and economic contexts, to promote children’s well-being. The study emphasises the need for comprehensive strategies to address the multifaceted associations with children’s physical development.

Children doi: 10.3390/children13050603

Authors: Jun Fang Rui’an Wang Zhanzhan Zhang Yuanfeng Zhong Yannan Wan Qian Chen Xuelin Xia Xuan Zhang

Background: Maternal dietary avoidance during breastfeeding of infants with food allergies (FA) is common, but its impact on growth and development is unclear. Methods: This prospective cohort study enrolled infants aged 4–6 months who were mainly breastfed from the child health care clinic of Children’s Hospital of Chongqing Medical University, Chongqing, China. The participants were classified into a group with clinically diagnosed FA and a non-food allergies (NFA) group. To analyze avoidance extent, the FA group was stratified into high (≥5 types) and low (<5 types) avoidance subgroups based on the median number of avoided food categories. Outcomes included anthropometric Z-scores and ASQ:SE-2 social–emotional scores at 12 months, analyzed using Generalized Estimating Equations. Results: High avoidance mothers comprised 50% of the FA group. Compared to the high avoidance group, the non-FA group showed significantly better linear growth (β = 0.84, 95% CI 0.38–1.30, p < 0.001). Weight and head circumference showed no differences. High avoidance was associated with higher ASQ:SE-2 scores versus both the low avoidance and non-FA groups (p < 0.001), indicating greater social–emotional concerns. Conclusions: Extensive maternal dietary avoidance was associated with suboptimal linear growth and higher social–emotional risk scores in infants with FA, underscoring the need for integrated nutritional and developmental monitoring. These findings warrant cautious interpretation given the exploratory nature of this single-center study.

Children doi: 10.3390/children13050604

Authors: Alessandro Colletti Michele Favro Luciano Sangiorgio

Background: Overactive bladder (OAB) is a common functional disorder in paediatric populations and is associated with significant psychological burden and impaired quality of life. Although oxybutynin is widely used as first-line pharmacological therapy, a substantial proportion of children exhibit incomplete symptom control or limited tolerability. Emerging evidence suggests that targeting metabolic dysfunction, oxidative stress, and neuromuscular excitability may provide additional therapeutic benefit. This retrospective observational study evaluated the clinical impact of an adjunctive nutraceutical formulation containing myo-inositol, microlipodispersed magnesium, folic acid, and vitamin C (LEVIGON™ PRO, Sanitpharma; Milan, Italy) in children with OAB receiving oxybutynin. Methods: Medical records of children diagnosed with OAB were retrospectively reviewed. After applying inclusion and exclusion criteria, 120 patients aged 5–15 years were included and allocated to two groups based on documented treatment: oxybutynin plus LEVIGON™ PRO (Group A, n = 60) or oxybutynin alone (Group B, n = 60). The primary outcome was complete daytime urinary continence at Day 112. Secondary outcomes included weekly incontinence episodes, voiding frequency, bladder wall thickness, uroflowmetry parameters, and Patient Perception of Bladder Condition (PPBC) scores. An exploratory subgroup analysis was performed in 34 children with impaired fasting glucose (ifg), assessing fasting glucose, insulin, and homa-ir. results: by day 112, complete daytime continence was achieved in 61.7% of patients in group a and 48.3% in group b (absolute risk difference 13.4%; nnt ≈ 7.5; p = 0.14). across secondary endpoints, the combination therapy group showed significantly greater longitudinal improvements (group × time interaction, p < 0.05), including reductions in weekly incontinence episodes, voiding frequency, post-void residual volume, and ppbc scores, as well as increases in mean voided volume, qmax, and reductions in bladder wall thickness. in the ifg subgroup, greater reductions in fasting glucose, fasting insulin, and homa-ir were observed in group a compared with group b (p < 0.01). Both treatments were well tolerated, with no serious adverse events reported. conclusions: adjunctive nutraceutical therapy combined with oxybutynin was associated with greater improvements in several clinically relevant secondary outcomes in children with OAB, with a favourable tolerability profile. Although the primary endpoint did not reach statistical significance, the overall pattern of findings may suggest a possible additive benefit; however, these findings may be influenced by residual confounding inherent to the retrospective observational design. Therefore, the results should be considered hypothesis generating and require confirmation in prospective randomized controlled trials.

Children doi: 10.3390/children13050602

Authors: James D. Geyer Jiaqi Gong Paul G. Cox Randi J. Henderson-Mitchell Camilo R. Gomez Adnan I. Qureshi Shelby G. Branch Sophia R. Geisser Paul R. Carney

Background/Objectives: Pediatric obstructive sleep apnea (OSA) is a complex disorder with a variable presentation and often challenging diagnostic testing. The history and physical examination in pediatric OSA frequently differ from those in adults. The treatment options are multifaceted and must be tailored to the individual patient. Artificial intelligence (AI) modalities currently employed in pediatric sleep medicine face several important limitations: modality fragmentation, lack of explainability, and limited semantic integration. Method: Our team proposes a new vision for AI and pediatric sleep medicine. This platform is based on a knowledge graph (KG) framework integrating structured and unstructured data to enable reasoning, personalization, and clinical decision support. Results: This framework represents a conceptual architecture; it has not yet been empirically implemented, and the use cases described herein are illustrative of its intended capabilities. Components of the infrastructure developed for similar applications have been successfully implemented. The quantitative feasibility pilot KG represented 100% multimodal data with >90% semantic completeness. Conclusions: Fully realized and deployed into the clinical space, this pediatric OSA KG system will enhance tertiary care programs and help project tertiary-level pediatric care into underserved regions.

Children doi: 10.3390/children13050601

Authors: Megan Lane Bobby Verdugo Natacha D. Emerson Miranda Kim Qiang Zhang Christine K. Thang Cambria L. Garell Allison Gabriella Depas Wendelin M. Slusser Shanika Boyce Alma D. Guerrero

Background/Objectives: Pediatric obesity is a public health epidemic in the United States and in many countries worldwide. Due to the interrelatedness of obesity and toxic stress, mindfulness is a promising practice to support healthful eating behaviors and combat stress in the management of this condition. In this pilot study we evaluated the acceptability and feasibility of implementing a brief mindfulness-based program for pediatric patients seeking treatment for overweight and obesity, with an assessment of exploratory outcomes. Methods: Nineteen children (ages 8–17 with body mass indices (BMIs) ≥ the 85th percentile) and caregiver dyads (n = 19) were recruited from a multidisciplinary pediatric weight management clinic. Four thirty-minute psychoeducational mindfulness-based sessions were provided via telehealth. Qualitative feedback was sought during and after program completion. Child and caregiver mindful eating and general mindfulness measures were collected from participant dyads at baseline, and one month and three months after program completion. Results: Qualitative program feedback from participants was generally positive. Session attendance rates were high (89%), with most participants highly engaged during sessions and the follow-up clinic visits. An analysis of exploratory measures data revealed no significant changes in child or caregiver dyad mindful eating or general mindfulness scores at one month (n = 9) or three months (n = 7) post-program completion compared to baseline (n = 10). Conclusions: This pilot, mindfulness-based program was feasible and acceptable to implement as a scalable behavioral intervention in long-term pediatric obesity treatment. Study of a larger, controlled sample is needed to determine the impact of program participation on mindful eating and general mindfulness, along with clinical obesity-related outcomes, in the management of pediatric obesity.

Children doi: 10.3390/children13050600

Authors: Domenico M. Romeo Chiara Velli Francesca Sini Maddalena Bianchetti Eugenio Mercuri

Background/Objectives: Dynamic movement orthoses (DMOs) are elasto-compressive bodysuits used in the rehabilitation of children with motor disabilities, mainly in children with cerebral palsy. Among the DMOs, the FLEXA® represents one of the most frequently used orthoses in clinical practice due to its adaptability and flexibility. The purpose of this case study is to describe the application of FLEXA® in an 18-month-old female child with choreic cerebral palsy. Methods: To evaluate the effect of the dynamic movement orthosis (FLEXA®), the Movement Disorder-Childhood Rating Scale (MD-CRS) 0–3 years was administered. The child was evaluated before the use of the FLEXA® bodysuit, and with the bodysuit donned approximately 30 min after its application. A follow-up using the same assessments was carried out at 6 months. Results: The results showed an important change in the severity of the movements according to the MD-CRS; mainly, the child’s movement disorder severity changed from a grade five severity (profoundly affected) without the bodysuit to grade three (moderately affected) with the use of the bodysuit. The benefit was maintained during follow-up even without the bodysuit, and a further improvement was observed in assessments with the bodysuit. Conclusions: This case report highlights the potential benefits of dynamic movement orthosis, like the FLEXA®, in managing movement disorders in children with choreic form of cerebral palsy. Extending the study to a larger sample would help to strengthen the validity of these findings and confirm the beneficial effects of use of DMOs for children with movement disorders.

Children doi: 10.3390/children13050599

Authors: Daiana Mariano Valentina Petrone Francesca Madia Mariasavina Severino Luca Basso Valeria Capra Maria Stella Vari Antonio Marras Giacomo Tantari Giuseppe d’Annunzio

Background/Objectives: Bainbridge–Ropers syndrome (BRPS) is a rare neurodevelopmental disorder caused by truncating and splicing pathogenic variants in the additional sex combs-like 3 (ASXL3) gene. It is primarily characterized by neurodevelopmental delay and craniofacial dysmorphism. Most reported cases involve de novo mutations in the ASXL3 gene, whereas inherited mutations have been rarely described. The present report aims to describe the clinical and molecular presentation of a familial case of BRPS and to highlight the potential role of parental mosaicism. Methods: We describe the clinical and molecular presentation of a 12-year-old boy and his 20-month-old half-brother, both affected by Bainbridge–Ropers syndrome. Trio-exome sequencing (ES) was performed in the family to identify variants in the ASXL3 gene, and targeted Sanger sequencing was also performed for segregation analysis. Results: Genetic analysis identified a previously unreported heterozygous frameshift variant in the ASXL3 gene (c.1648_1649del; p.Met550Aspfs*5) shared by both siblings. The variant was inherited from their clinically unaffected mother, who carries the mutation in the mosaic state with a variant allele fraction of approximately 15% in peripheral blood DNA. Conclusions: This observation highlights parental mosaicism as a potential mechanism underlying the familial recurrence of BRPS and emphasizes the importance of considering mosaic variants during the genetic evaluation and counseling of affected families.

Children doi: 10.3390/children13050598

Authors: Svetislav Polovina Andrea Polovina Jelena Erceg Ema Dobrijević Tanja Škorić Polovina Romana Gjergja Juraški

Background/Objectives: Abnormal general movements (GMs) in high-risk infants are among the most sensitive early predictors of cerebral palsy (CP) and other neurodevelopmental disorders. This study described changes in the quality of GMs over time in high-risk infants who received the Early Intensive Stojčević–Polovina Rehabilitation Method (EIR–SPM). The EIR–SPM is a rehabilitation method designed for children with CP, those at risk of developing CP, and children with other developmental disabilities. In high-risk infants, it is initiated within the first three months of corrected age, preferably while writhing movements (WMs) are still present. Methods: This study was conducted in eight high-risk infants with abnormal WMs and structural brain injury. The EIR–SPM was initiated between 41 and 47 weeks postmenstrual age (PMA) and was applied until 60 weeks PMA. Prechtl’s General Movements Assessment (GMA), the Detailed GM score, and the Motor Optimality Score–Revised (MOS–R) were assessed. Results: During the writhing period, two infants showed a poor repertoire (PR) pattern and six showed a cramped–synchronized (CS) pattern of GMs; at follow-up, three showed PR, and five showed CS. During the fidgety period, two infants showed normal fidgety movements (F+), two sporadic fidgety movements (sFM), one infant showed abnormal fidgety movements (aFM), and three showed absent fidgety movements (F−) at the first assessment, while at the second assessment, three infants showed F+, two sFM, one aFM, and two F−. The median Detailed GM score increased from 12 (range 11–17) to 13.5 (range 11–19; p = 0.068). The median MOS–R increased from 17.0 (range 12–24) to 19.5 (range 17–27) between the two fidgety assessments (p = 0.027). Conclusions: Improvements in motor repertoire, reflected by increased MOS–R scores, were observed during the EIR–SPM initiated in the writhing period. Larger controlled studies are needed to confirm these preliminary observations.

Children doi: 10.3390/children13050597

Authors: Natalia Zwilling Liat Hen-Herbst Liat Korn

Background: Fetal alcohol spectrum disorders (FASDs) are lifelong neurodevelopmental conditions resulting from prenatal alcohol exposure. Despite high FASD rates in high-risk adoptive populations, little is known about the experiences of adoptive parents in Israel, where underdiagnosis and limited professional awareness persist. Drawing on ecological and family systems theory, this study explored the daily challenges, coping strategies, and service-related barriers encountered by adoptive parents raising children with FASD. Methods: Using a qualitative, exploratory design, semi-structured interviews were conducted with 12 adoptive parents of children aged 9–18 years with a parent-reported clinical diagnosis of FASD made by a healthcare professional. The interviews focused on child-related difficulties, coping mechanisms, diagnostic experiences, and interactions with health, education, and welfare systems. The data were analysed using reflexive thematic analysis. Results: Five themes were identified: (a) child-related neurodevelopmental and behavioral challenges, (b) emotional and practical caregiving burden, (c) systemic barriers, including limited professional knowledge and fragmented diagnostic pathways, (d) coping strategies and family strengths, and (e) unmet needs and recommendations. Parents described fluctuating child functioning, chronic caregiving demands, and significant gaps in diagnostic and educational support. Conclusions: Adoptive parents raising children with FASD face substantial daily challenges compounded by systemic limitations. This study’s findings underscore the need for improved professional training, clearer diagnostic pathways, FASD-informed educational practices, and coordinated multidisciplinary services. These results provide direction for policy and service development to improve support for families affected by FASD.

Children doi: 10.3390/children13050596

Authors: Pınar Algedik Azad Asaf Şevket Duman Mesut Yavuz

Background/Objectives: Adolescent psychiatric inpatient units play a critical role in the management of severe psychiatric disorders and suicide risk. However, limited evidence exists regarding the clinical and familial factors that simultaneously influence suicidal ideation and treatment outcomes in hospitalized adolescents. This study aimed to identify demographic, diagnostic, and clinical predictors of suicidal ideation and clinical improvement among adolescents hospitalized in a tertiary child and adolescent psychiatry inpatient unit. Methods: This retrospective observational study included 75 adolescents aged 12–18 years who were hospitalized in a tertiary child and adolescent psychiatry inpatient unit between November 2023 and June 2025. Sociodemographic and clinical characteristics were obtained from medical records. Clinical improvement was evaluated using the Clinical Global Impression–Improvement (CGI-I) scale. Group comparisons were conducted using chi-square or Fisher’s exact tests for categorical variables and the Mann–Whitney U test for continuous variables. Multivariate logistic regression analyses were performed to determine independent predictors of suicidal ideation and clinical improvement. Results: Clinical improvement was evaluated in the full sample of adolescents (n = 75), and longer length of stay was independently associated with clinical improvement during hospitalization. Among adolescents admitted with suicidal ideation (n = 45), major depressive disorder, previous suicide attempt, irritability at admission, and fewer siblings were identified as independent predictors of suicidal ideation. In addition, female adolescents had higher rates of suicide attempts and non-suicidal self-injury, whereas psychotic disorders were more common among male adolescents. Conclusions: Suicidal ideation in hospitalized adolescents is strongly associated with affective pathology and prior suicidal behavior. Longer inpatient treatment duration appears to facilitate clinical improvement. These findings highlight the importance of early suicide risk stratification and adequate treatment duration in adolescent psychiatric inpatient care.

Children doi: 10.3390/children13050594

Authors: Tobias Goihl David F. Rusaw Siri Merete Brændvik Karin Roeleveld

Background/Objectives: Ankle–foot orthoses (AFOs) are commonly used to improve gait in children with cerebral palsy (CP), but their effect on specific gait patterns is underreported. This study evaluates the utilization of the Gait Pattern Classification System for Children with Spastic CP (GaP-CP) to investigate the effects of ankle–foot orthoses on gait kinematics, spatio-temporal parameters and the energy cost of walking. Methods: In this retrospective study, 66 ambulatory children with spastic CP underwent 3D gait analysis with and without AFOs or functional electrical stimulation. Gait patterns were classified according to GaP-CP. AFOs were articulated, flexible, or rigid. Thirty-six children also performed a 5 min walk test with gas exchange measurements. Step length, walking speed, and the energy cost of walking were calculated. Gait kinematics were analyzed with statistical nonparametric mapping. Non-parametric statistics were used to investigate orthotic effects for the total group and for each gait pattern. Results: Ankle kinematics improved in swing phase and initial contact (10 degrees less plantarflexion, p < 0.05) for the total group, dropfoot and genu recurvatum. During the stance phase, reduced knee extension in genu recurvatum (by 3 degrees, p < 0.05) and increased knee extension in crouch (by 3 degrees, p < 0.05) were observed. Median changes in non-dimensional step length were clinically significant (>0.039, p ≤ 0.02, effect size ≥ 0.55) for the total group and the dropfoot, genu recurvatum, and crouch subgroups, while changes in most gait indices, walking speed and the energy cost of walking were not clinically significant. Conclusions: The combined use of GaP-CP and kinematic analysis provided new insights into the effects of ankle–foot orthoses on gait. Articulated and flexible orthoses may not have provided adequate support for genu recurvatum and crouch gait, showing a potential value in gait pattern specific orthotic design to optimize gait kinematics.

Children doi: 10.3390/children13050595

Authors: Maria Del Nogal Avila Marta Soria López Isabel Sánchez-Vera Rosa Plaza-Clavero Daniel Cabello-Rivera Karen Knipping Alejandro López-Escobar

Background/Objectives: Gastroesophageal reflux disease (GERD) is prevalent in infants and frequently managed with acid-suppressive medications that elevate gastric pH. This pilot study aimed to evaluate how varying gastric pH levels (2.5, 4.0 and 6.0) influence the hydrolysis of milk proteins in human milk (HM), cow’s milk-based infant formula (CMF), and goat milk-based infant formula (GMF). Methods: Samples were subjected to a 30 min in vitro gastric digestion using pediatric human gastric juice obtained from clinical donors. Protein degradation was analyzed via SDS-PAGE densitometry, comparing digested aliquots to undigested controls. Results: At pH 2.5, caseins were highly digested in all samples, especially in HM and GMF. At pH 4.0, GMF displayed an apparent 51% greater casein degradation relative to CMF and HM in this pilot analysis. α-lactalbumin degradation was markedly higher in GMF at all pH levels; notably, at pH 4.0 and 6.0, only GMF exhibited digestion of this protein. Albumin showed almost complete degradation in HM and GMF at pH 2.5, and GMF maintained greater degradation at higher pH levels. β-lactoglobulin (absent in HM) was better digested in GMF at pH 2.5, whereas CMF showed higher hydrolysis observed at pH 4.0 and 6.0. Lactoferrin digestion was most efficient in HM and GMF at pH 2.5, with no differences observed at higher pH levels. Conclusions: These preliminary findings suggest that GMF may offer digestive advantages for infants with GERD under pharmacological acid suppression, particularly regarding casein and α-lactalbumin breakdown at higher pH. The distinct digestion kinetics of CMF and GMF at different pH levels provide a physiological basis for targeted infant feeding strategies. Further large-scale studies are required to validate these exploratory observations.

Children doi: 10.3390/children13050593

Authors: Kaja Kubiak Tomasz Konieczny Mateusz Henryk Kopczyński Jonasz Jurek Natalia Wierzejska Aneta Michalczewska Joanna Żyła Jan Stachurski

Objectives: To evaluate how often pain is assessed and treated in pediatric trauma patients transported by Emergency Medical Services (EMS) to a pediatric emergency department (ED), and to compare current practice with national recommendations of the Polish Ministry of Health for prehospital pediatric pain management. Methods: We conducted a retrospective analysis of EMS and ED documentation for all trauma patients under 18 years of age transported to the Pediatric Teaching Hospital of the University Clinical Center of the Medical University of Warsaw between 1 January and 31 December 2021. A total of 981 patients with injury or suspected injury or burns were included without exclusion criteria. For patients with documented pain scores, we analyzed pain intensity (0–10), the scales used [Visual Analog Scale (VAS), Numerical Rating Scale (NRS), Wong–Baker Faces Pain Rating Scale (FACES)], body region injured, Glasgow Coma Scale (GCS) score, suspected alcohol or psychoactive substance use, and type and route of analgesic administration. We further evaluated non-pharmacological interventions, pain reassessment, and achievement of at least 50% pain reduction, as defined in national guidelines. Statistical analysis included Student’s t-test or ANOVA for quantitative variables and maximum likelihood chi-square tests for qualitative variables (α = 0.05). Results: Pain was assessed in 839/981 (85.5%) patients; 651/839 (77.6%) reported pain, most frequently of moderate intensity. Despite this, only 208/981 (21.2%) patients received analgesics prehospitally. Morphine and paracetamol were the most frequently used drugs, predominantly administered intravenously, while non-opioid monotherapy was commonly used in patients with lower baseline pain scores. Less than half of all patients received any non-pharmacological intervention whatsoever. Pain was reassessed in 734/839 (87.5%) patients, with a mean reassessment time of approximately 10 min; however, in many cases reassessment occurred earlier than the expected onset of analgesic action. Overall, only 29.4% of patients with pain and documented reassessment achieved the recommended ≥50% reduction in pain intensity, and at least 70.2% of the cohort had no documented evidence of treatment fully complying with national recommendations. Conclusions: In this real-world prehospital and ED cohort, pediatric trauma pain remains under-treated, and adherence to national guidelines on opioid-based analgesia and pain reassessment is suboptimal. Further efforts are needed to improve documentation, expand the recommended pharmacological options for mild pain, and strengthen education on guideline-concordant pediatric pain management in EMS.

Children doi: 10.3390/children13050592

Authors: Simone Eisenhofer Martina Patrizia Neininger Astrid Bertsche Wieland Kiess Thilo Bertsche Thomas Michael Kapellen

Background: Effective sick-day management, including ketosis home management aimed at preventing diabetic ketoacidosis (DKA), is essential for families living with a child/adolescent with type 1 diabetes (T1D). Methods: Adolescents living with T1D and caregivers of younger children living with T1D were invited to participate in an interview consisting of five parts: (I) demographic data, (II) subjective self-ratings on competence in ketosis home management, (III) objective assessment of competence in ketosis home management using a standardized clinical case scenario consisting of 10 management steps, in which participants were asked to describe the actions they would take to prevent DKA, and (IV) practical demonstrations to objectively assess skills in (IVa) urine dipstick self-testing and (IVb) insulin administration, (V) household availability of (Va) urine dipsticks and (Vb) insulin cartridges. Results: (I) We enrolled 61 adolescents and 79 caregivers. (II) Competence in ketosis home management was subjectively self-rated as good to very good. (III) Adolescents reported 4 (median; Q25/Q75 3/5) and caregivers 5 (4/5) of 10 management steps. Never self-testing ketone levels was reported by 33% of adolescents and 11% of caregivers. (IVa) At least one handling error occurred in 100% of adolescents’ and in 98% of caregivers’ practical demonstrations of urine dipstick self-testing and in (IVb) 98% of adolescents’ and 98% of caregivers’ insulin administrations. (Va) Altogether urine dipsticks were available in 43% of households, whereas (Vb) insulin cartridges were available in 78% of households. Conclusions: Our results demonstrate a mismatch between challenges in ketosis home management and high subjective self-ratings.

Children doi: 10.3390/children13050591

Authors: Maximilian Leiblein Johannes Frank Ingo Marzi Katharina Sommer Katrin Eichler Thomas Vogl Nils Wagner

Background: Aneurysmal bone cysts (ABCs) of the proximal humerus in children are rare, locally aggressive lesions associated with substantial recurrence rates and risk of structural instability. Conventional treatment by curettage and bone grafting is often limited by recurrence, while selective arterial embolization (SAE) alone may not provide sufficient structural support. This study evaluates a single-stage treatment strategy combining embolization and structural reconstruction to address both the vascular and mechanical components of the disease. Methods: A retrospective analysis was performed on 12 pediatric patients (median age 9 years) with proximal humerus ABCs treated between 2020 and 2024. All patients underwent a standardized single-stage protocol consisting of preoperative SAE, intralesional resection with high-speed burr, and reconstruction using an allogeneic fibula graft combined with cancellous bone augmentation. Radiological consolidation, recurrence, and functional outcomes were assessed. Associations between prior surgery, cyst size, and recurrence were analyzed. Results: Primary consolidation was achieved in 75% of patients, with an overall healing rate of 91.7% after secondary interventions. Recurrence occurred in 16.7% of cases and was significantly associated with prior surgical treatment (p = 0.045). No significant correlation was found between cyst size and recurrence (p = 0.151). At final follow-up (median 8.5 months), all patients demonstrated complete healing according to the modified Neer classification following completion of treatment. Functional outcomes were favorable, with 91.7% of patients regaining full range of motion and no neurovascular complications observed. Conclusions: The presented single-stage approach combining SAE, intralesional resection, and structural allograft reconstruction addresses both the vascular supply and mechanical instability of proximal humerus ABCs. This strategy demonstrated high healing rates and favorable functional outcomes, with acceptable recurrence rates in this cohort while avoiding donor site morbidity. It represents a practical and effective treatment concept for this rare pediatric condition.

Children doi: 10.3390/children13050590

Authors: Gabriele Villani Raffaella Lamparelli Carmelo Geraci Gianfranco Maffei

Background: Preterm birth, the leading cause of neonatal mortality, is associated with reduced nephron endowment and an increased risk of kidney disease in later life. In preterm infants, the interruption of nephrogenesis leads to a lower nephron number and structural abnormalities. Prenatal factors such as intrauterine growth restriction, and postnatal factors including nephrotoxic medications, patent ductus arteriosus, perinatal asphyxia, and infections contribute to this deficit. Ultrasound is a key tool for assessing renal volume at birth and can, when indexed to body weight, be used to estimate nephron endowment, which is known to vary widely among individuals. Methods: This study analyzed 52 preterm infants with birth weight < 1000 g, assessing combined renal volume (sum of right and left kidney volumes) indexed to body weight. Results: The mean combined kidney volume-to-body weight ratio was 12.12 (SD = 2.03). Values below the 10th percentile (9.46) or more than one standard deviation below the mean (10.11) may indicate nephron deficiency at birth. Conclusions: Standardized ultrasound-based parameters enable the early identification of neonates at risk for nephron deficit, supporting targeted preventive strategies. Long-term follow-up is essential to detect early renal functional impairment and reduce the risk of chronic kidney disease.

Children doi: 10.3390/children13050589

Authors: Georgios Sideridis Mohammed H. Alghamdi

Background/Objectives: Bullying victimization is a significant threat to adolescents’ psychological well-being and academic functioning. However, most prior research has relied on variable-centered approaches that may obscure meaningful heterogeneity in students’ victimization experiences. The present study aimed to identify latent subtypes of bullying victimization among adolescents in Saudi Arabia using nationally representative PISA 2022 data and to examine whether the structure and prevalence of these subtypes differed across gender. Methods: Data were drawn from the Saudi Arabian sample of the Programme for International Student Assessment (PISA) 2022 and included 6709 adolescents. Bullying victimization was assessed using 11 categorical indicators representing different forms of victimization. Weighted descriptive analyses were first conducted to estimate the prevalence of specific bullying behaviors. Multigroup latent class analysis (LCA) was then applied separately across gender to identify victimization profiles and evaluate measurement and structural invariance. Sequential invariance testing was used to determine whether the latent classes had equivalent meaning and prevalence across males and females. This study involved secondary analysis of an existing large-scale educational dataset and did not require trial registration. Results: Weighted descriptive estimates showed that the prevalence of specific bullying victimization experiences ranged from 7.5% to 24.3%, with boys reporting greater exposure than girls on most overt and coercive forms. Class enumeration supported a parsimonious three-class solution for both genders, reflecting low, moderate, and high victimization severity. Approximately 71–79% of students were classified in the low-risk group, 14–18% in the moderate-risk group, and 3–14% in the high-risk group. Measurement invariance testing supported full invariance of item-response probabilities across gender, indicating that the latent classes represented substantively comparable victimization patterns for males and females. In contrast, structural invariance was not supported, as males were more likely to belong to the high-victimization class, whereas females were more likely to be classified in the low-risk group. Conclusions: The findings indicate that gender differences in bullying victimization are attributable to differences in the level of exposure rather than differences in the underlying structure of victimization experiences. Bullying victimization appears to be concentrated within a relatively small but highly vulnerable subgroup of adolescents. These results support the importance of universal school-based anti-bullying policies and prevention initiatives, while also highlighting the need for targeted psychosocial support and protective interventions for students experiencing chronic or multiple forms of victimization.

Children doi: 10.3390/children13050588

Authors: Liang Zhang Chengbin Wang Chen He Xiaonan Wang Lin Lin Jun Ma Sheng Wang

Background/Objectives: Right vertical infra-axillary thoracotomy to repair ventricular septal defects (VSDs) and atrial septal defects (ASDs) is less invasive than conventional surgical repair via median sternotomy. However, right vertical infra-axillary thoracotomy (RVIAT) may result in unilateral lung injury, a serious postoperative complication requiring extracorporeal circulation and unilateral lung collapse. The aim of this study was to evaluate whether repeated lung recruitment provides enhanced respiratory compliance and lung oxygenation in children who have undergone right vertical infra-axillary thoracotomy (RVIAT) to correct a congenital heart defect. Methods: Eligible participants were children with a common congenital heart defect corrected via RVIAT. Seventy-seven children were randomly classified into two groups. In group A (n = 39), an alveolar recruitment maneuver (ARM) was performed immediately after cardiopulmonary bypass. Children in group C (n = 38) did not receive any additional interventions during surgery. Results: The ARM group tolerated open lung ventilation without significant hemodynamic instability. Compared to controls, intraoperative PaO2, PaO2/FiO2 and lung compliance (Comdyn) improved in group A (p < 0.05), who also showed a significantly lower IL-6 (p < 0.05). In addition, group A had a lower incidence of lung injury and lung atelectasis than Group C at specific post CPB time points. Conclusions: Our findings provide some indication that the application of ARM could effectively improve the oxygenation profile, reduce postoperative pulmonary complications, and attenuate the postoperative inflammatory response in children with a common congenital heart defect corrected via the RVIAT technique.

Children doi: 10.3390/children13050587

Authors: Salvatore Palmese Renato Gammaldi Alessandro Vittori Marco Cascella

Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population.

Children doi: 10.3390/children13050586

Authors: Elisa Granocchio Claudia Maggiulli Luca Andreoli Stefania Gazzola Ilaria Pedrinelli Santina Magazù Daniela Sarti Marinella De Salvatore Martina Paini Sara Rinaldi Sara Visentin Anna Salvalaggio Sara Scotto Elisabetta Cane Elvira Bargagni Elena Giordano Sabrina Signorini Miriam Corradini Ivana Olivieri Ilaria De Giorgi Maria Carmela Oliva Antonio Trabacca Elisa Fazzi Serena Micheletti Cristina Marinaccio Elena Grosso Emanuela Pagliano

Background: Communication, language, and speech disorders are highly prevalent in children with cerebral palsy (CP) and substantially impact social, educational, and community participation. However, few studies have systematically characterized communicative and linguistic profiles using standardized assessments. This paper outlines the work of the ‘Italian CP & Language Network’ over the last two years, focusing on identifying research priorities, developing specialized assessment protocols, and proposing a shared classification system for speech and language disorders in children with CP. Methods: A survey was sent to 11 specialized centers to investigate clinical practices and assessment tools. Based on the results and an extensive literature review, the group developed three age- and complexity-based diagnostic protocols and a shared classification system. Results: The survey highlighted high variability in test selection, especially for speech and pragmatic assessment, and a significant need for ad hoc tools for augmentative and alternative communication (AAC). Three standardized protocols were defined: (1) early language (<48 months), (2) school-age language and pragmatics (4–12 years), and (3) minimally verbal children (6–12 years). A multi-level classification system for language and speech disorders was proposed to improve diagnostic consistency. Conclusions: Standardizing assessment is a critical step toward early identification of communicative vulnerabilities to guide tailored interventions and promote participation and quality of life across developmental stages. The group provides a framework for prospective multicenter data collection to correlate linguistic and speech phenotypes with neuroradiological features and motor outcomes.

Children doi: 10.3390/children13050585

Authors: Ahmet Yılmaz Mehmet Yiğit Gökmen

Background: Congenital muscular torticollis (CMT) is usually managed conservatively during infancy, whereas surgical treatment is considered for persistent deformity in older children. However, evidence remains limited regarding the outcomes of distal resection combined with proximal release of the sternocleidomastoid muscle in children presenting beyond infancy. This study aimed to evaluate the functional and cosmetic outcomes of this combined approach in patients aged 3 years and older. Methods: This retrospective single-surgeon series included 37 patients with CMT aged 3 to 14 years who underwent distal resection combined with proximal release of the sternocleidomastoid muscle between 2002 and 2024. Preoperative and postoperative assessments were performed using the clinical outcome framework originally described by Lee et al., goniometric measurement of cervical rotation and lateral flexion, and clinical evaluation of head tilt, facial asymmetry, scar appearance, lateral band formation, and sternocleidomastoid V-column contour. Patients were also analyzed according to age at surgery, as 3–10 years and 11–14 years. Results: The mean age at surgery was 4.7 years, and the mean follow-up duration was 3.4 years. Significant postoperative improvement was observed in all major functional outcomes. Mean cervical rotation improved from 54.2 ± 8.6° to 87.9 ± 3.4°, and mean lateral flexion improved from 24.1 ± 6.8° to 44.5 ± 3.2° (both p < 0.001). Preoperative functional assessment scores averaged 6.8 ± 1.4, whereas postoperative total outcome scores averaged 14.2 ± 0.9. At final follow-up, no patient had residual head tilt. Mild residual facial asymmetry persisted in 3 patients (8.1%). Overall, postoperative outcomes were rated as excellent in 33 patients (89.2%) and good in 4 patients (10.8%). A slight partial loss of the sternocleidomastoid V-column contour was observed in 34 patients (91.9%), although this finding was not documented as a major cosmetic concern in the available clinical records. Hypertrophic scarring developed in 1 patient (2.7%). No lateral band formation, recurrence, revision surgery, infection, or hematoma was observed. Conclusions: Distal resection combined with proximal release provided favorable functional and cosmetic outcomes in children older than 3 years with CMT. The technique was associated with marked improvement in cervical motion, correction of head tilt, low complication rates, and a high proportion of excellent or good results.

Children doi: 10.3390/children13050584

Authors: Tao Han Yuan Wang Jiageng Xiong Jie Cui Weimin Shen

Objective: To explore the application value of indocyanine green lymphography (ICGL) in the treatment of microcystic lymphatic malformation (mLM). Methods: This study was a prospective, randomized controlled clinical trial. Children with mLM who presented between November 2023 and November 2025 were recruited as subjects. They were randomly assigned in a 1:1 ratio to two groups: experimental group (ICGL-guided partial resection of mLM + penetration sclerotherapy), or control group (conventional partial resection of mLM + penetration sclerotherapy). Clinical baseline data were recorded, including gender, age, lesion location, and maximum lesion diameter. The primary outcomes were efficacy-related parameters (cure rate, effective rate, and number of subsequent treatments). Secondary outcome measures included intraoperative and postoperative parameters (operative time, postoperative drainage, follow-up duration) and related complications. Results: A total of 39 children completed the treatment and follow-up and were included in the final analysis (20 in experimental group and 19 in control group). The baseline characteristics were balanced and comparable between the two groups (p > 0.05). Regarding the primary outcomes, efficacy analysis revealed that the cure rate was significantly higher in the experimental group than in the control group (65.0% vs. 26.3%, p < 0.05). However, there were no significant differences between the groups in effective rate (experimental group: 95.0% vs. control group: 89.5%) or the number of cases requiring subsequent treatment (experimental group: 2 cases vs. control group: 3 cases) (p > 0.05). Furthermore, no statistical difference was observed between the two groups in secondary outcomes, including operative time, postoperative drainage, follow-up duration, or the incidence of postoperative complications (p > 0.05). Conclusions: ICGL-guided partial resection of mLM + penetration sclerotherapy improves postoperative outcomes in mLM. By enabling real-time intraoperative assessment of mLM lesion extent, this strategy facilitates resection of the main lesion and precise sclerotherapy of residual microcysts. These findings validate the significant application value of the ICGL in personalized treatment for mLM.

Children doi: 10.3390/children13050583

Authors: Mar Rey-Berenguel Juan Manuel Espinosa-Sanchez

Pediatric episodic vestibular syndrome (pEVS) is a frequent source of diagnostic uncertainty because recurrent vertigo, dizziness, and unsteadiness in children may arise from disorders with markedly different mechanisms, prognostic implications, and management pathways. Symptom descriptions are often imprecise, interictal examination may be normal, and similar recurrent attack patterns may reflect spontaneous, triggered, neurologic, autonomic, audiovestibular, or extravestibular conditions. This Perspective proposes a clinician-oriented, phenotype-first framework for the practical evaluation of pEVS, grounded in the International Classification of Vestibular Disorders and Bárány Society consensus criteria where available. The proposed approach begins with structured history taking and focused bedside examination, emphasizing the core symptom category, attack duration, trigger profile, and associated migraine, auditory, autonomic, and neurologic features. Recurrent attacks are then organized into clinically recognizable phenotypes, including spontaneous non-migraine and migraine-related presentations, auditory phenotypes, ultrabrief stereotyped attacks, trigger-related attacks, orthostatic/autonomic phenotypes, motion- or visually-triggered dizziness, episodic vertigo with transient neurologic signs, and anxiety-related presentations. Rather than providing an exhaustive etiologic review, this framework is intended to support bedside classification, guide selective ancillary testing, and facilitate longitudinal reassessment, as diagnostic reclassification may occur over time. A phenotype-driven approach may improve diagnostic reasoning, support more rational use of ancillary testing, and facilitate earlier recognition of both common and less frequent but clinically important disorders.

Children doi: 10.3390/children13050582

Authors: Marie-Louise (Jessica) A. J. van de Grint-Stoop Laurel A. Fish Chloe Austerberry Marialivia Bernardi R. M. Pasco Fearon

Background: Research on the well-established association between maternal mental health problems and poorer child outcomes has focused on negative parenting behaviour and overlooked psychosocial stimulation as a potential mediating mechanism. Additionally, whether the same association exists for fathers has been understudied. Methods: We addressed these gaps using data from the nationally representative UK-based Millennium Cohort Study, including n = 15,623 children and their mothers (n = 14,922) and fathers (n = 12,408). Parental mental health and the home learning environment (HLE) were measured using the parent-reported Rutter Malaise Inventory at 9 months of age and the HLE Index at age 3, respectively. At 5 years of age, socio-emotional functioning was measured using the parent-reported Strengths and Difficulties Questionnaire, and cognitive and language abilities were assessed directly using British Ability Scales subtests. Results: Structural equation modelling indicated that the HLE significantly mediated the negative associations between PMH and children’s cognitive abilities (mother: β = −0.01, 95% CI [−0.01, −0.01], p < 0.001; father: β = −0.004, 95% CI [−0.008, −0.001], p = 0.025), socio-emotional functioning (mother: β = −0.01, 95% CI [−0.01, −0.01], p < 0.001; father, β = −0.004, 95% CI [−0.007, −0.001], p = 0.022), and language skills (mother: β = −0.01, 95% CI [−0.01, −0.01], p < 0.001; father: β = −0.005, 95% CI [−0.010, −0.001], p = 0.020). Conclusions: These findings support our hypotheses, with stronger associations identified for mothers than for fathers. The findings suggest that further research is needed on the impact of positive parenting, including the home learning environment, in the context of parental depression, using measurement instruments that provide insight in the quality of positive parenting.

Children doi: 10.3390/children13050581

Authors: Zenobia Talati Jack Kennare Natasha L. Bear Lisa Y. Gibson Robyn Power Van Zyl Kruger Desiree Silva Susan L. Prescott Jacqueline A. Davis

Background: Globally, rates of children with physical and mental health problems are increasing. Health issues in early childhood often persist into adulthood, highlighting the need to ensure children are supported to flourish from the start of life. Objectives: This protocol describes methods used to test the acceptability and feasibility of a novel digital Flourishing Intervention (designed to empower parents and promote child wellbeing), comprising a Flourishing Check (a newly developed online questionnaire) and a Pathway Tool (an online directory of high-quality, evidence-based programmes and resources). Methods: Using a randomised feasibility trial, participants (N = 600 parents of children aged 0–5 years) will complete the Flourishing Check. The intervention group (n = 400) will access the Flourishing Check and Pathway Tool, whereas a waitlist control group (n = 200) will access the Flourishing Check only. Results: The primary aim is to assess the acceptability and feasibility of the intervention through a mixed-methods design incorporating quantitative data from pre- and post-intervention questionnaires and qualitative data from focus groups. This will be assessed using a traffic light system, which will inform if and how to proceed to a future effectiveness trial. Secondary aims are to assess changes in parent and child outcomes. Primary outcomes will be assessed using descriptive statistics and thematic analysis. Secondary outcomes will be analysed using mixed-effects regression models. Conclusions: We anticipate that the Flourishing Intervention will be feasible and acceptable to parents. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12626000187347).

Children doi: 10.3390/children13040580

Authors: Liliana Argueta-Figueroa Karina Alejandra Quiroz-Carlín Mario Alberto Bautista-Hernández Rafael Torres-Rosas María Eugenia Marcela Castro-Gutiérrez Yobana Pérez-Cervera Adriana Moreno-Rodríguez Alfonso Enrique Acevedo-Mascarúa Enrique Antonio Martínez-Martínez

Objective: To determine the publication bias of the reported prevalence of malocclusions in Mexican children and adolescents. Background: Publication bias determination is crucial in a systematic review, helping to ensure the conclusions’ validity and reliability. Nevertheless, without accurate knowledge of disease prevalence and patterns, the health system risks inefficiency, inequity, and failure to meet the population’s needs. On the other hand, malocclusions can impair proper chewing efficiency, contributing to digestive alterations, and nutritional deficiencies among other functional, psychological, and social problems. The data of the prevalence of malocclusion is imperative to implement early interventions in health services that prevent more severe skeletal discrepancies and reduce the need for invasive treatments in adolescence or adulthood. Methods: Studies were collected from five databases, following the PRISMA and Cochrane guidelines for systematic reviews. Eligibility criteria were full-text research in which the prevalence of malocclusions was reported. The risk of bias (Hoy tool), publication bias (the Doi plot and the Luis Furuya-Kanamori (LFK) index), and quality assessments (GRADE tool) were performed. The data were combined using a random-effects meta-analysis. Results: The result of the meta-analysis suggests a high prevalence of malocclusions in mixed dentition was 50.2% (95% confidence interval [CI]: 38.9–61.5%). However, the studies showed a risk of bias and publication bias. Conclusions: In Mexico, there is a high prevalence of malocclusions among children and adolescents. However, these results are not robust enough to draw solid conclusions, due to the low certainty of the evidence.

Children doi: 10.3390/children13040579

Authors: Laura Beckers Joery Verbruggen Vera Saldien Jozef De Dooy Eva van Zanten Thomas Peros Miranda Wiggelinkhuizen Philippe G. Jorens

Background: In the paediatric intensive care unit (PICU), certain drugs should be avoided or administered with strict precautions and close monitoring. This is due to their potential for toxicity or adverse effects or a lack of safety data, especially for critically ill children with organ failure. Additionally, practitioners must assess the unique pharmacokinetic and pharmacodynamic properties of drugs when treating critically ill children. In this narrative review, we highlight the risks, advantages, and disadvantages of three exemplary cases of drugs for paediatric patients hospitalised in the PICU: chloramphenicol, acetylsalicylic acid, and propofol. Methods: Apart from key papers on these drugs, a retrospective analysis of the English literature on chloramphenicol, acetylsalicylic acid (ASA), and propofol was performed on PubMed for papers from January 2014 to December 2025. Results: Chloramphenicol should be avoided in neonates due to the risk of grey baby syndrome. Acetylsalicylic acid (ASA) is contraindicated in children ≤18 years with suspected viral illness because of the risk of Reye’s syndrome, but remains essential for Kawasaki disease and post-cardiac surgery antiplatelet therapy. Propofol should be avoided when used for a longer period at high doses. With proper dosing and monitoring, propofol-related infusion syndrome (PRIS) is preventable, but high-risk patients should receive alternative treatment. Conclusions: This narrative review highlights the significant risks associated with the use of chloramphenicol, ASA, and propofol in paediatric intensive care settings. Their potential for life-threatening and severe adverse reactions emphasises the need for cautious and informed use. Clinicians must carefully consider the risks and benefits of these drugs. To minimise adverse events, strict monitoring, dose adjustments, and the use of safer alternatives are essential. However, it appears that their use in well-defined circumstances in acute illness in children is still warranted. The findings of this narrative review underscore the need for further research to focus on identifying high-risk biomarkers, genetic predispositions, and safer alternatives to improve evidence-based guidelines and reduce morbidity and mortality in paediatric intensive care.

Children doi: 10.3390/children13040578

Authors: Lawrence Sanchez Johanna Austeen Gjestland Per-Henrik Randsborg Ole Kristian Alhaug

Background/Objectives: Adolescent lumbar disc herniation (ALDH) is rare. Evidence on long-term surgical outcomes remains limited. The objective of this study was to evaluate mid- and long-term clinical outcomes following lumbar microdiscectomy in adolescents with lumbar disc herniation (LDH). Methods: A single-institution retrospective cohort study of patients under 19 years who underwent lumbar microdiscectomy over a ten-year period. Baseline clinical and radiological data were obtained from electronic patient records (EPR) and Magnetic Resonance Imaging (MRI). Patient-reported outcomes were collected at follow-up using the Oswestry Disability Index (ODI) as the primary outcome and Numeric Rating Scales (NRS) for back and leg pain and Global Perceived Effect (GPE) as secondary outcomes. Descriptive statistics were used to summarize results. Results: Seventeen of 27 patients (63%) participated. Mean age at surgery was 16.9 years, and mean symptom duration prior to surgery was 11.3 months. All patients underwent disc-preserving microdiscectomy. At a mean follow-up of 67.7 months, mean ODI was 9.5, mean NRS back pain was 2.8, and mean NRS leg pain was 2.3. Fourteen patients (82%) reported being completely recovered or much improved. Conclusions: Lumbar microdiscectomy in adolescents with LDH showed acceptable mid- to long-term outcomes, low disability, and low pain levels at more than five years of follow-up. Clinical and imaging findings resembled those seen in adults, though symptom duration before surgery was prolonged.

Children doi: 10.3390/children13040577

Authors: Adriana Verdezoto Alvarado Shannon M Robson

Background/Objectives: Fruit and vegetable (FV) availability/accessibility are associated with increased intake of FVs and are important determinants of intake. The aim of this analysis was to evaluate the pre-post changes in an FV accessibility intervention and examine cross-sectional associations between accessibility domains and diet quality categories at pre- and post-intervention. Methods: Thirty parent–child dyads (mean age = 41.2 ± 4.7; 9.2 ± 1.9) completed an 8-week pre-post intervention. Assessments included perceptions of accessibility, the Home Food Inventory with added accessibility domains, and three-day diet records used to calculate HEI-2020 scores. Stuart–Maxwell tests were used to evaluate changes in categorical responses, paired t-tests assessed pre-post changes, and independent t-tests compared accessibility by HEI category. Results: Parents reported a perceived increase in frequency of having the form of FVs prepared/ready for use (p = 0.034). No significant pre–post changes were observed in objective FV availability/accessibility domains, FV intake, or HEI scores for children and parents. Exploratory analyses showed that children and parents with HEI-total scores above national averages had higher mean FV location and visibility, with post-intervention visibility being significantly associated with higher HEI among children (p = 0.048) and location being significantly associated with higher HEI among parents at pre- (p = 0.033) and post-intervention (p = 0.046). Conclusions: The FV accessibility intervention did not significantly improve objective HFE accessibility or diet quality in this small sample. Exploratory findings suggest that FV accessibility domains may be associated with diet quality; however, these observations are preliminary. Larger and longer-term studies are needed to determine whether modifying FV accessibility can meaningfully improve children’s dietary intake.

Children doi: 10.3390/children13040576

Authors: Eyleen Pacheco Narváez Karina Pastor-Sierra Nany Castilla Herrera

Background: Pediatric lymphadenopathy is a common reason for consultation, but information from secondary-level care in Latin American middle-income settings remains limited. Objective: The objective of this study is to describe the clinical profile, documentation quality, and use of complementary tests among pediatric patients with lymphadenopathy treated at a secondary-level hospital in Córdoba, Colombia. Materials and Methods: A retrospective descriptive study was conducted through a review of 246 medical records of children with lymphadenopathy evaluated between January 2020 and June 2024. Sociodemographic variables, lymph node characteristics, local inflammatory signs, associated clinical conditions, and complementary tests were extracted from the charts. An exploratory composite variable of predefined clinical assessment features recorded in the charts was analyzed descriptively. Results: The median age was 6 years, with 58.9% being male, and 79.7% lived in urban areas. Cervical involvement predominated (87.8%); most documented nodes were ≤1 cm (59.3%), and local inflammatory signs were uncommon (7.3%). Complementary testing was limited (complete blood count: 37.8%, serology: 17.9%, tuberculin skin test: 6.9%, ultrasound: 7.7%, and biopsy: 4.1%), without significant rural–urban differences. At least one predefined clinical assessment feature was recorded in 83.7% of charts, most often multiple nodes or bilateral involvement; these findings should be interpreted descriptively rather than as direct indicators of malignancy or infection. Conclusions: In this secondary-level, record-based series, pediatric lymphadenopathy was usually documented as small cervical node enlargement with limited complementary testing. The main contribution of this study is to describe documentation patterns and real-world initial work-up in a Colombian secondary-level hospital, which may inform standardized assessment and referral pathways.

Children doi: 10.3390/children13040575

Authors: Kris Hughes Charles Lee Michael Capra Jane Pears Cormac Owens Michael McDermott Maureen O’Sullivan Sri Paran Israel Fernandez-Pineda

Background: Non-Wilms renal tumours (NWRTs) are rare paediatric malignancies and account for a small but clinically significant proportion of childhood renal cancers. Due to their low incidence and biological heterogeneity, outcome data are limited, and management is largely extrapolated from international collaborative protocols. No national data describing the incidence and outcomes of NWRTs in children in the Republic of Ireland (ROI) have previously been published. Objective: To determine the incidence, treatment strategies, and survival outcomes of NWRTs in children in the ROI. Methods: A retrospective cohort study was conducted of all children under 16 years of age with histologically confirmed renal tumours diagnosed and treated at Children’s Health Ireland (CHI) at Crumlin between January 2005 and December 2025. As CHI Crumlin is the single national paediatric oncology centre in the ROI, this cohort represents national case ascertainment for the study period. A total of 143 paediatric renal tumours were identified; Wilms tumours (n = 118) were excluded, leaving 25 children (17.48%) with NWRTs for analysis. No cases of bilateral renal tumours were identified. Histological subtypes included renal cell carcinoma (RCC), clear cell sarcoma of the kidney (CCSK), congenital mesoblastic nephroma (CMN), malignant rhabdoid tumour of the kidney (MRTK), and anaplastic sarcoma of the kidney. Demographic characteristics, treatment strategies, and survival outcomes were analysed. Results: Twenty-five children with NWRTs were identified: CCSK (n = 9), RCC (n = 7), CMN (n = 6), MRTK (n = 2), and anaplastic sarcoma of the kidney (n = 1). At a median follow-up of 107.9 months (range 4.5–181.3 months), overall survival for the cohort was 76%. Overall survival by histology was 100% for CMN, CCSK and anaplastic sarcoma, 43% for RCC, and 0% for MRTK. Treatment strategies varied by histology, with 68% undergoing upfront surgery, 32% receiving neoadjuvant chemotherapy, 60% receiving adjuvant systemic therapy, and 44% receiving radiotherapy. Tumour recurrence occurred in 4/25 patients (16%), confined to the RCC (3) and CMN (1) subgroups. Seven Event-Free Survival events were observed, comprising three RCC relapses and one RCC progression, one CMN relapse, and two MRTK progression-related deaths. No recurrences occurred in CCSK. Conclusions: NWRTs comprised 17.5% of all paediatric renal tumours diagnosed nationally during the study period and demonstrated marked heterogeneity in outcomes according to histological subtype. CMN showed excellent survival with six out of seven requiring surgery alone, whereas MRTK remained associated with dismal outcomes despite multimodal therapy. These national data support histology-driven, risk-adapted management and highlight the importance of continued international collaboration to improve outcomes in NWRTs.

Children doi: 10.3390/children13040574

Authors: Mirko Aldè Letizia Casella Umberto Ambrosetti Stefania Barozzi Eleonora Gandolfo Federica Di Berardino Diego Zanetti

Background/Objectives: Childhood hearing loss (HL) affects auditory, linguistic, and social development. Alongside conventional rehabilitation, music-based interventions have gained increasing attention for their potential to support both auditory and non-auditory domains. This narrative review aims to summarize current evidence on the use of music-based interventions in children with HL. Methods: A narrative review of the literature was conducted, examining studies involving pediatric cochlear implant or hearing aid users. Publications were categorized into three main areas: musical auditory perception, musical training, and music therapy. Results: Studies on musical auditory perception demonstrate persistent limitations in pitch and timbre perception in children with HL, while rhythmic abilities appear relatively preserved. Musical training interventions, particularly those targeting rhythm, have been associated with improvements in auditory perception, linguistic processing, and selected cognitive skills, although parental involvement and long-term designs remain limited. Existing literature on music therapy is scarce but suggests potential benefits extending beyond auditory skills to emotional regulation, social interaction, and quality of life. Conclusions: Music-based interventions represent a promising complementary approach in pediatric hearing rehabilitation. While musical training is more widely studied, music therapy is still underrepresented despite its holistic focus. Further structured studies are needed to define standardized protocols and outcome measures for music therapy in children with HL.

Children doi: 10.3390/children13040573

Authors: Qiang Fei Huazi Liu Xinning Wang Tianming Yuan

Objectives: Neonatal hyperbilirubinemia is a common disease in the neonatal period. In this meta-analysis, we aim to evaluate the efficacy of adjuvant drugs combined with phototherapy in the treatment of neonatal hyperbilirubinemia. Methods: Randomized controlled trials (RCTs) published before September 2025 were searched from PubMed, Embase, Web of Science, and the Cochrane Library. A Bayesian random-effects network meta-analysis was performed to calculate mean differences and 95% confidence intervals. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) and probability of being the best treatment (PbBT). Results: Thirty-five RCTs involving 4060 neonates were included. Compared with phototherapy alone, clofibrate, ursodeoxycholic acid, fenofibrate, and calcium phosphate significantly reduced bilirubin levels and shortened admission duration. Clofibrate showed the greatest efficacy in bilirubin reduction within 48 h (SUCRA = 0.91, PbBT = 60.9%) and in shortening hospitalization (SUCRA = 0.84, PbBT = 40.83%). Probiotics, zinc, and agar exhibited relatively modest effects, while phenobarbital showed no significant benefit. Conclusions: Adjunctive therapies were associated with greater reductions in bilirubin levels compared with phototherapy alone. Future high-quality RCTs are needed to confirm the long-term efficacy and safety of these adjuvant therapies.