Pediatric Reports doi: 10.3390/pediatric18040114

Authors: Erasmia I. Koiliari Christos Tsitsipanis Marianna Evangelia Kapsetaki Emmanouil L. Pasparakis

Background and Clinical Significance: This report investigates the complex intersection of macrostructural neuroprotection and cortical hyperexcitability during long-acting atypical antipsychotic maintenance. We present a novel clinical case demonstrating an apparent absence of detectable cerebellar vermis atrophy progression during long-acting injectable (LAI) aripiprazole maintenance, which temporally coincided with the emergence of a potential epileptogenic risk in an adolescent with bipolar disorder (BD) and cannabis use disorder. Beyond motor precision, the vermis modulates emotional-cognitive networks; deficits in these circuits impair impulse control, frequently driving comorbid substance use in youth. Case Presentation: A 16-year-old female with BD and cannabis use disorder presented with pronounced cerebellar and vermis atrophy on brain CT during an acute behavioral crisis. Following diagnostic reformulation, maintenance therapy was initiated via off-label monthly LAI aripiprazole (400 mg) alongside lithium. At 9-month follow-up, psychiatric relapses and cannabis use remitted completely. Repeat CT suggested macrostructural stability with zero apparent atrophy progression. However, during the 9th month, she abruptly developed daily generalized myoclonus. An awake electroencephalogram (EEG) revealed intense cortical hyperexcitability, documenting frequent interictal and ictal epileptiform discharges with generalized 3–4 Hz spike-wave complexes synchronized with the clinical myoclonus. Introduction of levetiracetam (500 mg BID) and cessation of adjunct methylphenidate led to complete clinical and neurophysiological remission. Conclusions: LAI aripiprazole may favorably influence the macrostructural trajectory of the cerebellum/vermis in adolescent BD, suggesting volume stabilization. However, clinicians must monitor for a drug-induced lowering of the seizure threshold, where macrostructural volume preservation coexists with microstructural electrical destabilization.

Pediatric Reports doi: 10.3390/pediatric18040113

Authors: Alícia Lima Anabela Paula Catarina Nunes Raquel Travassos Bárbara Oliveiros Carlos Miguel Marto Eunice Carrilho Inês Francisco Francisco Vale

Objective: The aim of this study is to assess caries-related indicators (DMFT and ICDAS indices), plaque index, salivary pH and buffering capacity, and dietary and oral hygiene habits in patients with cleft lip and/or palate undergoing orthodontic treatment, compared with a control group of healthy patients. Methods: This pilot case–control study included 26 patients undergoing orthodontic treatment, 13 patients with cleft lip and/or palate and 13 healthy individuals. The following variables were assessed: diet and oral hygiene through a questionnaire; salivary pH and buffering capacity; caries risk, using the DMFT and ICDAS indices; and plaque index, using the ImageJ Software. Results: No statistically significant differences were detected in the DMFT index, salivary pH, and plaque index; nor in the diet, oral hygiene and salivary buffering capacity. A slightly higher plaque index was observed in patients with cleft lip and/or palate compared to healthy patients. There was a statistically significant difference in the location of plaque, with a higher incidence in the upper central incisors in the study group. Conclusion: This pilot study suggests no statistically significant differences in the DMFT index, plaque index, salivary pH, and buffering capacity between patients with cleft lip and/or palate and healthy controls undergoing orthodontic treatment. However, a higher incidence of bacterial plaque on the upper central incisors was observed in patients with cleft lip and/or palate.

Pediatric Reports doi: 10.3390/pediatric18040112

Authors: Constantinos Papadopoulos Konstantina Dinaki Ioanna Gravalidou Rafail Ioannidis

Background and Clinical Significance: Intranasal foreign bodies are common pediatric otolaryngologic emergencies and are usually diagnosed and removed without difficulty. However, delayed or occult retention may mimic chronic unilateral sinonasal disease and occasionally result in severe inflammatory or infectious complications. This study presents three illustrative pediatric cases of delayed intranasal foreign bodies supported by a seven-year institutional experience. Case Presentation: A retrospective review was conducted of all pediatric patients (≤16 years) presenting with intranasal foreign bodies at a secondary referral hospital between January 2019 and May 2026. Demographic characteristics, clinical presentation, management, and outcomes were reviewed to provide institutional context. Among 82 identified patients, three children with delayed diagnosis and severe complications were selected for detailed presentation because they represented distinct clinical manifestations of prolonged foreign body retention. These included chronic unilateral rhinosinusitis caused by a retained peanut fragment, a medial orbital subperiosteal abscess secondary to a retained plastic nasal piercing component, and a foreign-body granuloma associated with retained nasal packing material. The remaining patients underwent uncomplicated removal, predominantly in the emergency department. Conclusions: The presented cases illustrate the diverse spectrum of complications that may occur following delayed intranasal foreign body retention in children. Persistent unilateral foul-smelling rhinorrhea, nasal obstruction, recurrent unilateral epistaxis, or refractory unilateral sinonasal symptoms should prompt careful evaluation for a retained foreign body. By combining detailed case descriptions with institutional experience, this report highlights the importance of maintaining a high index of suspicion and timely endoscopic management in children with persistent unilateral sinonasal symptoms.

Pediatric Reports doi: 10.3390/pediatric18040111

Authors: Francesco Accomando Melodie O. Aricò Enrico Valletta

Background: To assess temporal trends in psychiatric hospitalizations among adolescents admitted to a general pediatric ward in Forlì, Italy, between 2016 and 2025 and to examine diagnostic patterns and their association with sex and age, using the individual patient as the primary unit of analysis. Methods: Single-center retrospective study including all hospitalizations for psychiatric disorders in patients aged 10–17 years over a 10-year period. Each discharge episode was assigned to a single dominant diagnostic category. The primary analyses were conducted at the level of the individual patient (first admission), while episode-level analyses were retained as a pre-specified sensitivity analysis reflecting inpatient burden. Results: A total of 165 adolescents (210 hospitalization episodes) were included; mean (SD) age was 14.47 (1.73) years, and females were 77% of patients (80.5% of episodes). Admissions increased significantly over time (patients: IRR 1.20 per year, 95% CI 1.13–1.27; p < 0.001), with 124/165 (75.2%) patients first admitted in 2021–2025. Suicidal ideation/attempt (27.3%) and eating disorders (15.2%) were the most frequent diagnoses, and both showed a significant upward trend. Overall, diagnosis was associated with sex (p = 0.004): most diagnoses, including the two most frequent, were female-predominant, whereas psychomotor agitation was over-represented in males. Age at admission increased modestly over time and was higher in 2021–2025. Twenty-seven patients accounted for 45 readmissions, concentrated in the most severe diagnoses. Conclusions: Psychiatric hospitalizations of adolescents in a general pediatric ward rose substantially over the decade, especially from 2021, driven mainly by suicidal ideation/attempt and eating disorders. Findings were robust to analysis at the patient level and support the role of the general pediatric ward as a sentinel setting for severe adolescent mental distress.

Pediatric Reports doi: 10.3390/pediatric18040110

Authors: Darlenne B. Kenga Jahit Sacarlal Mohsin Sidat Valéria Chicamba Andrea Ntanga Kenga Yara Manjate Manuel D. Naiene Raquel I. Langa Ramígio Pololo Troy D. Moon

Background: Empiric antibiotic prescribing is frequently used in low- and middle-income countries because microbiological diagnostic capacity is often limited, highlighting the need for locally generated microbiological data to support evidence-informed empiric antibiotic selection. However, data on pediatric antibiotic prescribing practices in Mozambique remain scarce. This study aimed to characterize empiric antibiotic prescribing among hospitalized pediatric patients at Maputo Central Hospital prior to the implementation of a syndromic antibiogram intervention. Methods: An exploratory, retrospective, descriptive baseline analysis was conducted among pediatric patients aged 1 month to 14 years admitted with suspected bacterial infections between January and December 2023, prior to the implementation of a syndromic antibiogram intervention. Sociodemographic, clinical, microbiological, and antibiotic prescribing data were extracted from clinical records. Antibiotics were classified according to the WHO AWaRe framework, and associations between patient characteristics, treatment strategies, and outcomes were analyzed using R software version 4.6.0. Results: A total of 358 pediatric patients were included, with a median age of 14 months (IQR: 6–48), and 57% were male. Lower respiratory tract infections were the most frequent diagnosis. Empiric treatment predominated, accounting for 89% of cases, whereas microbiologically guided therapy was observed in only 11%. Urinary tract infections showed significantly higher proportions of microbiologically guided treatment compared with respiratory infections (p < 0.001). Monotherapy predominated, while Watch antibiotics accounted for 64.7% of prescriptions. Prolonged hospitalization was associated with respiratory distress, decreased skin turgor, referral status, infection type, and anemia. Conclusions: Pediatric antibiotic prescribing was characterized by extensive empiric therapy and high Watch antibiotic use, highlighting important antimicrobial stewardship challenges in Mozambique.

Pediatric Reports doi: 10.3390/pediatric18040109

Authors: Jakob Olbrich Alexander Hönning Icaro Luan Tavares Latado Andrea Laufer Janna Schwab Erik Haucke Alexander Jünemann Uwe Weibrecht José de Ribamar Bandeira Filho Kristina Zappel Sinan Bakir

Background/Objectives: Road traffic accidents represent the leading cause of death in children and adolescents in Brazil. In the state of Piauí, non-specialized facilities frequently manage critically injured pediatric patients. Targeted training programs are considered a key strategy for improving outcomes. This study assessed the feasibility of adapting a pediatric trauma course developed in a high-income setting for medical first responders in both pre-hospital and in-hospital settings in a resource-limited environment in northeastern Brazil. Methods: This prospective non-randomized mixed-methods feasibility-oriented implementation and educational evaluation study involved the design of a simulation-based course based on a literature review by a German interprofessional and interdisciplinary team. Local adaptation was achieved through a needs assessment, field visits, and stakeholder collaboration. Implementation included the training of Brazilian instructor candidates, who subsequently delivered the course under supervision. Data were collected using study-specific, non-validated questionnaires at two timepoints and analyzed descriptively and exploratively. Results: A total of 98 healthcare professionals participated in the needs assessment (mean experience 9.7 ± 6.3 years; 62.2% nursing staff); 66 completed the pediatric trauma management section. Although familiarity with the ABCDE approach was high (86%), confidence in pediatric trauma management was significantly lower than management in adults (47% vs. 68%, p = 0.0018), particularly for invasive procedures. During implementation, 38 participants completed the course, with a 100% recommendation rate; approximately 80% felt prepared to teach independently. However, participants and instructors highlighted the need for more practical training, longer course duration, and follow-up instructor training. Conclusions: A context-adapted, simulation-based pediatric trauma training program was feasibly implemented and well accepted in a resource-limited region of Brazil. The train-the-trainer approach shows promise for strengthening local pediatric trauma capacity, but sustained implementation requires continued instructor development, supervised teaching, and long-term evaluation of educational and clinical outcomes.

Pediatric Reports doi: 10.3390/pediatric18040108

Authors: April Edwell Susan Bessler Shannon Burke

A previously healthy 19-month-old female presented after her family found her upon awakening to be sleepy, uninterested in eating, and lethargic. On arrival, blood gas showed profound metabolic acidosis with normal lactate that did not improve with normalization of glucose and sodium. Her acidosis continued to worsen, so a broad workup was initiated, considering ingestions, DKA, and inborn errors of metabolism. In collecting further history, the patient’s nutrition history included a combination of breastfeeding and a vegan diet followed by her family. Her B12 level returned undetectably low. She improved dramatically over the next several hours after receiving an injection of cyanocobalamin. Ultimately, she was confirmed to have methylmalonic acidemia secondary to severe Vitamin B12 deficiency.

Pediatric Reports doi: 10.3390/pediatric18040107

Authors: Henrike Waterstrat Nico Grafe Wieland Kiess Andreas Merkenschlager Tanja Poulain

Objective: This study examined reading behavior and screen time in children and adolescents and their associations with sleep behavior and behavioral difficulties. Methods: This study was conducted as part of the LIFE Child study (Germany). Participants were 579 6- to 10.5-year-old children (younger age group) and 972 10.5- to 18-year-old children and adolescents (older age group). Information on reading (duration of reading, on paper or electronically), screen time, sleep difficulties, and behavioral difficulties was assessed via parental (younger sample) or self-reported (older sample) questionnaires. Associations of reading behavior and screen time with child age, sex, maternal education, behavioral difficulties, and sleep difficulties were assessed using linear regression analyses. Results: Girls reported longer reading times than boys, whereas boys reported longer daily screen time. In the younger age group, reading time increased with age. Daily screen time increased with age in both age groups. Higher screen time was significantly associated with more sleep difficulties in both age groups and with more behavioral difficulties in the older age group. In the younger age group, reading time was not associated with screen time, sleep difficulties, or behavioral difficulties. In the older age group, however, longer reading times were significantly associated with longer screen time, more behavioral difficulties, and more problematic sleep. Conclusions: These results indicate that both the use of electronic media and reading behavior are relevant for understanding child health and development. The findings suggest that guidance for families of older children should address not only screen use but also balance and context of reading activities.

Pediatric Reports doi: 10.3390/pediatric18040106

Authors: Slavica Ostojić Sanja Milenković Sonja Pavlović Gordana Kovačević Gordana Petrović Aleksandra Paripović Adrijan Sarajlija Marina Anđelković Vladimir Gašić Danijela Radivojević

Introduction/Aims: Myopathies with Tubular Aggregates (TAM) are rare, chronic neuromuscular disorders that may be inherited or acquired. The aim of this report is to present the diagnostic pathway and the challenges encountered in a family with three members affected by TAM caused by a rare ORAI1 variant. Case report: Two siblings (15 and 11 years old) developed severe rhabdomyolysis triggered by a viral respiratory infection. Histopathological analysis demonstrated numerous tubular aggregates with mild focal secondary inflammatory changes and no immunophenotypic evidence of autoimmune inflammatory myopathy. Whole-exome sequencing identified a likely pathogenic heterozygous missense variant, NM_032790.3(ORAI1):c.319G>A (p.Val107Met), in the ORAI1 gene, in both children and their asymptomatic mother. Conclusions: The identification of a rare ORAI1 variant in this family supports the association with TAM, broadens the spectrum of phenotypic presentation, and illustrates the phenotypic variability that may exist even among affected members of the same family. Careful interpretation of inflammatory changes in muscle biopsy, together with immunohistochemical and genetic findings, is essential to avoid misclassification of hereditary tubular aggregate myopathy as autoimmune inflammatory myopathy.

Pediatric Reports doi: 10.3390/pediatric18040105

Authors: Alessandro Frolli Francesco Cerciello Clara Esposito Sonia Ciotola Gaia De Candia Maria Carla Ricci Maria Grazia Russo

The journal retracts the article “Executive functions and foreign language learning” [...]

Pediatric Reports doi: 10.3390/pediatric18040104

Authors: Maha A. Odeh Garam Kiswani Alex Gileles-Hillel

Objectives: To compare clinical outcomes and racial disparities of children hospitalized for acute asthma exacerbation who required any respiratory support: invasive mechanical ventilation (IMV), non-invasive modalities (non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC)). Methods: We searched PubMed, Embase, Cochrane, and Scopus for randomized controlled trials (RCTs) and observational studies published between 2010 and 2025 that involved pediatric asthma patients (0–18 years) who received HFNC, NIV, or IMV. Network meta-analyses (NMA) were conducted separately for RCTs (change in asthma score) and observational studies (PICU length of stay). Subgroup analyses compared respiratory support modalities and failure rates. Racial and ethnic disparities were analyzed narratively. Results: In five RCTs (n = 233), compared to oxygen, HFNC showed no significant benefit (MD = 0.24; p = 0.58), whereas NIV showed the greatest improvement in asthma scores (mean difference [MD] = 1.24; p = 0.07), reaching significance in sensitivity analysis (MD = 2.5; p < 0.001). Observational NMA found no differences in PICU stay between respiratory support modalities, but HFNC was associated with 2-fold increase in PICU stay in a subgroup analysis compared to standard oxygen (p = 0.04) and with a higher failure rate compared to NIV (12.6% vs. 2.6%; OR = 5.3, p < 0.001). Black children had higher odds of intubation. Conclusions: Available evidence suggests that NIV may confer greater short-term clinical benefit in children with severe acute asthma requiring respiratory support, although findings should be interpreted cautiously given the limited and heterogeneous data. Further high-quality studies with standardized outcomes are needed to inform respiratory support selection.

Pediatric Reports doi: 10.3390/pediatric18040103

Authors: Kathryn Lotharius Kendell Lewis Clarissa Portocarrero Megha Srivastav Silvia Zervos Rebecca Urbonas Michelle Knecht Lea Sacca

There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social–emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O’Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015–2025) on pediatric HS (<18 years) and social–emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020–2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS.

Pediatric Reports doi: 10.3390/pediatric18040102

Authors: Bartłomiej Kociński Jowita Rosada-Kurasińska Piotr Ładziński Alicja Muszyńska Diana Zawierucha Robert Judek Paweł R. Bednarek Marcin Gładki Alicja Bartkowska-Śniatkowska

Objective: Extracorporeal Membrane Oxygenation (ECMO) has long been used in the treatment of acute respiratory and circulatory failure by providing time for damaged organs to recover. The aim of this study was to evaluate the safety and feasibility of interhospital transport of pediatric patients with acute respiratory failure who had undergone venovenous extracorporeal membrane oxygenation (VV ECMO) initiated at the referring facilities. Subjects and methods: Because of the critical condition of these patients, the high risk associated with transport, and the failure of conventional therapies, ECMO was initiated at the referring center. After cannulation, the patients were transported by ground ambulance to the Pediatric Intensive Care Unit in Poznań for further treatment. Results: Fourteen patients aged 2 months to 11 years with acute respiratory failure were transferred to our ECMO center. The mean time from decision to departure was 7.62 h, and the mean ICU stay before transfer was 4.14 days. The mean transport distance was 157.5 km. No mortality occurred during transport, and no serious adverse events were reported. Two technical complications were noted. Conclusions: Interhospital transport of pediatric patients on VV ECMO initiated at referring centers was feasible and safe, with favorable outcomes in patients who have exhausted conventional intensive care options. Effective collaboration between referring hospitals, ECMO centers, and emergency medical services was essential for optimal results.

Pediatric Reports doi: 10.3390/pediatric18040101

Authors: Estherline J. Thoby Aimee Lariviere Katherine Briski Anna Petrova

Background/Objective: In 2022, the American Academy of Pediatrics (AAP) revised the guidelines used to manage neonatal hyperbilirubinemia with a focus on reducing unnecessary testing and phototherapy. However, pediatricians’ knowledge and compliance with the current guidelines have not been assessed. We conducted a survey to evaluate New Jersey pediatricians’ current knowledge and practice patterns with the newly proposed guidelines. Patients and Methods: A questionnaire consisting of 28 closed-ended Likert-scale questions, along with demographic data, was distributed twice in 2024 to all members of the New Jersey AAP Chapter. Of 128 respondents, 120 who defined their involvement in the care of neonates with hyperbilirubinemia were analyzed. Results: The majority of survey respondents were general pediatricians (71.7%). Up to 70% recognized the risk factors for developing severe hyperbilirubinemia, except for Down Syndrome. Up to 60% of respondents utilized transcutaneous bilirubin in low-risk hyperbilirubinemia neonates and serum bilirubin after phototherapy initiation in high-risk neonates as recommended by the AAP. Almost all of the respondents followed the AAP recommended post-discharge follow-up and/or bilirubin measurement. The majority reported phototherapy initiation at the recommended thresholds; however, only 12.5% of surveyed pediatricians followed the recommended threshold for phototherapy discontinuation. Conclusions: Surveyed pediatricians in our study were most likely to comply with the 2022 AAP guidelines; however, opportunities remain for improving pediatricians’ awareness of specific risk factors, reducing unnecessary laboratory testing and discontinuation of phototherapy at the recommended level.

Pediatric Reports doi: 10.3390/pediatric18040100

Authors: Georgios Grammatikou Efterpi Pavlidou Nikolaos Strimpakos Konstantinos Chandolias

Background/Objectives: Preterm birth is associated with increased risk of motor delay and broader neurodevelopmental vulnerability. Existing reviews have examined neonatal therapy, family-centered care, or early developmental intervention broadly, but the independent evidence for physiotherapy-based interventions in which parents actively deliver or support motor or sensorimotor activities remains uncertain. This review evaluated the effects of early physiotherapy with structured, guided parental involvement on motor development in preterm infants and examined intervention content, parental burden, safety, adherence, and durability of effects. Methods: The review followed PRISMA 2020 and a prespecified PICO framework. The original PubMed, Scopus, and PEDro search was updated through 9 July 2026 using PubMed/MEDLINE, PEDro, Cochrane CENTRAL, ClinicalTrials.gov, backward and forward citation tracking, and linked-report searches. Eligible studies were randomized controlled trials of early physiotherapy, motor, or structured sensorimotor intervention with an active parent-delivered or parent-supported component and a validated motor or neurodevelopmental outcome. Multiple publications from the same randomized cohort were linked and participants were counted once. Risk of bias was evaluated with Cochrane RoB 2, intervention reporting with TIDieR, and certainty with GRADE. Results: Ten reports represented five independent randomized cohorts and 393 unique randomized infants. The Norwegian Parent-Administered Physical Therapy Intervention (NOPPI) produced a moderate short-term improvement in TIMP performance at term-equivalent age, but no consistent advantage in general movements, motor performance at 3 or 24 months, or school-age motor outcomes. COPCA and a NICU-to-home physiotherapy program produced developmental improvement over time or selected short-term gains, without consistent superiority over active or developmental care comparators. A parent-administered sensorimotor intervention by Fucile et al. improved oral-feeding outcomes but not TIMP motor performance, and its linked 18-month follow-up did not demonstrate a clear developmental advantage. Badura et al. found no significant effect of a 10-week parent-delivered general-movement-based program on MOS-R or Bayley-III motor outcomes; adherence was variable, and a transient increase in maternal depressive symptoms at discharge highlighted the importance of treatment burden. Conclusions: Guided parental involvement is feasible and may enhance short-term motor performance when activities are individualized, active, cue-responsive, and closely supervised. However, current evidence does not establish sustained superiority over well-structured usual or traditional care, developmental normalization, or benefit from passive sensorimotor input alone. Clinical implementation should combine competency-based parent training, explicit infant stress cues and stopping rules, realistic dose targets, ongoing professional support, and monitoring of adherence, parental well-being, and adverse events.

Pediatric Reports doi: 10.3390/pediatric18040099

Authors: Elizabeth Christian Sarah Williams Sara Tyson Husband Amanda Brown Mohammad Sabobeh Sarah Schwartzberg Eliza Hendrix Sherry Locket Deni Trone Jennifer Featherston Shankari Kalyanasundaram Shilpa Gorantla Maham Alam Zhongheng Cai Haitao Pan Saad Ghafoor

Background/Objectives: Children with cancer admitted to the pediatric intensive care unit (PICU) are at increased risk for post-intensive care syndrome (PICS-p) due to prolonged immobility, deep sedation, and severe illness. The ABCDEF bundle offers a framework for enhancing ICU care and patient recovery, but implementing all components in pediatric oncology patients is challenging. This study assesses the development and implementation of the BRAVE (Beginning Restorative Activities Very Early) initiative, specifically BRAVE2, to integrate the comprehensive ABCDEF bundle and a nurse-led mobility program, in collaboration with rehabilitation specialists, within a pediatric oncology intensive care unit. Methods: BRAVE2 was a quality improvement project conducted in a single pediatric ICU from 2022 to 2023. We analyzed ICU data to assess patient demographics, frequency of physical and occupational therapy (PT/OT) consultations, time to initial mobilization, and delirium screening rates (CAPD score of 9 or higher) for patients with ICU stays over 48 h. BRAVE2 addressed all elements of the ABCDEF bundle, including regular pain assessments, evaluation of spontaneous breathing readiness, sedation adjustments, delirium screening, early mobilization, and family engagement. Outcomes were monitored using statistical process control methods. Results: Of 140 patients, 117 (84%) remained in the ICU for more than 48 h. The delirium screening rate was 15.5%, consistently below the target of 30%. PT/OT consultations within 72 h occurred in 80.7% of patients, and early mobilization in 49.7% of patients, both below the 80% goal. However, 90.4% of patients with tracked mobility were able to ambulate during their ICU stay. No mobility-related safety incidents were reported. Conclusions: Rolling out a full ICU liberation plan in a pediatric oncology ICU is possible, and implementing a comprehensive one is feasible and sustainable despite challenges. Although therapist-led early mobilization did not meet targets, incorporating nurse-led mobility strategies and routine delirium screening has established a scalable model to enhance ICU care and support long-term recovery for these patients.

Pediatric Reports doi: 10.3390/pediatric18040098

Authors: Natalia Fraczek John S. Carlson Jordan L. Bernard Gillian Ogilvie Mary Mackrain

Background/Objectives: Children in early childhood experience higher rates of suspension and expulsion than K–12 students, with persistent racial disparities. Methods: This retrospective descriptive observational study examined exclusionary practices among children ages 0–5 reported by providers participating in a state-level Infant and Early Childhood Mental Health Consultation (IECMHC) initiative within the United States. Results: Providers (n = 689) reported that 3.50% of children were excluded in the 12 months prior to service initiation (1.90% suspended; 1.60% expelled), with higher rates among older children (ages 3–5), males, and Black, Indigenous, People of Color (BIPOC) children. Among a subset of providers of children (n = 395) receiving child-and-family-focused (CFF) consultation, only 28 were expelled (7.09%), with the highest rate observed in children ages 30–36 months. Children expelled during CFF consultation more frequently exhibited atypical protective factors, elevated behavioral concerns, aggression at referral, and higher cumulative adverse childhood experiences (ACEs). Conclusions: Findings suggest that CFF consultation may help mitigate childcare exclusionary practices when children present with severe social-emotional-behavioral challenges. Important considerations for future childcare research and prevention efforts are provided.

Pediatric Reports doi: 10.3390/pediatric18040097

Authors: Ngoc Dieu Thi Phan Toan Thi Thanh Do Tuan Van Nguyen Ngoc Bao Trinh Huy Gia Ngo Hoa Thi Ho Tam Thi Thanh Le Hiep Tri Ngo

Background: Children with Autism Spectrum Disorder (ASD) frequently exhibit severe food selectivity and micronutrient deficiencies, impacting growth and nutritional status. Evidence on integrated nutritional interventions in resource-constrained settings remains limited. Objective: To assess the feasibility and preliminary pre–post changes associated with a 12-week multicomponent nutritional intervention among Vietnamese children with ASD. Methods: In this exploratory single-arm pilot study, 56 children with ASD (mean age 59.0 ± 22.3 months; 80.4% male) were recruited from five community centers in Nghe An Province, Vietnam. The intervention comprised caregiver nutrition education, individualized dietary counseling, and daily multi-micronutrient supplementation. Anthropometric indicators, biochemical markers, feeding behaviors, and dietary intake were assessed at baseline and after 12 weeks. Pre–post changes were evaluated using paired statistical tests, and multivariable linear regression examined factors associated with growth response. Results: The study achieved a 100% completion rate, with all 56 recruited participants finishing the 12-week intervention and all scheduled follow-up assessments. Among children < 60 months, mean Weight-for-Age Z-score (WAZ) increased from −0.66 to −0.28 and mean Height-for-Age Z-score (HAZ) from −1.18 to −0.97 (p < 0.001). For children older than 60 months, mean HAZ increased from −0.87 to −0.58 (p < 0.001) and Body Mass Index-for-Age Z-score (BAZ) from −0.20 to 0.06 (p = 0.006). Significant increases occurred in serum zinc (10.29 to 11.72 µmol/L; p = 0.001), ferritin (31.74 to 34.79 ng/mL; p = 0.001), and hemoglobin (122.73 to 124.77 g/L; p = 0.002), while albumin remained unchanged. Concurrent improvements were observed in feeding behaviors and nutrient-dense food intake. Regression analysis indicated that lower baseline anthropometric status was significantly associated with greater gains in WAZ and HAZ. Conclusions: This community-based multicomponent intervention was feasible and associated with short-term improvements in feeding behaviors, dietary intake, selected biomarkers, and growth measures in children with ASD, supporting further evaluation in randomized controlled trials.

Pediatric Reports doi: 10.3390/pediatric18040096

Authors: Verónica Judith Picos-Cárdenas Roberto Iván Avendaño-Gálvez Alberto Kousuke De la Herrán-Arita Loranda Calderón-Zamora Salvador Cervín-Serrano José Alfredo Contreras-Gutiérrez Dora María Cedano-Prieto Juan Pablo Meza-Espinoza

Background: The chromosomal microdeletion syndrome 2q13 is characterized by craniofacial dysmorphism, developmental delay, intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder, cardiac abnormalities, and seizures. Case Presentation: In this study, we present a descriptive genomic observation of a teenage boy presenting with epilepsy, intellectual disability, and mild facial dysmorphism, found to carry a 48.55 kb 2q13 microdeletion restricted to the BUB1 locus alongside a concurrent 11q21 microdeletion. While his clinical features overlap with the 2q13 microdeletion spectrum, the exact pathogenic contribution of each variant remains a subject of hypothesis due to the lack of parental inheritance data. Conclusions: Further research is necessary to ascertain the impact of the concurrence of small deletions on these disorders. This case underscores the clinical complexity introduced by compound minor copy number variations and emphasizes the value of molecular cytogenetics in evaluating idiopathic neurodevelopmental disorders.

Pediatric Reports doi: 10.3390/pediatric18040095

Authors: Esteban López-Garrido Alejandra Guadalupe Polina Lugo Ana Patricia Ortega-González Hadassa Yuef Martínez-Padrón

Background: Prematurity remains a major global health challenge and is a leading cause of neonatal morbidity and mortality worldwide. The risk of adverse outcomes is inversely associated with gestational age and birth weight. Although advances in neonatal intensive care have improved survival rates over recent decades, very-low-birth-weight (VLBW) preterm neonates continue to experience substantial morbidity and remain vulnerable to long-term complications. Objective: This study aimed to evaluate the morbidity and mortality of very-low-birth-weight preterm neonates (<1500 g) admitted to the Neonatal Intensive Care Unit (NICU) of the Hospital Regional de Alta Especialidad de Ciudad Victoria (HRAEV), Mexico. Materials and Methods: A retrospective observational cohort study was conducted through a review of medical records of VLBW preterm neonates admitted to the NICU between January 2019 and December 2023. Demographic, perinatal, clinical, and outcome-related data were collected and analyzed. Results: A total of 58 VLBW preterm neonates were included. Mean gestational age was 29.8 ± 2.7 weeks, and mean birth weight was 1109 ± 238 g. The most common morbidities were respiratory distress syndrome (81.0%), apnea of prematurity (72.4%), hyperbilirubinemia (68.9%), pneumonia (34.5%), sepsis (32.7%), patent ductus arteriosus (25.8%), bronchopulmonary dysplasia (26.9% among infants who survived to 36 weeks’ PMA), necrotizing enterocolitis (15.5%), and intraventricular hemorrhage (12.0%) and retinopathy of prematurity (8.6%). Overall mortality was 10.3%. Conclusions: VLBW preterm neonates remain at high risk for significant morbidity despite relatively favorable survival rates. Respiratory distress syndrome, apnea of prematurity, hyperbilirubinemia, and sepsis were the most frequent complications, whereas deaths occurred mainly in the context of severe respiratory and systemic complications, including neonatal asphyxia, pulmonary hypertension, sepsis, shock, and multiple organ failure. Survival outcomes should be interpreted cautiously because of differences in study populations, referral patterns, local viability practices, and study design across neonatal settings.

Pediatric Reports doi: 10.3390/pediatric18040094

Authors: Alberto Verrotti Virginia Filippini Barbara Federici Valentina Biagioli Lino Nobili Pietro Ferrara Pasquale Striano

Growing evidence indicates a bidirectional relationship between the gut microbiota and sleep disturbances in children, with the microbiota–gut–brain axis (MGBA) mediating this interaction. Sleep, circadian rhythms, and the gut microbiota form an interdependent and developmentally dynamic network that plays a crucial role in neurodevelopment during infancy and childhood. Although the mechanisms underlying this complex interaction have not yet been fully elucidated, emerging evidence suggests that multiple dimensions of sleep—including duration, quality, timing, and regularity—are closely associated with gut microbial composition and function. These findings support the rationale for nutritional and microbiota-targeted interventions during critical developmental windows. However, most mechanistic and taxonomic evidence derives from adult or mixed-age cohorts, while methodological heterogeneity, geographic bias, and the predominance of cross-sectional studies limit causal inference. This review provides an overview of the recent literature investigating the role of the gut microbiota in sleep and sleep disorders in children and summarizes potential microbiota-based therapeutic strategies.

Pediatric Reports doi: 10.3390/pediatric18040093

Authors: Denis Ehrl Vadym Burchak Andrea Szelenyi Joerg-Christian Tonn Martin Staudt Dorothee Rabenhorst Mathias Kunz

Background and Importance: Congenital encephalocele refers to the protrusion of CNS tissue through a skull defect. As a rare neural tube malformation, clinical evidence is particularly limited for large encephaloceles, and management is subject to ongoing discussions. Clinical Presentation: A 3-month-old boy presented with a left hemisphere herniation above the level of the Sylvian fissure into a congenital parietal encephalocele. No focal deficits were appreciated. We hypothesized that early prenatal damage due to protruding brain tissue may have resulted in unihemispheric motor control of both body sides. As such, surgical repair guided by intraoperative electrophysiology and plastic reconstruction was scheduled. Intraoperatively, bilateral and symmetric extremity response upon transcranial electric stimulation of the contra-lesional right hemisphere was detected, whereas no responses from direct cortical and subcortical stimulation of the herniated brain parenchyma were elicited. Complete resection of the herniated supra-insular hemisphere was provided, and no ischemic changes or new deficits occurred. At 24-month follow-up, the patient showed voluntary movements with both upper extremities and voluntary grasping with his left (non-paretic) hand, no mirror movements, no signs of spasticity, good eye contact, and could speak several words. Conclusions: Safe resection with excellent outcome can be provided even for large encephaloceles. Intraoperative electrophysiological findings aid in identifying the absence of cortico-spinal projections and appear helpful to avoid post-operative deficits.

Pediatric Reports doi: 10.3390/pediatric18040092

Authors: Melania Vázquez-Ortega Héctor González-de la Torre María-Naira Hernández-De Luis Sergio Mies-Padilla Claudio-Alberto Rodríguez-Suárez

Background/Objectives: Acute bronchiolitis is one of the leading respiratory infections in infants and represents a substantial burden on healthcare services. Parents’ knowledge, attitudes and practices are key to its prevention and home management. The aim of this study was to analyze parents’ knowledge, attitudes, and practices regarding the prevention and home management of bronchiolitis in infants in Gran Canaria, Spain. Methods: A cross-sectional observational study was conducted. The Bronchiolitis Knowledge, Attitudes and Practices Questionnaire was used, comprising 26 items grouped into four dimensions: risk factors, signs and symptoms, prevention, and care/pharmacological support. Data were collected using an online questionnaire. Descriptive analyses, nonparametric tests, and multiple linear regression were performed. Statistical analysis was conducted using Jamovi (version 2.4.12). Statistical significance was set at p < 0.05. Results: A total of 162 parents were included. The mean normalized total score indicated an overall level of parental knowledge, attitudes, and practices regarding acute bronchiolitis. Prevention was the dimension with the lowest scores, whereas signs and symptoms and care/pharmacological support showed comparatively better results. Higher overall scores were associated with educational level and previous experience with bronchiolitis. Conclusions: Parents showed insufficient knowledge, attitudes and practices, particularly in relation to prevention. Targeted educational interventions are needed to improve the home management of bronchiolitis and help reduce healthcare burden.

Pediatric Reports doi: 10.3390/pediatric18040091

Authors: Lorenzo Gasparini Nicola Gobbi Daniele Zama Marcello Lanari

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

Pediatric Reports doi: 10.3390/pediatric18040090

Authors: Murat Demirekin Hatice Yalçın

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

Pediatric Reports doi: 10.3390/pediatric18040089

Authors: Vasiliki Georgousopoulou Georgios Manomenidis Aspasia Serdari

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

Pediatric Reports doi: 10.3390/pediatric18040088

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

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

Pediatric Reports doi: 10.3390/pediatric18040087

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

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

Pediatric Reports doi: 10.3390/pediatric18040086

Authors: Mariusz Olczyk Anna Socha-Banasiak Natalia Lwow Bartosz Waszczyk Elżbieta Czkwianianc

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

Pediatric Reports doi: 10.3390/pediatric18040085

Authors: Kostadin Gigov Petra Kavradzhieva Ivan Ginev Mihaela Prandzheva Mariya Miteva

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

Pediatric Reports doi: 10.3390/pediatric18040084

Authors: John Dotis Antonia Kondou Vasiliki Karava Maria Tsirevelou Ioannis Koutras Olympia Dadoudi George Liapis Despoina Tramma Maria Stamou Nikoleta Printza

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

Pediatric Reports doi: 10.3390/pediatric18040083

Authors: Georgina Domènech-Garcia Xavier Marimon Andoni Carrasco-Urribarren Alejandro E. Portela Caritat Bagur-Calafat

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

Pediatric Reports doi: 10.3390/pediatric18030082

Authors: Maurizio Aricò

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

Pediatric Reports doi: 10.3390/pediatric18030081

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

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

Pediatric Reports doi: 10.3390/pediatric18030080

Authors: Rita Nocerino Giorgia Cerase Emma Montella Albina Simeoli

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

Pediatric Reports doi: 10.3390/pediatric18030079

Authors: Mattia Pasquinucci Irene Marangoni Veronica Battistella Maria E. Pinto Alessandra Pasinato Fabio S. Chiarenza Davide Meneghesso

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

Pediatric Reports doi: 10.3390/pediatric18030078

Authors: Bui Thanh Liem Chu Van Thien Nguyen Trong Nghia Le Anh Phong Ngo Nhu Dinh Nguyen Huy Luan Phung Nguyen The Nguyen

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

Pediatric Reports doi: 10.3390/pediatric18030077

Authors: Vilya Bulgakova Artem Poromov Irina Leneva Natalia Pshenichnaya

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

Pediatric Reports doi: 10.3390/pediatric18030076

Authors: Gonca Vardar Giray Girgin Emel Kabakoglu Unsur Gulcan Seymen

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

Pediatric Reports doi: 10.3390/pediatric18030075

Authors: Alexandra-Antonela Obaciu Veronica Purdel Laura Bleotu Vlad Monescu Mariana-Alexandra Grecu Ioana Arbanas Oana Falup-Pecurariu

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

Pediatric Reports doi: 10.3390/pediatric18030074

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

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

Pediatric Reports doi: 10.3390/pediatric18030073

Authors: Yolanda Mayman Charné Petinger Brian van Wyk

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

Pediatric Reports doi: 10.3390/pediatric18030072

Authors: Yasuyo Kashiwagi Hironobu Okuno Takahito Moriyama Natsuko Inagaki Gaku Yamanaka

Persistent microscopic hematuria in children is often considered benign, yet recent evidence shows that a substantial proportion of affected individuals have underlying glomerular disease, particularly collagen IV-related nephropathies. We report a case of autosomal dominant Alport syndrome (ADAS) diagnosed just before discontinuation of long-term follow-up in a young woman initially presumed to have benign familial hematuria. The proband had persistent microscopic hematuria from early childhood, with normal renal function and no extrarenal manifestations. Her mother also had microscopic hematuria without kidney impairment, and the absence of accessible family history reinforced the assumption of benign familial hematuria. At age 42, the mother developed sensorineural hearing loss, and around the same time, the family learned that the maternal grandfather was undergoing dialysis for end-stage renal disease of unknown etiology. These findings prompted genetic testing, which identified a heterozygous pathogenic COL4A4 frameshift variant (c.2317_2318del; p.Arg773GlyfsTer14) in both the mother and the proband, confirming ADAS. This case illustrates the phenotypic variability of ADAS within a single family and highlights the limitations of relying solely on clinical features or incomplete family history. In contemporary practice, persistent glomerular hematuria warrants long-term follow-up and a low threshold for molecular testing of COL4A3-COL4A5, even in the absence of overt clinical signs. Earlier genetic evaluation would likely have enabled a timelier diagnosis in this case. This report underscores the importance of reassessing presumed benign hematuria and integrating genetic testing into the diagnostic approach for children and young adults with persistent microscopic hematuria.

Pediatric Reports doi: 10.3390/pediatric18030071

Authors: Nawaf M. Almuqati Mohammed Y. Al-Hindi Hibah A. Moussa Sama H. Alzahrani Manar A. Almuntashri Mansour A. Al-Qurashi Mawyah O. Barayyan Shaykhah M. Bin-Sifran

Objectives: We aimed to describe the healthcare utilization and economic burden of lower respiratory tract infections (LRTIs) among children aged 1–24 months across five tertiary hospitals in Saudi Arabia. Methods: This multicenter retrospective cohort study included 14,320 children diagnosed with LRTIs between August 2021 and July 2025. Data were extracted from the electronic medical records of the Ministry of National Guard Health Affairs. Demographics were analyzed using a patient-level dataset, whereas healthcare utilization and costs were evaluated at the episode level. Data were analyzed using descriptive and inferential statistics and multivariable logistic regression. Results: A total of 14,320 children contributed 22,895 LRTI-related episodes during the study period. Nearly half of the cohort (49.4%) were aged 1–6 months, and bronchiolitis was the predominant diagnosis (84.6%), followed by pneumonia (15.1%). Overall, 34.4% of patients required hospitalization, while 7.1% required ICU admission. LRTIs accounted for 21.0% of all pediatric ward admissions across participating hospitals. Total direct healthcare costs reached USD 23.0 million. Although ICU admissions represented only 7.1% of episodes, they accounted for 45.1% of total healthcare expenditures. In multivariable analysis, pneumonia was independently associated with higher odds of ICU admission compared with bronchiolitis (aOR 2.91, 95% CI 2.43–3.48; p < 0.001). Significant seasonal variation in LRTI episodes was observed, with higher episode volumes during winter months (p = 0.004). Conclusions: Pediatric LRTIs impose substantial clinical and financial burdens, particularly among younger infants, marked by disproportionate ICU-related costs.

Pediatric Reports doi: 10.3390/pediatric18030070

Authors: Bianca Ada Magnanini Irene Raso Sara Santacesaria Gaia Dell’Acqua Savina Mannarino

Artificial intelligence (AI) is rapidly transforming cardiovascular medicine, with growing applications in pediatric cardiology. AI techniques, particularly machine learning and deep learning, enable the analysis of complex and heterogeneous data, supporting diagnosis, risk stratification, and clinical decision-making. This paper provides an overview of current AI applications in this field, discusses existing challenges, and explores future perspectives. In pediatric cardiology, AI has shown promising results across multiple domains. In electrocardiography, AI algorithms improve diagnostic accuracy and enable early detection of cardiac conditions, even in asymptomatic patients, while facilitating telecardiology-based care pathways. In cardiac auscultation, AI-assisted digital stethoscopes enhance the distinction between innocent and pathological murmurs, supporting primary care physicians and optimizing referral to pediatric cardiologic centers. Multimodality imaging represents one of the most advanced areas of AI applications. In echocardiography, magnetic resonance and computed tomography, AI improves image acquisition, view classification, and automated quantification, contributing to more standardized and reproducible assessments. Additionally, emerging technologies such as virtual reality, integrated with AI, offer innovative tools for education, surgical planning, and patient-specific modelling. Despite these advances, several limitations remain, including limited availability of large pediatric datasets, challenges in model generalizability and issues related to interpretability and integration into clinical workflows. In conclusion, AI represents a powerful complementary tool in pediatric cardiology, with the potential to improve diagnostic accuracy, optimize healthcare resources and support the transition toward precision medicine.

Pediatric Reports doi: 10.3390/pediatric18030069

Authors: Ipshita Magh Rashmi Ranjan Das Ritwick Mohapatra Swarupa Panda Nirmal Kumar Mohakud

Background/Objectives: Bronchiolitis is the leading cause of hospitalization among infants, and early prediction of disease severity and clinical outcomes remains challenging. The Modified Tal (M-Tal) score is a clinical tool used to assess severity; however, its utility in predicting outcomes requires further validation. Methods: This prospective study was conducted over a 2-year period at a tertiary care teaching hospital. Infants aged 1–12 months diagnosed with moderate-to-severe bronchiolitis were enrolled. Demographic, clinical, management, and outcome data were recorded. Results: A total of 120 infants were included (mean age 7.7 months; 61.7% males). Moderate bronchiolitis accounted for 81.7% of cases. The mean duration of illness at admission was 4.1 days. Severe bronchiolitis was associated with significantly longer duration of oxygen therapy (p = 0.034) and hospital stay (p = 0.028). Each one-point increase in M-Tal score was associated with an increase of 0.69 days in hospital stay (p = 0.012), 9.8 h in oxygen requirement (p < 0.01), and 0.32 days in PICU stay (p = 0.04). Conclusions: The M-Tal score at admission is a useful predictor of clinical outcomes in infants with moderate-to-severe bronchiolitis. Higher scores are associated with increased need for respiratory support and prolonged hospitalization, supporting its role in early risk stratification and management planning.

Pediatric Reports doi: 10.3390/pediatric18030068

Authors: Tanja Poulain Juliane Ludwig Nico Grafe Andreas Merkenschlager Wieland Kiess

Background/Objectives: This longitudinal study examined the association between sleep duration, sleep difficulties, and sleeping place at one year (t1) and corresponding characteristics at 4/5 years of age (t2). Methods: Data were collected from 2018 to 2021 (t1) and from 2021 to 2024 (t2) in the LIFE Child cohort study conducted in Leipzig, Germany. Parents completed the Brief Infant Sleep Questionnaire at t1 and the Child Sleep Habits Questionnaire at t2. Associations between sleep characteristics at t1 and t2 were estimated using linear and logistic regression models. All associations were adjusted for child sex, age at t2, and maternal education. Results: The analyses showed significant associations between shorter sleep durations, later sleep onset times, more frequent nightly awakenings and bed sharing and room sharing at t1 and more sleep difficulties at t2. A shorter sleep duration at t2 was predicted by shorter sleep and more parent-perceived sleep difficulties at t1. Bed sharing and room sharing at t1 were significantly associated with a lower probability of sleeping alone at t2. Conclusions: These results indicate that sleep duration, sleep difficulties, and sleeping places are already stable in early childhood.

Pediatric Reports doi: 10.3390/pediatric18030067

Authors: Sanelisiwe Rosemary Mkhize Olufunmilayo Olukemi Akapo Siyonela Mlonyeni Mirabel Kah-Keh Nanjoh

Background: Pneumonia of viral and polymicrobial origin predominates the pathological profile of clinical childhood pneumonia, with high admissions rates in recent times. Identifying factors associated with prolonged hospital stay may aid in developing risk reduction strategies for improved admission outcomes. Methods: A facility-based historical cross-sectional study was conducted with a random selection of 186 medical records from January 2020 to December 2024 of children aged 0 to 5 with clinical pneumonia at a tertiary Hospital in Mthatha. Results: Over the five-year study period, clinical pneumonia accounted for 10.4% (95% CI: 9.8–11.1%, n = 950/9098) of the total under-five admissions. The median age was 108.5 (interquartile range (IQR) = 48.0–345.5) days, mainly comprising males (51.1%) and infants (65.2%), with viral (91.6%) and mild (88.0%) forms of pneumonia. The median length of hospital stay was 5 (IQR = 3.3–8) days, and 91 (49.5%) of the children had a prolonged hospital stay. In modified Poisson regression, infants [(relative risk (RR) = 2.7, 95% confidence interval (CI): 1.6–4.3), p < 0.001]; neonates (RR = 2.3, 95% CI: 1.2–4.6, p = 0.013); bacterial pneumonia (RR = 1.7, 95% CI: 1.2–2.6, p = 0.007); being hypoxic (RR = 2.2, 95% CI: 1.3–3.6, p = 0.003); absence of other respiratory tract infections (RR = 1.6, 95% CI: 1.2–2.1, p = 0.003), incomplete vaccination (RR = 1.5, 95% CI: 1.0–2.2, p = 0.038), non-usage of herbal medications (RR = 1.7, 95% CI: 1.3–2.2, p < 0.001), difficult breathing (RR = 1.7, 95% CI: 1.1–2.6, p = 0.028), current breastfeeding (RR = 0.6, 95% CI: 0.4–1.0, p = 0.048), other morbidities (RR = 0.7, 95% CI: 0.5–0.9, p = 0.002) were associated with prolonged length of hospital stay. Conclusion: Stratification of under-five children at admission according to age, type of pneumonia, vaccination status, and presence of other morbidities are needed to enhance monitoring and timely medical interventions.

Pediatric Reports doi: 10.3390/pediatric18030066

Authors: Anselm Chi-Wai Lee

Background. Acquired platelet dysfunction with eosinophilia (APDE) is a transient bleeding disorder initially thought to occur exclusively in Southeast Asia. There are no uniformly agreed diagnostic criteria, and its full clinical features have not been defined. Methods. A literature search was conducted through MEDLINE, EMBASE, and Google Scholar for publications on APDE in order to explore patient demography, epidemiology, diagnostic criteria, and laboratory findings of the disease. Results. Ten retrospective, observational studies, five case series, and 21 case reports were identified with a total of 431 patients. Diagnostic criteria varied, with a two-tier approach for the diagnosis of impaired platelet function. In recent years, cases of APDE have been reported extensively outside of the Malay peninsula. Male patients (243/390, 62.3%) predominated. Their ages ranged from 11 months to 30 years, with only 40 (9.3%) subjects aged 18 years or older. Eosinophilia was absent in 10 to 33% of subjects in a few observational studies. Thrombocytopenia was present in 42 (9.7%) subjects. Parasitic infestation was less common in the new millennium. Spontaneous recovery within six months was the trend, and serious complications were extremely rare. Conclusions. APDE is no longer restricted to Southeast Asia. A uniform set of diagnostic criteria is needed. Clinician awareness followed by reliable but easily available laboratory tests is essential to confirm diagnosis. It is proposed that rapid diagnosis can be accomplished by screening the blood smear for grey platelets by a trained examiner followed by confirmatory platelet aggregometry. National or international collaboration and prospective studies are required to delineate the core and variable clinical and laboratory features of APDE.

Pediatric Reports doi: 10.3390/pediatric18030065

Authors: Bogumiła Wójcik-Niklewska Zofia Oliwa Karina Dzięcioł Adrian Smędowski

Background and Clinical Significance: Blunt ocular trauma is a significant but often underestimated cause of visual impairment, particularly among adolescents involved in high-risk activities such as horseback riding. While most equestrian injuries affect the head and extremities, ocular trauma, especially commotio retinae, can result in severe visual complications. Case Presentation: We report the case of a 15-year-old girl who sustained blunt ocular trauma to the left eye following a fall from a horse and presented with decreased visual acuity. Multimodal imaging revealed outer retinal abnormalities on spectral-domain optical coherence tomography (OCT), including ellipsoid zone irregularities. Early-phase fluorescein angiography showed central hypofluorescence in the foveal region with surrounding mild mottled hyperfluorescence, without clear vascular abnormalities. Fundus photography demonstrated subtle macular changes. Visual acuity improved significantly following treatment, with partial resolution of macular changes, although mild outer retinal irregularities persisted on follow-up imaging. Conclusions: These findings underscore the importance of early ophthalmic evaluation and advanced retinal imaging in blunt ocular trauma. Given the high risk of visual injury during equestrian activities, especially in pediatric and adolescent populations, preventive strategies such as mandatory helmet use and rider education are essential. Implementation of standardized follow-up protocols is also recommended to monitor long-term retinal changes in patients with traumatic maculopathy.

Pediatric Reports doi: 10.3390/pediatric18030064

Authors: Or Brandes Chen R. Saar Orly Sapir-Budnero Amit Baumel

Background/Objectives: Digital parent training (DPT) programs offer scalable solutions for childhood disruptive behaviors but face significant engagement challenges. Although content tailoring may enhance outcomes, its clinical impact remains under-examined. This study aimed to (a) describe the correspondence between program recommendations, parental choices and engagement, and (b) examine how initial decisions are associated with subsequent engagement and therapeutic outcomes. Methods: A secondary analysis of three randomized trials included 151 parents of children (ages 3–7) with disruptive behaviors. Participants were classified as ‘Recommendation-Adherent’ (n = 63) or ‘Beyond-Recommendation’ (n = 88) based on whether initial content selections matched or exceeded program recommendations. Clinical outcomes (child behavior, parenting styles) and objective usage metrics were assessed at baseline and post intervention. Results: Many parents chose to expand the intervention scope beyond clinical recommendations (e.g., 91.5% selected the non-recommended Emotion Regulation module). However, this proactive initial intention did not increase objective engagement; groups did not differ significantly in total usage time, login days, or module completion rates. Although both groups showed comparable improvements in child behavior, intending to adhere to the recommended pathway was associated with significantly greater reductions in permissive parenting (laxness; p = 0.029) after adjusting for baseline differences. Conclusions: The findings highlight a discrepancy between parents’ intent to expand intervention scope and their actual engagement capacity. While the decision to adhere to a tailored pathway was associated with specific improvements in permissive parenting, the observational nature of the study precludes causal claims. Nevertheless, the results suggest that guided tailoring may serve as a protective function against choice overload. Aligning program demands with the practical realities of parental effort could help families focus finite energy on essential clinical targets.

Pediatric Reports doi: 10.3390/pediatric18030063

Authors: Mohammad Sabobeh Elizabeth Seewer William Hunt Stafford Nicolas Chiriboga Thomas Spentzas Shyam Popat Alyssa Clark David B. Kantor Hitesh S. Sandhu Saad Ghafoor

Background: Critically ill children requiring extracorporeal membrane oxygenation (ECMO) support are at high risk of immobility, deconditioning, and muscle loss. There is a lack of screening and diagnostic tools to quantify muscle loss in this population. Objective: This study aims to evaluate the use of bedside ultrasound as a practical and effective method for detecting muscle loss in this high-risk group. Materials and Methods: This is a secondary analysis of a prospective observational clinical study conducted between January 2024 and January 2025 that used ultrasound to describe muscle loss in critically ill children aged 2 to 18 years. Results: The primary study enrolled 35 patients, five of whom required ECMO support. All patients who required ECMO showed significant muscle loss (>10%) in the quadriceps femoris, as measured by muscle thickness and cross-sectional area, compared with baseline measurements obtained before ECMO cannulation. Conclusions: Point-of-care muscle ultrasound could be a reliable, cost-effective tool for assessing muscle loss in pediatric patients on ECMO.

Pediatric Reports doi: 10.3390/pediatric18030062

Authors: Taner Adiguzel Bulent Karadag

Background/Objectives: Childhood non-cystic fibrosis (non-CF) bronchiectasis is clinically heterogeneous. We aimed to describe fractional exhaled nitric oxide (FeNO) levels in affected children and examine associations with etiology, spirometry, and CT-defined disease extent. Methods: This single-center prospective observational study included 100 clinically stable children aged 6–18 years with CT-confirmed non-CF bronchiectasis evaluated between September 2014 and December 2015. FeNO was measured before spirometry using an online single-breath electrochemical technique. Chest CT was reviewed at the lobar level, with the lingula counted separately, and disease extent was summarized by the number of involved lobar regions. Associations were assessed using Spearman correlation and non-parametric tests. Results: Mean age was 14.9 ± 2.0 years, 55% were male, and mean FeNO was 20.9 ± 14.0 ppb. FeNO correlated positively with FEV1 (% predicted), FVC (% predicted), and FEF25–75 (% predicted) (all p < 0.01). FeNO was higher in males and adolescents than in females and younger children, respectively. FeNO did not differ by CT-defined lobar extent. It was lower in primary ciliary dyskinesia than in asthma overlap. Overall, 82% of the cohort received an ICS-containing maintenance regimen and household tobacco smoke exposure was present in 58%. Conclusions: FeNO was associated with selected functional indices and etiologic subgroups, but not with CT-defined structural extent, suggesting a greater role in clinical phenotyping than in reflecting radiologic burden. Rather than reflecting overall disease severity, FeNO may be more relevant as a marker of T2-leaning airway inflammatory phenotype in selected children with non-CF bronchiectasis. These findings should be interpreted as exploratory and hypothesis-generating, particularly for etiologic subgroup comparisons and for FeNO interpretation in the setting of treatment and environmental confounding.

Pediatric Reports doi: 10.3390/pediatric18030061

Authors: Tarlan Soumei Sara Hamideh Kerdar David D. Martin Parviz Rafiezadeh Ekkehart Jenetzky

Background/Objectives: Fever is a common concern among parents, often leading to heightened anxiety and misconceptions about its management. While fever phobia has been extensively studied in Western countries, data from the Middle East—particularly Iran—remain limited. Understanding parental knowledge and anxiety in this cultural context is essential for developing targeted educational interventions. This study aims to assess parental knowledge, behavior, and anxiety regarding fever in children and to identify factors associated with higher levels of anxiety among Iranian parents, thereby contributing culturally specific evidence to the international literature on pediatric fever management. Methods: A cross-sectional study was conducted involving 552 parents from Tehran, Iran, recruited through convenience sampling. Data were collected using self-administered questionnaires assessing demographic characteristics, knowledge about fever, treatment practices, and anxiety levels using a 10-point Likert scale. Principal component analysis (PCA) was performed to examine the underlying factors influencing parents’ decisions to reduce fever. Univariate and multivariate linear regression analyses on standardized z-values were conducted to determine the predictors of fever-related anxiety. Results: Results showed that 67.4% of parents experienced anxiety when managing their child’s fever, with 65.6% perceiving fever as harmful. Fear of febrile seizures (77.4%) and brain damage were significant concerns motivating parents to reduce fever. Female parental sex (β = 0.336, p = 0.004) and the perception of fever as harmful (β = 0.058, p < 0.001) were the strongest predictors of fever-related anxiety. The PCA identified two key factors influencing fever management behavior: well-being protection and medical risk prevention. Parents commonly treated fever using combinations with either Paracetamol or Ibuprofen (47.6%). Conclusions: Parental anxiety about fever in Iran is largely driven by misconceptions, especially regarding febrile seizures and brain damage. Culturally tailored education and clear communication from healthcare providers are essential to reduce these fears, improve fever management, and decrease unnecessary antipyretic use.

Pediatric Reports doi: 10.3390/pediatric18020060

Authors: Chiara Ionio Caterina Colombo Francesco Cavigioli Francesca Sala Rachele Cantella Marina Balestriero Giovanna Cardile Giulia Ciuffo Gianluca Lista

Background: Preterm birth increases the risk of socio-emotional difficulties and later behavioral problems. Early identification is essential, but the predictive value of socio-emotional assessments at different ages remains uncertain. Aim: This study sought to examine whether socio-emotional skills at 1, 2, and 3 years predict behavioral outcomes at 4 years in very preterm children. Methods: Fifty-seven preterm children were assessed longitudinally with the Bayley-III Socio-Emotional scale at 1, 2, and 3 years, and with the CBCL 1.5–5 at 4 years. Analyses included correlations, repeated-measures ANOVA, and regression models. Results: Mean socio-emotional scores were within the normative range at all ages, with a modest increase by age 3. Associations were observed between socio-emotional skills at 1 year and behavioral outcomes at 4 years, particularly internalizing and total problems. These associations were weaker at 2 years and not evident at 3 years. Regression analyses indicated that only 1-year socio-emotional scores were significantly associated with later outcomes, although models were unadjusted. Conclusions: Socio-emotional competencies at 1 year were associated with later behavioral outcomes in this sample of very preterm children. These findings suggest that early assessments may contribute to identifying children who could benefit from closer developmental monitoring, although further research with adjusted models is needed.

Pediatric Reports doi: 10.3390/pediatric18020059

Authors: Rogaya AlShugair Mansour Al-Qurashi Ahmad Mustafa Mohammad Y. Alhindi Abrar Ahmed Hend AlNajjar Mona AlDabbagh Ashraf Sahafi Hashim Almarzouki Nabila A. AlRashdi Eman A. AlThobaiti Syed Sameer Aga

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is among the most common inherited enzymatic disorders worldwide and is an important risk factor for neonatal hyperbilirubinemia. Regional data from Western Saudi Arabia based on universal newborn screening remain limited. Objectives: To determine the prevalence of G6PD deficiency among newborns delivered at a tertiary center in Jeddah, Saudi Arabia, and to evaluate its association with clinically relevant outcomes, including early-onset jaundice (<24 h), need for phototherapy, admission for hyperbilirubinemia management, and readmission after discharge. Methods: We conducted a retrospective cohort study at King Abdulaziz Medical City, Western Region, Jeddah, Saudi Arabia, between January 2020 and May 2025. Cord blood samples from live-born infants were screened using a qualitative fluorescent spot test. Demographic variables (sex, gestational age, birth weight) and jaundice-related outcomes were extracted from the electronic medical record. Categorical variables were compared using chi-square testing, with p < 0.05 considered statistically significant. Results: Among 14,964 screened newborns, 489 were identified as G6PD deficient, yielding a prevalence of 3.3%. Prevalence was higher in males than in females (5.6% vs. 0.9%). Among the G6PD-deficient infants, early-onset jaundice occurred in 17.2%, phototherapy was required in 36.0%, and 16.5% were admitted for hyperbilirubinemia management. Readmission for worsening jaundice requiring phototherapy occurred in 11.0%, and no exchange transfusions were required. Compared with term infants, late preterm infants had higher rates of early-onset jaundice (11/49, 22.4% vs. 73/440, 16.6%) and phototherapy use (22/49, 45.0% vs. 154/440, 35.0%) (p < 0.01). Conclusions: G6PD deficiency was identified in a substantial proportion of newborns in this large screened cohort and was associated with clinically significant jaundice-related outcomes, particularly among late preterm infants. These findings underscore the importance of universal screening and structured postnatal follow-up to reduce the risk of severe hyperbilirubinemia and its complications. Early identification of G6PD-deficient infants should be accompanied by careful bilirubin monitoring, clear discharge planning, and timely post-discharge follow-up, especially for those born late preterm.

Pediatric Reports doi: 10.3390/pediatric18020058

Authors: Ivonne Portaccio Enzo Picconi Tony Christian Morena Giorgio Conti Marco Piastra

Background: The landscape of paediatric oncology has undergone a remarkable transformation over recent decades. Advances in both oncological and supportive therapies have dramatically improved survival in children with haematological malignancies and solid tumours, with current survival rates exceeding 80% for many childhood cancers. However, this therapeutic success has brought with it an unexpected consequence: the intensification of treatment protocols has led to a parallel increase in life-threatening complications requiring intensive care support. Current evidence indicates that up to 40% of paediatric oncology patients will require admission to a Paediatric Intensive Care Unit (PICU) at some point during their disease trajectory. Objectives: This comprehensive review synthesises current evidence to provide an updated framework for PICU admission decision-making in oncology haematology patients. We have integrated the most recently published international guidelines, including the groundbreaking Phoenix 2024 sepsis criteria and the updated PALICC-2 2023 recommendations for paediatric acute respiratory distress syndrome. Beyond establishing admission criteria, we critically analyse the efficacy of advanced support strategies and examine emerging therapeutic approaches in this uniquely vulnerable population. Methods: Our methodology encompassed a systematic review of the literature published between 2011 and 2024, complemented by a detailed analysis of current international guidelines and expert consensus statements. We included randomised controlled trials, observational studies, meta-analyses, and consensus conference proceedings specifically addressing the intensive care management of paediatric patients with oncological or haematological conditions. Main Results: Several key findings emerge from our analysis. The Phoenix 2024 criteria represent a fundamental reconceptualisation of paediatric sepsis diagnosis, validated through an unprecedented dataset encompassing more than 3 million paediatric encounters. In the realm of respiratory support, early implementation of non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) has demonstrated remarkable efficacy, reducing the need for invasive mechanical ventilation by 45% (RR 0.45, 95% CI 0.26–0.78) when applied to appropriately selected patients. Extracorporeal membrane oxygenation (ECMO), whilst increasingly utilised, shows survival to decannulation ranging from 52% to 64%, though survival to hospital discharge remains less encouraging at 36–42%. Continuous renal replacement therapy (CRRT) has proven highly effective for tumour lysis syndrome, achieving metabolic correction in 90% of severe cases. Perhaps most promisingly, emerging biomarkers—particularly interleukin-6, interleukin-10, and procalcitonin—have substantially enhanced our ability to stratify infection risk, demonstrating sensitivity exceeding 85% for bacteraemia detection. Conclusions: The evidence unequivocally supports several core principles for optimising outcomes in this population. Early identification of deterioration through validated scoring systems enables timely intervention before irreversible organ failure develops. Prompt implementation of non-invasive respiratory support, when appropriately applied, can obviate the need for mechanical ventilation with its attendant complications. Perhaps most critically, centralisation of care in centres with dedicated expertise and comprehensive support capabilities fundamentally improves survival. These findings argue compellingly for the establishment of a formal national network of reference centres, implementing standardised protocols and structured care pathways specifically designed for critically ill paediatric oncology haematology patients.

Pediatric Reports doi: 10.3390/pediatric18020057

Authors: Akash Daswaney Nirali Borad Anhthu Trinh Stephanie Thompson Youmna Mousattat

Vitamin C, also known as ascorbic acid, plays a pivotal role in forming blood vessels, cartilage, muscles, and collagen in bones. We report a 6-year-old non-verbal female with global developmental delay who presented with complaints of lower limb pain and inability to bear weight. Symptoms started five weeks prior to presentation and had progressed from decreased activity to complete loss of weight-bearing. Physical examination showed gingival hyperplasia, perifollicular petechiae, lower limb edema, and corkscrew hair. Initial radiologic findings raised concerns of osteomyelitis, showing bone marrow edema, periosteal reaction, and cortical irregularity. However, correlation with dietary history limited to flavored milk and yogurt and lacking fruits and vegetables, in conjunction with clinical presentation, suggested vitamin C deficiency, and she was started on ascorbic acid. Vitamin C deficiency was later confirmed on day 7 by a low C deficiency level (<0.1 mg/dL). Treatment with ascorbic acid, multivitamins, and supportive therapy led to gradual recovery, and gastrostomy tube placement facilitated supplementation. This case highlights the importance of detailed dietary history and recognition of clinical signs of vitamin C deficiency. Early dietary assessment and clinical correlation can prevent unnecessary invasive procedures and prolonged antibiotic therapy. Early identification enables timely intervention, reducing morbidity and improving quality of life.

Pediatric Reports doi: 10.3390/pediatric18020056

Authors: Jiraporn Khorana Juthamas Jenyongsak Kanokkan Tepmalai Sireekarn Chantakhow

Background/Objectives: Hirschsprung disease (HSCR) is a congenital condition characterized by absence of ganglion cells in the distal bowel. The principle of surgical treatment is resection of the aganglionic bowel with restoration of intestinal continuity. Several operative techniques have been developed. This study aimed to compare outcomes between the Duhamel procedure and transanal endorectal pull-through (TERPT) in Hirschsprung disease using propensity score-based methods. Methods: Hirschsprung patients who underwent Duhamel or TERPT from January 2006 to December 2021 were included. The primary outcome was a composite endpoint at 6 months comprising obstructive symptoms, fecal soiling, or Hirschsprung-associated enterocolitis. Propensity scores were estimated via logistic regression incorporating eight preoperative covariates. The primary analysis employed overlap weighting (ATO), with multiple sensitivity analyses performed to assess robustness. Results: A total of 239 patients were included (TERPT, n = 181; Duhamel, n = 58). Before weighting, seven of eight covariates demonstrated meaningful imbalance (SMD > 0.10); ATO weighting achieved satisfactory balance across all covariates (all SMD < 0.10). A good composite outcome was achieved in 51.9% of TERPT and 53.4% of Duhamel patients, with no significant difference in the primary ATO-weighted analysis (OR 0.94, 95% CI 0.39–2.28; p = 0.897). No significant differences were observed in individual outcome components. Findings were consistent across all sensitivity analyses. TERPT was associated with significantly shorter operative time, lower estimated blood loss, and shorter hospital stay (all p < 0.001). Conclusions: No statistically significant differences were detected in 6-month postoperative functional outcomes between TERPT and the Duhamel operation. TERPT was associated with improved perioperative outcomes. However, these findings should be interpreted with caution due to limited statistical power and baseline differences between groups. Prospective multicenter studies with standardized outcome definitions and longer follow-up are warranted.

Pediatric Reports doi: 10.3390/pediatric18020055

Authors: Adrianna Ćwiertnia Laura Chuchla Tomasz Ociepa

Candida dubliniensis is an opportunistic yeast closely related to Candida albicans and an uncommon cause of central nervous system (CNS) infection. While isolates are often susceptible to azoles, reduced susceptibility or acquired resistance may occur, making species identification and antifungal susceptibility testing clinically relevant. We report a 3-year-old boy with Philadelphia chromosome-positive B-cell precursor acute lymphoblastic leukemia (ALL) in hematologic remission who developed chronic meningitis during maintenance chemotherapy. The initial presentation was non-specific (marked somnolence without fever or meningeal signs) and lumbar puncture performed to exclude CNS relapse revealed neutrophil-predominant pleocytosis and elevated protein; the cerebrospinal fluid (CSF) culture grew C. dubliniensis. Treatment with intravenous liposomal amphotericin B followed by prolonged fluconazole led to clinical improvement and sterile CSF. Six months later, progressive gait disturbance, limb pain, and episodic severe headaches recurred; repeat CSF cultures again yielded C. dubliniensis, with a changed susceptibility profile. Spine MRI demonstrated leptomeningeal enhancement involving the cauda equina nerve roots. Intravenous voriconazole with therapeutic drug monitoring was initiated and combined with intrathecal liposomal amphotericin B (seven doses, dose-escalated up to 3 mg), which was well tolerated and associated with rapid neurologic improvement, CSF sterilization, and radiologic resolution. At 12 months of follow-up, the patient remained infection-free and in leukemia remission. This case highlights that C. dubliniensis chronic meningitis may present subtly yet progress, requiring repeated CSF cultures with susceptibility testing; intrathecal liposomal amphotericin B can be a safe and effective adjunct to systemic therapy in refractory or recurrent disease.

Pediatric Reports doi: 10.3390/pediatric18020054

Authors: Raisa-Maria Sucaciu Alina Grama Alexandra Mititelu Bianca Raluca Mariș Ioana Filimon Bobe Petrushev Daniel Cristian Popescu Gabriel Benţa Tudor Lucian Pop

Background. Autoimmune sclerosing cholangitis (ASC) is a rare clinical entity characterized by overlapping features of autoimmune hepatitis and primary sclerosing cholangitis. It predominantly affects pediatric patients. Therapeutic management is often complex, requiring a multidisciplinary and individualized approach, especially in the context of associated autoimmune diseases. Case presentation. We present the case of a female patient diagnosed at the age of 10 with ASC, for which immunosuppressive therapy with prednisone, azathioprine (AZA), and ursodeoxycholic acid (UDCA) was initiated, with an initially favorable course. One year later, following a Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, the patient experienced reactivation of liver disease and subsequently developed ulcerative pancolitis (UC), for which 5-aminosalicylic acid (5-ASA) therapy was initiated. Due to repeated hepatic flares and/or colitis relapses, therapy was escalated successively to mycophenolate mofetil, tacrolimus, and eventually infliximab (IFX). Despite treatment, the liver disease progressed, culminating in liver cirrhosis. Our patient developed portal hypertension and esophageal varices, with two episodes of upper gastrointestinal bleeding requiring endoscopic band ligation. At the age of 14, the patient developed recurrent episodes of non-infectious ulcerative stomatitis. Biopsy of the lesions revealed non-specific chronic inflammation, unrelated to colitis activity (confirmed microscopic remission of UC). By exclusion, an adverse drug reaction was suspected, with AZA being the most likely cause. Following its discontinuation, the lesions resolved. Beyond the physiological and therapeutic aspects, the patient displays marked emotional fragility due to prolonged and repeated hospitalizations (18 out of 60 months), which have impacted treatment adherence. Conclusions. This case highlights the complexity of managing pediatric patients with multiple autoimmune diseases. The necessary combination of immunosuppressive therapies may lead to significant adverse effects and further complicate disease progression. Moreover, psychological components play a crucial role in treatment compliance and therapeutic success, emphasizing the need for an integrated approach that includes specialized psychological support.

Pediatric Reports doi: 10.3390/pediatric18020053

Authors: Giovanni Giulio Valtolina Diego Boerchi Luca Milani

Background: research suggests that adolescents with a migrant background may be particularly vulnerable to behavioral addictions, including problematic gaming and Internet use. Methods: we compared Italian (ITA) and non-Italian (WIC) students on Internet Gaming Disorder (IGD) and Internet Addiction (IA) and examined whether coping strategies and interpersonal-relationship quality were associated with these outcomes, using robust linear models estimated with the GENLIN procedure in IBM SPSS Statistics 31 and regression-based models on observed variables. A total of 535 students (64.5% female; aged 9–18) completed the Video Games Addiction Questionnaire (VGA), the Internet Addiction Test (IAT), the Children’s Coping Strategies Checklist–Revised (CCSC), and the Assessment of Interpersonal Relations (AIR). Results: robust generalized linear models showed that WIC adolescents reported significantly higher IGD levels than their Italian peers, while no differences emerged for IA. Gender differences were evident only in unadjusted models, with males reporting higher IGD and females higher IA; however, these effects were not significant once age and nationality were considered simultaneously. Age was positively associated with IA but not with IGD. Avoidance coping was associated with higher levels of both IGD and IA, whereas active coping was negatively associated with IGD. Relationship quality was not associated with IGD but showed protective effects for IA: better relationships with mothers and with both male and female peers were associated with lower IA scores. Overall, the findings highlight that IGD and IA follow partially distinct developmental patterns. Migrant background emerged as a specific vulnerability factor for IGD, while IA appears more closely linked to age-related processes, coping styles, and interpersonal-relationship quality. Conclusions: the results call for differentiated prevention and intervention approaches targeting the distinct etiological mechanisms of each problematic behavior, focusing on coping and migration-related stress and belonging for IGD, and on strengthening coping repertoires and relational resources for IA.

Pediatric Reports doi: 10.3390/pediatric18020052

Authors: Damiano Rizzi Lavinia Barone Alessandra Balestra Maria Montanaro Francesca Nichelli Emanuela Schivalocchi Giulia Rampoldi Marco Spinelli Giulia Ciuffo Letizia Pomponia Brescia Valerio Cecinati Marco Zecca Claudia Greco Francesca Lionetti Jessica Rotella Giulia Gambini Catherine Klersy Chiara Ionio

Background: A paediatric cancer diagnosis is a profound stressor for the entire family system. Although coping strategies are well-studied, their link to the quality of the parent–child attachment relationship remains less explored. In this study, we investigated whether dyadic attachment dynamics—specifically closeness and conflict between parent and child—are associated with the use of adaptive or maladaptive coping strategies in caregivers of children undergoing active treatment for oncohaematological diseases. Methods: We conducted a multicentre, cross-sectional study across three Italian paediatric oncohaematology centres. A total of 165 caregivers of 91 paediatric patients aged 3–17 years completed self-report measures assessing parent–child relationship quality (Child–Parent Relationship Scale-CPRS), coping strategies (COPE-NVI), perceived social support (MSPSS), and resilience (RS-14). We tested whether the quality of the parent–child attachment relationship is associated with caregivers’ coping strategies. We hypothesised that Attachment Closeness would be associated with adaptive coping (Positive Attitude, Social Support, Problem Orientation), whereas Attachment Conflict would be associated with maladaptive coping (Avoidance). We conducted multiple linear regression models, adjusted for key covariates and with robust standard errors clustered at the family level, to test these hypotheses. Results: Higher levels of emotional closeness (CPRS) were significantly associated with greater use of adaptive coping strategies, specifically Positive Attitude (β = 0.20, p = 0.049) and Problem Orientation (β = 0.26, p = 0.002), even after controlling for sociodemographic factors, social support, and resilience. Conversely, higher levels of relational conflict were significantly associated with greater use of the maladaptive Avoidance strategy (β = 0.14, p = 0.015). The hypothesis linking closeness to Social Support seeking was not supported. Conclusions: The findings suggest that the parent–child attachment relationship is a significant correlate of caregiver coping strategies in caregivers of children with cancer. Interventions aimed at supporting the caregiver–child dyad by fostering emotional closeness and reducing conflict may promote more adaptive parental coping mechanisms, thereby enhancing family resilience and psychological adjustment throughout the treatment journey.

Pediatric Reports doi: 10.3390/pediatric18020051

Authors: Francesco Accomando Vittorio Albertazzi Francesco Girelli Michela Biscarini Melodie O. Aricò Enrico Valletta

Background: Systemic lupus erythematosus (SLE) may present with heterogeneous clinical manifestations in pediatric patients. Although infections are a major cause of morbidity and mortality in SLE, severe bacterial infections rarely represent the presenting clinical event leading to diagnosis. Case description: We report the case of a 13-year-old boy diagnosed with SLE with Sjögren’s syndrome overlap who presented with pneumococcal sepsis. The patient was admitted with high-grade fever and facial swelling, and blood cultures grew Streptococcus pneumoniae. Although an initial clinical response to antibiotic therapy was observed, fever subsequently recurred, accompanied by persistent systemic symptoms and progressive laboratory abnormalities. Further investigations revealed hematologic abnormalities, serosal involvement, renal disease, and a characteristic autoantibody profile. The patient fulfilled the 2019 ACR/EULAR classification criteria for SLE after comprehensive autoimmune evaluation. The overlap with Sjögren’s syndrome was supported by the autoantibody profile and imaging findings involving the parotid glands. Following treatment with intravenous methylprednisolone pulses, oral prednisone, hydroxychloroquine, and mycophenolate mofetil, the patient showed rapid clinical improvement and sustained remission. Conclusions: This case highlights that severe invasive bacterial infection may occasionally be the clinical circumstance that leads to the diagnosis of pediatric systemic lupus erythematosus. Persistent systemic inflammation or evolving multisystem involvement despite appropriate antimicrobial therapy should prompt consideration of an underlying autoimmune disease, even in patients without a prior history of immune dysfunction.

Pediatric Reports doi: 10.3390/pediatric18020050

Authors: Kerttu Kivisikk Pilvi Ilves Mairi Männamaa Eve Õiglane-Shlik Nigul Ilves Norman Ilves Inga Talvik Dagmar Loorits Pille Kool Rael Laugesaar

The aim of this study was to assess long-term outcomes in patients with different vascular types of childhood stroke. Methods: Data for children with childhood stroke (aged 29 days to 18 years) were collected from the Estonian Pediatric Stroke Database. Outcomes (death, recurrent stroke, epilepsy, neurodevelopmental outcome by pediatric stroke outcome measure (PSOM)) were assessed at a minimum of two years after stroke. Results: Long-term outcome data were available for 44 patients with childhood stroke (including three patients who died of stroke). According to the PSOM, based on gender, age, location of stroke and epilepsy, there were no differences in outcomes, but patients with a Pediatric NIH Stroke Scale (PedNIHSS) score of ≥6 had worse outcomes compared to patients with a score of <6. Children with arterial hemorrhagic stroke (AHS) were more likely to die, suffer from epilepsy and develop problems in the cognition/behavior PSOM subscale compared to children with arterial ischemic stroke (AIS). Combined poor outcomes (epilepsy, PSOM ≥ 1, recurrent stroke, mortality) occurred in 75% (33/44) of all patients with long-term outcome data. Conclusions: Combined poor outcomes occurred in 75% of the patients with childhood stroke. Patients with AHS showed higher mortality and worse long-term outcomes compared to patients with AIS in certain neurodevelopmental domains.

Pediatric Reports doi: 10.3390/pediatric18020049

Authors: Stanimira Elkina Irina Halvadzhiyan Venetsiya Bozhanova

Background: Secondary pseudohypoaldosteronism (PHA) is a rare, transient condition caused by renal tubular resistance to aldosterone, most commonly associated with urinary tract infection (UTI) and/or congenital anomalies of the kidney and urinary tract (CAKUT). It mimics primary adrenal disorders, presenting with life-threatening electrolyte disturbances in early infancy. Case Presentation: We report a male infant admitted twice within the first four months of life with severe dehydration, hyponatremia, hyperkalemia, metabolic acidosis, and acute kidney injury (AKI). Urine cultures grew Klebsiella pneumoniae and later Escherichia coli. Imaging studies demonstrated obstructive CAKUT, including posterior urethral valves, bilateral megaureters, hydronephrosis, and bladder diverticulosis. Congenital adrenal hyperplasia was excluded. Further evaluation showed markedly elevated plasma renin and aldosterone levels, confirming secondary PHA. The patient was successfully treated with intravenous fluids, electrolyte correction, and antibiotic therapy. Subsequently, oral sodium chloride and bicarbonate supplementation were added. Stepwise surgical correction of the urinary tract anomalies was initiated. Conclusions: Secondary PHA should be considered in infants presenting with failure to thrive, dehydration, hyponatremia, and hyperkalemia, particularly in the presence of UTI or CAKUT. Early recognition and differentiation from primary adrenal disorders are essential to prevent life-threatening complications. Prompt correction of electrolyte imbalance and management of the underlying urinary tract pathology are crucial for favorable outcomes.

Pediatric Reports doi: 10.3390/pediatric18020048

Authors: Matvei A. Mozhaev Samuel J. Thomas Evfrosiniia A. Mozhaeva Vraj S. Patel Mia N. Aboukhaled Antonia Bartlett Muhammad Ansari Brooke N. Shook Mark M. Walsh

Background/Objectives: An 8-kg, 16-month-old child was brought to the emergency department of a regional community hospital with shallow respirations. Due to her pallor and the diluted appearance of the first blood sample, the emergency physician suspected sepsis associated with severe anemia. Her first laboratory results revealed a hemoglobin of 1.7 g/dL. Subsequent laboratory data revealed positive fibrin split products and hypofibrinogenemia with reticulocytosis. Because this regional community hospital did not have a pediatric intensivist, the emergency physician instead consulted a neonatal intensivist for guidance. Methods: A femoral intraosseous line was placed to allow aggressive massive transfusion. After consultation with the neonatal intensivist, packed red blood cells were transfused at a rate of 30 mL/kg/h. After transfusion, the patient became agitated and required repeated paralytic, sedative, and analgesic boluses of succinylcholine, ketamine, midazolam, dexmedetomidine, and fentanyl, with fentanyl and dexmedetomidine drips. The patient arrived at a tertiary care center 13 h after admission. Results: At the tertiary care center, the patient was weaned off the drips and was theorized to have secondary autoimmune hemolytic anemia due to sepsis after positive direct and indirect Coombs test. She was treated with a course of antibiotics, including cefepime and vancomycin, without steroids or immunotherapy. Five months later, her hemoglobin had returned to 12.1 g/dL, and she tested negative on direct and indirect Coombs test. Conclusions: This case highlights the importance of collaboration between and within departments to successfully manage pediatric hemostatic resuscitation.

Pediatric Reports doi: 10.3390/pediatric18020047

Authors: Helena Ferreira Carolina Pinto da Costa Sofia Silva Faria Ana Luísa Correia Sofia Aroso

Background/Objectives: This aim of this study was to describe the demographic, clinical, and laboratory characteristics of hospitalized children with benign acute childhood myositis (BACM) and to evaluate seasonal patterns, including changes observed during the COVID-19 pandemic. Methods: We conducted a retrospective single-center review of pediatric patients hospitalized with a diagnosis of BACM between January 2016 and December 2024. Clinical, laboratory, and epidemiological data were analyzed, including seasonal distribution before and after the COVID-19 pandemic. Results: We identified 47 cases of BACM, with a male predominance (66%) and a median age of 7 years. Most cases (72%) occurred during autumn and spring. The most common prodromal symptoms were fever, cough and rhinorrhea. Bilateral calf pain was the most frequent presenting symptom. The median creatine phosphokinase (CPK) level was 4986 U/L, with higher values in boys (p = 0.040). Higher CPK levels were associated with longer hospital stays in our cohort (p = 0.030). Influenza B was the most frequently identified pathogen (63%). No BACM cases were recorded during the COVID-19 pandemic period (2020–2022), followed by an increase in 2024. All patients fully recovered, with a median hospital stay of 3.2 days. Conclusions: BACM is a self-limiting condition with a characteristic clinical and laboratory profile. The absence of cases during the COVID-19 pandemic suggests a possible association between reduced viral circulation and BACM incidence. Awareness of its typical presentation may support early diagnosis, reduce unnecessary investigations, and facilitate appropriate clinical management.

Pediatric Reports doi: 10.3390/pediatric18020046

Authors: Yumeng Wu Yandi Chen Qiong Zhang Yiran Peng Jing Zou

Objectives: This study aimed to investigate preventive management strategies and optimal intervention timing for dental ankylosis of primary teeth complicated by suspected pre-eruptive intracoronal resorption (PEIR), providing an evidence-based framework for clinical diagnosis and management. Methods: This case retrospectively reports a 7-year-old patient with an ankylosed mandibular left second primary molar (tooth 75), exhibiting radiographic features suggestive of pre-eruptive intracoronal resorption. The patient was in the mixed dentition stage with dental crowding. Preventive and interceptive orthodontic management was implemented to address space deficiency and guide occlusal development. The timing of extraction and space maintenance of tooth 75 was guided by space regaining, PEIR lesion progression, and crown development of tooth 35. Results: The permanent successor of tooth 75 (tooth 35) erupted successfully, dental crowding was alleviated, and a favorable occlusion was established. Conclusions: Early diagnosis and timely, individualized intervention for ankylosed primary teeth play an important role in preventing malocclusion and promoting normal eruption of the permanent successor tooth.

Pediatric Reports doi: 10.3390/pediatric18020045

Authors: Gennaro Confuorto Renato Baldi Elisa Cigarini Giorgio Di Lorenzo Silvia Menabue Federico Spagnolo Margherita Trani Massimo Zanni Livio Presutti Daniele Marchioni Paolo Gambelli

Background: Pediatric adenotonsillectomy is commonly performed for infectious and obstructive indications, but postoperative hemorrhage remains a concern. This study describes outcomes from a high-volume territorial network in southern Modena province, Italy. Methods: Retrospective observational study of 10,753 pediatric patients (aged 3–18 years) undergoing adenotonsillectomy at Sassuolo Hospital and affiliates (Vignola, Pavullo) from 2005 to 2024. Indications included recurrent tonsillitis (Paradise criteria), obstructive sleep apnea (OSA) (polysomnography-confirmed or clinical), and recurrent otitis media or otitis media with effusion (OME). Surgical techniques included curettage adenoidectomy and Colorado microdissection needle tonsillectomy. Our institutional postoperative care protocol included analgesics, oral hydration, soft diet, antibiotics (amoxicillin) and scheduled follow-up; however, no analysis regarding this protocol was intended to demonstrate correlations with study outcomes. Primary outcomes were postoperative hemorrhage (overall and requiring revision), stratified by indication, age, and technique, and contextualized against ranges reported in large published cohorts (qualitative, exploratory comparison). Secondary outcomes included pain (VAS scores), infection rates, and tissue regrowth. Data completeness was verified via electronic records (95.6%). Statistical analyses used descriptive statistics with 95% confidence intervals (95% CI) and inferential tests for within-cohort comparisons (χ2 tests, Fisher’s exact test, and t-tests where appropriate). Results: A total of 10,753 procedures were analyzed (4325 tonsillectomies, 3942 adenotonsillectomies, 2486 adenoidectomies). Postoperative hemorrhage occurred in 202 patients (1.88%; 95% CI 1.64–2.15%); surgical revision was required in 75 (0.70%; 95% CI 0.56–0.87%), with multifactorial stratification showing higher risk for infectious indications (OR 1.41 vs. OSA), younger age < 5 years (OR 2.1), and tonsillectomy origin (OR 8.25 vs. adenoidectomy); all rates are at the lower end of literature ranges (2–5% and 0.9–2.5%, respectively), in line with large published cohorts, although these comparisons are qualitative and exploratory. Mean VAS pain scores decreased from 3.2 (day 1) to 1.1 (day 7). No significant infections occurred; tissue regrowth rates aligned with the literature (adenoidal 6–26%, tonsillar 5–10%). Conclusions: Sassuolo Hospital’s experience highlights favorable postoperative outcomes and low complication rates in adenotonsillar surgery. Limitations include the retrospective design, potential selection bias and long period evaluation. Prospective studies are needed to confirm these findings.

Pediatric Reports doi: 10.3390/pediatric18020044

Authors: Albina Ponosheci Biçaku Kurtesh Sherifi Ardian Biçaku Sadije Namani

Background: Tuberculous meningitis (TBM) is the most severe manifestation of tuberculosis in children, with high mortality rates and long-term neurological sequelae. Early diagnosis is challenging due to its nonspecific symptoms and insidious onset. Case Presentation: An 8-year-old previously healthy male, fully vaccinated, presented with a two-week history of fever, headache, vomiting, and abdominal pain. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis, elevated protein, and low glucose levels, while multiplex polymerase chain reaction (PCR) testing for bacteria and viruses yielded negative results. Brain computed tomography (CT) revealed mild ventricular dilation and pansinusitis. Empirical antibacterial and antiviral therapy were initiated; however, the patient subsequently experienced neurological deterioration, including cranial nerve deficits and hemiparesis. Brain magnetic resonance imaging (MRI) demonstrated acute infarctions of the basal ganglia, raising suspicion for TBM. Repeated CSF sampling and Xpert MTB/RIF assay confirmed infection with Mycobacterium tuberculosis. Anti-tuberculosis treatment was initiated in combination with adjunctive corticosteroids, anticonvulsant and anticoagulant therapies, and supportive care, including neurosurgical intervention for hydrocephalus. After 16 months of treatment, the patient showed clinical improvement but sustained left-sided hemiparesis, visual impairment, and cognitive deficits. Conclusions: This case highlights the diagnostic challenges of pediatric TBM in immunocompetent and Bacillus Calmette–Guérin (BCG)-vaccinated children, particularly in the presence of initially negative microbiological findings. It emphasizes the importance of maintaining a high index of clinical suspicion and the crucial supportive role of neuroimaging findings, as well as the earlier initiation of empirical TB therapy especially when epidemiological plausibility exists. Early recognition and intervention remain critical to reducing morbidity and mortality associated with this devastating disease.

Pediatric Reports doi: 10.3390/pediatric18020043

Authors: Abby Marks Meghan Berthelot Hana Jones Anna Kate Taylor Karis Chang Sydney Crozier Sharon M. Cosper

Background/Objectives: The proportion of teenagers with access to a smartphone has reached 89 percent, marking a large increase in access to technology. Adolescence is a period of neuroplasticity where functional, structural, and systemic changes occur. Teenagers have experienced more persistent feelings of sadness and suicidality in recent years than ever before. Given the changes in this generation of adolescents and because adolescence is a period of neuroplasticity, this study seeks to understand the effects of smartphone use in adolescence. Methods: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A total of 104 articles met the criteria for inclusion. Results: Analysis of results revealed five key themes: Psychological Disturbances (n = 52), Sleep (n = 43), Socioemotional Function (n = 23), Executive Function (n = 14), and Sensory Processing (n = 1). Conclusions: Results suggest that smartphones have a variety of effects on adolescent brain function that are primarily negative. The results of this study can inform the general population about the ways in which smartphone usage affects adolescent brain functioning. Further research is warranted to determine a causal relationship between smartphone use and adolescent brain functioning.

Pediatric Reports doi: 10.3390/pediatric18020042

Authors: Dumitru Marius Dănilă Cristina-Mihaela Popescu Irina Profir Ada Ștefănescu Gabriela Gurău

Background: Pancreatic trauma (PT) in children is rare and associated with significant morbidity. The optimal form of management—operative versus non-operative—remains controversial, particularly in the presence of acute post-traumatic peripancreatic fluid collection, which may later evolve into pancreatic pseudocysts. Isolated pancreatic injuries without associated organ damage are uncommon and pose diagnostic and therapeutic challenges. Case Presentation: We report a 5-year-old boy who sustained an isolated grade IB blunt pancreatic head contusion following blunt abdominal trauma after falling onto a wooden fence. He presented with epigastric pain, repeated emesis, and an abdominal wall bruise. Initial ultrasound (US) findings were subtle; however, serial imaging and contrast-enhanced computed tomography (CECT) revealed focal contusion of the pancreatic head/uncinate process with a small peripancreatic fluid collection. Pancreatic enzymes were markedly elevated, with peak serum lipase reaching approximately 6579 U/L. The child remained hemodynamically stable and was managed conservatively with bowel rest, intravenous fluids, octreotide, proton-pump inhibition, pancreatic enzyme replacement therapy (PERT), and antibiotics. Serial US demonstrated the dynamic evolution of an acute peripancreatic fluid collection (APFC) (~2 cm), which remained stable without complications. Clinical and biochemical parameters gradually improved, and no invasive intervention was required. The patient was discharged on hospital day 16 with planned outpatient imaging follow-up. Conclusions: This case demonstrates that isolated pediatric pancreatic contusions complicated by small, evolving peripancreatic fluid collections can be safely managed non-operatively in hemodynamically stable patients. Serial ultrasound plays a key role in monitoring lesion evolution and guiding management decisions. In accordance with current pediatric trauma guidelines, careful observation with structured follow-up may prevent unnecessary invasive interventions while achieving excellent clinical outcomes.

Pediatric Reports doi: 10.3390/pediatric18020041

Authors: Martha J. Arias-Mendoza Emilia M. Ochoa-Acosta Andrés A. Agudelo-Suárez

Background/Objectives: The assessment of knowledge, attitudes, and practices (KAP) has been utilized to establish effective strategies for improving oral health in various communities. This study evaluated the effect of an educational strategy on mothers’ knowledge and practices regarding their children’s oral health. Methods: A before-and-after design was conducted in Santander, Colombia. The educational strategy was delivered through interactions with mothers via face-to-face and digital modalities. A structured questionnaire related to oral health knowledge and practices was administered before and after the educational intervention. Descriptive and paired tests were applied to observe statistically significant differences (before–after). Per-Protocol Analysis (PPA) and Intention-to-treat (ITT) analysis were performed. Ethical approval was obtained (CEBIC, 2022). Results: Fifty-eight mothers participated (median age 27 ± IQR 7 years). Observed pre–post changes were observed in the knowledge and practice dimensions, with statistically significant increases in scores and a shift from lower to higher performance categories (p < 0.001). Effect sizes ranged from moderate to large (r = 0.34–0.96), although their magnitude should be interpreted cautiously. ITT analysis showing significant changes, despite the loss of follow-up. Subgroup analyses suggested post-changes across several of the sociodemographic variables. Given the small sample size and cell counts in some categories, these analyses should be considered exploratory. Conclusions: Pre–post analyses showed changes in knowledge and practices related to children’s oral health. However, the quasi-experimental design limits causal inference and the findings should be interpreted as changes associated with the intervention. Further research and intervention alternatives are recommended from multiethnic and multicultural perspectives.

Pediatric Reports doi: 10.3390/pediatric18020040

Authors: Maša Marisavljević Nina Stanojević Ivana Bogavac Ivana Milanović Slavica Maksimović Silvana Punišić Jelena Đorđević

Background: Tetrasomy X (48, XXXX) is an extremely rare sex chromosome aneuploidy characterized by highly variable phenotypic manifestations. It includes various medical issues, a wide range of developmental delays, and neurocognitive deficits. Methods: The present case report provides a comprehensive neurodevelopmental profile of a 4.5-year-old girl with Tetrasomy X, with the aim of contributing to phenotype delineation, exploring genotype–phenotype associations, and emphasizing the importance of early, targeted intervention. A multidisciplinary assessment was conducted, encompassing cognitive, speech–language, motor, sensory, adaptive, and socioemotional functioning, using a battery of standardized and culturally adapted instruments. Results: Results revealed borderline intellectual functioning and mild global developmental delay, with marked intra-individual variability across domains. Motor development was significantly delayed and speech and language assessment demonstrated a pronounced receptive–expressive discrepancy. Sensory processing evaluation revealed a pattern of global sensory under-responsiveness, representing a novel and underreported feature in Tetrasomy X. Adaptive functioning was uneven, with relative strengths in daily living skills and weaknesses in motor abilities. Conclusions: This detailed early developmental characterization highlights the heterogeneity of Tetrasomy X and challenges some of the previous assumptions. The findings underscore the necessity of individualized, multidisciplinary assessment and early intervention to optimize developmental outcomes and quality of life in affected individuals.

Pediatric Reports doi: 10.3390/pediatric18020039

Authors: Albina Tummolo Emanuela Ponzi Simonetta Simonetti Mattia Gentile

In this paper [...]

Pediatric Reports doi: 10.3390/pediatric18020038

Authors: Amani N. Alansari Marwa Messaoud Salma Mani Amine Ksia

Background: Hydatid disease poses unique management challenges in pediatric populations due to developing anatomy and growth considerations. This systematic review evaluates the efficacy and safety of medical, surgical, and combination therapies for pediatric hydatid liver disease. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library from inception to January 2025 identified studies investigating treatment outcomes in pediatric hydatid liver disease. Data was synthesized through qualitative analysis of treatment effectiveness, complications, and patient outcomes. Results: Fifteen studies were included, comprising controlled trials, cohort studies, and cross-sectional studies. Treatment efficacy correlated significantly with cyst size: small cysts (<5 cm) responded well to albendazole monotherapy (88.3–97.6% success at 6–12 months); medium-sized cysts (5–6 cm) benefited from percutaneous interventions (PAIR) with 97.1% technical success; large cysts (>6 cm) required surgical management. Laparoscopic approaches demonstrated advantages over open surgery, including shorter hospitalization (5.6 ± 2.2 vs. 12.1 ± 1.5 days) and reduced analgesic requirements. Omentoplasty emerged as superior for residual cavity management with fewer complications than tube drainage approaches. Conclusions: This review supports personalized treatment algorithms based primarily on cyst characteristics. The findings recommend standardized protocols incorporating cyst size, location, and complexity as key decision points, with expanded access to minimally invasive techniques. Future research should focus on prospective comparative studies with standardized outcome measures.

Pediatric Reports doi: 10.3390/pediatric18020037

Authors: Giovanni Ceschia Germana Longo Jose M. Igeno San Miguel Marco Daverio Enrico Vidal

Introduction: Endotoxin-mediated septic shock is a life-threatening condition characterized by systemic inflammation and hemodynamic instability. While Polymyxin-B hemoadsorption (Toraymyxin®) is well-studied in adults, its use in pediatric patients remains less explored and requires modified approaches to minimize invasiveness and complications. Case Presentation: We report a 9-year-old boy (25 kg) with endotoxin-mediated septic shock due to Klebsiella pneumoniae, who developed oliguric acute kidney injury requiring continuous renal replacement therapy (CRRT). On Day 4, worsening conditions prompted the initiation of Toraymyxin® treatment, directly integrated into the ongoing CRRT circuit. This approach minimized extracorporeal volume expansion, avoided circuit replacement, and was complication-free. The patient improved rapidly, allowing CRRT discontinuation and transfer to the ward within 28 days. Conclusions: This case highlights the feasibility, safety, and potential benefits of integrating the Toraymyxin® cartridge into an ongoing CRRT circuit in pediatric septic shock, minimizing extracorporeal volume, avoiding additional vascular access, and supporting hemodynamic stabilization.

Pediatric Reports doi: 10.3390/pediatric18020036

Authors: Paula A. Ospina Sara Fisher Beverly A. Wilson Lesley Pritchard David D. Eisenstat Cindy Fuengeling Margaret L. McNeely

Background/Objectives: Children with acute lymphoblastic leukemia (ALL) often experience treatment-related side effects. Physical therapy (PT) surveillance programs are helpful in identifying impairments; however, they do not typically incorporate assessments for peripheral neuropathy, motor proficiency, and foot drop. Our aim is to explore the feasibility of conducting additional functional tests to an existing surveillance program to improve the identification of impairments and characterize the prevalence of treatment-related deficits in children with ALL. Methods: A prospective, longitudinal descriptive study, embedded into a quality improvement initiative, was conducted. The surveillance program included standard assessments for ankle range of motion, activity level, balance, functional capacity, pain, gait, and kneeling to standing. Additional tests included motor and sensory function, foot posture, motor performance, quality of life, feasibility (recruitment and completion rates), service provision, and self-reported symptoms. Data were collected over 3 months. Results: Twenty children completed the study and 19 completed all assessments. Nineteen children presented deficits in at least two physical function tests. The most prevalent deficit identified from standard PT tests included decreased ankle range of motion (n = 19; 95%), and the most common deficit seen in the additional tests was impaired motor and sensory function (n = 14/19; 74%). Pain was the most common self-reported symptom in the checklist and the second worst subscale score in the pain dimension of the quality of life questionnaire (p < 0.001). Conclusions: Several treatment-related deficits were identified in children with ALL. Further research is warranted to explore the use of a standardized symptom checklist for the timely identification of functional limitations and impairments.

Pediatric Reports doi: 10.3390/pediatric18020034

Authors: Dimitrios Karamitsos Ioanna Paraskevi Papandrea Nikoletta Rokidi Ioanna Saougou Chrysoula Kosmeri Alexandros Makis

Background: Pediatric-onset Evans syndrome (pES) is a rare autoimmune disorder defined by the coexistence or sequential development of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA), frequently accompanied by autoimmune neutropenia (AIN) and characterized by a relapsing, multilineage course. Increasing evidence suggests that pES may represent a broader immune dysregulation phenotype rather than an isolated hematologic disorder. Methods: We conducted a retrospective, single-center study of children diagnosed with pES and followed for up to 13 years at a tertiary referral center. Clinical data regarding hematologic evolution, extra-hematological immunopathological manifestations, treatment requirements, infectious complications, and genetic findings were analyzed descriptively. Results: Six children (4 males) were included, with a median age at first cytopenia of 7 years (range 3–15) and a median follow-up of 8 years (range 1–13). ITP preceded AIHA in 3/6 patients (50%), one patient (16.7%) developed AIHA first, and two (33.3%) showed partial or evolving multilineage disease with DAT positivity prior to overt hemolysis. AIN occurred in 3/6 patients (50%). Extra-hematological immunopathological manifestations occurred in 5/6 patients (83.3%), with two (33.3%) developing more than one. Second-line therapy was required in 3/6 patients (50%). Infectious episodes occurred in 83.3% of patients, predominantly viral or mild bacterial infections, with no life-threatening events. Whole-exome sequencing performed in three patients identified a heterozygous TNFAIP3 variant of uncertain significance in one case; no pathogenic variants were detected. Conclusions: pES demonstrates clinical heterogeneity, frequent multilineage cytopenia, and substantial extra-hematological immune involvement. Multisystem manifestations may be associated with increased treatment burden. Long-term multidisciplinary monitoring and cautious interpretation of genetic findings are essential for individualized pediatric care.

Pediatric Reports doi: 10.3390/pediatric18020035

Authors: Jasmine Keurentjes Laurie-Eve Brault Stéphanie Bégin Maude Perreault Véronique Gingras

Background: Worldwide breastfeeding initiation and exclusive rates at 6 months remain lower than recommended. Our scoping review aimed to identify interventions to improve breastfeeding duration in primiparous women. We assessed interventions’ effectiveness during the prenatal and postnatal periods separately or combined. Methods: Eight databases and grey literature were searched in March 2023, using a keyword search strategy. Results: We identified 16,161 articles from 2013 to 2023, and 35 met our eligibility criteria. The studies were conducted mostly in low–middle income countries (62.9%), and they proposed a variety of interventions in the prenatal period (n = 8), the postnatal period (n = 11) and in a combination of both periods (n = 16). It appears that a combination of various interventions, in both the prenatal and postnatal periods, targeting young women who intended to breastfeed, with low education levels, and with a partner, showed positive effects on exclusive breastfeeding rates until 6 months. Combined approaches such as workshops or individual education and support sessions during the prenatal period with support by professionals or peers until at least 6 months also showed improvements on breastfeeding duration. Conclusions: Our scoping review was the first to have identified potentially effective interventions, alone or in combination, to improve breastfeeding duration among primiparous women. Further studies should be conducted to cover a longer period, beyond six months. They should also explore the role of sociodemographic factors, such as ethnicity, in interventions’ effects.

Pediatric Reports doi: 10.3390/pediatric18020033

Authors: Karmela Dzaja Lidia Gavic Ana Glavina Marija Badrov Danijela Delic Vukic Livia Sukanec Antonija Tadin

Background: Pediatric oral mucosal lesions are common and may indicate local or systemic disease, yet their recognition in primary healthcare often depends on non-dental professionals. Aim: To assess the preparedness of dentists, pediatricians, and family/general practitioners for pediatric oral mucosal conditions based on self-assessed diagnostic confidence, clinical management, and referral behavior. Methods: An online cross-sectional survey was conducted among 632 primary healthcare professionals (dentists: n = 262; family/general practitioners: n = 278; pediatricians: n = 92). The questionnaire assessed clinical exposure, self-assessed knowledge, diagnostic confidence, management practices, and referral patterns. Data were analyzed using chi-square or Fisher’s exact test and the Kruskal–Wallis test (p < 0.05). Results: Dentists reported significantly higher self-assessed knowledge and diagnostic confidence than pediatricians and family/general practitioners (p < 0.001). Good self-assessed knowledge of pediatric oral health was reported by 26.3% of dentists, compared with 7.9% of family/general practitioners and 6.5% of pediatricians. While most pediatricians (80.4%) and family/general practitioners (77.0%) reported routinely examining the oral cavity in children, independent treatment of oral mucosal lesions was more frequently reported by dentists (75.2%) than by pediatricians (52.2%) or family/general practitioners (70.9%) (p < 0.001). Referral patterns differed between groups, and willingness to attend future pediatric oral health education was high across all professionals (75.0–84.2%). Conclusions: Dentists demonstrated higher diagnostic confidence in pediatric oral mucosal lesions than pediatricians and family/general practitioners, who more often relied on referral. These findings support the value of targeted education and strengthened interdisciplinary collaboration in primary pediatric healthcare.

Pediatric Reports doi: 10.3390/pediatric18020032

Authors: Xiaoyan Feng Peter Zimmermann Nicolas Pardey Richard Gnatzy Stefan Bassler Jona T. Stahmeyer Martin Lacher Jan Zeidler

Background: Ovarian torsion (OT) is a rare but urgent surgical condition in children and adolescents. Evidence on how management differs between pediatric (PD) and non-pediatric (Non-PD) departments in Germany remains limited. Methods: We conducted a retrospective cohort study using anonymized claims data from two major German statutory health insurance funds (2010–2019), covering 6.3 million insured individuals (≈1 million children). Patients ≤18 years with an inpatient diagnosis of OT (ICD-10-GM N83.5) were analyzed with respect to demographics, department type (PD vs. Non-PD), hospital type (university/maximum care [UM] vs. non-university/maximum care [Non-UM]), surgical procedures, and outcomes. Results: A total of 293 patients (mean age 12.4 ± 4.5 years) were included; 71% were adolescents (12–18 years). Adolescents were predominantly treated in Non-PD (89%), whereas younger children were more often managed in PD (50%; p < 0.0001). Most cases were treated in Non-UM (82%). Laparoscopy was more commonly used in Non-PD departments (85%), while open surgery and oophorectomy occurred more frequently in PD and university hospitals (UM). Ovary-sparing procedures accounted for 77% of all cases, whereas 23% underwent oophorectomy. Mean hospital stay was longer in PD (6.7 ± 9.0 days) than in Non-PD (4.9 ± 2.2 days; p = 0.0167). Readmission rates were comparable across groups. Conclusions: Management of OT in Germany varies markedly by department and hospital type. PD and UM treat more younger patients but perform oophorectomy more frequently, whereas Non-PD and Non-UM favor laparoscopic, ovary-sparing strategies. These differences highlight the urgent need for standardized, evidence-based protocols prioritizing ovarian preservation and optimizing long-term outcomes in affected children and adolescents.

Pediatric Reports doi: 10.3390/pediatric18020031

Authors: Maria van Veelen Kelly Bakewell Christopher W. A. Jolley Sheng-Ang Ho James Chapman Lauren Edwards Rahul Kumar Francis J. Gilchrist

Aim: To undertake a prospective review to identify the intra-procedure complications in children undergoing flexible bronchoscopy with six-lobe lavage and a retrospective review to identify the rates of delayed discharge and readmission. Methods: The prospective review analysed consecutive procedures from August 2023 to August 2024 and collected data on intra-procedure and immediate post-procedure desaturations, laryngospasm, bronchospasm/wheeze, tachypnoea, pyrexia, hypothermia, and vomiting. The retrospective review analysed consecutive paediatric flexible bronchoscopies from October 2014 to August 2023 identifying discharge delays and readmissions. All children underwent flexible bronchoscopy at a single tertiary paediatric centre under general anaesthesia (GA) with a single aliquot BAL obtained from all six lobes. When cytology was required, the BAL from the right middle or most affected lobe was changed to triple aliquot. Results: Six hundred and twenty-two procedures performed on 540 children were analysed. This included 502 in the retrospective review and 120 in the prospective review. In the prospective group 4/120 (3.3%) children experienced a significant (<90%) desaturation requiring anaesthetic intervention; 11/120 (9.2%) experienced an immediate post-procedure complication such as desaturation, pyrexia, tachypnoea, wheeze, or vomiting; 53/622 (8.5%) had their discharge delayed overnight; and 13/120 (11%) children in the prospective group experienced hypothermia. A further 18/622 (3%) children re-attended hospital within 48 h of discharge. Conclusions: Flexible bronchoscopy with bronchoalveolar lavage in all six lobes under GA in children is a safe procedure with low incidence of major complications when performed by expert clinicians. Parents should be advised of a 9% risk of delayed overnight discharge.

Pediatric Reports doi: 10.3390/pediatric18010030

Authors: William Hunt Stafford Jennifer McArthur Saad Ghafoor

As survival rates for children with cancer and immune disorders have improved, clinical focus has shifted toward managing serious treatment-related complications. Intestinal perforation remains life-threatening and is typically diagnosed by signs of peritonitis and inflammation. This report presents three high-risk pediatric patients who developed severe intestinal perforation without the usual clinical symptoms. Each patient was receiving high-dose corticosteroids and/or targeted biologic immunomodulators (ruxolitinib, anakinra, tocilizumab, eculizumab). Classic indicators such as fever, leukocytosis, hemodynamic instability, and abdominal pain were absent, despite surgical findings of fecal contamination and bowel necrosis. All three patients survived to hospital discharge. These cases demonstrate that potent immunomodulatory therapies can mask the physiological response to perforation. Relying solely on traditional clinical signs may delay diagnosis. In this population, subtle findings such as persistent gastrointestinal bleeding, feeding intolerance, or minor imaging abnormalities should prompt consideration of perforation. Early imaging and multidisciplinary review are essential for timely intervention and improved outcomes.

Pediatric Reports doi: 10.3390/pediatric18010029

Authors: Tania Gaspar Marina Carvalho Miguel Arriaga Barbara Sousa Margarida Gaspar-Matos

Purpose: Higher health literacy is associated with better health behaviors and better overall well-being; however, the contribution of relational and socio-economic factors to this association remains insufficiently explored. The present study aimed to examine the relationships between health literacy, well-being, social support, and stress among adolescents. In particular, the mediating roles of social support (family, peers, and teachers) and stress in the association between health literacy and well-being were analyzed. Participants and Methods: Data were drawn from the 2022 wave of the Health Behaviour in School-aged Children (HBSC) study, an international survey conducted every four years in collaboration with the World Health Organization (WHO) and implemented according to a standardized protocol. The sample comprised 7643 students from the 6th, 8th, 10th, and 12th grades of Portuguese public schools. Of the participants, 53.9% were female, and the mean age was 15.05 years (SD = 2.36). Gender-based comparisons indicated statistically significant differences for all study variables, with the exception of health literacy. Results: Mediation analysis reveals an effect of health literacy on well-being. After the inclusion of the mediating variables, the direct effect of health literacy on lack of well-being remained negative. All four mediators showed statistically significant indirect effects, accounting for the difference between the total and direct effects. These findings indicate that the association between health literacy and lack of well-being was partially mediated by family support, peer support, relationships with teachers, and stress. Health literacy influenced lack of well-being both directly and indirectly through these mediating pathways, with stress emerging as the strongest indirect contributor. Conclusions: The findings support an ecological interpretation of health literacy and well-being, as these constructs are embedded within multiple interacting systems. Individual adolescent characteristics, such as gender, age, and stress management, are interconnected with interpersonal contexts, including relationships with family members, peers, and teachers. In addition, adolescents’ socio-economic circumstances appear to play a relevant role in shaping both health literacy and perceptions of well-being.

Pediatric Reports doi: 10.3390/pediatric18010028

Authors: Miguel A. Palomo-Colli Daniela Vega-Ruiz Argelia Escobar-Sánchez Matilde Galicia-Esquivel Luis E. Juárez-Villegas Abigail Morales-Sánchez

Background: Pediatric lymphomas comprise a heterogeneous group of malignancies with substantial variation in their clinical presentation. In Mexico, detailed case-based characterization remains limited. This study summarizes the demographic and clinical characteristics of pediatric lymphomas diagnosed at a national referral center over an 11-year period. Methods: We conducted a retrospective review of lymphoma cases in children aged 0–17 years diagnosed at the Children’s Hospital of Mexico between 2004 and 2014. Cases were classified according to the ICCC-3 system and further described by histopathological subtype, age group, sex, and clinical outcomes. Results: Hodgkin lymphoma (HL) was the most frequent diagnosis, followed by non-Hodgkin lymphoma (NHL). Among HL cases, nodular sclerosis and mixed cellularity predominated, particularly in school-age children and adolescents. Within NHL, precursor T-cell lymphoma represented the largest subgroup, whereas mature B-cell lymphomas, such as diffuse large B-cell lymphoma, were less common than typically reported in high-income settings. Burkitt lymphoma occurred mainly among younger children. HL showed high survival, while some NHL subtypes exhibited poorer outcomes. Conclusions: This large hospital-based case series provides characterization of pediatric lymphomas in a major Mexican referral center. While HL subtype patterns resembled global trends, the predominance of precursor T-cell lymphomas within NHL contrasts with observations from high-income regions. These findings highlight the value of institutional case registries and the need for more comprehensive outcome reporting in future studies.

Pediatric Reports doi: 10.3390/pediatric18010027

Authors: Eleni Vathi Konstantinos Petsios Evangelos Dousis Ioannis Koutelekos Despoina Koumpagioti Eirini Anastasopoulou Anastasia Ntikoudi Eugenia Vlachou Eleni Evangelou

Background/Objectives: High-quality pediatric emergency care requires timely access, effective communication, privacy, pain management, comfort, and child- and family-centered practices; however, implementation may be constrained by several barriers. The aim of the study was to evaluate the quality of pediatric emergency care as perceived by healthcare professionals, with emphasis on child-centered care and variations based on workplace and professional characteristics. Methods: A cross-sectional survey was performed in the emergency departments in two tertiary public pediatric hospitals in Athens, Greece. A study-developed 14-item Quality of Care Assessment Scale with paired ratings of agreement with quality principles and implementation in practice was completed by 162 professionals (122 doctors, 24 nurses, 16 assistant nurses). Independent items evaluated perceived barriers, overall assessments (0–100), and information provided to parents/children (5-point Likert scale). Inferential tests and descriptive statistics were also used (p < 0.05). Results: There was a significant degree of agreement with quality principles, but there was a constant lack of implementation (principle–practice gap). The primary perceived weakness was waiting times; child-friendly settings and privacy during examinations and information-giving were also lacking. Internal consistency ranged from good to acceptable (implementation α = 0.800; agreement α = 0.711). Children were most frequently rated as “moderately informed” (48.1%), while parents were most frequently rated as “quite informed” (50.0%). Compared to the organization of care (mean 60.85), perceived safety was higher (mean 73.27). Perceptions varied by age, educational level, profession, department, shift rotations, and hospital. The main barriers were workload (30.2%), poor coordination (34.0%), and lack of resources (46.9%). Conclusions: Health professionals seem to perceive that consistent delivery of child-centered care is impaired by organizational and structural limitations. Reducing the standards-to-practice gap requires targeted system-level interventions that focus on staffing, care organization, environment, and professional support.

Pediatric Reports doi: 10.3390/pediatric18010026

Authors: Angeliki Giannakea Vicky Nanousi Voula Chris Georgopoulos

Background/Objectives: Adolescence is a critical developmental period during which peer attitudes and school experiences play an important role in social inclusion and academic adjustment. Although attention-deficit/hyperactivity disorder (ADHD) is common in secondary school populations, adolescents’ own knowledge and attitudes toward ADHD remain underexplored, particularly in non-Anglophone contexts. This study aimed to assess knowledge and attitudes toward ADHD among Greek secondary school students, focusing on awareness of the disorder, perceptions of ADHD-related classroom behaviors, and views on educational support and intervention. Methods: A cross-sectional survey was conducted among 154 adolescents aged 12–18 years attending Gymnasium (Grades 7–9) and Lyceum (Grades 10–12) in Greece. Data were collected using an anonymous online questionnaire assessing prior awareness of ADHD, perceptions of classroom behaviors associated with ADHD, attitudes toward inclusion and teacher support, and views on educational and therapeutic interventions. Adolescents with and without a self-reported ADHD diagnosis completed different questionnaire sections according to study design. Descriptive statistics and chi-square tests were used for data analysis. Results: Approximately two thirds of participants (66.9%) reported prior awareness of ADHD. Among typically developing adolescents (n = 134), 83.0% recognized distractibility due to external noise, 70.4% noted off-topic interruptions, and 60.0% reported peers getting up without permission. While 75.5% believed students with ADHD can participate in the classroom, 65.9% also reported academic challenges such as incomplete homework or lower performance. Overall, 79.2% of participants stated that school success depends on teacher and specialist support; however, among adolescents with ADHD (n = 20), only 60.0% endorsed this, with 40.0% emphasizing personal effort. Speech-language therapy was viewed as helpful by 55.6% of typically developing adolescents, though 76.9% of adolescents with ADHD reported not receiving such services. Conclusions: Greek adolescents demonstrate moderate awareness of ADHD and generally supportive attitudes toward peers with ADHD, alongside some uncertainty regarding available educational supports. Schools may represent an important context for improving adolescents’ mental health literacy and understanding of ADHD-related support options.

Pediatric Reports doi: 10.3390/pediatric18010024

Authors: Kifayat Ullah Chukwuma Mbaeyi Javeria Saleem Muhammad Ishaq Muhammad Rana Safdar Aslam Pervaiz Tamkeen Ghafoor Mumtaz Ali Laghari Sumbal Hameed Fatima Majeed Usman Javed Iqbal Amjad Mehmood

Background: The COVID-19 pandemic significantly disrupted health systems, including the delivery of childhood immunizations. This study assessed COVID-19 vaccination coverage in families of children with incomplete routine immunization and explored why adults accepted COVID-19 vaccines despite skipping routine vaccination for their children in the district of Swat, Khyber Pakhtunkhwa, Pakistan. Methods: A mixed-methods study was conducted in Swat District during March 2022–April 2023. A cross-sectional survey assessed COVID-19 vaccination in household members of children under 2 years of age for whom vaccination registries showed missed routine vaccinations. In-depth interviews with 18 household members explored motivations for vaccine acceptance through thematic analysis. Results: Among 249 families of children with incomplete immunization found through vaccination records, 237 families (88% response) were interviewed. Among 382 children below 2 years of age in these families, 29.5% (n = 113) were fully vaccinated, 67.5% (n = 258) were incompletely vaccinated according to age, and 2.9% (n = 11) had not received any vaccine. Data from 237 of the defaulter children—one per household—was included in further analysis. Among household members above 12 years of age, 87% (964/1103) of males and 82% (n = 901/1093) of females were vaccinated against COVID-19. Households with at least one fully vaccinated child were significantly more likely to have vaccinated family members. Multivariable analysis showed maternal COVID-19 vaccination (AOR 2.08, 95% CI: 1.15–3.76) and urban residence (AOR 2.08, 95% CI: 1.14–3.79) were associated with full childhood vaccination. In-depth interviews revealed that key motivators for COVID-19 vaccination included the perception that it was mandatory, house-to-house vaccination, and fear of hospitalization or death. Conclusions: Vaccine requirements and ease of access to vaccination services enhanced coverage with COVID-19 vaccines among families of children with incomplete routine immunization. Ethical use of vaccine requirements and community education to enhance levels of risk perception of vaccine-preventable diseases could potentially improve childhood immunization.

Pediatric Reports doi: 10.3390/pediatric18010025

Authors: Vanessa Groß Anna Theresa Schauß Lara Marie Bogensperger Antonia Schwarz Bikash Parajuli Sanika Rapole Janina M. Patsch Notburga Payr Kurt Payr Stephan Payr

Background/Objectives: Injuries remain a major cause of childhood morbidity and mortality in Europe, despite improved prevention. Infants under one year are particularly vulnerable because of limited motor control and complete dependence on caregivers. Existing studies are often small or cover broad age ranges, limiting infant-specific insights. This study aims to provide a comprehensive overview of injury types, mechanisms, and treatments, focusing exclusively on infants aged zero to one year. Methods: This retrospective study analyzed 29,574 infants and children (<2 years) treated at a level 1 trauma department from 1993 to 2022. Primary data included main diagnosis, injury mechanism, and treatment. Injuries were classified by diagnosis and mechanism. Surgeries were categorized by procedure type. Results: Injury frequency increased with age. A total of 31.1% of cases occurred in infants (<12 months) and 68.9% in children (12–24 months). Head injuries were the most common trauma type (44%), particularly among infants (69.9%; children: 32.2%), while wounds (infants: 10.2%; children: 31.5%) and fractures (infants: 4.2%; children: 8.4%) were more frequent in children. Falls were the predominant mechanism (77.9%) across both groups. Most injuries were treated conservatively. A total of 228 surgical interventions were performed (0.8%), mainly for wounds (54.8%) and fractures (30.3%). Conclusions: This study shows that, even within the first two years of life, child development shapes both injury frequency and type. As mobility and independence increase, injuries rise, from predominantly head trauma among infants to a higher incidence of wounds and fractures in children. The majority of injuries were minor and managed conservatively.

Pediatric Reports doi: 10.3390/pediatric18010023

Authors: Eli Mireya Sandoval-Gallegos Alejandra López-García Karen Rubí Escamilla-Gutiérrez José Arias-Rico Quinatzin Yadira Zafra-Rojas Esther Ramírez-Moreno Araceli Monter-Arciniega Nelly del Socorro Cruz-Cansino Alma Delia Román-Gutiérrez Zacnicté Olguín-Hernández

Background: Adolescence is a critical stage for establishing lifelong dietary habits and preventing non-communicable diseases through adequate intake of bioactive compounds. Numerous studies have thoroughly examined the antioxidant profile of traditional diets such as the Mediterranean diet. In contrast, current research provides limited insights into the antioxidant properties of foods typically consumed by Mexican adolescents. Objective: So, this study aimed to quantify the total phenolic compound (TPC) content and antioxidant capacity (AC) of frequently consumed foods and to estimate dietary intake in Mexican adolescents. Methodology: The selected food groups were identified based on their frequency of consumption by 15% or more of the adolescent population, considering those that have demonstrated a sufficient quantity of antioxidants. It was analyzed TPC and ABTS•+ and DPPH• to determine the antiradical activity of the analyzed samples. Results: The estimated daily intake of TPC was 1484.01 mg GAE/person, while AC intake was 345.67 mg AAE/person (ABTS•+) and 5399.14 µmol TE/person (DPPH•). Cereals and fruits were the major contributors to total antioxidant intake, while the contribution of leafy vegetables and nuts was relatively low. The statistical analysis revealed a significant positive correlation between TPC and AC. The results of the study indicate the antioxidant potential of the adolescent diet. Conclusions: Despite certain limitations, the values obtained from the study are comparable to those of other studies that employed similar methodologies. Consequently, promoting the early consumption of fresh plant-based foods rich in antioxidants, such as polyphenols, which can enhance the dietary profile and contribute to adolescents’ long-term health, constitutes a significant area of research.

Pediatric Reports doi: 10.3390/pediatric18010022

Authors: Akihiro Ichiki Keisuke Takata Tadashi Moriwake

Background: Pancreatic involvement in Kawasaki disease (KD) is rare. Case presentation: A 13-year-old adolescent presented with severe epigastric pain, elevated pancreatic enzyme levels, and conjunctival injection, but he lacked a fever and the other classic features of KD. The patient was initially diagnosed with acute pancreatitis and treated conservatively. As his abdominal pain improved, mucocutaneous findings emerged, leading to a diagnosis of complete KD. A literature review was conducted to summarize reported cases of KD-associated pancreatitis. This review highlights the older age of affected patients, the variability in the timing of pancreatitis onset, and a tendency toward delayed diagnosis. Conclusions: Pancreatic involvement, including pancreatitis, can occur before typical mucocutaneous features and should be considered in older children and adolescents presenting with unexplained abdominal pain and pancreatic enzyme elevation. Increased awareness of this atypical presentation may help reduce diagnostic delay and support timely management.

Pediatric Reports doi: 10.3390/pediatric18010021

Authors: Entesar Z. Dalah Najlaa K. Al Mazrouei Zahra A. Al Ali

This study aims to establish diagnostic reference levels (DRLs) for common pediatric nuclear medicine (NM) procedures performed within the Dubai Health sector. The established DRLs will serve as a benchmark for pediatric NM practice, supporting standardized healthcare delivery and guiding ongoing quality improvement and internal audit activities. Patient dose survey data were collected from the solo NM center within the Dubai Health sector. The study included common scintigraphy procedures using gamma cameras and the hybrid positron emission tomography with computed tomography (PET/CT) procedures. Scintigraphy procedures include the dynamic and static renal scans, and ocular eye scans. The hybrid PET/CT procedures entail tumor/infection and neuroendocrine scans. Patient demographics, administered activities, CT doses, and study description were recorded. Both weight bands of <5, 5–<15, 15–<30, 30–<50, and 50–<80 kg, and age bands of <1, 1–<5, 5–<10, and 10–<15 years were considered. Statistical analysis was performed to determine the 25th percentile, median and 75th percentile of the dose distribution. The median value was used to establish the DRLs for the Dubai Health sector. The analyses revealed significant variation in the administered activities across the different pediatric NM procedures. The proposed DRLs for various pediatric NM procedures for the weight band 15–<30 kg are as follows: renal dynamic 98.4 MBq, renal static 96.2 MBq, ocular eyes 18.5 MBq, tumor/infection 155 MBq, and neuroendocrine 80 MBq. This work provides the first pediatric NM DRLs for the Dubai Health sector, offering a key reference for developing the local DRLs for the Emirate of Dubai. The findings indicate that achieving meaningful dose optimization will require systematic revision of existing imaging protocols, with targeted parameter adjustments informed by continuous dose monitoring and benchmarking to enhance patient safety and overall diagnostic quality.

Pediatric Reports doi: 10.3390/pediatric18010019

Authors: Marco Sciveres Silvio Veraldi Francesco Cirillo Giuseppe Maggiore

Cholestatic diseases in children represent a heterogeneous group of disorders that, with few exceptions, have no cure. For decades, off-label drugs and/or drugs with little evidence of efficacy have been used to treat pruritus or as supportive therapy. In recent years, a family of molecules known as bile acid transporter inhibitors (IBATis) has been developed, with two of these being approved for treating pruritus in progressive familial intrahepatic cholestasis (PFIC) and Alagille syndrome (ALGS). Blocking the ileal reabsorption of bile acids (BAs) lowers serum levels. This contributes to reducing cholestatic pruritus. Such a mechanism of action may also have a potential benefit in other cholestatic diseases and even in the consequences of chronic cholestasis. This is a narrative review of the literature, including the most recent communications, to summarize data on the efficacy and safety of IBATis in the treatment of pruritus in PFIC and ALGS in children, including a description of the latest results from their use in a real-world setting. Reports on off-label use and experiences in adults are also discussed. This review aims to help physicians understand the potential and limitations of these new drugs in the treatment of cholestatic pruritus.

Pediatric Reports doi: 10.3390/pediatric18010020

Authors: Olivia-Oana Stanciu Andreea Moga Laura Balanescu Mircea Andriescu Ruxandra Caragata Radu Balanescu

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3–10 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management—including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis—led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome.

Pediatric Reports doi: 10.3390/pediatric18010018

Authors: Andreea Cerghit-Paler Dorottya Gabor-Miklosi Iolanda Muntean George-Andrei Crauciuc Daniela Toma Laura Beligan Liliana Gozar

Background: Borderline left ventricle represents a heterogeneous spectrum of congenital heart disease for which accurate prediction of suitability for biventricular versus univentricular circulation is often difficult. Serial fetal echocardiography may provide dynamic information to support postnatal decision-making. Case Presentation: We report the case of a fetus diagnosed at 32 weeks’ gestation with a borderline left ventricle, ventricular disproportion, hypoplastic left-sided structures, ductal-dependent systemic circulation, and a non-restrictive ostium secundum atrial septal defect. Serial fetal echocardiographic evaluations demonstrated stable left ventricular dimensions, preserved systolic function, impaired diastolic relaxation, and absence of endomyocardial fibroelastosis. Postnatal echocardiography confirmed hypoplastic aortic arch and coarctation. Following multidisciplinary evaluation, a biventricular repair strategy was selected. At 14 days of life, the patient underwent aortic arch reconstruction and partial atrial septal defect closure with preservation of a small therapeutic interatrial communication. Postoperative evolution was favorable, with progressive left ventricular growth and preserved function. At 2-year follow-up, echocardiography showed normalized mitral and aortic valve z-scores, good left ventricular systolic performance, and no evidence of myocardial fibrosis. Conclusions: This case highlights the value of serial fetal echocardiography in guiding individualized management of borderline left ventricle. Careful assessment of ventricular function and atrial septal physiology may support selection of a biventricular strategy in selected patients and contribute to favorable mid-term outcomes.

Pediatric Reports doi: 10.3390/pediatric18010017

Authors: Martina Gnazzo Giuditta Bargiacchi Luigi Vetri Lucia Parisi Davide Testa Daniela Smirni Agata Maltese Valentina Baldini Giulia Pisanò Eva Germanò Beatrice Gallai Antonella Gagliano Carola Costanza Michele Roccella Marco Carotenuto

Background: Violent TV series and streaming content are increasingly accessible to children, raising concerns about behavioral imitation and psychological effects. This study examined copycat behaviors and associated emotional and somatic symptoms among children who reported watching the age-restricted series Squid Game. Methods: In this observational study of 228 Italian primary school children (aged 8–11), 128 who had watched Squid Game formed the analytic sample. They were categorized into a Copycat Behavior (CB) group or a Non-Copycat Behavior (NCB) group based on self-reported imitation of scenes or games from the series. Parents completed the Child Behavior Checklist (CBCL). Group differences were assessed using Mann–Whitney U tests, and gender distribution was compared with Chi-square tests (α = 0.05). Results: Among viewers, 42 children (32%) engaged in imitation behaviors, typically reenacting game-based violent scenes with friends (52%), siblings (28%), or classmates (20%). Age and gender distributions did not differ between groups. The CB group scored slightly higher on the CBCL Somatic Complaints scale compared with the NCB group (M = 54.12 vs. 52.92; U = 1414.5, p = 0.033), although this difference was small. No significant differences emerged on other CBCL syndrome or broadband scales. Conclusions: Among children engaging in copycat behaviors exhibited a small, subclinical increase in somatic complaints. While causality cannot be inferred, the findings highlight the need to protect vulnerable children—particularly those prone to somatic distress—from unsupervised access to violent, age-inappropriate content. Media literacy for parents and educators, and longitudinal studies including non-viewers are recommended.

Pediatric Reports doi: 10.3390/pediatric18010016

Authors: Masatoshi Otsugu Fumikazu Tojo Rena Okawa Kazuhiko Nakano

When fabricating custom-made mouthguards for children, tooth replacement is an important factor for dentists to consider. In addition, orofacial myofunctional disorders and deleterious oral habits—such as incompetent lip seal and tongue thrusting—are relatively common among children and are associated with an increased risk of oral and dental trauma. Therefore, individual oral functional characteristics should be taken into account when designing custom-made mouthguards for pediatric patients. This report presents a case involving the design, fabrication, and appliance management of a custom-made mouthguard for a Japanese boy exhibiting incompetent lip seal and tongue thrusting. In this case, the anterior palate region of the mouthguard was left uncut, and multiple holes were created using a carbide bur to permit tongue–palate contact and provide sensory feedback related to tongue elevation. Over a 20-month follow-up period, no oral or dental trauma was observed. During appliance use, the patient demonstrated improved tongue elevation and an increased frequency of lip seal at rest. This case illustrates a custom mouthguard design that incorporates individual oral functional characteristics in a pediatric patient.

Pediatric Reports doi: 10.3390/pediatric18010015

Authors: Lara Marie Bogensperger Sandeep Patwardhan Stephan Payr

The management of supracondylar fractures in children remains a challenging area of orthopedic practice. Medial comminution is a recognized complication that can result in unstable fracture patterns, which can pose challenges in diagnosis and management. However, when anticipated surgical treatment with an additional medial K-wire is administered, stable fixation is typically ensured. However, an additional radial comminution poses several challenges for reduction, alignment assessment, and pin configuration for stable fixation, as presented in this case. This case report presents a fracture pattern of a Gartland type 3 fracture with medial and lateral comminution that has not been sufficiently described previously and illustrates an effective pin configuration that has yet to be theoretically described.