Children doi: 10.3390/children13070856

Authors: Cynthia Angeline Rahmat Budi Kuswiyanto Sri Endah Rahayuningsih Rodman Tarigan Diah Asri Wulandari Susi Susanah

Background/Objectives: Anemia in early childhood remains a key global health issue due to its impact on growth and development. While biological determinants of anemia have been extensively studied, parenting styles remain unexplored. This study aimed to examine the association between parenting styles, anemia, and developmental outcomes among under-five children. Methods: From February to March 2026, a cross-sectional study was carried out in Bandung, Indonesia, involving children aged 6–59 months who visited the Pasirkaliki Primary Health Centre. Anemia was confirmed by laboratory testing, defined as a hemoglobin level ≤ 11 g/dL. The Parenting Styles and Dimensions Questionnaire was used to assess parenting styles, while the Pre-Screening Developmental Questionnaire was used to examine child development. Statistical analyses were performed using the Mann–Whitney U test, Chi-square test or Fisher’s exact test, and logistic regression analysis. Results: One hundred and ninety-three subjects were included in the analysis, among which 20.2% were anemic, with a significantly higher proportion among children aged below 24 months (p < 0.001). Permissive parenting was significantly more common among children with anemia and was associated with higher odds of anemia (aOR = 10.31; 95% CI: 3.92–27.10). Children with anemia had significantly higher odds of developmental delay (aOR = 19.49; 95% CI: 6.46–58.84), after adjustment for child age, maternal education, and family income. Conclusions: Permissive parenting was associated with anemia, while anemia was associated with increased odds of developmental delay in under-five children, highlighting the importance of considering not only biological but also psychosocial factors in early child health interventions.

Children doi: 10.3390/children13070855

Authors: Dimitris Chatzopoulos Eleni Mouchou-Moutzouridou Elpida Pogonidou Loukia Kapodistria

Background: Active breaks are short periods of physical activity integrated into classroom. The aim of this study was to examine the effects of a brief music–movement active break on preschool children’s executive functions, mathematics performance, lesson enjoyment and engagement in classroom activities. Methods: The sample consisted of 53 preschool children (five- to six-year-old) who were randomly assigned to an intervention group (n = 25) and a control (n = 28). The intervention group participated in a 5-min music–movement active break, whereas the control group continued with regular seated classroom activities. At baseline and post-intervention, children completed measures of executive functions (inhibitory control, working memory, and cognitive flexibility), mathematics assessments and engagement. At the end of the intervention children also reported their enjoyment using a 3-point smiley-face scale. Results: At post-intervention, the music–movement group demonstrated significantly better performance in inhibitory control compared to the control. Moreover, the intervention group exhibited higher levels of engagement in classroom activities compared to baseline. No significant group differences were observed in mathematics outcomes and self-reported enjoyment, as assessed by the smiley-face scale. Conclusions: The findings suggest that a brief music–movement active break can positively influence children’s inhibitory control and may also contribute to improved task engagement. Although smiley-face scales are commonly used in preschool research, classroom observations from the present study suggest potential limitations in their suitability for assessing enjoyment in this age group.

Children doi: 10.3390/children13070854

Authors: Sydney Ariagno Vida Alami Dexiang Gao Kristen Eisenman Mary Benson Vanessa A. Fabrizio Adam B. Hill Jenna Demedis

Background: Pediatric hematopoietic cell transplantation (HCT) conveys significant risk of mortality, morbidity, impaired quality of life, and multifactorial distress. One potential strategy for improving experience and relieving suffering is proactive specialty palliative care (SPC) utilization. However, SPC is not routinely incorporated into pediatric HCT. One barrier to SPC integration is unknown pediatric HCT provider perceptions of SPC services, particularly among providers with lived experience working within a collaborative HCT-SPC partnership. Objective: This single-institution pilot study aimed to (1) describe an approach to standardized, proactive pediatric HCT-SPC clinical partnership, and (2) quantify acceptability, appropriateness, and satisfaction regarding the program among pediatric HCT providers. Methods: Survey methods were used to assess attitudes among HCT providers who had worked with the SPC clinical partnership for at least three months. Core survey metrics were the validated Acceptability of Intervention Measure and Intervention Appropriateness Measure. Additional survey items were adapted from the Perceptions of Palliative Care Instrument. Results: Respondents reported high mean scores for acceptability (4.96) and appropriateness (4.93) on a 5-point scale. Overall satisfaction with SPC integration averaged 8.72 (SD 1.13) on a 10-point scale. Satisfaction scores for each individual service provided by SPC were similarly high. No significant differences in responses were found based on provider type, prior SPC training, or years in practice. Conclusions: In this single-institution pilot study, pediatric HCT providers with lived experience working in an environment with standardized SPC collaboration view SPC as highly acceptable, appropriate, and beneficial for their patients, supporting the feasibility and value of proactive SPC integration in pediatric HCT care.

Children doi: 10.3390/children13070853

Authors: Enes Çelik Hande Yüksel Bulut

Background/Objectives: Respiratory pathogens are frequently detected during asthma exacerbations in children. This study aimed to evaluate the distribution of respiratory pathogens, associated clinical features, and factors related to severe exacerbation in children hospitalized for asthma exacerbations during a two-year period. Methods: This retrospective observational study included children aged 1–18 years hospitalized for asthma exacerbation between April 2023 and April 2025. Demographic, clinical, laboratory, and pathogen data were retrospectively obtained from medical records and analyzed. Results: A total of 312 children were included; 135 patients (43.3%) were female, and the median age was 5.70 years (IQR, 3.42–8.79). A respiratory pathogen was detected in 235 patients (75.3%). Among patients with single infections (n = 203), rhinovirus (RV) was the most common pathogen (n = 130), followed by respiratory syncytial virus (RSV) (n = 18). Compared with RSV infection, RV infection was associated with higher frequencies of allergic rhinitis and aeroallergen sensitization, as well as higher neutrophil and eosinophil counts and higher total IgE levels. RV was detected throughout the year, peaking in autumn, whereas RSV occurred predominantly in winter. RSV infection was observed in younger children and was associated with more frequent severe exacerbations in unadjusted comparisons; however, only younger age and moderate-to-severe asthma remained independently associated with severe exacerbation in multivariable analysis. Conclusions: Respiratory pathogens were detected in most children hospitalized for asthma exacerbation, with RV being the predominant pathogen. Younger age and moderate-to-severe asthma were the main factors associated with severe exacerbation.

Children doi: 10.3390/children13070852

Authors: Ghareeb O. Alshuwaier

Background: Obesity among Saudi adolescents has risen sharply, yet whether school athletic participation is associated with students showing improved dietary habits and better anthropometric profiles compared to those of their non-athlete peers remains unclear. This study compared anthropometric indices and dietary habits between school athletes and non-athletes in Riyadh. Methods: A cross-sectional study was conducted with 124 male secondary school students (70 athletes and 54 non-athletes aged 16–17 years) in Riyadh, Saudi Arabia. Athletes were defined as students who reported engaging in vigorous-intensity sport for ≥3 days/week for ≥60 min/session. BMI, body weight, and waist circumference were measured objectively. Dietary habit frequencies across ten food categories were assessed using the validated Arab Teens Lifestyle Study (ATLS) questionnaire. Independent samples t-tests and chi-square tests were used; effect sizes were calculated as Cohen’s d. A Bonferroni-corrected threshold (p < 0.005) was applied for multiple dietary comparisons. Results: Athletes had significantly lower BMI (23.64 ± 5.39 vs. 30.28 ± 7.25 kg/m2; p < 0.001, d = 1.06), body weight (p < 0.001, d = 0.93), and waist circumference (85.46 ± 12.61 vs. 95.50 ± 17.89 cm; p < 0.001, d = 0.66). Obesity prevalence was 15.7% among athletes versus 51.9% among non-athletes. Of ten dietary variables, only fresh fruit consumption showed a between-group difference (62.9% vs. 40.7% high-frequency; p = 0.010), which did not survive Bonferroni correction. Conclusions: School athletes demonstrated substantially better anthropometric profiles than their non-athlete peers, but dietary habit frequencies were largely similar across both groups. The high obesity prevalence among non-athletes underscores the need for school-based programs that combine structured physical activity with targeted nutrition education.

Children doi: 10.3390/children13070851

Authors: Luca Pecoraro Andrea Dell’Anna Elisabetta Di Muri Emiliano Altavilla Francesca Marasciulo Alessio Signore Flavia Indrio

Upper respiratory tract infections and inflammatory nasal disorders are highly prevalent in childhood and represent a major cause of morbidity and healthcare utilization. Humans are continuously exposed to airborne microorganisms, allergens, and pollutants. Although the nasal mucosa provides effective mechanical and immunological defenses, these mechanisms may be impaired by inflammation, environmental pollutants, and mucociliary dysfunction, increasing susceptibility to infection and airway inflammation. Nasal irrigation (NI) contributes to the restoration of nasal homeostasis by mechanically removing mucus, pathogens, allergens, and inflammatory mediators, while also improving mucociliary clearance (MC), mucus rheology, and epithelial barrier function. Hypertonic solutions (HS) may provide additional osmotic and decongestant effects. Current evidence suggests that NI is a safe and well-tolerated adjunctive intervention that may improve symptoms and support mucosal function in acute and chronic upper airway diseases. This narrative review provides an updated overview of NI, with particular focus on pediatric populations. This paper integrates the pathophysiological mechanisms of mucociliary dysfunction, environmental exposures, and pediatric-specific anatomical and functional characteristics into a unified framework to understand the role of NI in childhood respiratory diseases. Clinical indications, administration techniques, solution selection, safety aspects, and age-specific practical considerations are discussed, highlighting the importance of appropriate technique, caregiver education, and adherence to basic hygiene principles.

Children doi: 10.3390/children13070850

Authors: Mihaela Zaharie Marioara Boia Aniko Manea Roxana Maria Jeleriu Mirabela Adina Dima Ileana Enatescu Daniela Iacob

Background/Objectives: Gram-negative neonatal sepsis remains a cause of morbidity and mortality in preterm infants, yet the relationship between early clinical severity and long-term neurodevelopmental outcomes is incompletely defined. This study aimed to characterize Gram-negative sepsis in preterm infants and to evaluate its short-term and 18–24-month neurodevelopmental consequences. Methods: We conducted a retrospective observational cohort study of preterm infants admitted to a tertiary neonatal intensive care unit between 1 January 2022 and 31 December 2023. Infants with culture-proven Gram-negative neonatal sepsis, including both early-onset sepsis (EOS) and late-onset sepsis (LOS), were included. Clinical, microbiological, therapeutic, and laboratory data were collected, and survivors were assessed at 18–24 months’ corrected age using the Bayley Scales of Infant and Toddler Development. Results: Among infants with culture-proven Gram-negative sepsis, late-onset cases were more frequent than early-onset cases, and Klebsiella pneumoniae was the most common pathogen (38.0%). Multidrug-resistant organisms were associated with 52.0% of infections. In-hospital mortality was 26.0%. Major short-term complications included intraventricular hemorrhage (24.0%), severe intraventricular hemorrhage (20.0%), necrotizing enterocolitis (12.0%), bronchopulmonary dysplasia (20.0%), and meningitis (10.0%). Among survivors who underwent neurodevelopmental assessment, neurodevelopmental impairment was observed in 38.0%, most frequently affecting the language (22.5%) and cognitive (20.0%) domains. Infants with neurodevelopmental impairment had significantly lower gestational age and birth weight and higher inflammatory biomarker levels. In multivariable analyses, lower gestational age emerged as the strongest independent predictor of both mortality (adjusted OR 0.19, 95% CI 0.04–0.99) and neurodevelopmental impairment (adjusted OR 0.12, 95% CI 0.02–0.71). Conclusions: Gram-negative neonatal sepsis in preterm infants was associated with substantial mortality, severe neonatal complications, and a high burden of later neurodevelopmental impairment. Lower gestational age was independently associated with adverse short- and long-term outcomes. These findings support early recognition, targeted antimicrobial therapy, and structured neurodevelopmental follow-up in this high-risk population.

Children doi: 10.3390/children13070849

Authors: Charlie Gill Anne Greenough James Cook

Sickle cell disease (SCD) is one of the most common inherited blood disorders worldwide. Clinical manifestations are variable, but include hyposplenism, renal impairment, cardiovascular disease, respiratory complications, and cerebrovascular disease. Frequent painful vaso-occlusive crises, hospitalisations, and other physical and psychological ramifications can have profound effects, including children missing school time resulting in impaired academic performance and adults missing work leading to employment loss. This narrative review examines the possible risks and benefits of exercise in the SCD population. Regular exercise plays an important role in improving physical and mental health, but fears around the potential consequences of exercise for the SCD population are present in children, their families, schools, and other organisations. This can result in children not taking part in as much regular exercise as their peers and being excluded from group activities. Studies have suggested that healthcare professionals often do not discuss the possible benefits of physical exercise with patients, likely because there are no guidelines regarding a safe level of activity. An acute increase in inflammation secondary to exercise could increase the risk of vaso-occlusive crises, but regular physical activity is known to play an important role in disrupting chronic inflammation across a wide range of pro-inflammatory diseases. Indeed, studies have demonstrated positive responses to exercise in the SCD population, from improvements in skeletal muscle microvasculature to performance in cardiovascular tests. It is important that recommendations are developed regarding types of exercise and the ideal amount of exercise for maximum benefit with minimum risk in SCD individuals.

Children doi: 10.3390/children13070848

Authors: Katarina Tomelić Ercegović Josipa Glavaš Ivana Sikirica Andrea Vrdoljak Helena Tokić Jelica Perasović Željka Karin

Background: This randomized controlled trial aimed to evaluate the effects of a school physician-led counseling intervention on total cholesterol (TC) levels, adherence to the Mediterranean diet, physical activity, and sedentary behavior in children aged 6–7 years with elevated cholesterol levels in a Mediterranean setting. Methods: A one-year randomized controlled study was conducted among children aged 6–7 years with elevated TC levels, excluding those with familial hypercholesterolemia (FH). Participants were randomly assigned to either a control group (n = 38) or an intervention group (n = 39). All participants received standard care consisting of educational materials and baseline counseling, while the intervention group additionally participated in three structured follow-up counseling sessions conducted by school physicians during the one-year study period. Counseling focused on Mediterranean dietary habits, implementation of basic dietary principles in cases of elevated TC levels, promotion of physical activity, and reduction in sedentary behavior. TC levels were measured at baseline and at the end of the study. Dietary habits, physical activity, and sedentary behavior were assessed using validated questionnaires. For the primary outcome, a descriptive change-from-baseline analysis, unadjusted mean difference, the approximate 95% confidence interval, and Cohen’s d effect size were calculated. Results: At baseline, no significant differences in TC levels were observed between groups (p = 0.852). After the intervention, mean TC levels were lower in the intervention group than in the control group (4.977 ± 0.414 mmol/L vs. 5.137 ± 0.410 mmol/L); however, the between-group difference did not reach statistical significance (p = 0.089). The unadjusted mean difference at follow-up was −0.160 mmol/L, with an approximate 95% confidence interval from −0.35 to 0.03 and a small-to-moderate effect size in favor of the intervention group (Cohen’s d = −0.39). Descriptive change-from-baseline analysis showed a greater mean reduction in TC in the intervention group than in the control group (−0.364 mmol/L vs. −0.195 mmol/L). A statistically significant improvement in adherence to the Mediterranean diet was observed in the intervention group compared with the control group (p < 0.001). Favorable changes were also observed in several physical activity and sedentary behavior variables, including participation in organized physical activity, walking and running activities, and reduced television viewing and video gaming time. Given the exploratory nature of behavioral analyses and the number of physical activity and sedentary behavior outcomes examined, these findings should be interpreted cautiously. Conclusions: The school physician-led counseling intervention did not result in a statistically significant between-group difference in TC levels after one year, although the direction and magnitude of change favored the intervention group. The intervention was associated with improved adherence to the Mediterranean diet and favorable exploratory lifestyle-related behavioral changes. Nevertheless, the findings should be interpreted cautiously in light of the relatively small sample size, non-significant primary outcome, and exploratory nature of behavioral analyses.

Children doi: 10.3390/children13070847

Authors: Koçkar Oran Cebeci Şengül

Background/Objectives: To explore potential associations between pediatric obesity and retinal and anterior segment ocular structures using OCT and ocular biometry. This study was designed as an exploratory, hypothesis-generating analysis without a pre-specified primary endpoint; all findings should be interpreted accordingly. Methods: This retrospective cross-sectional study included 52 children (104 eyes): 27 obese children (body mass index (BMI) percentile ≥95%) and 25 healthy controls (BMI percentile 5–85%). Optical coherence tomography (OCT) and ocular biometry were used to assess retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), focal loss volume (FLV), global loss volume (GLV), Early Treatment Macular Map 5 (EMM5), corneal parameters, axial length (AL), anterior chamber depth (ACD), and white-to-white corneal diameter (WTOW). Group comparisons and cluster-robust bootstrap regression adjusted for inter-eye dependency, age, and sex; Bonferroni correction was applied. Results: Obese children showed nominally higher GCC average thickness, RNFL, and EMM5 values and shallower ACD; however, no parameter survived Bonferroni correction. ACD showed the most internally consistent exploratory pattern (unadjusted p = 0.006; adjusted p = 0.018; Bonferroni p = 0.249); however, this finding did not survive Bonferroni correction and should not be interpreted as a confirmed association. Other corneal and biometric parameters were not significantly different. Conclusions: Pediatric obesity may be associated with subtle ocular structural variations, but all findings are exploratory and hypothesis-generating. Larger prospective, pre-registered studies are needed to determine whether pediatric obesity is associated with structural ocular changes.

Children doi: 10.3390/children13070846

Authors: Lea A. Wehrli Federico G. Seifarth

Objective: Minimally invasive surgery in Hirschsprung disease (HSCR) management was introduced in the mid-1990s. Despite decades of clinical application of various laparoscopic approaches, there remains a paucity of high-powered prospective studies and comprehensive systematic reviews in the literature. This study aimed to systematically review and summarize published techniques and outcomes of laparoscopic- and robotic-assisted surgery in HSCR. Methods: A systematic literature review was conducted using PubMed and the Cochrane Library. Studies reporting technical and outcome data of laparoscopic- or robotic-assisted surgery for HSCR were included. Data extraction and analysis were performed in accordance with the PRISMA 2020 guidelines. Parameters of interest included surgical technique, age at primary pull-through (PT), operative time, and functional outcomes. Outcomes of laparoscopic- versus robotic-assisted Yancey–Soave PT were compared. Results: A total of 700 publications were screened, of which seven studies met the inclusion criteria. Data from 556 patients were analyzed. A total of 338 underwent laparoscopic-assisted, and 218 underwent robotic-assisted pull-through. Large variability of the reported transanal resection technique (modified Yancey–Soave PT) was reported. Four studies reported functional outcomes in patients aged over four years. Three studies directly compared laparoscopic- and robotic-assisted PT; two reported no difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC). Functional outcomes were assessed using the Krickenbeck classification in three studies and the bowel function score in one study, with no significant differences reported in patients aged >4 years. Conclusions: Laparoscopic- and robotic-assisted Yancey–Soave PT appears to be safe for HSCR. Large variability in the applied surgical technique—despite being commonly classified as modified Yancey–Soave PT—as well as heterogeneity in the bowel function assessment, limit direct comparability between studies. To date, no single minimally invasive approach has demonstrated clear superiority over others. Prospective, randomized controlled studies are required to enable robust comparative evaluation of techniques, overall costs, and outcomes.

Children doi: 10.3390/children13070845

Authors: Janhavi Nowbotsing Petro Erasmus Mariaan van Aswegen

Background/Objectives: Motor impairments, including reduced muscular strength and coordination, are commonly reported in children with autism spectrum disorder (ASD) and may negatively affect functional mobility and participation in daily activities. Despite increasing recognition of these challenges, structured resistance training programs for children with ASD remain limited. This study aimed to examine the effects of a 12-week resistance training program on muscular strength and functional performance in children aged 9–11 years with mild ASD. Methods: A selected-group repeated-measures design was employed. Twenty-eight children with specialist-confirmed mild ASD were allocated to an exercise (n = 14) or control group (n = 14) using a strength-matched allocation procedure. The intervention followed established exercise guidelines for youth. Assessments were conducted at baseline, week 6, and week 12 and included handgrip strength, vertical jump height, and 10-m walk time. Non-parametric Friedman tests assessed changes over time, followed by Durbin–Conover post hoc comparisons where appropriate. Effect sizes (r) were calculated. Results: No significant overall time effect was observed for handgrip strength, although a between-group difference favoring the exercise group was observed at week 6. Vertical jump height demonstrated a significant effect over time, with improvements observed in the exercise group from baseline to week 6 and a between-group difference at week 6. Walking time improved significantly across the study period, with improvements observed in both the exercise and control groups. Conclusions: These findings suggest that structured resistance training is a feasible intervention that may support improvements in physical function in children with mild ASD. Resistance training may therefore represent a useful component of exercise programs aimed at improving functional mobility and participation in children with developmental conditions.

Children doi: 10.3390/children13070844

Authors: Noemí Núñez-Enamorado Ana Camacho-Salas María López-Maestro María Carmen Gallego-Herrero Ana Martínez de Aragón Sara Vila-Bedmar Sara Vázquez-Román Berta Zamora-Crespo Carmen Rosa Pallás-Alonso María Teresa Moral-Pumarega

Background/Objectives: Severe brain injury (SBI) in very preterm infants includes heterogeneous lesions with distinct timing, burden and outcomes. We used cranial ultrasound (CUS) to describe SBI entity, documented timing, three-domain burden, deaths following documented withdrawal, withholding or non-escalation of life-sustaining treatment for poor neurological prognosis (neuro-WWLST), and survivor outcomes. Methods: Retrospective single-center cohort (1991–2020) of 2841 very preterm infants (<32 weeks’ gestation and/or birth weight ≤ 1500 g) with complete CUS within 48 h after birth. CUS was summarized by four windows, three domains—parenchymal lesion, intraventricular hemorrhage (IVH) and ventriculomegaly—and three mutually exclusive entities: periventricular hemorrhagic infarction (PVHI), cystic periventricular leukomalacia (cPVL and grade 3 IVH without PVHI/cPVL (IVH3 entity). Cross-outcome analyses used common maximal-burden CUS. Results: SBI occurred in 286/2841 infants (10.1%) and neuro-WWLST death in 45/2841 infants (1.6%); 43/45 occurred within SBI, and 43/89 SBI deaths (48.3%) followed documented neuro-WWLST. Using common maximal-burden CUS, severe three-domain involvement was more frequent among neuro-WWLST deaths than survivors (37.2% vs. 8.6%). Among SBI survivors with follow-up, cerebral palsy (CP) occurred in 87/176 (49.4%) and clinically classified school-age cognitive sequelae in 50/155 (32.3%). Outcomes varied by entity, with mainly ambulatory unilateral CP after PVHI, more frequent non-ambulatory bilateral CP after cPVL, and a heterogeneous IVH3 profile. Severe three-domain involvement identified a small subgroup with higher outcome burden, but outcomes were not deterministic. Conclusions: A structured, descriptive CUS approach separating lesion entity, documented timing and multidomain burden may support transparent cohort-level description of SBI trajectories, documented neuro-WWLST deaths and survivor outcomes.

Children doi: 10.3390/children13070843

Authors: Emel Isıyel Nur Mutlu Gülay Çakmak Özlem Tekşam

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects.

Children doi: 10.3390/children13060842

Authors: Marcin Losin Maciej Chojnicki Weronika Lotkowska Ewelina Wojciechowska Maciej Murawski Bartosz Regent Piotr Czauderna

Background and Objectives: Pulmonary sequestration (PS) is a rare congenital lung anomaly with anomalous systemic arterial supply. Surgical resection is the standard treatment, but some children have contraindications. Endovascular embolization (EE) is an established alternative; published pediatric experience is limited, particularly in neonates. We report a two-centre experience with extended follow-up and quantitative hemodynamic data. Methods: Six pediatric patients (five male; median age 6 months, range 11 days to 4 years and 8 months) underwent EE for PS at two centres in Gdańsk, Poland, between 2020 and 2025. Contraindications to surgery were severe pulmonary arterial hypertension, high-output cardiac failure, low body weight with comorbidity, complex extralobar anatomy or refused parental consent. Procedures were performed under general anesthesia via right common femoral arterial access; device strategy was tailored to vessel anatomy. Results: Technical success was 100% with no procedural complications. Median feeding-artery diameter was 3.4 mm (range 2.1 to 5.3 mm). An Amplatzer-family vascular plug was used in five patients (83.3%), pushable platinum coils in two (33.3%) and Onyx-18 in one (16.7%); two had hybrid combinations and one underwent planned staged two-step embolization. Median procedural duration was 51 min. At median follow-up of 50 months (range 11 to 68), all patients showed sequester regression on imaging. Reverse cardiac remodelling occurred within five weeks in the patient with pre-procedural left ventricular dilation (Z-score +2.45 returning to normal); systolic pulmonary artery pressure fell from 35 to 40 to 17 mmHg within six weeks in the neonate treated at 11 days of life for high-output cardiac failure. No patient required surgical resection. Conclusions: Endovascular embolization is safe and effective in pediatric patients with pulmonary sequestration and contraindications to surgery, including neonates with comorbidity. Documented reverse cardiac remodelling and rapid hemodynamic improvement support its use in selected cases.

Children doi: 10.3390/children13060841

Authors: Wen-Kan Feng Kun-Long Hung Ting-Hao Wang

Fatigue and muscle wasting are common clinical manifestations of inherited and acquired neuromuscular disorders, including peripheral neuropathies, neuromuscular junction disorders, and myopathies. These conditions encompass a wide disease spectrum with variable prognoses, making accurate diagnosis essential for appropriate management. Congenital myasthenic syndromes (CMSs) are rare, inherited disorders characterized by impaired neuromuscular transmission. Although symptoms often begin in infancy or early childhood, later onset during adolescence or adulthood is increasingly recognized. Clinical phenotypes vary according to the underlying molecular defect, but fatigable weakness predominantly affecting axial and proximal limb muscles is a hallmark feature. We report an adolescent male who developed progressive proximal muscle weakness and wasting over several years, resulting in significant functional impairment. Initial evaluation suggested limb–girdle muscular dystrophy. However, comprehensive investigations, including whole-exome sequencing, identified a heterozygous CHRNB1 mutation consistent with postsynaptic CMS. Targeted pharmacological therapy led to clinical improvement. This case highlights the importance of considering CMS in patients presenting with limb–girdle weakness and underscores the value of genetic testing in establishing an accurate diagnosis and guiding treatment.

Children doi: 10.3390/children13060840

Authors: Prabhadevi C. Maganur Satish Vishwanathaiah Renad Hussain Mohammed Ariji Shaima Mansour Alabdali Nawar Ebrahem Ahmed Moafa Mohammed Jafer Hammam Ahmed Bahammam Noura Alessa Ahtesham Ahmad Qurishi Ahmed Ibrahim Atiah Ruwayni Esraa Eissa Ibrahim Abujamilah Bushra Mohammed Ahmad Wasili Wejdan Faris Saleh Alhaider Anas Ali Mohammed Dahmas

Background: The paediatric dentistry domain requires effective management of pain in children during invasive procedures such as the inferior alveolar nerve block (IANB). This study aimed to evaluate the effectiveness of Buzzy BEETM in reducing pain perception during IANB in children. Methods: This crossover study recruited 38 children aged 6–10 years scheduled for bilateral dental procedures requiring IANB. The washout period was 7 days, and two visits were scheduled for procedures on either side. Two randomly allocated groups received the study intervention, with each group receiving it alternately at each visit. Outcomes measured were pulse rate; subjective pain assessment using the Wong–Baker FACES Rating Scale (WBS); objective pain assessment using the Sound, Eyes and Motor (SEM) scale; and parental rating of observed pain on a scale of 1–10. Results: A statistically significant reduction in pulse rate after IANB was observed in the Buzzy BEE group at the first (p = 0.02) and second (p = 0.002) visits. At the second visit, the WBS scores (p < 0.001) and ‘eye’ (p = 0.004) and ‘motor’ (p = 0.002) scores on the SEM scale were significantly reduced in the Buzzy BEE group. The crossover analysis identified a significant treatment effect on pulse rate (p < 0.001) and significant carryover effects on WBS and SEM scores (p < 0.001). Conclusions: The use of Buzzy BEE reduced pulse rates during IANB, suggesting a positive impact on children’s anxiety. The carryover effects in the current study limit the consistency of improvements in subjective and objective pain perceptions. Further studies with a larger sample size and an extended washout period are recommended to evaluate the effectiveness of Buzzy BEE in reducing pain perception during IANB.

Children doi: 10.3390/children13060839

Authors: Huazhang Liu Minghui Pan Liming Jin Guangjie Chen Chang Tao Xiang Yan

Objective: The aim of this study was to evaluate the safety and efficacy of robot-assisted laparoscopic ureteroureterostomy (RALUU) and laparoscopic ureteroureterostomy (LUU) for duplicated kidney malformations in infants. Methods: This retrospective comparative cohort included infants with duplicated kidney malformations who underwent RALUU or LUU between May 2021 and April 2025. Perioperative variables assessed included operative duration, blood loss, oral feeding time, FLACC pain score, hospital stay, and complications. Follow-up outcomes included changes in anteroposterior pelvic diameter (APD), ureteral diameter (UD), and renal function (RF) of the affected upper moiety, assessed using renal ultrasonography and radionuclide imaging, with preoperative measurements serving as the baseline reference. The minimum follow-up duration was 12 months. Surgical success was determined based on fulfillment of all three criteria: resolution or alleviation of clinical symptoms, a reduction in APD and UD, and preserved or improved upper-moiety renal function compared with baseline. Results: The final cohort consisted of 52 infants (RALUU, n = 28; LUU, n = 24). Demographic and clinical profiles were comparable between groups. RALUU was associated with a shorter operative duration than LUU (139.6 ± 16.6 vs. 151.8 ± 21.6 min, p = 0.029). Estimated blood loss, time to oral feeding, FLACC pain score, and hospital stay were comparable. Postoperative complications were observed in 2 RALUU patients and 3 LUU patients. One patient in the LUU group developed urine leakage, which was managed conservatively. Postoperative urinary tract infection occurred in 2 patients in each group. No patient required secondary surgery. At a mean follow-up of 26.8 ± 10.4 and 28.1 ± 11.7 months in the RALUU and LUU groups, both groups showed significant reductions in APD and UD, with preserved RF and a modest postoperative increase. Conclusions: Both RALUU and LUU were safe and effective for duplicated kidney malformations in infants. RALUU was associated with a shorter operative time, while postoperative recovery, complication rates, and follow-up outcomes were comparable.

Children doi: 10.3390/children13060838

Authors: Hilmi Onur Kabukçu Sarper Müftüoğulları Eren Yıldız

Objectives: The diagnosis of pediatric acute appendicitis remains challenging due to clinical findings that overlap with nonspecific abdominal pain (NSAP). In this study, the value of fibrinogen in the diagnosis of pediatric acute appendicitis and in the classification of disease severity was investigated. Methods: In a single-center, retrospective cohort study, 145 patients aged 1 month to 18 years who underwent contrast-enhanced abdominal computed tomography were divided into three groups: NSAP (n = 62), uncomplicated appendicitis (n = 44), and complicated appendicitis (n = 39). Hemogram parameters, CRP, procalcitonin, albumin, and fibrinogen levels were compared. Diagnostic performance was assessed using ROC analysis, and independent predictors were evaluated via multivariate logistic regression. Results: Fibrinogen levels showed a gradual and statistically significant increase from NSAP to uncomplicated appendicitis and then to complicated appendicitis (p < 0.001 for all pairwise comparisons). In distinguishing appendicitis from NSAP, fibrinogen achieved the highest diagnostic accuracy among the biomarkers examined (AUC = 0.95); CRP, WBC, ANC, and NLR demonstrated lower discriminatory performance. In multivariate logistic regression analysis, fibrinogen was validated as an independent predictor of appendicitis (p < 0.001). Conclusions: Fibrinogen demonstrates high discriminatory performance in the diagnosis of pediatric acute appendicitis and shows a graded relationship with disease severity. These findings suggest that fibrinogen may be a promising biomarker for the evaluation of pediatric acute appendicitis. However, larger prospective multicenter studies are required before its routine integration into diagnostic algorithms can be recommended.

Children doi: 10.3390/children13060837

Authors: Jacquelyn Raftery-Helmer Ashley S. Hart Alyssa L. Faro Diana Baez Phoebe Moore

Background/Objectives: Incorporating parent training into cognitive-behavioral therapy for anxious youth has not been shown to significantly improve outcomes perhaps because these interventions have not addressed potential interfering psychological barriers to implementing parenting changes and rarely offer between-session support. There is growing evidence that Acceptance and Commitment Therapy (ACT) can target these psychological barriers and generate more flexible and adaptive behavioral repertoires in parents of children with a variety of presenting challenges. Methods: Following a pilot trial of “Acceptance and Commitment Therapy for Parents of Anxious Children (ACT-PAC)” a six-week group-based intervention focused on targeting psychological barriers to parenting change using mindfulness and acceptance approaches, we collected qualitative feedback from participants in two post-treatment phases by conducting individual interviews and a focus group with participants that completed the intervention. Results: Analysis of interview responses revealed that parents found ACT principles and processes to be helpful, and many also appreciated the ACT-PAC group setting that allowed parents to recognize their experiences were shared by others and to self-disclose in a non-judgmental space. Feedback from the focus group further provides preliminary evidence that ACT-PAC is acceptable to and feasible for parent participants and suggests modifications such as involving additional caregivers, making resources more readily available, and creative structural changes that may facilitate between-session practice. Conclusions: Results suggest that the group-based intervention can be both maintained and improved for future participants. Limitations to generalizability in light of possible selection bias and the small focus group sample size are addressed.

Children doi: 10.3390/children13060836

Authors: Marta Kinga Labecka Magdalena Plandowska Agnieszka Jankowicz-Szymańska

Background/Objectives: Promoting postural health in children requires not only adequate knowledge but also the implementation of health-promoting behaviors in the school environment. Teachers play a key role in this process; however, the extent to which their knowledge is reflected in everyday practice remains unclear. The study aimed to analyze and compare the levels of knowledge among preschool, early school, and physical education teachers regarding postural health in children and adolescents, including postural abnormalities, ergonomics, the selection of corrective exercises, and behaviors that promote correct body posture. Methods: A cross-sectional study was conducted on a sample of 153 teachers in Poland: 24 preschool (P), 53 early school education (EE), and 76 physical education (PE) teachers. The self-report Teachers’ Body Posture Literacy Questionnaire (TBPLQ) was used to assess knowledge regarding postural abnormalities. Results: PE achieved the highest TBPLQ scores, with significant differences observed mainly in comparison with EE (r = 0.30–0.50, p < 0.001). Across all groups, teachers performed best in recognizing postural abnormalities and worst in selecting appropriate corrective exercises. Although knowledge levels were relatively high, only weak correlations were found between knowledge and postural hygiene-promoting behaviors. The largest behavioral differences concerned the use of appropriate sportswear during physical education classes (η2 > 0.14). Conclusions: Teachers demonstrated relatively high levels of knowledge regarding posture health. However, a clear knowledge–behavior gap was identified. Knowledge was only partially translated into proactive health-promoting actions, particularly regarding corrective interventions and communication with parents. The results suggest the need for educational initiatives for teachers focusing on proactive health-promoting and postural hygiene behaviors.

Children doi: 10.3390/children13060835

Authors: Christine B. Mirzaian Tamara Matic Melissa Lee Wilson Imani Franklin Vanessa Castro Salvador Gonzalez Seongwook Amos Byun Alexis Deavenport-Saman Olga Solomon Irina Quebles Marie Kanne Poulsen Stephanie A. Bughi-Capecci Larry Yin

Background/Objectives: The COVID-19 pandemic had a negative effect on early intervention (EI) delivery to children with developmental delays or disabilities. This study aimed to compare school readiness of children who received, or attempted to receive, EI before, during, and after the COVID-19 pandemic stay-at-home order. Methods: A prospective cohort study was conducted with a single state-funded center that delivers federally mandated EI. School readiness assessments were performed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Fisher’s Exact tests, and Kruskal–Wallis ANOVA were performed to compare scores in children who began EI in the three time periods related to the COVID-19 pandemic. Results: A total of 56 children were enrolled in this study, the timing of EI start was available in 43, and 22 were able to complete all assessments. Statistically significant differences were found in WPPSI-IV Verbal Comprehension Index T scores (100 ± 15) across the COVID-19 phases, with the lowest scores arising during the pandemic (76.2 ± 9.3); the highest scores, pre-pandemic (98.0 ± 6.2); and intermediate scores, post-pandemic (81.5 ± 10.1, p < 0.05). Many children exhibited mental health concerns, with 29/56 (52%) being referred to community-based mental health services. Conclusions: In this study, lower scores were reported for markers of school readiness in children who received or attempted to receive EI during the COVID-19 stay-at-home orders compared to those pre- and post-pandemic. High mental health needs were identified, particularly among children with mild–moderate symptoms of autism or those who underwent EI during the COVID-19 stay-at-home orders.

Children doi: 10.3390/children13060834

Authors: Ziad D. Baghdadi

Purpose: To provide an evidence-calibrated, time-bound clinical framework for using 38% silver diamine fluoride (SDF) as interim stabilization for severe early childhood caries (SECC) in young children, addressing gaps in existing guidelines regarding treatment duration, exit criteria, equity, and system accountability. Methods: This framework was developed from the American Academy of Pediatric Dentistry (AAPD) guidance (2017–2025), the 2024 Cochrane review, real-world utilization studies, and a narrative review proposing a preservation-to-precision heuristic. Recommendations are expressed using GRADE terminology. Results: The framework includes ten recommendations, a systems drift principle, explicit time thresholds (<6 months, 6–12 months, >12 months), a 12-month reassessment mandate, equity guardrails, a bridge vs. destination consent model, and a future research agenda. A clinical vignette contrasts appropriate short-term bridging with prolonged temporization due to access barriers. Conclusions: SDF is conditionally recommended for caries arrest in primary teeth. In children with SECC, SDF should be used within a documented, time-bound preservation-to-precision pathway. SDF should not become an open-ended substitute for definitive restorative care. Explicit equity implementation prevents the framework from penalizing underserved children.

Children doi: 10.3390/children13060833

Authors: Mirko Aldè Stefania Barozzi

Hearing and balance disorders represent some of the most challenging conditions encountered in pediatric healthcare [...]

Children doi: 10.3390/children13060832

Authors: Federica Vallone Carmine Vincenzo Lambiase Mariana Amorim Susana Silva Milton Severo Francesco Raimondi Maria Clelia Zurlo

Objective: Based on the Person-Centered Approach, this study targeted parents of very preterm (VPT) infants in Neonatal Intensive Care Units (NICUs) from Italy and Portugal. The primary aim was to classify parents by identifying latent classes of perceived risks (NICU stressors) and resources (sources of social support). Potential specificities in class membership according to Country of Belonging and sociodemographic factors were also investigated. Methods: Overall, 303 parents (92 Italian; 211 Portuguese) completed a survey including sociodemographic factors, Parental-Stressor-Scale-NICU, and Multidimensional-Scale-of-Perceived-Social-Support. Data were analyzed by multigroup latent class analysis and multinomial logistic regression. Results: Three statistically valid and cross-country classes were identified and labelled as Class 1, Adjusted/Beneficial-and-Supported-System, Class 2, Stressed-and-Supported-System, and Class 3, Parental-Role-Alteration-with-Family-Supported-System. Portuguese parents were mainly grouped in Classes 1 and 2, while Italian parents were in Class 3. Men were less likely to belong to Classes 2 and 3, while older parents having another child were more likely to belong to Class 3. Conclusions: The experience of parents of VPT infants in NICUs is inherently challenging, yet identifying specific risk profiles featured by the unique nuances of stressors and sources of support while accounting for further factors (Country of Belonging, Gender, Age, Having another child) can foster the customization of interventions aimed at providing parents with the necessary resources for adjusting to this extremely demanding experience.

Children doi: 10.3390/children13060831

Authors: Joseph Mahgerefteh

Hypertension is the leading risk factor for cardiovascular disease. Epidemiologic studies have demonstrated that pediatric hypertension may increase the risk of premature heart disease. Pediatric hypertension affects about 4% of children and clusters with other risk factors and social disparities in health. In addition to observed target organ damage, there is evidence for tracking blood pressure from childhood to adulthood. Ambulatory blood pressure monitoring is the recommended method for diagnosis, and echocardiography is used to assess target organ damage. A diagnostic workup in children depends on the age at presentation, severity of hypertension, diurnal pattern, evidence of target organ damage, and response to treatment. Treatment follows a similar framework to adult hypertension and studies demonstrate improvement in intermediate outcomes with treatment. However, further studies are needed to establish benefit in hard outcomes. This review focuses on studies evaluating the epidemiology of pediatric hypertension and its association with cardiovascular outcomes. Relevant domains included prevalence, blood pressure tracking, and cardiovascular sequelae. To compile data for this narrative review, a PubMed/MEDLINE database search was performed for studies published between 1997 and April 2026.

Children doi: 10.3390/children13060830

Authors: Charlotte Aßmann Philipp Deindl Martin E. Blohm Dominique Singer Ahmed Aboalqez

Background/Objectives: While packed red blood cell transfusions are commonly administered in anemic neonates, transfusion strategies in preterm infants have been the subject of debate for decades, particularly due to questionable long-term benefits and limited evidence regarding short-term physiological effects. In non-intubated preterm infants, established transfusion thresholds are considered, but individual clinical judgment often plays an important role in the final decision. This study aims to assess the short-term cardiorespiratory effects of red blood cell transfusions in non-intubated very-low-birth-weight (VLBW) infants who were either spontaneously breathing or receiving non-invasive respiratory support. Methods: Retrospective, single-center analysis of 68 VLBW infants (<1500 g) who received 99 red blood cell transfusions between 2019 and 2023. Cardiorespiratory parameters were observed over a 24 h period before and after transfusion. Results: Following transfusion, there was a significant decrease in the frequency of bradycardia events per 24 h (6.51 ± 5.55 to 4.24 ± 3.8; p = 0.004), accompanied by an improvement in the depth of oxygen desaturations (78.7 ± 4.18 to 81.0 ± 3.71; p = 0.001). No significant changes were detected in the desaturation frequency, FiO2 or heart rate. Conclusions: In clinically stable very-low-birth-weight infants receiving non-invasive ventilatory support, packed red blood cell transfusion is associated with modest, short-term improvements in cardiorespiratory stability. However, these effects are limited in scope. Further research is needed to identify which patient subgroups derive the most significant benefit from these transfusions.

Children doi: 10.3390/children13060829

Authors: Ju Yin Su He Xiao Zhang Xiaomeng Liu Baoping Xu Yiqin Song

Objectives: To investigate the clinical and epidemiological characteristics of respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (ALRTI) among hospitalized children in the Baoding region of Hebei Province, China. Methods: The study subjects were inpatients diagnosed with ALRTI at a pediatric hospital in Baoding between 1 June 2017 and 31 December 2024. A retrospective analysis was conducted on the detection of RSV and other common respiratory viruses in respiratory specimens to evaluate the clinical epidemiological characteristics of RSV. Viral detection was performed using immunofluorescence (IF) or polymerase chain reaction (PCR) assays. Results: The overall RSV detection rate was 16.8% (4945/29,399), with 6.7% co-infections. The RSV detection rate was 29.8% (2604/8729) in infants younger than 1 year and 18% (942/5232) in the 1-year-old group, then showing a decreasing trend with increasing age, with the lowest rate of 3.8% (283/7366) observed in the ≥5 years age group. The RSV detection rate decreased from 19.9% before the COVID-19 pandemic (2017–2019) to around 13% during and after the pandemic (χ2 = 233.732, p < 0.001), accompanied by a drop in the proportion of children under 2 years from 78.5–79.6% before the COVID-19 pandemic to 42.1–51.1% after the pandemic period (χ2 = 387.565, p < 0.001). RSV seasonality shifted from a typical single winter–spring peak in the pre-COVID-19 era to a markedly reduced peak during the pandemic, in contrast to a delayed summer–autumn “off-season” pattern observed in the post-pandemic period. Conclusions: RSV remains the predominant pathogen for hospitalized ALRTI in Baoding, particularly among infants. Detection rates of RSV declined with increasing age. The COVID-19 pandemic has profoundly impacted RSV prevalence patterns and seasonality, underscoring the critical need for long-term surveillance.

Children doi: 10.3390/children13060828

Authors: Iuliana Margasoiu Alin Constantin Pînzariu Lorena Mihaela Manole Elena-Lia Spoială Gabriela Păduraru Gabriela Ghiga Irene Paula Popa Dragomir Nicolae Șerban Ionela Lăcrămioara Șerban Laura Mihaela Trandafir

Background: Childhood obesity is increasingly associated with gut microbiome dysbiosis. This systematic review (PROSPERO CRD420251131354) evaluates evidence from studies published between 2020 and 2026 assessing how nutritional and lifestyle interventions influence gut microbiota in children with obesity. Methods: A systematic search of PubMed, EMBASE and EBSCO identified 21 interventional studies involving children aged 5–18 years with obesity, with the last search conducted in April 2026. Interventions comprised prebiotics, probiotics, synbiotics, postbiotics, high-fiber diets, calorie-restricted dietary approaches, and lifestyle modifications such as physical activity. Microbiome outcomes were analyzed using 16S rRNA sequencing, quantitative real-time polymerase chain reaction (qPCR), or metagenomics. Risk of bias was evaluated using the RoB 2 and ROBINS-I (version 2) tools. Due to substantial heterogeneity in study design, participant characteristics, intervention types, and analytical methods, a meta-analysis was not feasible. Results: Across 21 studies, nutritional interventions included measurable but heterogeneous alterations in gut microbiome composition. Inulin supplementation was associated with a significant increase in alpha diversity and with higher relative abundances of Bifidobacterium, Blautia, Megasphaera, Subdoligranulum, and Eubacterium coprostanoligenes. Synbiotic supplementation increased Prevotella and Dialister and reduced the Firmicutes/Bacteroidetes ratio. High-fiber dietary interventions increased Faecalibacterium, Bifidobacterium, and Clostridium, while reducing Bacteroides, and were associated with shifts in metabolic pathways related to carbohydrate, lipid, and nucleotide metabolism. Calorie-restricted diets and combined diet–exercise interventions increased beneficial taxa such as Akkermansia muciniphila, improved microbial diversity, and correlated with favorable metabolic and anthropometric outcomes. Overall, nutritional and lifestyle interventions in pediatric obesity were associated with taxon-specific and context-dependent microbiome changes, rather than uniform restructuring. Conclusions: Nutritional interventions can modulate gut microbiota diversity, composition, and predicted function in pediatric obesity; however, the observed effects vary substantially across studies. The limited number of trials, small sample sizes, and methodological heterogeneity underscore the need for larger, standardized studies to better define clinical and therapeutic implications.

Children doi: 10.3390/children13060827

Authors: Balagangadhar R. Totapally

Pediatric critical care medicine has evolved into a highly specialized discipline that continues to adapt to the changing realities of clinical practice [...]

Children doi: 10.3390/children13060826

Authors: Benedetta Leonardi Federica Calì Chiara Pierri Ugo Giordano Giovanni Di Salvo Giovanni Antonelli Giulio Calcagni Marcello Chinali

Background: The impact of overweight and obesity on blood pressure and cardiac remodelling in pediatric congenital heart disease (CHD) remains incompletely defined, particularly across different ventricular physiologies and cardiac anatomies. Aim: To assess the association of overweight and obesity with arterial blood pressure and cardiac remodelling in pediatric and young adult patients with CHD, according to ventricular physiology and cardiac anatomy. Methods: In this observational study, pediatric CHD patients undergoing clinical and echocardiographic evaluation were classified by weight status and ventricular physiology, with additional stratification by cardiac anatomy. Associations between body mass index (BMI), arterial hypertension, and echocardiographic parameters were analyzed. Results: A total of 451 patients were included (mean age 13.1 ± 3.9 years; 74 univentricular, 377 biventricular). Overall, 16% were overweight and 7% obese. Hypertension was present in 16% and increased across BMI categories (14%, 26%, and 50%). BMI was associated with blood pressure category (p < 0.001), higher systolic blood pressure (p < 0.001), and increased left ventricular (LV) mass (p = 0.007), interventricular septal thickness (p < 0.001), and posterior wall thickness (p < 0.001), without evidence of systolic dysfunction. In adjusted models, overweight/obesity remained associated with worse blood pressure classification, both as a three-category outcome (OR 2.1, 95% CI 1.4–3.2; p < 0.001) and as a binary outcome (OR 2.3, 95% CI 1.5–3.7; p < 0.001), as well as with higher systolic blood pressure (β = 5.1 mmHg, 95% CI 2.4–7.8; p < 0.001), left ventricular mass index (LVMI) (β = 10.0, 95% CI 4.3–15.8; p < 0.001), interventricular septal thickness at end-diastole (IVSd) (p < 0.001), and left ventricular posterior wall in diastole (LVPWd) (p < 0.001), but not with diastolic blood pressure or systolic function. No significant associations were observed in univentricular patients, whereas in biventricular circulation higher BMI was consistently associated with worse blood pressure and remodeling, without systolic dysfunction. Conclusions: Excess body weight is independently associated with adverse blood pressure status and early LV structural remodelling in pediatric and young adult patients with CHD, despite preserved systolic function. These findings support early cardiovascular risk surveillance and preventive strategies targeting overweight and obesity in CHD care.

Children doi: 10.3390/children13060825

Authors: Felipe Caamaño-Navarrete Claudio Hernández-Mosqueira Guido Contreras-Diaz Indya del-Cuerpo Daniel Jerez-Mayorga Tomás Herrera-Valenzuela Eduardo Guzmán-Muñoz Jordan Hernandez-Martinez Pablo Valdés-Badilla Cristian Núñez-Espinosa Pedro Delgado-Floody

Background: Adolescent mental health is a global concern, with lifestyle factors such as diet and physical activity (PA) playing a crucial role. While the Mediterranean Diet adherence (MDA) is known for its neuroprotective benefits on mental health, the mechanisms by which they are related remain unclear. Therefore, the aim of this study was twofold: (1) to examine the associations between MDA, PA, and screen time (ST) with anxiety symptoms, depression, stress, and total psychological distress in Chilean adolescents; and (2) to determine whether PA mediates the relationship between MDA and anxiety symptoms. Methods: A cross-sectional study was conducted with 322 Chilean school-aged adolescents 158 males and 164 females (14.98 ± 1.96 years). Mental health outcomes (depression, anxiety, and stress) and lifestyle behaviors, including MDA, PA, and ST, were comprehensively assessed using validated self-reported questionnaires. Results: After adjusting for age and sex, multiple linear regression models showed that higher MDA was significantly and inversely associated with anxiety (b = −0.23, p = 0.044), stress (b = −0.25, p = 0.022), and total psychological distress (b = −0.72, p = 0.022). Conversely, ST was identified as a consistent risk factor, positively predicting higher levels of anxiety (b = 0.45, p = 0.008), stress (b = 0.42, p = 0.008), and total distress (b = 1.11, p = 0.014). Furthermore, PA was inversely linked to anxiety (b = −0.35, p = 0.013) and successfully mediated the relationship between MDA and anxiety symptoms (Indirect Effect = −0.047, 95% CI: −0.10 to −0.01). No significant mediation effects were observed for depression or stress. Conclusions: The present study identifies robust inverse associations between MDA and symptoms of anxiety, depression, and stress in Chilean adolescents. A key finding is the specific pattern of relationships observed: while higher MDA is directly linked to lower levels of depression and stress, its association with anxiety is shared with levels of PA. Despite these findings, the cross-sectional nature of the study limits the establishment of causal relationships, and further longitudinal research is needed to confirm these directional pathways.

Children doi: 10.3390/children13060824

Authors: Krenar Xhafa Urh Groselj

Background/Objectives: Dyslipidemia is increasingly linked to retinal microvascular changes, yet its impact in pediatric populations remains unclear. Given the retina’s role as a microvascular model, this review evaluates the association between dyslipidemia and retinal vascular alterations in children and adolescents. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to evaluate the association between lipid profiles, body composition, and retinal vascular parameters in individuals younger than 19 years. Four eligible studies were found. Results: Triglyceride (TG) levels, total cholesterol (TC) levels, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (apoB) levels were associated with smaller retinal arteriole diameters (CRAE), whereas there was no consistent association between venular diameter (CRVE) and lipid levels. In addition, families with familial hypercholesterolemia (FH) had lower capillary densities and larger foveal avascular zone areas detected by optical coherence tomography angiography (OCT-A) compared to control subjects. The presence of both obesity and dyslipidemia resulted in greater degrees of arteriolar narrowing. Conclusions: These findings suggest that adverse metabolic profiles in childhood may be linked to early microvascular alterations. However, the limited number of heterogeneous studies highlights the need for larger longitudinal investigations.

Children doi: 10.3390/children13060823

Authors: Neslihan Atmaca Murat Tozlu Sertaç Peker Betül Kargül

Objectives: Oral hygiene maintenance may be influenced by both malocclusion severity and orthodontic appliance type during early orthodontic treatment. Therefore, this study aimed to evaluate the relationship between orthodontic treatment need assessed using the Index of Orthodontic Treatment Need (IOTN) and oral hygiene status measured using the Simplified Oral Hygiene Index (OHI-S) in children undergoing early orthodontic treatment and to compare short-term oral hygiene outcomes between clear aligner and removable appliance therapies. Methods: Twenty-four children aged 6–12 years with anterior dental crossbite were included in this prospective observational cohort study. Patients treated with clear aligners (n = 12) or removable appliances (n = 12) were evaluated. Orthodontic treatment need was assessed using the IOTN Dental Health Component (DHC) and Aesthetic Component (AC), and oral hygiene status was evaluated using the OHI-S at baseline and day 14. Statistical analyses were performed with p < 0.05 considered significant. Results: A statistically significant positive correlation was observed between IOTN-DHC and IOTN-AC scores (rs = 0.648; p = 0.001). Participants with higher orthodontic treatment need had poorer oral hygiene status at baseline, and this difference remained evident at day 14. Day-14 OHI-S scores were significantly higher in the removable appliance group than in the clear aligner group (p = 0.039). In addition, the reduction in OHI-S scores was significantly greater in the clear aligner group (p = 0.043). When all participants were analyzed together, oral hygiene status improved significantly from baseline to day 14 (p < 0.001). Conclusions: Higher orthodontic treatment need was associated with poorer oral hygiene status during early orthodontic treatment. Clear aligners were associated with more favorable short-term oral hygiene outcomes than removable appliances.

Children doi: 10.3390/children13060822

Authors: Evangelia Amprasi Nerantzoula Koufou Ioannis Trigonis Ioannis Tsartsapakis Aglaia Zafeiroudi Olga Kouli

Background/Objectives: In interceptive sports like volleyball, the ability to accurately time an action relative to a moving object (Coincidence Anticipation Timing—CAT) is critical. This study investigated the effects of a structured 8-week deliberate practice intervention on CAT accuracy and its long-term retention in young female athletes. Methods: Thirty-two female volleyball players (aged 8–10 years) were randomly assigned to an Experimental Group (EG, n = 16) and a Control Group (CG, n = 16). The EG underwent a specialized 8-week training program focusing on progressive cognitive load and immediate knowledge of results, while the CG followed standard volleyball training. A single-blind assessor measured CAT at two velocities (5 mph and 10 mph) using the Bassin Anticipation Timer at three time points: pre-test, post-test, and a 2-month retention test. Results: ANCOVA revealed a significant group-by-time interaction (p < 0.001), with the EG demonstrating a substantial reduction in absolute timing error. The effect size was markedly higher at 10 mph (partial η2 = 0.400) compared to 5 mph (partial η2 = 0.197). Crucially, the EG maintained their performance gains during the retention test (p < 0.05), whereas the CG showed no significant improvement over time. Conclusions: Targeted deliberate practice effectively enhances temporal prediction accuracy in children, likely by facilitating a shift from reactive to predictive motor control. The robust retention of these skills underscores the significant neuroplasticity of the 8–10 age window, suggesting that early foundational timing interventions provide long-lasting benefits for athletic development.

Children doi: 10.3390/children13060821

Authors: Angelo Aliberti Mirko Piscopo Franklin Garcia-Godoy Luigi Ausiello Lucia Grumetto Teresa Ponticorvo Francesco Giordano

Background: Bisphenol A (BPA) release from resin-based dental materials is a growing concern due to its potential endocrine-disrupting effects, particularly in pediatric patients. This in vitro study evaluated cumulative BPA release and elution kinetics from commonly used pediatric resin-based materials, due to the limited evidence available. Methods: Three restorative materials (Clearfil Majesty ES-2, Estelite Sigma Quick, and Stela Automix) and one orthodontic material (Transbond XT) were investigated. Eighteen disk-shaped specimens (5.5 mm in diameter and 2 mm in thickness) were prepared for each material and immersed in artificial saliva (pH 6.8) at 37 °C for 1, 7, and 28 days. BPA concentrations were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). BPA release kinetics were evaluated during the early (1–7 days) and late (7–28 days) release phases. Results: All investigated materials released measurable BPA concentrations, with cumulative BPA release progressively increasing up to 28 days. Clearfil Majesty ES-2 and Estelite Sigma Quick exhibited the highest cumulative BPA concentrations, whereas Stela Automix showed markedly lower values. Transbond XT also demonstrated measurable BPA release. For all materials, BPA release kinetics were significantly higher during the early phase than during the late phase (p < 0.001), indicating a non-linear release behavior over time. Conclusions: BPA release from pediatric restorative and orthodontic resin-based materials is material-dependent and characterized by progressive cumulative accumulation associated with significantly higher early-phase release rates. These findings highlight the importance of assessing the safety of resin-based materials used in pediatric dentistry.

Children doi: 10.3390/children13060820

Authors: Merve Yavuz Ibrahim Bingol

Background/Objectives: Serum neuron-specific enolase (NSE) is a biomarker of neuronal injury, but its prognostic role in pediatric convulsive status epilepticus (CSE) remains uncertain. We evaluated the association between serum NSE levels and short-term neurological outcome, assessed model calibration with internal bootstrap validation, and examined whether NSE provides incremental discrimination beyond established clinical severity scores. Methods: This was a single-center retrospective cohort study of children aged 1 month to 18 years admitted to a tertiary pediatric intensive care unit (PICU) with CSE as the primary admission diagnosis between January 2024 and November 2025. The primary outcome was poor neurological outcome at hospital discharge, defined as a worsening of ≥1 point in the Pediatric Cerebral Performance Category (PCPC) score from baseline (ΔPCPC ≥ 1) or in-hospital death. A multivariable logistic regression model adjusting for NSE, PRISM III, acute symptomatic etiology, and mechanical ventilation was developed, with bootstrap optimism-corrected internal validation (2000 resamples) and formal calibration assessment. Separate models for in-hospital mortality and for neurological deterioration among survivors were conducted as secondary analyses. Diagnostic operating characteristics were reported with 95% Wilson confidence intervals. The study followed the STROBE and TRIPOD reporting guidelines. Results: Of 132 children included (median age 26 months, 56.1% male), 60 (45.5%) had a poor neurological outcome including 18 deaths (13.6%). Serum NSE was significantly higher in the poor-outcome group (median 22.0 vs. 14.4 μg/L; p < 0.001). In the primary multivariable model, NSE (adjusted OR 1.11 per μg/L; 95% CI 1.06–1.19; p = 0.001) and PRISM III (adjusted OR 1.15; 95% CI 1.03–1.37; p = 0.013) were independently associated with poor outcome. The model showed acceptable calibration (Hosmer–Lemeshow p = 0.130) and a bootstrap optimism-corrected AUC of 0.759. NSE remained independently associated with both in-hospital mortality (aOR 1.13) and with ΔPCPC ≥ 1 in survivors (aOR 1.09). The AUC for NSE alone was 0.741 (95% CI 0.65–0.82) for poor outcome and 0.885 (0.79–0.96) for mortality. The combined PRISM III + NSE model showed a numerically higher but not statistically significant AUC compared with PRISM III alone (0.784 vs. 0.726; DeLong p = 0.103). Conclusions: Higher serum NSE is independently associated with adverse short-term neurological outcome and mortality in pediatric CSE, including in survivor-only analysis. However, the present data do not demonstrate clinically meaningful incremental prognostic value beyond PRISM III, and the proposed cutoff was derived and tested in the same cohort and is therefore optimistic. These findings are hypothesis-generating and require external validation in prospective multicenter cohorts with serial sampling and long-term neurodevelopmental follow-up before routine clinical use can be advocated.

Children doi: 10.3390/children13060819

Authors: Maria Athanasopoulou Maria Tsanti Marios Papasotiriou Alexandra Efthymiadou Aristeidis Giannakopoulos Dionisios Chrysis Eirini Kostopoulou

Background/Objectives: Advanced technologies in type 1 diabetes mellitus (T1DM) management have reshaped the strategies used to achieve optimal glucose control. Continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems are effective alternatives to multiple daily injections (MDI). This study aims to evaluate glycemic regulation in children and adolescents transitioning from MDI to insulin pumps and to raise awareness among patients and their families regarding the benefits of these systems. Methods: 50 pediatric patients with T1DM (24 males, 26 females; mean age 10.76 ± 3.2 years) were evaluated. Cycle 1 established MDI metrics 3 months pre-transition. In cycle 2, patients transitioned either to an AID system (Medtronic MiniMed 780G, (Northridge, CA, USA), 78%), or a non-automated system (Omnipod DASH, 22%). Data were assessed at 3 and 6 months post-initiation. Parameters assessed were glycosylated hemoglobin (HbA1c), time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI) and coefficient of variation (CV). Results: The cohort exhibited a statistically significant increase in TIR (p = 0.0038) with mean values of 70.9% at 3 months and 73.2% at 6 months. TAR significantly reduced (p = 0.033) to 26.5% and 24.3% at 3 and 6 months, respectively. Sub-analysis in the AID group revealed a marked increase in TIR (p = 0.0001) alongside significant reductions in TAR (p = 0.0009) and GMI (p = 0.03). Conclusions: Transitioning from MDI to insulin pump therapy, particularly AID systems, leads to modest but significant improvements in specific sensor metrics (TIR, TAR) in real-world clinical practice. The consistency of these results across age groups indicates that AID systems can successfully overcome pediatric and adolescent diabetes management challenges.

Children doi: 10.3390/children13060818

Authors: Yo Iwata Tomoya Handa Hitoshi Ishikawa

Background/Objectives: Low-dose atropine eye drops are widely used to slow myopia progression in children, but by reducing accommodation they may affect near ocular alignment and binocular visual function. Evidence on ocular alignment and strabismus-related findings remains insufficiently synthesized. This review examined low-dose atropine for pediatric myopia control in relation to ocular alignment and strabismus-related findings. Methods: PubMed/MEDLINE and Web of Science Core Collection were searched from inception to 16 April 2026. English-language studies addressing low-dose atropine, myopia control, ocular alignment, strabismus, binocular vision, accommodation, and vergence were screened. Of 247 records, 166 underwent screening after duplicate removal. Twenty-three database-derived and four manually identified full-text articles were reviewed. Eleven studies were included. Results: Of eleven included studies, six were clinical or interventional studies and five were case reports or case series. Case-based reports described near-predominant esodeviation, convergence excess-type deviation, elevated accommodative convergence/accommodation (AC/A) ratios, diplopia, reduced fusion, and acquired esotropia during fixed low-dose or escalating atropine use; most fixed low-dose cases improved after discontinuation or treatment modification. Clinical and interventional studies did not show consistent worsening of ocular alignment, near point of convergence (NPC), fusional vergence, or binocular vision. More consistent changes included pupil dilation, receded near point of accommodation (NPA), reduced accommodative amplitude and facility, selected fusional vergence changes, and short-term binocular or accommodative fluctuations. Conclusions: Low-dose atropine appears to be useful for pediatric myopia control and is generally well tolerated. However, selected cases may be temporally associated with ocular alignment abnormalities or strabismus-related findings. Careful monitoring may be warranted in children with unstable binocular systems and during dose escalation.

Children doi: 10.3390/children13060817

Authors: Pacharapan Surapolchai Phakatip Sinlapamongkolkul Sariya Prachukthum Tasama Pusongchai Wallee Satayasai Sudatip Kositamongkol

Background: Iron deficiency is common in very-low-birth-weight (VLBW) infants because of limited iron stores, rapid postnatal growth and repeated phlebotomy. Early detection is essential to prevent anaemia and neurodevelopmental impairment. This study investigated the prevalence of, and factors associated with, iron deficiency at hospital discharge using serum ferritin and the reticulocyte haemoglobin equivalent (RET-He). Methods: In this prospective cohort study, iron status was evaluated in 68 VLBW infants admitted between April 2022 and March 2024 at 36 weeks post-menstrual age (PMA) or at discharge. Iron deficiency was defined as serum ferritin below 75 ng/mL or RET-He below 28 pg. Univariable and multivariable logistic regression analyses were performed to explore clinical factors associated with iron deficiency. Iron status and anaemia were reassessed at 6–12 months of age. Results: At 36 weeks PMA or discharge, 39.7% of the infants were iron deficient, whereas only 1.5% were anaemic. Higher gestational age (aOR 1.81, 95% CI 1.07–3.06) and lower haemoglobin at birth (aOR 0.63, 95% CI 0.42–0.96) were independently associated with iron deficiency. Bronchopulmonary dysplasia showed a possible association (aOR 14.02, 95% CI 1.23–160.34), though this estimate should be interpreted cautiously. At 6–12 months, 18.8% of the patients had anaemia and 50% had iron deficiency, with no significant associated factors identified, likely reflecting the limited sample availability. Conclusions: Iron deficiency is common in VLBW infants and often precedes anaemia. Assessment of iron status beyond haemoglobin before discharge may be clinically justified to guide early supplementation, though further prospective multicentre studies are needed to confirm whether routine dual-biomarker screening is warranted.

Children doi: 10.3390/children13060816

Authors: Veerle Heesters Hannah Schwarz Henriette A. van Zanten Katharina Bibl Tobias Werther Katrin Klebermass-Schrehof Angelika Berger Sophie Jansen Arjan B. te Pas Ruben Witlox Michael Wagner

Background/Objectives: The Leiden University Medical Center (LUMC) and the Medical University of Vienna (MUV) both implemented video recording and review in their neonatal intensive care unit (NICU). The two centers initiated collaborative, multicenter video review sessions to facilitate international knowledge exchange. Methods: In this exploratory, descriptive study, collaborative video review sessions were organized with the interprofessional NICU staff of the LUMC and the MUV. We aimed to describe our experience with organizing these sessions and to report procedural variations, and document lessons learned that led to new perspectives on care. Results: We conducted five sessions using recordings of different patients undergoing intubation, less invasive surfactant administration, umbilical, central-catheter insertion and physiologically based cord clamping after birth. The videos were selected to ensure technical and clinical comparability. Sessions were attended by a mean of eight providers per center. A total of 19 relevant differences were described, of which seven (37%) prompted changes in practice or new insights for one or both centers. Finally, we developed a roadmap for organizing multicenter video review sessions. Conclusions: This study shows that multicenter video review may represent a feasible and innovative educational approach for identifying practice variations and fostering cross-institutional clinical refinement.

Children doi: 10.3390/children13060815

Authors: Simon Loth Julia Hauer Marcus Krüger Renée Lampe Irina Sidorenko Alexander Bieber Christian Brickmann

Background: Extremely and very preterm infants are at high risk for adverse neurodevelopmental outcomes. Early prediction remains challenging when relying on static clinical markers or single time-point neuroimaging. Serial cranial ultrasound (CUS) enables repeated bedside assessment of cerebral growth and may provide longitudinal trajectory biomarkers integrable with routine clinical data. Methods: In this retrospective two-center cohort study, 89 preterm infants (<32 weeks’ gestation and/or <1500 g birth weight) were assessed using the Bayley-III at 24 months corrected age. Brain volume trajectory features were derived from serial CUS using a standardized ellipsoid model. A three-level analytical framework was applied as follows: univariate regression (62 models, Bonferroni and Benjamini–Hochberg correction), multivariate SVM classification with five-fold GroupKFold cross-validation, ensuring patient-level data separation and feature importance analysis with interaction characterization using stratified Spearman correlation and two-dimensional partial dependence plots. Results: Multivariate classification yielded modest but above-chance performance (balanced accuracy 0.277–0.463, Cohen’s κ 0.042–0.152). Respiratory morbidity duration—mechanical ventilation and BPD severity—were the most robustly associated univariate predictors, surviving Bonferroni correction. Brain volume trajectory features showed no significant univariate associations but contributed conditionally within the multivariate framework as follows: the interaction between brain volume slope and trajectory linearity was the strongest for cognitive outcome (Δr = 0.47), and postnatal growth restriction showed amplified adverse effects at lower birth weight for motor outcome (Δr = 0.47). Conclusions: This study demonstrates the value of ML methods as structured analytical tools for characterizing predictor–outcome relationships in preterm neurodevelopment; respiratory morbidity and brain volume trajectory features emerged as the most informative predictor classes. Prospective multicenter validation is required before clinical translation.

Children doi: 10.3390/children13060814

Authors: Yosi Yaffe Batel Hazan-Liran

The landscape of child and adolescent mental health has become increasingly complex, moving away from solely child-focused approaches to more holistic, systemic models that consider youth development within the context of the family environment [...]

Children doi: 10.3390/children13060813

Authors: Naqiya Arsiwala Anoushka Krishnakumar Yutika Chirlikar Donato Rigante

Multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) are pediatric inflammatory conditions which share overlapping clinical features, yet their long-term cardiovascular trajectories remain incompletely characterized. Understanding differences in myocardial strain evolution and coronary artery Z-score progression is essential for optimizing surveillance strategies and risk stratification. Aims of this review were to comprehensively compare the long-term evolution of myocardial strain parameters and coronary artery Z-scores in children with MIS-C versus KD through mid- and long-term follow-up assessment studies, and to identify clinical implications for monitoring and management. A comprehensive literature search was conducted in PubMed to identify studies evaluating myocardial strain and coronary artery Z-scores in MIS-C and KD. Publications from January 2020 to February 2026 were considered for MIS-C, with earlier key studies on KD included to contextualize established cardiac outcomes. Observational studies and cohort reports describing echocardiographic findings and follow-up data were reviewed. Available evidence indicates that MIS-C commonly presents with acute myocardial dysfunction, frequently characterized by reduced global longitudinal strain despite preserved or mildly reduced ejection fraction; in most cases, myocardial strain abnormalities substantially improve within weeks to a few months following treatment. In contrast, myocardial strain impairment in KD, which typically presents at less than 5 years of age, is less pronounced; coronary artery involvement shows an opposite trend, as KD is more frequently associated with coronary dilations and aneurysm formation, reflected by persistent elevations in coronary artery Z-scores, whereas coronary abnormalities in MIS-C are milder and often transient. Recovery patterns therefore differ, with MIS-C demonstrating rapid myocardial functional recovery, and KD carrying a greater risk of long-term coronary artery sequelae. MIS-C and KD exhibit distinct cardiovascular phenotypes: MIS-C is primarily characterized by reversible myocardial dysfunction, whereas KD remains a condition most strongly associated with a risk of persistent coronary artery abnormalities. Deciphering these differences may help guide disease-specific cardiac monitoring and long-term follow-up strategies in affected children.

Children doi: 10.3390/children13060812

Authors: Tina Gentile Sonia Vanacore Martina Caputo Francesco Pio Litta Annelyse Martine Garret-Bernardin Beatrice Basile Simone Piga Alessandra Putrino Angela Galeotti

Background/Objectives: Dental anxiety represents a major challenge in paediatric dentistry and is a frequent cause of non-cooperative behaviour during dental treatment. Nitrous oxide/oxygen inhalation conscious sedation is widely used to reduce anxiety in children, while audiovisual distraction is a non-pharmacological behavioural technique aimed at diverting attention from stressful stimuli. Evidence regarding the combined effect of these two approaches during dental treatment is still limited. Methods: This randomized crossover clinical trial included 25 paediatric patients aged 4–7 years with dental anxiety and previous failed attempts at conventional dental treatment. Each child underwent two dental treatment sessions under nitrous oxide/oxygen conscious sedation, one with and one without audiovisual distraction. Anxiety and behaviour were assessed using the Modified Venham Scale and the Facial Image Scale (FIS). Vital parameters were recorded before, during, and after sedation. Results: A significant reduction in heart rate over time was observed in both groups (p < 0.05). In children aged 4–5 years, the combined audiovisual distraction and conscious sedation approach was associated with significantly lower heart rate values compared to conscious sedation alone (p < 0.05). No significant differences were found between the two approaches for behavioural scores assessed by the Venham and FIS scales. Conclusions: Although behavioural scores did not differ significantly, audiovisual distraction contributed to greater physiological stability, particularly in terms of heart rate control. This no-pharmacological approach may complement the pharmacological effects of nitrous oxide sedation by enhancing the overall sense of relaxation and comfort during dental care.

Children doi: 10.3390/children13060811

Authors: Marius-Cosmin Colceriu Diana Jecan-Toader Paul Luchian Aldea Bogdan Bulată Dan Delean Alina Grama Alexandra Mititelu Tudor Lucian Pop Simona Clichici Teodora Mocan Andreea-Liana Boț (Răchişan)

Background: Vitamin D, through its role in antimicrobial peptide (AMP) expression, may influence innate immunity and inflammation in urinary tract infections (UTIs). This study evaluated its role in patients with vesicoureteral reflux (VUR) and its contribution to the pathophysiology of reflux nephropathy (RN). Methods: We conducted a cross-sectional observational study of 25 pediatric patients with VUR, representing a subgroup analysis of a larger cohort examined in a previous study. We determined patients’ vitamin D status, correlated it with recurrent UTIs and RS, and explored its relationship with urinary LL-37, NGAL, and IL-6 levels as markers of innate immune function. Results: Serum vitamin D levels ranged from 10.7 to 123.2 ng/mL (mean 39.5 ng/mL); 12% had deficiency and 20% had insufficient levels. Low vitamin D levels were detected in patients with more than five acute pyelonephritis (APNs), with a mean value classified as insufficient (27.3 ng/mL). Patients with RS had a lower mean vitamin D level compared to those without (30.51 ng/mL vs. 41.23 ng/mL), though the difference was not statistically significant (p = 0.39). No significant associations were found between vitamin D and urinary IL-6 or NGAL levels. A strong positive correlation was observed between vitamin D and urinary LL-37/creatinine (r = 0.78, r2 = 0.61). Conclusions: Vitamin D appears to influence the frequency of UTIs and the development of RS, primarily by modulating LL-37 secretion, suggesting a possible role in the pathophysiology of RN.

Children doi: 10.3390/children13060810

Authors: Silvia Karina Carrión Sari Luis Martínez-Lostao Carlos Colás Sanz David Jerves Donoso Diego Fernández-Lázaro María Teresa Sobrevia Elfau

Background: Egg allergy is one of the most common food allergies in early childhood and is traditionally managed through strict avoidance diets, which may negatively affect nutrition and quality of life. Early oral immunotherapy (OIT) may represent an alternative therapeutic strategy; however, controlled studies in children younger than two years remain limited. Methods: We conducted a prospective observational study using historical controls. Thirty-one children younger than two years with IgE-mediated egg allergy underwent OIT using pasteurized liquid egg white (maximum dose: 30 mL; 3300 mg protein). Twelve children managed with an avoidance diet served as the historical control group. Outcomes included desensitization rates, adverse reactions, and longitudinal changes in skin prick test (SPT) wheal diameters, serum-specific IgE (sIgE), specific IgG4 (sIgG4), and sIgE/total IgE ratios. Results: At six months, 29/31 children (93.5%) in the OIT group did not experience allergic reactions after ingestion of any egg preparation, compared with none in the historical control group (p < 0.001). In the control group, 7/12 children (58.3%) continued to react to less-cooked egg preparations, whereas 5/12 (41.7%) remained reactive to all forms of eggs. During the induction phase, 24/31 OIT-treated children (77.4%) experienced mild adverse reactions, predominantly isolated cutaneous or gastrointestinal symptoms, and no patient required intramuscular adrenaline administration. In contrast, allergic reactions occurred in 11/12 controls, including anaphylaxis in 6/12 (50.0%) patients (p = 0.0301). The OIT group demonstrated significant reductions in SPT wheal diameters, sIgE levels, and sIgE/total IgE ratios (all p < 0.001), accompanied by increased sIgG4 levels. Conclusions: Early OIT with pasteurized egg white in children younger than two years with IgE-mediated egg allergy was associated with high desensitization rates, favorable short-term safety outcomes, and significant immunological changes. These findings support the potential role of early active intervention as an alternative to exclusive avoidance strategies in infants with egg allergy.

Children doi: 10.3390/children13060809

Authors: I Ketut Alit Utamayasa Prima Hari Nastiti Ayurveda Zaynabila Heriqbaldi Bagas Triambodo Mahrus Abdur Rahman

Background: Heart failure (HF) remains a major complication of acyanotic congenital heart disease (CHD) in children. Evidence integrating clinical and echocardiographic variables for HF severity stratification in pediatric acyanotic CHD remains limited. This study aimed to identify factors associated with moderate HF and develop an exploratory internally validated prediction model. Methods: This retrospective single-center outpatient study included 219 children aged 0–16 years with acyanotic CHD, identified from medical records spanning January 2023 to December 2025. Moderate HF was defined as Ross score 7–9 (≤5 years) or NYHA class III (>5 years). Multivariable analysis was performed using Firth’s penalized logistic regression. Internal validation used bootstrap optimism correction and leave-one-out cross-validation (LOOCV). Model discrimination was assessed using area under the receiver operating characteristic curve (AUC). Results: Moderate HF was identified in 131 patients (59.8%). LV remodelling defined by LVIDD z-score > +2 (adjusted OR 3.70, 95% CI 1.22–11.24; p = 0.021) and higher mean pulmonary arterial pressure (MPAP) (adjusted OR 1.03 per mmHg, 95% CI 1.00–1.06; p = 0.049) were independently associated with moderate HF. Premature birth showed an inverse association with moderate HF (adjusted OR 0.25, 95% CI 0.13–0.48; p < 0.001). The exploratory five-variable model demonstrated acceptable discrimination (apparent AUC 0.780, 95% CI 0.728–0.849; bootstrap-corrected AUC 0.760; LOOCV AUC 0.749, 95% CI 0.681–0.811), with adequate calibration. An MPAP threshold of ≥26.4 mmHg yielded 78.6% sensitivity for moderate HF identification. Conclusions: LV remodelling and elevated MPAP were independently associated with moderate HF in children with acyanotic CHD. The exploratory internally validated model demonstrated acceptable discrimination using routinely available variables. This model is exploratory and not yet ready for clinical use; prospective multicenter external validation is required before any clinical implementation.

Children doi: 10.3390/children13060808

Authors: Anita V. Chaphekar James Peugh Andrew F. Beck Carolina M. Bejarano Danielle Scharf Kimberly Stevens Claire M. Aarnio-Peterson

Objectives: We sought to examine associations between area-level socioeconomic deprivation and: (1) hospitalization length; (2) severity; and (3) clinical outcomes in adolescents hospitalized for atypical anorexia nervosa or anorexia nervosa (AN). We hypothesized that more socioeconomic deprivation would be associated with longer length of hospitalization, greater illness severity, and poorer clinical outcomes. Methods: We conducted a study of individuals aged 11–18 years with AN who were admitted for medical instability. Tract-level socioeconomic deprivation was characterized by using a deprivation index (range 0–1, higher scores indicating more deprivation). Outcomes of interest included (1) hospitalization length defined as duration in days between admission and discharge, (2) illness severity defined as percentage of goal weight at admission and global Eating Disorder Examination Questionnaire (EDE-Q) score and (3) clinical outcomes defined as re-admission rate, 3- and 6-month follow up percentage goal weight, and 3- and 6-month weight restoration status. We used multivariate regression to assess associations between deprivation index and outcomes of interest. Results: A total of 121 adolescents were included. The mean age was 15.4 years (range 11.0–17.9 years). Higher deprivation was associated with a lower percent of target goal weight achieved at 3-month follow up (Estimate= −19.8; p-value = 0.029; 95% CI= −37.5 to −2.1). Contrary to our initial hypothesis, higher deprivation index scores were associated with shorter hospitalization lengths (Estimate = −15.4; p < 0.001; 95% CI = −22.6 to −8.2). Conclusions: Higher deprivation was associated with a lower percent of target goal weight achieved at 3-month follow up and shorter length of hospitalization. This study adds to the extant literature by using a novel method, geocoding, to examine the relationship between socioeconomic deprivation and eating disorder outcomes. Future studies with more diverse samples (including Spanish speakers) are needed.

Children doi: 10.3390/children13060807

Authors: Lara Mendes Rita dos Santos Cátia Martins Cláudia Carmo Marta Brás Cristina Nunes

Background/Objectives: Child-to-parent violence (CPV) refers to persistent physical, psychological, or financial violence perpetrated by children or adolescents against their parents. Although CPV has attracted increasing academic and professional attention in recent years, evidence regarding its predictors remains fragmented. This systematic literature review aimed to synthesize empirical evidence on the predictors of adolescent CPV, with a particular focus on developmental victimization, personality traits, and psychopathology. Violence refers to the intentional use of physical, psychological, or symbolic force to cause harm, control, or suffering, while aggression corresponds to intentional behavior aimed at harming another individual, which may or may not involve physical violence and is often broader and more situational. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD42024596076). Searches were carried out in January 2025 across six electronic databases (PsycINFO, Web of Science, Scopus, PubMed, MEDLINE, and CINAHL). Empirical studies published between 2000 and 2025 examining predictors of CPV in adolescence, namely developmental victimization, personality traits, and psychopathology, were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: The search identified 862 records, of which 46 studies met the inclusion criteria and were retained for full-text analysis. Most studies were quantitative in design and published within the last 15 years, with Spain accounting for most of the empirical evidence. The findings consistently demonstrated associations between CPV and exposure to direct or vicarious family victimization, maladaptive personality traits—particularly psychopathic features—and a range of psychopathological symptoms, including substance use, mood and anxiety disorders, and neurodevelopmental conditions. Conclusions: The results support a multifactorial and developmental understanding of CPV, highlighting early victimization as a central risk context interacting with personality and mental health vulnerabilities. Limitations of the existing literature are discussed, and directions for future research are proposed, emphasizing the need for longitudinal and qualitative studies to inform prevention and intervention strategies.

Children doi: 10.3390/children13060806

Authors: Meilin He Chie Obuchi Inho Chung

Background/Objectives: This study examined how different types of language activities in educational settings predict language ability in preschoolers with cochlear implants (CIs) versus normal-hearing (NH) peers. Predictor variables included two dimensions of language activities (language learning activities: shared reading, word games, and story retelling; daily communication activities: routine conversations and free play talk), as well as auditory utilization status (awareness of sounds, perception of speech sounds, and attentive listening to teachers/peers), learning attentional state, and family socioeconomic status (SERS). The outcome variable was language ability, measured with the Mandarin Clinical Evaluation of Language for Preschoolers’ Core Scale (MCELP-CS), and control variables included age and, for the CI group only, age of implantation. Methods: Participants included 189 CI (mean age = 4.53 years, SD = 0.83) and 210 NH preschoolers (mean age = 4.64 years, SD = 0.83). All predictor and control variables were collected via teacher-reported questionnaires (self-compiled by the research team). Statistical analyses used hierarchical regression with separate models for each group. Results: For the CI group, after controlling for age and age of implantation, engagement in language learning activities emerged as the most stable and independent predictor of language ability. Auditory utilization status was another significant predictor, and its inclusion substantially increased the model’s R2. For the NH group, language ability was primarily predicted by age-related maturation, with language learning activities showing additional predictive value, while daily communication activities and learning attentional state contributed very little. Conclusions: Findings suggest that for educational rehabilitation of CI preschoolers: increasing engagement in language learning activities in classrooms may be more beneficial than relying on daily conversation or merely improving attention alone; meanwhile, auditory utilization skills should also be fostered synergistically. Importantly, language intervention models designed for NH preschoolers cannot be directly transferred to CI preschoolers.

Children doi: 10.3390/children13060805

Authors: Laura Ferro Eleonora Centonze Mariagrazia Monaci Giuseppe Di Maria Stefania Cristofanelli

Background/Objectives: Adolescence is a crucial stage of development, in which life skills are essential for promoting psychological well-being. Social and Emotional Learning (SEL) interventions aim to develop social–emotional and relational skills that foster resilience and adaptation. Short-term effects may be nonlinear and influenced by gender differences, with possible fluctuations in self-assessments due to increased social–emotional awareness (response shift). Methods: This action research study involved 179 preteens (ages 11–17) from educational settings in Aosta Valley. The SEL program consisted of three experiential sessions on key life skills, led by psychologists and psychiatrists and including group activities and role-playing. Quality of life was assessed before and after the intervention using the Q-LES-Q, which measures satisfaction and well-being in the areas of social relationships, physical health, academic performance, leisure activities, and subjective feelings. Subscale scores were calculated as the mean of the corresponding items. Results: The results revealed nonlinear patterns: a decline in satisfaction with social relationships, which may reflect a response shift. Males reported higher initial levels and greater perceived positive effects, while females reported lower post-intervention scores, likely due to greater self-reflection and self-criticism. Conclusions: The data highlight the complexity of the short-term effects of SEL interventions and the importance of considering developmental trajectories and gender differences when evaluating their effectiveness.

Children doi: 10.3390/children13060804

Authors: Hale Cotuk Yucel Selda Ozdemir

Background: Joint attention is a fundamental skill supporting early social communication and cognitive development. However, its development in children with severe visual impairment and its relationship with early play behaviors remain insufficiently understood. This study aimed to compare joint attention skills and play behaviors in toddlers with severe visual impairment and sighted peers, and to examine the relationship between these two developmental domains. Methods: The sample included 17 toddlers with severe visual impairment (no light perception) and 20 sighted toddlers aged 16–36 months. Groups were matched based on language developmental age scores. Joint attention skills were assessed using structured observational categories adapted to visual status, while play behaviors were evaluated with the Developmental Play Assessment. Data were collected through semi-structured play and interaction sessions in familiar environments to support natural behavior. Analyses were conducted using non-parametric tests, including the Mann–Whitney U test and Spearman correlation analysis. Results: Toddlers with severe visual impairment scored significantly lower than sighted peers across all joint attention categories. In play development, these children showed higher levels of indiscriminate actions, whereas sighted peers demonstrated more advanced play behaviors, including combinational and symbolic play. Significant associations were found between joint attention and play skills in both groups; however, these relationships were stronger in sighted children, particularly for higher-level play forms. Conclusions: These findings suggest distinct developmental trajectories and underline the importance of early intervention targeting these foundational skills in early childhood development and highlight important implications for early intervention practices.

Children doi: 10.3390/children13060803

Authors: Jun Kohyama

In this Special Issue of Children, entitled “Insufficient Sleep Syndrome in Children and Adolescents”, recent advances in pediatric sleep medicine are explored through several diverse and thought-provoking perspectives on insufficient sleep syndrome (ISS) across developmental stages and clinical contexts [...]

Children doi: 10.3390/children13060802

Authors: Panagiotis Pipelias Christina Kanaka-Gantenbein Panagiota Pervanidou

Early life stress (ELS) and adverse childhood experiences are critical determinants of neurodevelopmental trajectories and long-term somatic and psychiatric health outcomes. This narrative review synthesizes current evidence, identified through searches in PubMed, Scopus, and Web of Science, on the neurobiological and epigenetic mechanisms through which early environmental exposures shape developmental programming and stress responsivity across the lifespan. A central framework is the dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, which mediates adaptive and maladaptive stress responses. During sensitive developmental periods, including prenatal, perinatal, and early postnatal stages, increased neuroplasticity confers heightened vulnerability to environmental influences, resulting in persistent alterations in stress regulation systems, brain circuitry, and endocrine function. The review further examines the role of maternal stress during gestation, with emphasis on placental regulatory mechanisms and fetal programming processes that establish long-term physiological set points. In parallel, emerging evidence on paternal stress is considered, highlighting potential contributions of germline epigenetic modifications and postnatal environmental transmission pathways. At the molecular level, epigenetic mechanisms—including DNA methylation, histone modifications, and non-coding RNA regulation—are discussed as key mediators linking early environmental exposures to stable changes in gene expression without alterations in DNA sequence. Collectively, the evidence supports ELS as a fundamental biological embedding process with enduring consequences for health across the lifespan. A deeper understanding of these mechanisms, alongside the identification of reliable biomarkers, is essential for early detection and the development of targeted preventive and intervention strategies in pediatric populations.

Children doi: 10.3390/children13060801

Authors: Anamaria Violeta Țuțuianu Dan Alexandru Slăvescu Abel Emanuel Moca Teodora Ștefănescu Lucian Roman Șipoș Horia Câlniceanu Anca Ionel

Background and Objectives: Child dental neglect is a clinically significant form of maltreatment that frequently reflects broader challenges related to caregiving within the family environment. Although oral manifestations have been described in prior research, the socio-behavioral profile of responsible caregivers remains insufficiently characterized, particularly in Central and Eastern European contexts. This study aimed to identify caregiver-level socio-behavioral characteristics associated with child dental neglect and to examine their relationships with clinical outcomes. Materials and Methods: A retrospective cross-sectional analytical study was conducted on 333 children (aged 4–17 years) diagnosed with dental neglect, presenting at a municipal hospital and a private dental practice in Oradea, Romania (2020–2024). Caregiver-level variables included age, educational attainment, socioeconomic status, health condition, substance use, and family structure. Associations were analyzed using Fisher’s Exact Test, Pearson Chi-Square, and Mann–Whitney U test, with Bonferroni correction applied where appropriate. Results: Most caregivers were young adults (93.1%), with low educational attainment (40.2% had no formal schooling) and high rates of alcohol use (47.1%). Low family income was present in 89.2% of cases and was significantly associated with non-adherence to the dental treatment plan (p  =  0.039). Caregivers without formal education were associated with neglect in rural areas (43.4% vs. 26.2%; p  <  0.001). Children of drug-using caregivers were significantly older at presentation (median: 12 vs. 8 years; p  =  0.014), and caregiver drug use was more prevalent in urban settings (18.0% vs. 1.8%; p  <  0.001). Over half of the children (52.9%) came from disrupted family environments. Conclusions: Dental neglect was consistently associated with young, poorly educated, and financially disadvantaged caregivers exhibiting high rates of substance use and unstable family structures. These factors may interact in complex ways, highlighting the multifactorial nature of dental neglect. Dental professionals are well positioned for early identification and have a professional and ethical responsibility to integrate child safeguarding into routine clinical practice.

Children doi: 10.3390/children13060800

Authors: Mehmet Cengiz

Background/Objectives: Childhood obesity is associated with chronic low-grade systemic inflammation. This exploratory cross-sectional study aimed to evaluate associations between a comprehensive panel of serum micronutrient levels and four systemic inflammatory indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and monocyte-to-lymphocyte ratio (MLR)—in a pediatric cohort, with iron as the primary focus and zinc as a secondary exploratory analysis. Methods: We included 410 children (mean age 7.2 ± 3.8 years; 205 male) attending a tertiary pediatric clinic. Of these, 399 had complete BMI percentile data and were included in obesity-stratified analyses; patients were classified as having obesity (BMI ≥ 95th percentile; n = 56) or not having obesity (n = 343). The remaining 11 children lacked BMI percentile data and were included only in full-cohort analyses. Serum iron, ferritin, folate, zinc, vitamin D, vitamin B12, magnesium, and phosphorus were measured alongside complete blood count parameters. Spearman correlations and multivariable ordinary least squares regression were performed. Benjamini–Hochberg false discovery rate (FDR)-adjusted q-values were computed for all Spearman correlations; all remaining analyses are exploratory and all findings should be interpreted with caution. Results: All four inflammatory indices were significantly higher in children with obesity (SII: 487.1 vs. 332.1, p < 0.001; NLR: 1.30 vs. 1.03, p = 0.001). Low serum iron was more prevalent in the group with obesity (42.9% vs. 27.1%, p = 0.025). In multivariable regression, serum iron was significantly associated with NLR (β = −0.009, 95% CI [−0.012, −0.005], p < 0.001) and SII (β = −3.268, 95% CI [−4.404, −2.132], p < 0.001) after adjustment for age and BMI percentile. In an exploratory analysis restricted to children with obesity and complete data (n = 39), zinc was associated with SII (β = −11.912, 95% CI [−21.836, −1.988], p = 0.025); however, the overall model was non-significant (p = 0.067), zinc showed no association in the full cohort, and—given the small sample and absence of multiple comparison correction—this finding must be considered strictly hypothesis-generating. Conclusions: Systemic inflammatory burden is elevated in children with obesity. Iron shows consistent associations with inflammatory indices independent of age and BMI. Zinc shows a potentially relevant, exploratory association with inflammation, specifically in the subgroup with obesity, warranting replication in adequately powered prospective studies. These findings are consistent with a role for iron status assessment in the clinical evaluation of pediatric obesity and warrant further prospective investigation of zinc-related inflammatory associations.

Children doi: 10.3390/children13060799

Authors: Ana Ilić Ivana Rumbak Martina Pavlić Lidija Šoher Daniela Čačić Kenjerić Jasna Pucarin-Cvetković Darja Sokolić

Background/Objectives: In Croatia, national data on adolescents’ dietary habits are limited, resulting in a lack of evidence-based food-based dietary guidelines and public health interventions. This study aims to conduct an in-depth evaluation of dietary habits in a national sample of Croatian adolescents stratified by region, sex and age, from the National food consumption survey on adolescents and adults (NIPNOD 2018–2023). Methods: This cross-sectional study included 258 adolescents (50.4% boys; aged 10 to < 18) from the NIPNOD 2018–2023 survey (OC/EFSA/DATA/2017/01), conducted according to the EU Menu methodology. For analysis, the sample was divided into two age groups (10–13 and 14–17 years). To assess dietary intake, two 24 h recalls were analyzed using NutriCro® v. 3.0 software. Dietary intake was compared with European Food Safety Authority dietary reference values (DRV). The contribution of 14 food groups to daily energy intake was analyzed. Diet quality was assessed using the Diet Quality Index for Adolescents (DQI-A). Results: The mean daily energy intake was 1820 ± 529 kcal, consisting of 45.5 ± 7.0% carbohydrates, 37.8 ± 6.3% fats, and 15.1 ± 3.1% protein. The observed two-day mean intake suggested that 51.6% of adolescents had carbohydrate intake within the EFSA DRV range, while 5.4% and 32.2% had protein and fat intake within the EFSA DRVs, respectively. The main contributors to daily energy intake were grains and grain products (31.5%), meat, poultry, fish, and eggs (18.1%), and cakes, confectionery, sweets, and sugar (14.9%). Frequent breakfast skipping and snack consumption were common, particularly among older adolescents. Adolescents had moderate overall diet quality (57.4 ± 11.6% DQI-A), with no differences between age groups. Conclusions: Analysis of the dietary habits of adolescents in Croatia indicates that most have inadequate macronutrient intake, irregular meal frequency, and moderate overall diet quality. These results highlight the need to develop public health strategies and interventions to improve dietary habits among adolescents in Croatia.

Children doi: 10.3390/children13060798

Authors: Hossam M. Ajabnoor Danah Alshihri Farah Albaqami Layan Alghamdi Layla M. Alhazmi Rana Alghamdi Alyaa M. Ajabnoor Rawan O. Almadfaa Reham M. Baamer

Background: Magnetic resonance imaging (MRI) in children may require sedation to minimize motion artifacts and obtain diagnostic-quality images. Intranasal dexmedetomidine (IN DEX) is increasingly used as a non-invasive sedation option; however, evidence regarding its reported effectiveness and safety as a sole agent in routine clinical practice remains limited. This systematic review and meta-analysis aimed to evaluate the reported efficacy and safety of IN DEX monotherapy for pediatric MRI. Methods: A systematic search of PubMed, MEDLINE, and Embase via Ovid, Scopus, Web of Science, and the Cochrane Library was conducted for studies published from 17 December 1999 to 10 January 2026. Observational studies involving pediatric patients undergoing MRI with IN DEX as the sole sedative agent were included. Outcomes included sedation success, rescue sedation use, bradycardia, hypotension, sedation onset time, and MRI duration. Random-effects meta-analyses were performed, and methodological quality was assessed using the National Institutes of Health quality assessment tool. Results: Twelve observational studies comprising 1828 children were included. The pooled reported sedation success rate was 84% (95% CI: 73–95%), and rescue sedation was required in 19% (95% CI: 8–29%) of cases. The pooled incidences of bradycardia and hypotension were 3% (95% CI: 0–6%) and 1% (95% CI: 0–3%), respectively; no clinically significant events requiring intervention were reported. The pooled mean sedation onset time was 18.4 min, and the pooled mean MRI duration was 38.9 min. Substantial heterogeneity was observed across the efficacy outcomes. Conclusion: Intranasal dexmedetomidine appears to be a feasible and well-tolerated option for pediatric MRI sedation. Although pooled observational data suggest high reported sedation success and low adverse-event rates, findings should be interpreted cautiously because of substantial heterogeneity across studies.

Children doi: 10.3390/children13060797

Authors: Katarina Stanković Vladan Šubarević Mladen Novković Sandra Šipetić-Grujičić Ivana Fajertag Slađana Vasiljević Jadranka Maksimović Isidora Vujčić

Background/Objectives: Pediatric tracheotomy has evolved from an emergency procedure for acute infections to a planned intervention for chronic conditions requiring prolonged airway support. This study aims to describe the clinical characteristics, indications, and outcomes of pediatric tracheotomy over a 21-year period at a tertiary care center. Methods: A retrospective observational case series was conducted, including 246 pediatric patients (0–18 years) who underwent tracheotomy between 2004 and 2024. Data were collected from medical records and included demographics, indications, procedural details, complications, decannulation, and mortality. Patients were categorized into airway obstruction (AO) and respiratory support (RS) groups. Statistical analyses were performed using the Mann–Whitney U test, Chi-square and Fisher’s exact test. Results: A significant increase in tracheotomy procedures was observed over time. Respiratory support was the predominant indication (75.2%), mainly due to neurological disorders, while airway obstruction accounted for 24.8%. Patients in the AO group were significantly younger and more likely to undergo urgent procedures (p < 0.001). Complication rates were comparable between groups (AO 16.4% vs. RS 21.1%; p = 0.295). Decannulation was significantly more successful in the AO group (16.4% vs. 5.4%; p = 0.012). Mortality did not differ significantly between groups and was associated with underlying comorbidities. Conclusions: Pediatric tracheotomy is increasingly performed for chronic respiratory support. While procedural safety is high, outcomes vary by indication, with better decannulation rates in airway obstruction cases. Multidisciplinary, individualized management is essential for optimizing patient outcomes.

Children doi: 10.3390/children13060796

Authors: Pu Xu Ying Li Ying Chen Tongying Han Peicen Zou Qinglin Lu Dongmiao Zhang Jie Chen Yajuan Wang

Background: Moderate-to-severe preterm brain injury (PBI), including intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), remains an important cause of adverse neurodevelopmental outcomes in preterm infants. Early risk stratification using routinely collected clinical data may help prioritize surveillance in vulnerable infants. Methods: We retrospectively included 318 preterm infants admitted between 2015 and 2024 as the development cohort. Thirty-three candidate predictors derived from perinatal factors, first laboratory tests within 24 h of admission, and selected early hospitalization variables were evaluated. Seven machine-learning algorithms were developed using stratified 10 × 5 nested cross-validation with prespecified preprocessing, class-balancing, and feature-selection procedures. Candidate models were compared primarily using the mean fold-level area under the receiver operating characteristic curve (AUROC). After model selection, the finalized LightGBM model was calibrated using Platt scaling, and its pooled out-of-fold (OOF) performance was summarized. Two prespecified thresholds (Youden and high-sensitivity) were used for risk stratification. A small independent temporal cohort of 35 infants was used for preliminary external validation. Results: PBI occurred in 62/318 infants (19.5%) in the development cohort and 6/35 infants (17.1%) in the temporal external cohort. During candidate-model comparison, LightGBM achieved the highest mean fold-level AUROC (0.768, 95% CI 0.708–0.825). The finalized 14-feature LightGBM model, evaluated using pooled OOF predictions after Platt calibration, yielded an AUROC of 0.747 (95% CI 0.679–0.811), a PR-AUC of 0.392, and a Brier score of 0.136. At the Youden threshold (0.18), sensitivity was approximately 0.70 and specificity approximately 0.85; at the high-sensitivity threshold (0.10), sensitivity was approximately 0.95 and specificity approximately 0.50. Key predictors included ventilation status and early physiologic and laboratory indicators. In the small temporal external cohort (n = 35), the AUROC was 0.897 (95% CI 0.672–1.000); however, this high point estimate should not be overinterpreted because of the limited sample size, wide confidence interval, and suboptimal calibration, and should therefore be considered preliminary. Conclusions: We developed an interpretable LightGBM model using routinely available early postnatal and early hospitalization data to support risk stratification for PBI in preterm infants. The model showed moderate internal discrimination and a positive net benefit across clinically relevant thresholds. Preliminary temporal external validation in a small cohort yielded highly uncertain estimates; larger multicenter studies are needed to confirm generalizability, refine calibration, and determine the most appropriate implementation strategy before routine clinical use.

Children doi: 10.3390/children13060795

Authors: Sara González-Astray Cristo-Manuel Marrero-González Irene González-Pérez Judith Arbelo-Molina Alfonso Miguel García Hernández Aythamy González-Darias

Background: Perinatal death in Neonatal Intensive Care Units (NICUs) represents one of the most emotionally challenging experiences for nurses. While parental bereavement has been widely studied, nurses’ experiences in neonatal end-of-life care remain insufficiently explored. Objective: To explore the experiences of NICU nurses facing perinatal death, focusing on emotional, professional, and institutional dimensions of care. Methods: A qualitative study with a hermeneutic phenomenological approach was conducted through ten semi-structured interviews with NICU nurses in a tertiary-level hospital in Spain. Data were analyzed using reflexive thematic analysis supported by NVivo 15. Results: Seven main themes were identified: emotional responses, therapeutic bond, coping strategies, perceived institutional support, training needs, infrastructure and humanization, and professional repercussions. Nurses reported intense emotional responses, including sadness, guilt, moral distress, and perceived failure, particularly in cases of prolonged hospitalization or unexpected death. Peer support emerged as a key protective factor, whereas the lack of formal psychological support and adequate infrastructural conditions were identified as significant gaps. Conclusions: Strengthening institutional support for NICU nurses through structured debriefing, accessible psychological services, targeted training in neonatal palliative care, and improved care environments may enhance their well-being and resilience, contributing to sustainable and compassionate clinical practice.

Children doi: 10.3390/children13060794

Authors: Imanul Hassan Abdul Shukor Nurul Farehah Shahrir Nur Khairah Badaruddin Normala Salim Sri Devi Sukumaran

Background/Objectives: Hospital-Acquired Infections (HAI) represent one of the most frequent adverse events during care delivery, with the pediatric population (0–18 years) presenting unique vulnerabilities due to their developing immune systems, dependence on caregivers, and need for invasive devices. Despite the availability of general guidelines, existing high-level evidence is largely extrapolated from adult studies, and pediatric settings differ significantly in patient physiology and equipment size. This scoping review aims to map the key concepts, types of evidence, and research gaps related to strategies preventing HAI in pediatric patients. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The Population, Concept, and Context (PCC) framework will be utilized. We will include any strategy, intervention, or protocol aimed at preventing HAI. A comprehensive search will be conducted across ten major electronic databases and grey literature sources. Two independent reviewers will screen titles, abstracts, and full texts, followed by data extraction using a standardized tool to categorize the interventions and key findings. Results: The findings will synthesize diverse practices into a usable format for clinical decision-makers and identify gaps where primary pediatric research is lacking. This consolidated data aims to guide resource allocation and assist hospital infection control committees in updating pediatric safety protocols. Conclusions: This scoping review will establish a comprehensive baseline of pediatric-specific HAI prevention strategies. The findings will inform evidence-based practice, identify critical research gaps, and guide future investigations in the prevention of pediatric infections in healthcare settings.

Children doi: 10.3390/children13060793

Authors: Milena Stoyanova Dinnar Yahya Mari Hachmeriyan Mariya Levkova

Background: Cancer predisposition syndromes (CPS) are increasingly recognized in pediatric oncology. In many cases, malignancy in children represents one manifestation of a broader genetic syndrome, often accompanied by dysmorphic features or other distinctive clinical findings. Methods: Clinical documentation and genetic test reports of pediatric patients evaluated over a six-year period (2020–2025) at a genetic counseling unit in a tertiary university hospital in Varna, Bulgaria, were retrospectively reviewed. Referral patterns, clinical characteristics, and genetic findings in children assessed for suspected CPS were analyzed. Results: In total, 430 children underwent genetic testing during the study period; among them, 42 fulfilled the criteria for CPS and were subsequently included in the analysis. Patients were categorized into three groups: those with malignancy (21.4%), those with high-risk hematologic/immune features without malignancy (9.5%), and those referred based on phenotypic features alone (69.0%). Most referrals originated outside oncology services, primarily from general pediatric clinics and outpatient settings, highlighting the importance of non-oncologists in early CPS recognition. Multisystem phenotypic features were common, with 69.0% of patients exhibiting involvement of two or more clinical domains. Genetic testing, predominantly using multigene panels and exome sequencing, identified clinically relevant variants in established CPS genes, most frequently in autosomal dominant conditions within this diagnosis-confirmed cohort. The most common diagnostic categories included NF1 spectrum disorders and RASopathies. Conclusions: These findings emphasize that CPS identification often relies on recognition of non-oncologic features rather than malignancy alone. Genetic counseling plays a central role in diagnosis, risk assessment, and cascade testing. Strengthening awareness among general pediatricians and improving access to genetic services are critical for optimizing early detection and prevention strategies.

Children doi: 10.3390/children13060792

Authors: Margarita Panova Maria Spasova Snezhana Stoencheva Teodora Dimcheva Iglika Sotkova-Ivanova Pamela Boykova

Background: The use of low-molecular-weight heparins (LMWH) for the treatment and prevention of thromboembolic diseases in pediatric patients is increasing, although optimal dosing and monitoring strategies remain insufficiently defined. Methods: This study was conducted at the Clinic of Pediatrics, University Hospital “St. George”, and included 26 hospitalized patients aged 0–18 years with confirmed arterial or venous thrombosis receiving treatment or prophylaxis with enoxaparin. A total of 42 samples were analyzed. Anti-factor Xa activity was measured using an LMWH-calibrated anti-FXa assay (Innovance Heparin, Siemens Healthineers) on a Sysmex CS-2500 analyzer. Therapeutic and prophylactic dosing followed CHEST 2012 guidelines. The study evaluated age- and weight-based dosing, the number of dose adjustments required to achieve target Anti-Xa levels, and the relationship between Anti-Xa levels and anticoagulant response. Results: The mean baseline Anti-Xa level achieved with the initial weight-based dose (1.0 mg/kg/12 h) was significantly lower in children aged 1–2 years compared with older age groups. Older children, as well as patients with oncological and nephrological diseases, achieved higher anticoagulant levels with standard prophylactic dosing. Age under 1 year, oncological disease, and baseline Anti-Xa level < 0.3 IU/mL were identified as independent predictors of the need for more frequent dose adjustments to achieve a therapeutic response. Conclusions: Monitoring of Anti-factor Xa levels is essential in pediatric patients receiving LMWH for both treatment and prophylaxis. Standard dosing regimens may be insufficient in younger children and specific clinical subgroups, supporting the need for individualized dosing strategies.

Children doi: 10.3390/children13060791

Authors: Joungmin Kim

Background/Objectives: Children’s mental health and positive development are shaped by family, environmental, and individual factors. Although neurodevelopmental disabilities (NDDs) are well-established correlates of poorer mental health outcomes, few national-scale studies have simultaneously modeled positive (flourishing) and negative (anxiety, depression) outcomes within a unified ecological framework. This study examined how parent mental health, peer victimization, neighborhood and school context, and four NDD diagnoses (autism spectrum disorder [ASD], attention-deficit/hyperactivity disorder [ADHD], developmental delay, and learning disability) are associated with flourishing, current anxiety, and current depression in a national sample of U.S. children aged 6–17 years. Methods: Cross-sectional data from the 2023–2024 National Survey of Children’s Health (NSCH; N = 71,172) restricted to ages 6–17 with complete data (unweighted n = 64,263; weighted population estimate ≈ 44.6 million children) were analyzed using Complex Sample logistic regression (SPSS 30), accounting for stratified design (state × stratum), household clustering, and sampling weights. Three hierarchical models were estimated for each outcome. NDD-stratified subgroup analyses (n = 13,971; weighted ≈ 8.6 million) triangulated moderation findings. Multiple imputation (m = 5) sensitivity analyses confirmed robustness. Results: Weighted prevalence was 60.7% for flourishing, 13.2% for current anxiety, and 5.1% for current depression. In Block 2 models, poorer parent mental health and more frequent bullying victimization were robustly associated with all outcomes (flourishing OR = 0.62 and 0.65; anxiety OR = 1.64 and 1.63; depression OR = 1.95 and 1.75; all p < 0.001). Supportive neighborhood (flourishing OR = 1.40, depression OR = 0.80) and safe school (flourishing OR = 1.20, anxiety OR = 0.87) were protective. ADHD was the strongest disability-specific correlate (flourishing OR = 0.29; anxiety OR = 4.69; depression OR = 4.27). Three of the twelve interaction terms were significant, all involving ADHD. Relative to children without any NDD, subgroup analyses suggested attenuated associations of parent mental health and bullying with anxiety and depression among children with any NDD (e.g., bullying on anxiety: no-NDD aOR = 1.73 vs. Any-NDD 1.52); however, formal interaction tests identified ADHD as the only significant moderator of these associations. On the absolute-risk scale, however, the increase in internalizing problems with more frequent bullying was larger in children with ADHD. Conclusions: Family mental health support and bullying prevention are universally relevant levers for improving children’s mental health and flourishing. Although attenuation of the odds-ratio associations was observed primarily in ADHD-related analyses, specifically for the internalizing outcomes (anxiety and depression), universal anti-bullying and parent mental health interventions remain relevant for children with NDDs, supporting integration into pediatric clinical and public-health programs alongside disability-specific support pathways.

Children doi: 10.3390/children13060790

Authors: Vilma Ivanauskienė Aušrelė Kudrevičienė Vaida Aleksejūnė Renata Dzikienė Ilona Aldakauskienė Rasa Tamelienė

Preterm birth remains a major global health concern, affecting approximately one in ten neonates, with an estimated 15 million infants born prematurely each year. Prematurity and clinical factors such as antibiotics, cesarean delivery, and limited access to mother’s own milk disrupt microbiota development in VLBW infants; although human milk supplies nutrients and a microbial community, its composition and clinical role are not yet well understood. However, the composition and clinical significance of the human milk microbiota (HMM) in VLBW infants remain insufficiently characterized. Background: This review aims to summarize recent evidence (2021–2025) on the microbiome of MOM in mothers of VLBW (<1500 g) preterm infants and to evaluate its potential role in neonatal health. Methods: The study used a systematic literature review, searching PubMed and Google Scholar with predefined criteria and keywords. Results and Conclusions: MOM microbiota of VLBW in infants is dominated by Staphylococcus, Enterococcus, Streptococcus, Enterobacteriaceae, and Acinetobacter, with lower levels of Veillonella, Clostridium sensu stricto, Pseudomonas, Haemophilus, and Bifidobacterium; its diversity increases over lactation, and feeding type influences infant gut colonization and immune development, though links to necrotising enterocolitis (NEC) remain limited. Further research using multi-omic approaches is needed to clarify these mechanisms and their clinical implications.

Children doi: 10.3390/children13060789

Authors: Camille Schunder Agnès Gras-Vincendon François Brezin

Introduction: Medical care for transgender minors is understudied, largely because these forms of care are relatively recent. The primary objective of this work was to describe the cohort of transgender adolescents who initiated follow-up at the Strasbourg University Hospital before the age of 18, whether or not they began hormone therapy prior to reaching adulthood. Method: This was an observational, retrospective, single-center, descriptive study conducted among adolescents who had attended at least one consultation in our center before the age of 18 between January 2017 and March 2024. Results: Our population consisted of 115 patients predominantly made up of transmasculine (AFAB) adolescents (68%). Compared with the general population, we observed significantly higher rates of psychiatric co-occurrences, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Only 46.1% initiated gender-affirming hormone therapy (GAHT) in our cohort, and just 34.8% before age 18. A total of 6% of adolescents received puberty blockers as monotherapy. The mean age at GAHT initiation was 16.99 years. Transition pathways appear to differ according to the adolescent’s type of schooling. The rate of retransition/treatment interruption in our sample ranged from 0% to 6.1%, depending on the criteria applied. We did not identify any adolescent who retransitioned to their sex assigned at birth after starting GAHT by the end of the data collection. Discussion: The high prevalence of psychiatric co-occurrences raises important questions regarding how to improve care for these adolescents. The predominance of AFAB adolescents similarly prompts reflection on the barriers that transfeminine adolescents may face when seeking to transition before adulthood. In addition, the substantial number of adolescents presenting with ASD or ADHD underscores the need for particular vigilance regarding their specific needs and overall well-being. Finally, the variability in retransition rates depending on the criteria applied highlights the absence of a consensual definition, which limits the comparability and validity of existing studies. Conclusions: Long-term prospective studies are needed to objectively demonstrate the effectiveness of current transition pathways. Academic research in this field should be strengthened, along with the development of larger prospective datasets, to improve the overall health of this population.

Children doi: 10.3390/children13060788

Authors: Agata Maria Kawalec-Rutkowska Anna Kawalec Katarzyna Kiliś-Pstrusińska

Abnormalities of the urachus detected in infancy and early childhood are often interpreted as persistent congenital abnormalities requiring surgical correction. However, growing clinical experience suggests that a proportion of these findings may reflect ontogenetic immaturity of the urachus rather than fixed pathological conditions. As a transient embryological structure, the urachus undergoes postnatal remodeling and involution, which may explain the spontaneous regression of urachal anomalies observed during follow-up. This paper proposes ontogenetic immaturity of the urachus as a biological substrate for the natural resolution of selected urachal changes, including cystic dilatation and incomplete obliteration. We discuss the developmental background of urachal maturation and emphasize the importance of distinguishing delayed involution from true structural pathology. The clinical implications of this concept are highlighted, with particular focus on the role of careful observation and longitudinal monitoring as an alternative to early surgical intervention in asymptomatic or mildly symptomatic patients. Recognizing ontogenetic immaturity as a reversible developmental state may help reduce overtreatment and support more individualized, developmentally informed management strategies. Integrating principles of developmental biology into clinical decision-making reinforces the value of conservative approaches in selected urachal conditions and under-scores the broader relevance of ontogeny in kidney and urinary tract disease.

Children doi: 10.3390/children13060787

Authors: Indrani Bhattacharjee Catalina Le Cacheux Eric B. Ortigoza Jonathan Dillman Sherwin S. Chan Alain Cuna

Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely.

Children doi: 10.3390/children13060786

Authors: Jakub S. Gąsior

Fundamental movement skills (FMSs), typically categorized into locomotor, object control, and stability skills, constitute the essential building blocks for more complex physical activities and are essential for participation in everyday tasks, sports, and physical activities [...]

Children doi: 10.3390/children13060785

Authors: Taufiq Hidayat Irwanto Irwanto Ali Rohman Shabrina Nur Imanina Ayurveda Zaynabila Heriqbaldi Bagas Triambodo Afrizal Alif Azzam Muhyiddin Achmad Ari Pratama Mahrus A. Rahman I Ketut Alit Utamayasa Nur Syamsiatul Fajar Mochamad Amin

Background/Objectives: Ventricular septal defect (VSD) is the most common congenital heart disease in children and is often associated with growth impairment and malnutrition. Increased metabolic demand, feeding difficulties, and recurrent infections contribute to poor nutritional status. Insulin-like growth factor-1 (IGF-1), a key mediator of growth hormone activity, reflects nutritional and metabolic conditions. Previous studies have evaluated endocrine and growth abnormalities in heterogeneous congenital heart disease populations. However, data specifically examining the relationship between serum IGF-1 levels and nutritional status in isolated pediatric ventricular septal defect remain limited, particularly in Southeast Asian populations. Methods: The single centre observational case–control study was conducted at Dr. Soetomo Hospital, Surabaya, involving 110 children (55 VSD patients and 55 healthy controls). VSD diagnosis was confirmed by echocardiography. Nutritional status was assessed using WHO anthropometric criteria. Serum IGF-1 levels were measured using ELISA. Statistical analyses compared IGF-1 levels between groups and across nutritional categories. Results: Moderate and severe wasting were more common in the VSD group. Median IGF-1 levels were significantly lower in VSD patients compared to controls (5.18 vs. 21.4 ng/mL; p < 0.001). A positive association between IGF-1 levels and nutritional status was observed. Conclusions: Children with VSD have poorer nutritional status and significantly lower IGF-1 levels compared to healthy controls. This association may be explained by the dysregulation of the growth hormone–IGF-1 axis. IGF-1 may complement nutritional assessment for identifying and monitoring growth impairment and guiding early nutritional interventions in pediatric VSD.

Children doi: 10.3390/children13060784

Authors: Adina Mihaela Frenti Florin Filip Elena Tătăranu Vlad Dima Roxana Axinte Alina Sânzâiana Melinte Mirabela Dima Iulia Ciubotariu Petronela Vicoveanu Smaranda-Ileana Jurchis-Irimie Smaranda Diaconescu

Background and Objectives: Lung ultrasound (LUS) has fundamentally transformed neonatal respiratory diagnostics, offering a radiation-free, bedside-applicable modality capable of guiding surfactant therapy, characterizing pulmonary pathology, and monitoring treatment response in real time. While surfactant replacement therapy is firmly established for neonatal respiratory distress syndrome (RDS), its role in acute complications—specifically pulmonary hemorrhage (PH) and pneumothorax (PTX)—remains uncertain and heterogeneous in clinical practice. This review examines how LUS-based phenotyping can improve the diagnostic precision and therapeutic sequencing of surfactant administration in these high-risk scenarios, and how comorbidities such as hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension, sepsis, and coagulopathy modulate clinical outcomes. Materials and Methods: We conducted a structured narrative review of studies published from 2020 onward, sourced from PubMed, Web of Science, Semantic Scholar, and Mendeley, using PRISMA-inspired selection principles. The search combined terms including “lung ultrasound,” “neonatal POCUS,” “surfactant therapy,” “pulmonary hemorrhage,” “neonatal pneumothorax,” and “LUS score.” Studies focusing on neonatal populations, clinical LUS applications, and surfactant use in PH and PTX were prioritized. Results: Quantitative LUS scoring systems (range 0–18) predict surfactant need and re-dosing with AUC values of 0.85–0.87, outperforming clinical estimates alone. In PH, LUS reveals dense consolidation with alveolar flooding patterns, guiding the timing of rescue surfactant after hemodynamic stabilization; response monitoring via serial LUS is feasible and informative. In PTX, hallmark signs—absent lung sliding, loss of B-lines, and the pathognomonic lung point—allow diagnosis within seconds, guiding immediate thoracentesis and subsequent surfactant administration if underlying RDS is confirmed. Nationally implemented LUS protocols in neonatal intensive care units have demonstrated significant reductions in radiation exposure without compromising diagnostic accuracy. Conclusions: LUS-guided decision algorithms—integrating ultrasonographic phenotyping, quantitative scoring, and hemodynamic assessment—represent the current best framework for individualizing surfactant therapy in neonatal PH and PTX. Standardization of POCUS training and protocol implementation in neonatal units is essential. Prospective multicenter trials are urgently needed to define optimal indications, timing, and dosing in these vulnerable populations.

Children doi: 10.3390/children13060783

Authors: Onur Bağcı Aybüke Yazıcı Ayşe Ören Gaffari Tunc Ipek Guney Varal

Objective: Delaying postpartum cord clamping may contribute to neonatal circulation by allowing continued placental transfusion. The timing of cord clamping is still debated and is called delayed cord clamping (DCC) if performed more than 30 s after birth. This study evaluated the effect of DCC on the clinical outcomes of preterm infants. Methods: Preterm infants (gestational age < 30 weeks) admitted to our Level 4 neonatal intensive care unit in 2023–2024 were evaluated retrospectively. Delayed cord clamping at postnatal 60 s was practiced when infants were considered stable. The demographic characteristics and morbidities of infants who did and did not have DCC were compared. Results: A total of 156 infants were included in the study. Of these, 70 infants were in the DCC group, and 86 infants were in the non-DCC group. Median gestational age was 28 weeks (interquartile range [IQR]: 26–30 weeks) and 26 weeks (IQR: 25–28 weeks), and median birth weight was 1000 g (IQR: 780–1300 g) and 850 g (IQR: 685–1095 g), respectively (p < 0.001 for both). The DCC group had a higher rate of antenatal steroid (ANS) use (p < 0.001), higher APGAR scores (p < 0.001), and lower rates of intraventricular hemorrhage (IVH) (p < 0.001), respiratory distress syndrome (RDS) (p < 0.001), bronchopulmonary dysplasia (BPD) (p = 0.013), feeding intolerance (p = 0.01), and mortality (p = 0.016) compared to the non-DCC group. Grade 3 IVH was not observed in the DCC group. In logistic regression analysis, not performing DCC was associated with significantly greater odds of IVH (odds ratio [OR]: 2.92, 95% CI: 1.48–5.77, p < 0.01), BPD (OR: 2.25, 95% CI: 1.18–4.29, p = 0.01), RDS (OR: 3.97, 95% CI: 1.86–8.48, p < 0.001), and mortality (OR: 3.44, 95% CI: 1.21–9.81, p < 0.01). However, these differences were not statistically significant after correcting for birth week, birth weight, Apgar score, and ANS. Conclusions: When applied in preterm infants under 30 weeks of gestational age, DCC can promote hemodynamic stability and reduce morbidities such as IVH and RDS. Also, implementing DCC with unstable infants will provide more conclusive information about its effectiveness.

Children doi: 10.3390/children13060782

Authors: Luciana Margara Inés Piñas-Bonilla Pablo Abián Alfredo Bravo-Sánchez David Ortiz-Sánchez María Ramírez-delaCruz Paula Esteban-García Javier Portillo Carlos Ramírez Javier Abián-Vicén

Background/objectives: Obesity is a multifactorial condition influenced by interactions between genetic susceptibility and environmental factors. The fat mass and obesity-associated (FTO) gene has been widely linked to obesity risk, particularly the rs9939609 polymorphism, which is associated with higher body mass index (BMI) and adiposity. However, evidence in adolescents remains inconsistent, and lifestyle factors such as physical activity and diet may modify genetic risk. The objectives of this study were: (i) to examine the influence of environmental, genetic, physical activity, and dietary factors on the BMI and overweight-related variables of adolescents, and (ii) to assess the impact of the rs9939609 polymorphism in the FTO gene on these variables. Methods: A cross-sectional study was conducted involving 206 adolescents aged 12 to 16 years. Body mass index (BMI), physical fitness, physical activity levels, adherence to the Mediterranean diet, mobile phone usage, and FTO rs9939609 genotyping from buccal swabs were collected. Results: No significant associations were found between the FTO genotype and BMI, or with physical activity, mobile phone usage and dietary habits. Boys showed higher physical fitness and physical activity levels than girls (p < 0.05). The only factor significantly associated with BMI was regular breakfast consumption: adolescents who habitually ate breakfast had a lower prevalence of overweight (χ2 = 7.98, p = 0.005). Conclusions: The rs9939609 polymorphism in the FTO gene was not associated with overweight in this adolescent cohort. The findings underscore the relevance of healthy behaviours, particularly regular breakfast consumption and physical activity, especially among boys, as factors potentially associated with lower prevalence of overweight during adolescence.

Children doi: 10.3390/children13060781

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

Background/Objectives: Allergic rhinitis (AR) is increasingly recognized in early childhood; however, its prevalence and environmental determinants within urban informal settlements remain under-researched. This study investigated the prevalence and risk factors associated with allergic rhinitis among children under five years old attending preschools in Alexandra Township, Johannesburg. Methods: A cross-sectional study was conducted involving 3265 children. Data were collected through self-reported surveys with caregivers, designed to assess demographic, clinical, and environmental variables. Multivariate logistic regression analysis was employed to determine adjusted odds ratios (AORs) and p-values for potential environmental and clinical risk factors. Results: The findings show a prevalence of 37.3% (n = 1214) for allergic rhinitis, 47.3% (n = 1544) for rhinitis, and 42.7% (n = 1394) for rhinoconjunctivitis. Exposure to open sewerage pipelines was associated with the highest risk (AOR: 4.85, p < 0.001), followed by prolonged residence in the township (greater than 24 months; AOR: 2.74, p < 0.001) and proximity to local waterways (AOR: 1.89, p < 0.001). Additional significant factors included frequent paracetamol consumption and walking to school, while asthma and eczema exhibited an association with the presence of AR. Conclusions: The elevated prevalence of allergic symptoms within this cohort is linked to localized macro-environmental hazards, suggesting that infrastructural challenges in informal urban settings may influence early respiratory health outcomes. Protecting pediatric respiratory health may necessitate multisectoral interventions, with a specific emphasis on ensuring safe sanitation and clean household energy, to complement traditional clinical management in these vulnerable communities.

Children doi: 10.3390/children13060780

Authors: Maddalena Comune Irene Furnari Erika Silvestro Simone Spolaore Federica Percivati Silvia Nurisso Silvia Garazzino Marco Denina

Background: Staphylococcus aureus neonatal osteomyelitis (SA-NOm) is a rare condition with the potential for lifelong skeletal morbidity. Available evidence remains scarce and inconsistent, with notable differences in clinical presentation, therapeutic regimens, and reported outcomes, underscoring the need for a systematic evaluation combining clinical experience with existing literature. Methods: We retrospectively reviewed data from all neonates admitted to Regina Margherita Children’s Hospital, Turin, Italy, between 2017 and 2024 with a diagnosis of SA-NOm. A structured narrative review of the pertinent literature published over the past 25 years was conducted to identify additional cases and compare management approaches. Results: Four neonates with SA-NOm were identified at our center (institutional cohort) while a literature review retrieved 38 additional cases (literature cohort) to establish a combined cohort (n = 42). Of these, 78% were born at term, with a male-to-female ratio of 1.6:1 (26 males, 16 females). Approximately half of the combined cohort presented identifiable risk factors for SA-NOm, including neonatal intensive care unit admission, prematurity, sepsis, or maternal complications. Across the combined cohort, the mean age at presentation was 19 days. The most common presenting signs were local swelling and reduced mobility of the affected limb, although systemic symptoms often complicated early recognition. Long bones were most frequently involved—particularly the femur, humerus, and tibia—with equal distribution between upper and lower extremities. The mean intravenous antibiotic duration for the combined cohort was 31.6 days, followed by two to three weeks of oral therapy. Empiric regimens varied, including glycopeptides alone or combined with second- or third-generation cephalosporins, anti-staphylococcal penicillins, or carbapenems. Sequelae rates were rarely reported in the literature, likely due to limited follow-up, whereas extended surveillance in our cohort revealed substantial long-term morbidity, including restricted joint mobility, limb length discrepancy, and persistent radiographic abnormalities. Conclusions: SA-NOm, due to its rarity and potential for long-term skeletal sequelae, requires early diagnosis and timely empiric antibiotic therapy based on local resistance data. Prospective multicenter studies are needed to define standardized diagnostic and therapeutic protocols.

Children doi: 10.3390/children13060779

Authors: Seung Hwan Baek Young Mi Park Teahyen Cha So Jin Yoon Jung Ho Han Jeong Eun Shin Ho Seon Eun Min Soo Park Joohee Lim Soon Min Lee

Background: Neonatal morbidities are major determinants of clinical outcomes and healthcare utilization in preterm infants. However, population-level evidence quantifying the cumulative contribution of neonatal morbidities to neonatal intensive care unit (NICU) length of stay (LOS) and medical costs remains limited. Methods: We conducted a nationwide retrospective cohort study using the Korean Health Insurance Review and Assessment Service database. Preterm infants admitted to NICUs between 2020 and 2023 were identified. After exclusions, 30,034 infants with complete birth weight data and 31,240 with complete gestational age data were included. Major neonatal morbidities—including bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL)—were identified using ICD-10 odes. Associations of individual morbidities and cumulative morbidity burden with NICU LOS and medical costs were evaluated using multivariable regression and generalized linear mixed models. Results: Mean NICU LOS was 26.5 days, and mean total medical cost was 41.9 million KRW. All major morbidities were associated with prolonged LOS and increased costs. BPD showed the strongest association with LOS, whereas NEC and sepsis were associated with the highest costs. NICU LOS and medical costs increased in a stepwise manner with increasing numbers of morbidities; each additional morbidity was associated with an 8.0-day increase in LOS and a 32.5 million KRW increase in medical costs (both p < 0.001). Conclusions: Greater cumulative morbidity burden was associated with prolonged hospitalization and increased healthcare costs in preterm infants.

Children doi: 10.3390/children13060778

Authors: Gabriela Telman-Kołodziejczyk Adrian Guźniczak Patrycja Sosnowska-Sienkiewicz Danuta Januszkiewicz-Lewandowska

Importance: A comprehensive analysis of childhood cancer and cancer predisposition syndromes (CPSs) incidence can provide insights that lead to improvements and modifications in treatment protocols through personalized therapy, thereby reducing toxicity. Purpose: This study aimed to analyze age-specific hospital-based childhood cancer rates and the distribution of CPSs in a 20-year pediatric cohort from the region. Materials: A total of 2190 patients, aged from birth to 17 years, diagnosed with any type of neoplasm classified by ICD-10 codes at Karol Jonscher’s Clinical Hospital of Poznan University of Medical Sciences (KJCH PUMS) between 1 January 2000, and 31 December 2019, were included, with 193 (8.8%) having an underlying CPS. Results: The pediatric population of the Greater Poland Region has declined over the past two decades. The most common diagnoses can be grouped into three main categories: (1) leukemias, involving 704 patients (32.1%); (2) central nervous system (CNS) tumors, represented by 382 children (17.4%); and (3) lymphomas, including 279 patients (12.7%), together accounting for 1353 cases (61.8%). The age-specific hospital-based case rate for childhood cancer (all types combined) peaked in the 0–28 days age group at 71.8 per 100,000 person-years (95% CI: 52.2–96.4), with a trend to decrease with age and a slight increase among adolescents aged 16–17 years (13.6 per 100,000, 95% CI: 12.0–15.4). The age-specific incidence of CPS-positive cancers declined from 18.0 (95% CI: 8.2–29.4) per 100,000 person-years in the first month of life to 0.7 (95% CI: 0.3–1.2) in 16–17-year-olds. CPS-positive children were diagnosed at significantly younger ages for four cancer types: liver and intrahepatic bile duct tumors (C22: A = 0.097, adjusted p < 0.001), myeloid leukemia (C92: A = 0.179, adjusted p < 0.001), lymphoid leukemia (C91: A = 0.309, adjusted p = 0.007), and renal tumors (C64: A = 0.335, adjusted p = 0.013). Conclusions: CPSs likely play a significant and underestimated role in pediatric cancers, especially during early childhood. Improving access to genetic testing could greatly enhance risk assessment, personalized treatment, and long-term outcomes in pediatric oncology.

Children doi: 10.3390/children13060777

Authors: Paul Schwanitz von Keitz Kira Henriette Liebau Wolfram Mittelmeier Susanne Froehlich

Background: Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal disorder in newborns. Flexion–abduction orthoses are widely used in early treatment; however, in vivo data on their biomechanical load characteristics remain limited. This study aimed to evaluate axial force transmission in a hip flexion–abduction orthosis and to compare load patterns between healthy newborns and infants with DDH. Methods: In this exploratory observational study, 36 newborns (19 healthy, 17 with unilateral DDH) were examined within the first week of life. Axial forces transmitted through a Mittelmeier–Graf hip flexion–abduction orthosis (MGO) were measured using integrated force sensors under symmetrical and asymmetrical adjustment configurations. Intergroup comparisons were performed using non-parametric statistical tests. Results: Mean axial forces were significantly higher in healthy infants than in those with DDH under both symmetrical (4.02 N vs. 2.51 N; p = 0.019) and asymmetrical (3.67 N vs. 1.83 N; p = 0.001) conditions. Relative load corresponded to approximately 11–12% of body weight in healthy infants and 5–7% in the DDH group. No significant intra-individual differences were observed between dysplastic and contralateral hips. Orthosis configuration (symmetrical vs. asymmetrical) did not significantly affect load distribution. Conclusions: This exploratory in vivo study demonstrates that axial load transmission in a hip flexion–abduction orthosis is low and influenced by underlying hip pathology. Infants with DDH generate lower forces than healthy newborns, potentially reflecting altered biomechanics. As no significant differences were observed between orthosis configurations, symmetrical adjustment may be favored in clinical practice due to better usability and compliance. Further studies with larger cohorts are needed to confirm these findings.

Children doi: 10.3390/children13060776

Authors: Yumeng Liu Jinpeng Hu Shuo Zhang Qingqi Chong Jinxia Wang Xiaohui Gong Zhibao Lv Qingfeng Sheng

Background: Determining surgical assessment in infants with necrotizing enterocolitis (NEC) without radiographic pneumoperitoneum remains challenging. This study aimed to describe clinical factors associated with surgical intervention and to retrospectively assess an eight-parameter indicator in this setting. Methods: A retrospective study was conducted on infants with Bell stage II–III NEC treated between July 2014 and June 2023. Patients without radiographic pneumoperitoneum were classified into the conservative management group (CON) and surgical intervention group (SUR). Variables considered clinically relevant and suitable for bedside assessment were evaluated for the construction of an exploratory composite indicator. For selected parameters, each item was coded as present or absent, and the total number of positive parameters was calculated for each infant. Clinical characteristics, parameter frequencies, and the distribution of the composite indicator were compared between groups. Receiver operating characteristic (ROC) curve analysis was used descriptively to summarize the apparent discrimination of the composite indicator for observed surgical intervention. Results: A total of 115 infants were included; 70 received conservative management and 45 underwent surgical intervention. Eight bedside parameters were selected: endotracheal intubation history, hypotension, peritonitis, radiographic abnormalities, leukopenia, thrombocytopenia, acidosis, and hyponatremia. The SUR group had a higher frequency of several bedside abnormalities and a higher composite indicator score than the CON group. The exploratory composite indicator showed an area under the ROC curve of 0.842 for distinguishing infants who underwent surgical intervention from those managed conservatively. Conclusions: Infants with NEC who underwent surgical intervention showed a higher burden of bedside clinical, radiographic, and laboratory abnormalities. This exploratory eight-parameter indicator may provide a practical descriptive summary of disease severity and surgical concern in this challenging clinical setting.

Children doi: 10.3390/children13060774

Authors: Dhawal Sanjay Bandrey Christie S. Vieux Haley M. Laughlin Cara Price Susan Landry Johanna R. Bick Dana M. DeMaster

Background/Objectives: Children born very preterm (VPT; <33 weeks gestation) are at increased risk for atypical neurodevelopment and deficits in self-regulation, including executive function (EF) and emotion regulation (ER). Responsive parenting interventions, such as Play and Learning Strategies (PALS), improve caregiver behavior; however, their effects on neurodevelopmental outcomes in VPT populations remain limited. This study describes a randomized controlled trial evaluating a digital adaptation of PALS (ePALS). Methods: Families of toddlers aged 15–28 months born very preterm were randomized to either the ePALS intervention or an active control condition. Assessments were conducted at pre-test and post-test to evaluate caregiver responsiveness, child EF and ER, and neural development using behavioral tasks, EEG, and MRI. Results: To date, 84 families have been randomized (43 ePALS, 41 control). Preliminary findings indicate that parents in the ePALS condition demonstrate greater improvements in responsiveness compared to the control group. Intervention adherence rates are reported. Conclusions: These findings support the feasibility and preliminary efficacy of a digitally delivered parenting intervention for improving caregiver responsiveness in families of VPT toddlers. Ongoing analyses will evaluate long-term behavioral and neurodevelopmental outcomes.

Children doi: 10.3390/children13060775

Authors: Thyde Dumont-Mathieu Marianne Barton Rosalie Chuckta Natalia Suarez Martinez Deborah Fein

Background: The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child-care visits. Early identification facilitates early intervention (EI), which improves developmental outcomes. Historically, Non-Hispanic Black and Hispanic/Latino children in the United States receive autism diagnoses and autism-specific services later than Non-Hispanic White children. Variability in pediatric screening rates may indicate that systemic factors impede screening and referral; enhanced screening across community settings may support autism identification and connection to services. Methods: A feasibility study was conducted with one early learning program (ELP) to determine if screening for autism in ELPs is feasible. ELP teachers and staff received one 90 min training session on screening with the Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R). They were then tasked with independently screening ELP-enrolled children between 16 and 30 months old. Results: Eighty children were eligible for screening and 79 screenings were completed; 14 screens were positive and 65 were negative. Of the 14 positive screens, eight referrals were made to EI. All eight families completed EI evaluations and were eligible for EI services. One family declined an evaluation. Five positive autism screens were for children already receiving general EI services. Those five screening results were communicated to the child’s EI team and an autism-specific evaluation was completed; four of the five children subsequently received autism diagnoses. Conclusions: Our data supports the feasibility of completing autism-specific screenings within an ELP setting.

Children doi: 10.3390/children13060773

Authors: Giulia Stanca Maria Sframeli Camilla Verdilio Beatrice Berti Lavinia Fanelli Natalia Longoni Marisa Maniaci Giorgia Coratti Chiara Cutrì Roberta Onesimo Concetta Palermo Daniela Leone Anna Falco Giulia Norcia Valentina Giorgio Carolina Ausili Cefaro Antonella Cerchiari Sonia Messina Marika Pane Eugenio Mercuri

Background/Objectives: The advent of disease modifying therapies (DMTs) for Spinal Muscular Atrophy (SMA) has highlighted the need for reliable tools to assess bulbar function in type I individuals. The Oral and Swallowing Abilities Tool (OrSAT) was originally developed to evaluate swallowing and feeding abilities in infants with SMA type I during the first two years of life. This study aimed to assess the applicability of the OrSAT in a cohort of children with SMA type I older than 2 years. Methods: Fifty-two children with genetically confirmed SMA type I, aged 2 to 12.6 years, were included. All participants had received at least one DMT, administered either soon after diagnosis or when treatment became available. Bulbar and feeding abilities were assessed using the OrSAT and results were grouped according to clinical subtype and feeding modality. Given the small sample size of the subgroups and the ordinal nature of OrSAT scores, comparisons between groups were performed using the non-parametric Kruskal–Wallis test. Results: At follow-up, 27 children were orally fed, 19 were exclusively tube-fed, and 6 were tube-fed but were also able to eat some food by mouth. The OrSAT scores reflect a wide spectrum of bulbar function from severe to no impairment. Most children who required exclusive tube-feeding at follow-up had already been tube-fed at treatment initiation, while a small number showed improvement in swallowing abilities and the partial recovery of oral feeding during follow-up. Conclusions: Our results suggest that the OrSAT, previously used only in the first two years of life, may also be applicable in older children to describe bulbar involvement and monitor changes over time. However, further studies are needed to refine the tool for this age group and to formally validate its use in older children with SMA type I. Its use may contribute to the longitudinal assessment of swallowing abilities and support rehabilitative management.

Children doi: 10.3390/children13060772

Authors: Carter James Kornak White Xue-Cheng Liu Scott E. Van Valin

Background: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder occurring during the pubertal growth spurt, and prior studies have demonstrated regional seasonal variation in presentation volume. The relationship between seasonality, socioeconomic deprivation, and disease severity remains incompletely characterized. This study investigated whether SCFE presentation volume demonstrates seasonal variation and whether seasonality is associated with socioeconomic deprivation, body mass index (BMI), and radiographic severity. Methods: We retrospectively reviewed children newly diagnosed with SCFE at a single institution in Wisconsin (USA) between January 2012 and March 2024. Variables included age, sex, race, Area Deprivation Index (ADI), BMI, month of symptom onset, Southwick slip angle, stability, chronicity, and symptom duration. Presentation volume was analyzed using 3-month rolling averages and sinusoidal regression with 12-month periodicity. Associations among ADI, BMI, and slip angle were assessed using linear regression and Spearman’s correlation. Results: In total, 122 of 160 patients met the inclusion criteria. SCFE presentation volume demonstrated significant seasonality (p < 0.05). Lower-volume months were associated with higher neighborhood deprivation and greater radiographic severity (p < 0.05). ADI correlated with slip angle (r = 0.29, p < 0.05) and BMI (r = 0.33, p < 0.05), whereas BMI was not significantly associated with slip angle. Chronic slips demonstrated greater slip angles than acute presentations (p < 0.05). Conclusions: SCFE presentation volume in Wisconsin follows a significant seasonal pattern, and social determinants of health may influence the timing of presentation and disease severity.

Children doi: 10.3390/children13060771

Authors: Barbara Sgobbi Lorenzo Antichi Maria Elena Bolis Laura Morlacchi Daniele Donati Ilia Bresesti Massimo Agosti

Objective: This pilot study aimed to explore how a receptive music intervention, based on musical genres reflecting maternal listening preferences during pregnancy, affects distress levels in Italian preterm infants. Specifically, it investigated the effects of soft pop/rock music, compared with classical music, on infants’ LF/HF ratio (derived from heart rate variability [HRV]) and peripheral oxygen saturation (SpO2), which were used as physiological markers of distress. Method: This retrospective observational pilot study analyzed clinical data routinely collected between May 2014 and January 2015 from 27 preterm infants (gestational age 23–32 weeks; birth weight < 1500 g) who received receptive music therapy as part of standard family-centered care in the NICU. Maternal listening preferences during pregnancy were assessed in 30 mothers via an ad hoc questionnaire; a content analysis identified, at the group level, the three most frequently reported artists (i.e., Jovanotti, Vasco Rossi, and W. A. Mozart), which were used to create three standardized playlists. According to the internal clinical procedure, each infant underwent four sessions on consecutive days: a no-music condition on Day 1, followed by the three music conditions on Days 2–4 in randomized order. The LF/HF ratio and SpO2 were measured at five time points per session (one pre-test, three intra-session time points, and one post-test). Wilcoxon signed-rank tests were used to compare conditions and time points, with effect sizes and a Benjamini–Hochberg (FDR) correction for multiple comparisons. Results: The LF/HF ratio did not differ significantly across music conditions or relative to the no-music condition. SpO2 was higher during the Mozart condition than during the no-music condition at three of the five time points; this association remained significant after FDR correction, with medium-to-large effect sizes. No effect was observed for the soft pop/rock conditions on physiological indexes. Conclusions: Receptive music therapy based on maternal listening during pregnancy was not associated with changes in the LF/HF ratio. The Mozart condition was associated with higher SpO2 than the no-music condition. Given the small sample, the single-center setting, and the retrospective observational design, these findings are preliminary and require confirmation in larger, adequately powered prospective trials. Future studies should also examine the specific musical features (e.g., tempo, harmonic structure, voice timbre) that may drive these physiological responses.

Children doi: 10.3390/children13060770

Authors: Chiara Tirone Simona Fattore Nicoletta Menzella Davide De Tomaso Martina Giaimo Stefano Cecere Alessandro Perri Irene Messana Tiziana Cabras Barbara Manconi Alessandra Olianas Cristina Contini Giulia Guadalupi Gavino Faa Massimo Castagnola Federica Iavarone Giovanni Vento

Background: Oxidative stress plays a key role in the pathogenesis of complications in preterm infants, including bronchopulmonary dysplasia (BPD). Thymosin β4 (Tβ4) and thymosin β10 (Tβ10) are proteins involved in tissue repair and responses to oxidative stress, but their role in extremely preterm neonates remains poorly understood. Methods: A total of 149 saliva samples from 18 infants with gestational age < 30 weeks were analyzed. Salivary proteins and their proteoforms were characterized using an integrated proteomic platform based on nano-HPLC-ESI-MS. Relative quantification was performed using extracted ion current (XIC) peak areas. Associations with postmenstrual age, oxygen requirement, and BPD development were assessed, including longitudinal analysis using generalized estimating equation (GEE) models. Results: Significant correlations were found between postmenstrual age and total Tβ4 (p = 0.001), oxidized Tβ4 percentage (p = 0.025), and total Tβ10 (p = 0.043). Higher oxygen requirement was associated with lower levels and percentages of oxidized Tβ10 (p = 0.005; p < 0.001). No significant differences were observed during the first week of life between neonates who later developed BPD and those who did not. However, longitudinal analysis showed that in neonates without BPD, total and oxidized Tβ10 and total Tβ4 increased over time, whereas in neonates with BPD, these biomarkers remained stable or decreased. The increase in oxidized Tβ10 percentage was slower in infants with BPD. Conclusions: Although no early differences were detected, longitudinal trajectories of Tβ4 and Tβ10 differed between infants with and without BPD. Postnatal changes in these proteins may be associated with differences in clinical course and exposure to postnatal oxidative stress.

Children doi: 10.3390/children13060769

Authors: Cristiano Becker Juliana Barbosa Goulardins Juliana Cristina Fernandes Bilhar Marques Ramon Jeronimo Cuevas Gajardo

Despite its increasing use in pediatric neurorehabilitation, Cuevas Medek Exercise (CME) remains rooted in clinical tradition, with limited theoretical articulation in relation to contemporary models of motor development, control, and learning. While clinical observations and reports from practice suggest possible functional benefits in children with motor delays, the absence of a conceptual framework limits its integration into evidence-informed physical therapy practice and education. This perspective proposes a conceptual model for CME that aligns its core principles with current theoretical constructs in motor behavior and developmental neuroscience. By examining key elements of CME—such as distal initiation, postural challenge, and task variability—through the lens of affordances, self-organization, and experience-dependent plasticity, the article presents CME not merely as a technique, but as a conceptual developmental approach informed by embodied action. We argue that such reframing may support more rigorous clinical reasoning, contribute to interdisciplinary dialogue, and inform a theoretical basis for future research exploring the proposed mechanisms and potential effects of CME. More broadly, this perspective contributes to ongoing discussions on how clinically derived interventions can be conceptually integrated within contemporary rehabilitation science. While the present article does not provide empirical validation, it offers a theoretical framework intended to inform future investigation and critical reflection in pediatric physical therapy.

Children doi: 10.3390/children13060768

Authors: Yeşim Yiğit Özge Yılmaz Ece Onur Yurda Şimşek Arzu Oran Esra Toprak Kanık Hasan Yüksel

Background: Acute bronchiolitis is one of the most common lower respiratory tract infections in early childhood and is frequently associated with recurrent wheezing and later development of asthma. Identifying biomarkers related to airway epithelial injury and disease severity may improve risk stratification. Materials and Methods: A total of 155 children aged 1–36 months who presented with their first episode of wheezing were enrolled. Clinical data and bronchiolitis symptom scores were recorded at admission. Serum levels of CC16, surfactant protein-D (SP-D), YKL-40, and isoprostane were measured. Patients were followed for one year to assess recurrence of wheezing. Results: According to symptom scores, 81 patients had mild and 74 had moderate bronchiolitis; no severe cases were observed. The distribution of bronchiolitis severity differed significantly between recurrent and non-recurrent wheezing groups. Serum YKL-40 levels were significantly correlated with disease severity (p < 0.05), and the effect size analysis indicated a moderate effect. SP-D levels showed a non-significant trend with severity (p = 0.17). No significant associations were observed for CC16 or isoprostane. Conclusions: Serum YKL-40 may be a potential biomarker reflecting disease severity in children with acute bronchiolitis. Further longitudinal studies are needed to evaluate the prognostic value of epithelial injury markers for recurrent wheezing and asthma development.

Children doi: 10.3390/children13060767

Authors: Yuri Nurdiantami Hilda Meriyandah Tokie Anme

Background/Objectives: Household poverty is a known risk factor for early childhood development. However, the extent to which caregiver education may moderate income-related developmental disadvantages remains underexplored in Southeast Asian contexts. This study investigated whether caregiver educational attainment buffers the association between household income, child-rearing environments, and early developmental outcomes in Indonesia. Methods: This study utilized cross-sectional data from Indonesian caregivers. To maximize statistical power, analyses of the home environment using the Index of Child Care Environment included the full sample (N = 933). Analyses of developmental outcomes using the Early Childhood Development Index were restricted to 3- and 4-year-old children (N = 355). General Linear Models (GLMs) were conducted, controlling for child age and sex. Results: For the home environment, both household income (p = 0.042) and caregiver education (p = 0.021) were independent, significant predictors, with no significant interaction. However, for developmental outcomes, the Income × Caregiver Education interaction was statistically significant (p < 0.001). Conclusions: Income and caregiver education were independently associated with the home environment, while their interaction was associated with developmental outcomes among children aged 3 to 4 years. These findings are consistent with an educational buffering hypothesis and warrant further longitudinal research.

Children doi: 10.3390/children13060766

Authors: Valentin Stroe Lacramioara Eliza Chiperi Horatiu Suciu Marius Harpa David Emanuel Anitei Liliana Gozar

Background/Objectives: Early thrombosis of systemic-to-pulmonary artery shunts (SPS) remains a major cause of morbidity and mortality in neonates with duct-dependent pulmonary circulation. Despite advances in surgical technique, no universally accepted perioperative thrombosis-prevention protocol exists. We evaluated the early outcomes of a standardized perioperative thrombosis-prevention protocol applied in neonates undergoing SPS placement. Methods: This single-center case series included nine consecutive neonates undergoing primary modified Blalock–Taussig shunt placement between January 2024 and July 2025. A predefined and standardized perioperative thrombosis-prevention protocol was uniformly applied, incorporating preoperative aspirin when feasible, intraoperative systemic heparinization targeting activated clotting time (ACT) > 300 s, meticulous shunt flushing and de-airing, preferential distal anastomosis to the main pulmonary artery when anatomically suitable, and early postoperative continuous heparin infusion followed by enteral aspirin. The primary endpoint was early shunt thrombosis within 30 days. Results: Median age at surgery was 28 days (range 14–35), and median operative weight was 3.2 kg (range 2.8–3.6). Cardiopulmonary bypass was required in 33.3% of patients. Delayed sternal closure was performed in 22.2%. Despite recognized prothrombotic risk factors—including complex anatomy, hypoplastic pulmonary arteries, and low cardiac output syndrome (33.3%)—no early shunt thrombosis occurred (0/9). There were no reinterventions, no early mortality, and no major bleeding or intracranial hemorrhage. Conclusions: In this single-center neonatal series, implementation of a standardized perioperative thrombosis-prevention protocol was associated with preserved early shunt patency without increased bleeding risk. Although limited by a small sample size, these findings support the feasibility and short-term safety of a standardized perioperative management strategy in neonatal systemic-to-pulmonary shunt surgery. These findings should be considered hypothesis-generating and not evidence of definitive effectiveness.

Children doi: 10.3390/children13060765

Authors: Selma Cakmakci Harun Demirci Gonca Altinisik Inan Servet Guresci Suheyla Aytac Arslan Arzu Yazal Erdem Derya Ozyoruk Ibrahim Qaddoumi Inci Ergurhan Ilhan Neriman Sari

Purpose: We aim to review our experience in treating children with ependymoma, the third most common malignant central nervous system tumor in children, at Ankara Bilkent City Hospital. Methods: We reviewed medical records of children <18 years old at diagnosis with ependymoma followed up between 2006 and 2024. Clinical, pathological, radiological, treatment, and outcome data were evaluated. Results: Thirty-two patients (56% males) were included. Median age at diagnosis was 6.8 years (range: 0.6–17 years). Sixteen tumors (50%) were Grade 2 histology. Resection extent was gross total resection (GTR, n = 16), subtotal resection (STR, n = 15), or biopsy (n = 1). Radiotherapy was given to 10 patients; chemotherapy to 3; and both to 11. Eight patients underwent surgery only. In univariate analysis, resection extent significantly impacted both event-free survival (EFS) (3-year EFS 79.0% in GTR vs. 38.9% in STR, p = 0.009) and overall survival (3-year OS 100% in GTR vs. 79.4% in STR, p = 0.035). Four patients (12.5%) died. Six patients remained alive with active disease; three were lost to follow-up. Conclusions: The best outcomes occurred in patients who underwent GTR. The EFS/OS rates were comparable to those in the literature. Our findings suggest that chemotherapy and radiotherapy in relapsed ependymoma may prolong survival.

Children doi: 10.3390/children13060764

Authors: Mustafa Dogan Metin Tan Emre Tepeli Ozlem Gul Dolunay Gurses Guven Yenmis Mehmet Dokur

Background/Objectives: In individuals with a genetic predisposition, acute rheumatic fever (ARF) can manifest as arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. It occurs after a latent period of 1–3 weeks of untreated upper respiratory tract infections caused by group A beta-hemolytic streptococci. The presence and severity of carditis determine the prognosis for ARF. Carditis manifests as pancarditis, and although all patients have pericarditis, not all experience a pericardial effusion. Patients with severe carditis exhibit pericardial effusion more frequently. The physiopathology of ARF remains unclear, specifically which patients will experience carditis, arthritis, or chorea. However, the Turkish population has fully clarified the physiopathology and clinical features of Familial Mediterranean fever (FMF), a common rheumatic disease. In the Turkish population, the heterozygous positivity rate for the FMF gene mutation is 15–35%. For these reasons, we examined the presence of FMF gene mutations in our patients to determine whether there is a correlation between the clinical course of ARF and the FMF gene mutation. Methods: The study included 60 patients with arthritis (n = 11), carditis (n = 26), or both (n = 23), as well as 60 healthy controls. These pediatric patients underwent screening for mutations in exons 2 and 10 of the MEFV gene. Results: There was no statistically significant difference between the patient and control groups in terms of the incidence of MEFV gene mutations in exon 10. However, in patients with ARF, the exon 2 E148Q variant was significantly more common than in the control group. Conclusions: This study suggests a relationship between certain clinical manifestations of ARF and MEFV gene mutations in children.

Children doi: 10.3390/children13060763

Authors: Despoina Ourda Maria Karatzioti Marianthi Koutsokosta Athanasios Gregoriadis Vassilis Barkoukis

Background/Objectives: This study examined the association between parental physical activity and preschool children’s physical activity and social behavior. Methods: Participants were 151 preschool children (70 girls, 81 boys; Mage = 52.51 months, SD = 3.38) attending public and private kindergartens in Thessaloniki (Greece) and Nicosia (Cyprus). Children’s psychosocial development was assessed by kindergarten teachers using the Strengths and Difficulties Questionnaire, while parents reported their own and their children’s physical activity through the Preschool-age Children’s Physical Activity Questionnaire (home version). Descriptive statistics and Pearson correlations were computed, and the main hypotheses were tested using multiple linear regression analyses. Results: Results indicated a consistent positive association between parental physical activity and children’s physical activity across intensity levels. Parental physical activity frequency and duration during both weekdays and weekends was significantly associated with children’s low-, moderate-, and vigorous-intensity physical activity, while parental beliefs about physical activity were negatively associated with children’s sedentary behavior. In contrast, parental physical activity showed no significant association with all indicators of social behavior at school, including emotional symptoms, conduct problems, hyperactivity/inattention, and prosocial behavior. Conclusions: Overall, the findings support the role of parental physical activity as an important correlate of preschool children’s physical activity behavior, while its direct association with broader psychosocial development appears small. These results highlight the importance of parental role modeling and attitudes toward physical activity, particularly in shaping children’s movement behaviors.

Children doi: 10.3390/children13060762

Authors: Laura Beccani Monica Valle Sara Damilano Francesco Venturelli Massimo Vicentini Olivia Vecchi Silvia Faccioli

Background/Objectives: Early motor intervention is increasingly recognized as a critical component in the management of infants with, or at high risk of, cerebral palsy (CP). This systematic review aimed to synthesize recent evidence on early motor interventions in infants aged 0–2 years and to identify current gaps in knowledge. Methods: We performed a systematic literature review across PubMed, Embase, CINAHL, and Scopus. Studies published between 1 January 2020 and 5 October 2024 were included. Eligible studies were Randomized Controlled Trials (RCTs), non-randomized trials, and cohort studies that involved infants aged 0–2 years diagnosed with CP or classified as at high risk of CP who received early motor interventions targeting motor outcomes. Study selection and data extraction were executed by two independent reviewers following standardized protocols. The Rob2 Checklist was used to assess the risk of bias. This systematic review protocol was registered on PROSPERO with the ID 506784. Results: Six articles representing four RCTs were included. Although intervention protocols varied, shared therapeutic principles emerged across studies. Most participants were approximately 12 months old; only one study included infants younger than 3 months, highlighting limited evidence in the earliest detectable risk period. No consistent superiority of experimental interventions over standard care was observed; however, notable within-group improvements in motor and developmental domains were reported across both study arms. Major limitations included heterogeneity of outcome measures, limited use of CP-specific standardized tools, and insufficient assessment of functional and goal-based outcomes. Conclusions: Current evidence indicates a shift toward meaningful, family-centered early motor interventions, emphasizing active participation and parental involvement. Five core principles were identified: early initiation, task specificity, active experience, guided support, and engagement of both the child and caregivers. Future research should focus on earlier intervention timing, standardized outcome measures, and caregiver-related outcomes to optimize early intervention strategies during critical developmental windows.

Children doi: 10.3390/children13060761

Authors: Norma Olvera Molly R. Matthews-Ewald Tamal J. Roy Rhonda Scherer Luz M. Garcini Consuelo Arbona

Background/Objectives: Binge eating behavior has been deemed a significant factor associated with adolescent obesity. Understanding the underlying factors contributing to binge eating is critical, particularly among youth at risk of obesity. Hispanic and African American/Black children and adolescents experience disproportionately higher rates of obesity compared to their White peers. This study investigated the associations among anxiety, sleep quality, and binge eating among 315 Hispanic and African American/Black boys and girls, while controlling for demographic and adiposity covariates. Methods: Participants completed self-report surveys and underwent objective assessments of height, weight, and body fat percentage. Results: Descriptive analyses indicated a mean age of 10.71 years for boys and 10.92 years for girls. Most participants (71.9%) were classified as overweight or obese, and 94.1% were U.S.-born. Hierarchical regression analyses showed that both anxiety (β = 0.24, p < 0.001) and sleep quality (β = 0.23, p < 0.001) were significantly linked with higher levels of reported binge eating, after controlling for age, ethnicity, gender, and body fat percentage. The full model accounted for 15.4% of the variance in binge eating. Conclusions: These findings highlight the importance of targeting anxiety and sleep quality in interventions aimed at reducing binge eating among Hispanic and African American/Black early adolescents.

Children doi: 10.3390/children13060760

Authors: Yoon Lee Minsoo Shin Jahye Jung Ah-Ram Sul Yong Hee Hong

Background/Objectives: Pediatric obesity poses significant public health challenges and is associated with an increased risk of adult obesity. Healthcare professionals play an important role in providing patient-centered care; however, barriers to effective pediatric obesity management remain insufficiently explored in South Korea. Methods: Eleven healthcare professionals managing pediatric obesity participated in focus group interviews. Audio-recorded interviews were transcribed verbatim and analyzed using thematic content analysis. Four main themes emerged: (1) the current status of pediatric obesity management, (2) clinical experiences and outcomes, (3) awareness of governmental policies, and (4) areas needing improvement. Results: Participants described multiple barriers to pediatric obesity management, including limited clinical resources, time constraints, low awareness among patients and families, and perceived inadequacies in reimbursement policies. Participants also reported low treatment adherence and frequent dropout during follow-up care. Many participants reported limited awareness of governmental initiatives related to pediatric obesity management but expressed willingness to utilize such programs if they became more accessible and better integrated into clinical practice. Conclusion: The findings suggest that pediatric obesity management in South Korea may be influenced by structural, financial, and sociocultural barriers. Participants emphasized the need for improved multidisciplinary collaboration, greater institutional support, and increased accessibility of obesity-related programs and resources. Further comparative and context-specific studies may help inform tailored approaches to pediatric obesity management.

Children doi: 10.3390/children13060759

Authors: Aleksandra Moluszys Łukasz Mański Mirella Kozakiewicz Marek Niedoszytko Eliza Wasilewska

Background/Objectives: Breathing is increasingly recognized as an integral component of the motor system, interacting with postural control and movement. Despite this, clinical assessment of respiratory function in children remains largely limited to physiological parameters, with relatively few tools available to evaluate breathing as an organized motor pattern. The aim of this study was to develop and preliminarily validate the Breath Motor Pattern Index (BMPI), an observational tool designed to assess the organization of respiratory motor patterns in children. Methods: A scoping review was conducted to identify key components of respiratory motor pattern organization. Based on these findings, the BMPI was developed and evaluated in a cohort of 210 children aged 0–72 months, divided into three groups: healthy controls, children with neurological conditions, and children with respiratory disorders. Inter-rater and test–retest reliability was assessed using intraclass correlation coefficients (ICC). Measurement error was quantified using the standard error of measurement (SEM) and minimal detectable change (MDC95). Construct-related validity was examined through correlations with the Gross Motor Function Measure (GMFM-88) and comparisons between clinical groups. Results: The BMPI showed high inter-rater reliability (ICC = 0.998) and test–retest reliability (ICC = 0.999), with low measurement error (SEM = 0.55; MDC95 = 1.53). A weak but statistically significant correlation with GMFM-88 was observed (rho = 0.23, p < 0.001). BMPI scores differed significantly between groups (p < 0.001), with lower values observed in the neurological group and higher values in the pulmonary group. Conclusions: The BMPI appears to be a promising observational tool with potential clinical applicability for assessing respiratory motor pattern organization in children. The findings support the conceptualization of breathing as an integrated component of the motor system while highlighting the need for further psychometric and longitudinal validation studies. Future research should further investigate the responsiveness of the BMPI as well as its potential utility in clinical decision-making and therapeutic monitoring.

Children doi: 10.3390/children13060758

Authors: Usha Devi Jörn-Hendrik Weitkamp Jeffrey S. Shenberger Parvesh Mohan Garg

Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal emergencies in neonates and also presents major diagnostic challenges. Despite extensive research, NEC still lacks a practical definition and relies on a set of nonspecific clinical, laboratory, and radiological findings rather than a single pathognomonic presentation or test. The modified Bell staging system remains the most widely used framework in clinical practice and research, but it was originally developed to guide treatment decisions rather than aid diagnosis and has important limitations when applied as a diagnostic aid. Clinical and radiological criteria used for early stages of NEC are nonspecific, disease progression is not always linear, radiographic signs are inconsistently present, and histopathological confirmation is unavailable in most of the cases as surgery is not undertaken in all the cases. These limitations have led to the opinion that even the modified Bell staging is “broken” when it is used to define the disease itself. At the same time, increased understanding about gut immunity and microbiome progression, and neonatal hemodynamics make it increasingly clear that NEC is not a single uniform disease. It is now regarded as a heterogeneous syndrome comprising multiple phenotypes that share a final common pathway of intestinal injury and necrosis differing in timing, predisposing factors, mechanism, and clinical course. These presentations overlap with several neonatal conditions including spontaneous intestinal perforation, septic ileus, cow’s milk protein allergy, congenital heart disease-related intestinal hypoperfusion, viral enterocolitis, malrotation with volvulus, and intussusception. This review discusses controversies in the definition and staging of NEC, consolidates alternative diagnostic criteria beyond Bell’s system, and elaborates on a phenotype-based framework for clinical distinction. Also, the review sheds light on the clinical mimickers, practical bedside diagnosis using serial clinical assessment and imaging, consequences of NEC, and emerging precision medicine approaches. A shift from stage-based labeling toward a practical, phenotype-informed framework may improve diagnostic precision, reduce misclassification, and enhance both clinical care and research.

Children doi: 10.3390/children13060756

Authors: Dafni Moriki Dimosthenis Maris Aspasia Mavronasou Panagiotis Dalamarinis Despoina Koumpagioti Maria Tsouprou Vasilis Grammeniatis Michalis Kalogiannis Angeliki Galani Eleni A. Kortianou Konstantinos Douros

Background: Preschool wheezing is common, but distinguishing transient wheezing from early persistent asthma remains difficult. Oscillometric techniques, including impulse oscillometry (IOS), may provide objective prognostic information. Objective: To systematically review longitudinal studies assessing whether oscillometric measurements obtained at preschool age are associated with later asthma-related outcomes or lung function impairment. Methods: PubMed, Scopus, and MEDLINE (via EBSCOhost) were searched from inception to 28 February 2026. Eligible studies included preschool-aged children or closely related early-childhood populations assessed with IOS or forced oscillation technique (FOT), longitudinal follow-up, and later asthma-related or spirometric outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias with QUIPS. Owing to substantial heterogeneity, findings were synthesized qualitatively. Results: Seven longitudinal cohort studies, encompassing 1077 children, met the eligibility criteria; baseline oscillometry was performed between ages 2 and 7 years, and follow-up ranged from 1 to 10 years. Short-term classification and longer-term prognostic studies were interpreted separately. Resistance-based indices, particularly R5, showed the most consistent associations with later asthma-related outcomes and lower subsequent spirometric indices, including FEV1 and FEV1/FVC. Most studies were at moderate risk of bias, and some reports came from related cohorts. Conclusions: Preschool oscillometry may provide complementary physiological information to assess asthma risk in symptomatic or high-risk preschool-aged children, particularly through resistance-based measures. However, evidence remains limited, heterogeneous, and insufficient to support a single validated cutoff, routine screening of apparently healthy children, or routine stand-alone prognostic use.