Search Results (354)

Background: Diaper dermatitis (DD) frequently occurs following pediatric gastrointestinal surgery and may lead to severe morbidity despite preventive measures. This study aims to evaluate the effectiveness of potato-derived protease enzyme inhibitor cream (PPEIC) in preventing DD after gastrointestinal surgery in children. Methods: In this double-blinded, single-center RCT, 30 patients under three years of age undergoing gastrointestinal surgery were randomized 1:1 to prevention using PPEIC or Panthenol cream (PC). The creams were applied after each diaper change for four weeks postoperatively. At two and four weeks, two observers evaluated photographs of the perianal region for the presence and severity of DD. The primary outcome was the severity of DD four weeks after surgery. Results: From November 2020 to March 2023, 30 patients were included. Two patients withdrew directly after randomization, resulting in 13 PPEIC and 15 PC patients. In total, nineteen patients (73.1%) developed DD—eight (66.7%) in the PPEIC group and 11 (78.6%) in the PC group (p = 0.665)—of whom twelve (63.2%) suffered severe DD. All DD cases developed within the first two weeks, resulting in half of the patients discontinuing the preventive cream before the four-week endpoint. Conclusions: This study highlights the significant issue of DD after gastrointestinal surgery, which affects 73.1% of diapered children despite prevention with PPEIC or PC. Although the study was unable to identify a superior preventive method, it offers valuable insights and goals for future research. Full article

Background: Despite its central role in pediatric pre-surgical evaluation of drug-resistant focal epilepsy, conventional analog ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT (aPET) systems often yield modest epileptogenic zone (EZ) detection rates (~50–60%). Silicon photomultiplier–based digital PET/CT (dPET) promises enhanced image quality, but its performance in pediatric epilepsy remains untested. Methods: We retrospectively analyzed 22 children (mean age 11.5 ± 2.6 years) who underwent interictal brain ¹⁸F-FDG PET/CT: 11 on an analog system (Discovery ST, 2018–2019) and 11 on a digital system (Biograph Vision 450, 2020–2021). Three blinded nuclear medicine physicians independently scored EZ localization and image quality (4-point scale); post-surgical histology and ≥1-year clinical follow-up served as reference. Results: The EZ was correctly identified in 8/11 analog scans (72.7%) versus 10/11 digital scans (90.9%). Average image quality was significantly higher with dPET (3.0 ± 0.9 vs. 2.1 ± 0.9; p < 0.05), and inter-reader agreement improved from good (ICC = 0.63) to excellent (ICC = 0.91). Conclusions: Our preliminary findings suggest that dPET enhances image clarity and reader consistency, potentially improving localization accuracy in pediatric epilepsy presurgical workups. Full article

Childhood obesity increases chronic disease risk, but no comprehensive synthesis has evaluated the impact of school-based combined nutrition education and physical activity interventions on cardiometabolic biomarkers in children aged 3 to 12 years. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251085194). Five databases were systematically searched through June 2025. Twelve randomized controlled trials involving 18,231 children were included and assessed using the PEDro scale. Ten trials demonstrated significant improvements in at least one cardiometabolic biomarker. Blood pressure (8 studies) outcomes showed systolic reductions of 1.41–6.0 mmHg in six studies. Glucose metabolism (5 studies) improved in two studies with reductions of 0.20–0.22 mmol/L. Lipid profiles (7 studies) improved in three studies, including total cholesterol (−0.32 mmol/L). Insulin levels (5 studies) decreased significantly in two investigations. Anthropometric improvements included BMI and body fat. Physical activity increased by >45 min/week and dietary habits improved significantly. Programs with daily implementation (90-min sessions 4x/week), longer duration (≥12 months), family involvement (parent education), and curriculum integration (classroom lessons) showed superior effectiveness. Interventions targeting children with overweight/obesity demonstrated higher changes compared to the general population. However, methodological limitations included a lack of assessor blinding, absence of subject/therapist blinding, and inadequate retention rates. School-based interventions combining nutrition and physical activity can produce significant improvements in cardiometabolic biomarkers, supporting comprehensive, sustained multicomponent programs for early chronic disease prevention. Full article

Background and Objectives: Anemia and stunting are major public health concerns for young Indonesian children. Limited information is available from studies on multi-micronutrient supplements in Indonesia. The objective of this study was to investigate the effect of 12-month multi-micronutrient powder (MNP) supplementation on serum hemoglobin levels, anemia, and growth. Methods: A randomized double-blinded placebo-controlled study was performed, including 232 eligible children aged 8–10 months old. Children with severe anemia or stunting/those classed as underweight were not included as subjects. The study was performed in a low-socioeconomic-status community in Jakarta. With an active-to-placebo ratio of 60:40, 139 subjects received MNP sachets twice/day, and 93 subjects received placebo sachets, mixed with complementary food. The outcome parameters were hemoglobin level, anemia, and growth indicators. Per-protocol analysis was performed for 179 (intervention: 110; control: 69) subjects. Results: There were no differences at baseline between the groups, except for the weight-for-length z-scores (WLZ). Upon intervention, the serum hemoglobin level and anemia proportion did not change significantly within the group, and no significant differences were found between the groups (p > 0.05). However, subgroup analysis of non-anemic children at baseline showed a significant increase in hemoglobin levels in the youngest age group (8.0–8.9 months old) receiving MNP compared to placebo (0.13 vs. −0.79, p = 0.031). Iron deficiency anemia proportion showed a similar upward trend upon intervention in both groups. No significant differences in growth were found between both groups. Conclusions: This study failed to find a significant effect of 12-month MNP supplementation on serum hemoglobin level, anemia, and growth. Full article

Background: Dental anxiety often poses a significant barrier to effective dental care in pediatric patients. This study evaluated the efficacy and safety of oral midazolam at two different doses for sedation and amnesia in preschool children undergoing dental procedures under 30 min, including primary teeth extraction, root canal treatment, dental filling, and stainless-steel crown. Methods: This prospective, double-blind, randomized controlled trial included 80 children aged 3–6 years with dental anxiety (Types 1 and 2 of the Frankl Behavior Rating Scale) at the National Hospital of Odonto-Stomatology, Hanoi. following the CONSORT guidelines. Participants were randomly assigned to receive oral midazolam at 0.3 mg/kg or 0.6 mg/kg. Sedation efficacy, onset time, procedure duration, cooperation level (Houpt Behavior Rating Scale), recovery time, and amnesia at 12 h, 24 h, and 1 week, as well as adverse events, were recorded and analyzed. Results: Both midazolam doses were effective for sedation (0.3 mg/kg: 95% vs. 0.6 mg/kg: 100%, p = 0.49). The higher dose (0.6 mg/kg) provided significantly longer effective procedural time (27.3 ± 4.1 min vs. 20.3 ± 4.0 min, p < 0.001) and better patient cooperation (95% vs. 78.9%, p = 0.045), but slightly prolonged recovery time (34.6 ± 4.6 min vs. 31.8 ± 4.4 min, p = 0.008). Both doses produced similar amnesic effects, with approximately 90% anterograde amnesia at 12 h post-procedure. Adverse events were minimal and mild. Conclusions: Both 0.3 mg/kg and 0.6 mg/kg doses of oral midazolam are safe and effective for sedation and amnesia in preschool children undergoing dental procedures. While the 0.6 mg/kg dose provides better procedural cooperation and prolonged sedation, it also requires a slightly longer recovery time. Full article

Background: Oral mucositis (OM) is a common and debilitating complication of cancer therapy, particularly in patients undergoing chemotherapy and radiotherapy. It significantly impairs quality of life and may necessitate the interruption of cancer treatment. This study aimed to evaluate the efficacy and safety of OROSOL, an oral spray device, in managing oral mucositis in pediatric patients undergoing chemotherapy or radiotherapy. Methods: This randomized, double-blind, placebo-controlled clinical trial compared OROSOL to a placebo in children with oral mucositis aged 3 to 17 years. Participants were followed for 28 days with regular medical visits. The primary endpoints were changes in the Oral Assessment Guide (OAG) scores and key symptoms (mucositis score, difficulty in oral feeding, ulceration and erythema, and pain sensation). Safety was assessed via adverse events and local tolerability. Results: Both groups were demographically balanced at baseline (p > 0.6). OROSOL demonstrated significantly greater improvements in the mucositis score beginning on Day 7 (p = 0.0122) and maintained superiority through Day 28 (p = 0.0007). Notable reductions in mucositis severity were observed, with significantly faster relief in the OROSOL group compared to the placebo (p < 0.001 for most timepoints). Oral feeding difficulty also showed a marked decline, with significant improvements starting from Day 5 (p = 0.0153). Ulceration and erythema scores significantly decreased from Day 14 onwards (p = 0.0188). Pain sensation showed a marked reduction from Day 14 (p = 0.0014). No serious adverse events were reported, and tolerability was consistent across all participants. Conclusions: OROSOL has a significant impact on reducing mucositis severity, oral feeding difficulty, ulceration, erythema, and pain. Coupled with its excellent safety profile, it is a valuable therapeutic option. This treatment is particularly beneficial for pediatric patients, ensuring improved comfort and recovery without notable adverse effects. Full article

Obesity is considered a global pandemic. In Mexico, 7/10 adults, 4/10 adolescents, and 1/3 children are overweight or obese, and it is estimated that 90% of cases of type 2 diabetes (T2D) are attributable to these pathologies. Visceral adipose tissue (VAT) presents increased lipolysis, lower insulin sensitivity, and greater metabolic alterations. Glucagon-like peptide-1 (GLP-1) is a polypeptide incretin hormone that stimulates insulin secretion dependent on the amount of oral glucose consumed, reduces plasma glucagon concentrations, slows gastric emptying, suppresses appetite, improves insulin synthesis and secretion, and increases the sensitivity of β cells to glucose. Liraglutide is a synthetic GLP-1 analog that reduces VAT and improves the expression of Glucose transporter receptor type 4 (GLUT 4R), Mitogen-activated protein (MAP kinases), decreases Fibroblast growth factor type β (TGF-β), reactivates the peroxisome proliferator-activated receptor type ɣ (PPAR-ɣ) pathway, and decreases chronic inflammation. Currently, there are many studies that explain the decrease in VAT with these medications, but there are no studies that compare the decrease in patients with obesity and prediabetes vs. obesity and type 2 diabetes to know which population obtains a greater benefit from treatment with this pharmacological group; this is the reason for this study. The primary objective was to compare the difference in the determination of visceral adipose tissue in people with obesity and type 2 diabetes vs. obesity and prediabetes treated with liraglutide. Methods: A quasi-experimental, analytical, prolective, non-randomized, non-blinded study was conducted over a period of 6 months in a tertiary care center. A total of 36 participants were divided into two arms; group 1 (G1: Obesity and prediabetes) and group 2 (G2: Obesity and type 2 diabetes) for 6 months. Inclusion criteria: men and women ≥18 years with type 2 diabetes, prediabetes, and obesity. Exclusion criteria: Glomerular filtration rate (GFR) < 60 mL/min/1.73 m² elevated transaminases (>5 times the upper limit of normal), and use of non-weight-modifying antidiabetic agents. Conclusions: No statistically significant difference was found in the decrease in visceral adipose tissue when comparing G1 (OB and PD) with G2 (OB and T2D). When comparing intragroup in G2 (OB and T2D), greater weight loss was found [(−3.78 kg; p = 0.012) vs. (−3.78 kg; p = 0.012)], as well differences in waist circumference [(−3.9 cm; p = 0.049) vs. (−3.09 cm; p = 0.017)], and glucose levels [(−1.75 mmol/L; p = 0.002) vs. (−0.56 mmol/L; p = 0.002)], A1c% [(−1.15%; p = 0.001) vs. (−0.5%; p = 0.000)]. Full article

Background: Effective pain management in children is essential, particularly when administering local anaesthesia. This study was undertaken to compare pain perception in children after application of pre-cooled and plain topical anaesthetic gel during local anaesthetic administration. Methods: A randomised, single-blinded controlled trial was conducted among 51 children between the ages of 6 and 12, visiting the paediatric clinic, Jazan (REC-45/10/1070). Children were allocated into one of the following three groups using a simple randomisation having a 1:1:1 allocation ratio into Group I (n = 17): Plain topical anaesthetic gel, Group II (n = 17): Pre-Cooled topical anaesthetic gel, and Group III (n = 17). An ice pack was applied for a period of 1 min at the injection site. The intensity of pain and the behaviour of the children were assessed using Face, Leg, Activity, Cry, Consolability (FLACC), the Modified Wong–Baker Scale (WBS) and the Frankel Behaviour Rating Scale (FBRS). Results: A significant difference in FBRS scores was observed during anaesthesia, with the highest median score [3 (3,3)] in the pre-cooled topical anaesthetic gel group (p value < 0.001). FLACC scores varied significantly among groups, with the ice pack group [3 (3, 3)] and [4 (4, 5)] showing the highest median score (p value < 0.001). WBS scores also differed significantly between groups (p value < 0.001) with a lower value in the pre-cooled topical gel group [0 (0, 0), 2 (0, 2)]. Conclusions: This study concluded that, the use of a pre-cooled topical anaesthetic gel before LA administration reduced the pain better than that of plain anaesthetic gel and ice pack application at the injection site during infiltration. Full article

Background/Objectives: Early care and education programs promote children’s social–emotional development, predicting later school success. The COVID-19 pandemic worsened an existing youth mental health crisis and increased teacher stress. Therefore, we applied an infant and early childhood mental health consultation model, Jump Start Plus COVID Support (JS+CS), aiming to decrease behavioral problems in children post-pandemic. Methods: A cluster randomized controlled trial compared JS+CS to an active control, Healthy Caregivers–Healthy Children (HC2), at 30 ECE centers in low-income areas in South Florida. Participants were not blinded to group assignment. Teachers reported on children’s social–emotional development at baseline and post-intervention using the Devereux Early Childhood Assessment and Strengths and Difficulties Questionnaire. We assessed whether teacher stress, classroom practices, and self-efficacy mediated the relationship between JS+CS and child outcomes. We also explored whether baseline behavior problems moderated JS+CS effects on child protective factors, relative to HC2. Results: Direct group-by-time differences between JS+CS and HC2 were limited. However, JS+CS demonstrated significant within-group improvements in teacher-reported child protective factors, behavior support practices, and classroom safety practices. Classroom safety practices consistently mediated positive changes in child behaviors, including the DECA total protective factor score and subdomains of initiative and self-regulation. Additionally, teacher perceptions of behavior support mediated gains in child attachment. Conclusions: JS+CS shows promise in building protective systems around children through intentional support for teachers, underscoring the value of whole-child, whole-environment approaches in early intervention. Full article

Background/Objectives: Bystander first aid in paediatric choking is crucial. It ought to be universally comprehensible and backed up by evidence-based guidelines. However, there still are inconsistencies in guidelines worldwide. The objective of this research was to assess the knowledge of medical students on paediatric choking rescue manoeuvres and their educational backgrounds in order to evaluate the impact of differences in educational curricula. Methods: Medical students from a total of 12 universities across Canada, Libya, and Poland were surveyed online. The questionnaire assessed the respondents’ experience, training, and knowledge in first aid regarding foreign body airway obstruction in infants and children. Results: Out of 324 responses, 290 were evaluated. Although the students studied in only 3 countries, they represented 37 countries of origin. A total of 7 new reference groups were created based on guideline identification. A comparison of 4 clinical scenario questions revealed that certain training providers communicate recommendations more effectively to medical students, as their guidelines seem to have better knowledge retention. Conclusions: There are important differences in medical student knowledge, possibly due to discrepancies in training programs and guidelines. Variability was found in body position, anti-choking suction devices, blind finger sweeps, and medical follow-ups. More research is needed to standardize training and improve worldwide choking management outcomes. Full article

Background and Objectives: The common cold (acute rhinopharyngitis) and acute rhinosinusitis are highly prevalent conditions that significantly impact quality of life, often leading to nasal congestion, inflammation, and discomfort. Given the growing demand for non-pharmacological treatment options, particularly for vulnerable populations such as children and pregnant women, alternative therapies are increasingly being explored. NESOSPRAY HE-C, a nasal spray formulated with a glycerol-based filmogenic solution, acts by forming a protective osmotic film on the nasal mucosa. This mechanism facilitates mechanical cleansing, enhances decongestion, and reduces inflammation while preserving mucosal integrity. Its purely topical and mechanical mode of action provides a non-systemic alternative for symptom management. Materials and Methods: This randomized, double-blind, parallel-group clinical trial evaluated the efficacy and safety of NESOSPRAY HE-C (n = 29) compared to a placebo nasal spray (n = 26) in patients aged ≥ 3 years diagnosed with the common cold or acute rhinosinusitis. Participants had a baseline Rhinosinusitis Symptom Severity Score (RSSS) of ≥25/50. Treatment consisted of administering 2–3 sprays per nostril, four times daily, every 4 to 6 h, for up to 8 days or until symptom resolution. The primary outcomes included changes in total RSSS, Wisconsin Upper Respiratory Symptom Survey (WURSS) score, and individual symptom scores (rhinorrhea, nasal congestion, cough, poor sleep, facial pain, and fever). Safety assessments included adverse event monitoring and treatment tolerability, with subgroup analyses performed for children and pregnant women. Results: Baseline demographics were comparable between the treatment groups. NESOSPRAY HE-C demonstrated a significantly greater reduction in total RSSS from Day 3 onward (p = 0.0008), with sustained superiority through Day 8 (p < 0.0001). Significant improvements in rhinorrhea and nasal congestion were observed within 2 h of administration (p = 0.0089), while reductions in cough (p = 0.0052), poor sleep (p = 0.0005), and facial pain (p = 0.0111) emerged by Day 3. Fever reduction was most pronounced on Days 6 (p = 0.0001) and 8 (p = 0.0312), indicating a delayed but significant effect. In terms of the WURSS score, NESOSPRAY HE-C showed a significant improvement from Day 1, with a greater reduction in symptom severity compared to placebo. This trend of greater improvement continued through Day 8. The treatment was well tolerated, with no reports of serious adverse events or allergic reactions. Efficacy was consistent across all subgroups, including children, pregnant women, and adults. Conclusions: NESOSPRAY HE-C provides rapid and sustained symptom relief for the common cold and acute rhinosinusitis, serving as a safe and effective non-pharmacological alternative to conventional treatments. By leveraging its osmotic action and barrier-forming properties, it facilitates mechanical cleansing, enhances decongestion, and reduces inflammation while preserving mucosal integrity. Additionally, by forming a protective film on the nasal mucosa, it protects against future irritations, further supporting its role as a valuable therapeutic option, particularly for individuals seeking non-systemic symptom management. Full article

Some estimates suggest that one in seven good readers and the majority of children with reading difficulties suffer from oculomotor dysfunction (OMD), an umbrella term for abnormalities in comfortable and accurate fixations, pursuits, and saccades. However, national vision evaluation programs worldwide are often limited to distance visual acuity (dVA), not testing for OMD despite its high prevalence and the ease of detecting it in brief optometric evaluations. We hypothesized that reading acquisition is dependent on good oculomotor functions, and therefore inadequate oculomotor control will be associated with reading difficulties. We retrospectively examined and compared oculomotor evaluations (using DEM and NSUCO) and reading assessments (using standardized national reading norms) of a normative class (28 first graders (6–7 yr. olds)) that were independently obtained while blind to the other assessment. Better oculomotor performance as estimated by DEM was associated with better reading performance, and almost a third (29.6%) of the children were categorized by DEM as having OMD-related difficulties. Control analysis revealed dVA was not positively associated with reading performance. Linear regression analyses further corroborated these findings. Since this study is based on a small cohort and since there are studies suggesting that DEM may actually reflect visual processing speed or cognitive factors rather than oculomotor function, replications are needed to substantiate the direct contribution of oculomotor functions to reading acquisition. Young children struggling with reading may benefit from a comprehensive visual evaluation, including oculomotor testing, to provide a more thorough assessment of their learning-related difficulties. Full article

Background/Objectives: Minimally verbal autistic children face significant communication challenges, often unmet by traditional therapies. Social robots, like NAO, offer predictable, structured interactions that may improve engagement and language skills. This study aimed to evaluate the effectiveness of NAO-assisted therapy in improving communication and social interaction in minimally verbal autistic children compared to standard therapeutic approaches. Methods: In a single-blind, randomized, controlled study, 37 autistic children aged 4–12 years were assigned to either NAO-assisted therapy or standard speech therapy. Participants were assigned to either an NAO-assisted therapy group or a standard speech therapy control group. The intervention included 12 weekly 45 min sessions. Communication outcomes were measured using the Language Development Level Test (TVL) and mand request observations. Results: All 37 participants completed the 12 sessions without adverse events, highlighting the intervention’s feasibility and safety. Children in the NAO-assisted therapy group showed greater improvements in verbal communication (on average, 159 ± 49% more children exhibited improvement across verbal aspects (range: 107–284%; p < 0.001)) particularly in spontaneous communication, compared to the control group. The therapy also increased mand production (from 6.8 ± 4.3 in session 1 to 16.7 ± 7.7 in session 12; p < 0.001; average gain: 0.9 per session), demonstrating steady growth in communicative initiative. These findings underscore the structured and engaging nature of NAO-assisted therapy in supporting consistent progress in communication skills. Conclusions: NAO-assisted therapy is a promising, safe, and effective intervention for enhancing communication in minimally verbal autistic children, offering unique benefits in promoting spontaneous and consistent verbal engagement. Full article

Background/Objectives: Chronic attention problems occur in approximately 25% of children after acquired brain injury (ABI). When delivered daily, transcranial direct current stimulation (tDCS) may improve attention; however, access to daily in-clinic tDCS treatment can be limited by other commitments, including concurrent therapy, school commitments, and caregiver schedules. Treatment access can be improved through home-based interventions, though these require several practical and safety considerations in a pediatric ABI population. This study evaluated the safety, feasibility, and tolerability of remotely monitored at-home tDCS during online gamified attention training in pediatric ABI. Methods: We conducted a randomized, single-blind, dose-controlled clinical trial of at home tDCS in Brisbane, Australia (10 tDCS sessions; 20 min; 1 mA or 2 mA; bilateral dorsolateral prefrontal cortex). Participants attended our clinic at baseline for clinical assessments, fitting of the personalized tDCS headband, and training in how to use tDCS at home. All sessions were remotely supervised using live videoconferencing. We assessed the feasibility and tolerability of at-home tDCS and our customized, personalized at-home tDCS headband as primary outcomes. As secondary outcomes, we evaluated changes in functional connectivity (fc) and reaction time (RT). Results: Seventy-three participants were contacted over six months (January-June 2023) and ten were enrolled (5 males; mean age: 12.10 y [SD: 2.9]), satisfying a priori recruitment timelines (CONSORT reporting). All families successfully set up tDCS and completed attention training with excellent protocol adherence. There were no serious adverse events over the 100 total sessions. Nine participants completed all stimulation sessions (1 mA: n = 5, 2 mA: n = 4). Participants in the 2 mA group reported greater tingling, itching, and discomfort (all p < 0.05). One participant in the 1 mA group was unable to complete all sessions due to tolerability challenges; however, these challenges were resolved in the second half of the intervention by gradually increasing the stimulation duration across the 10 days alongside additional coaching and support. Conclusions: Overall, daily remotely supervised at-home tDCS in patients with pediatric ABI is safe, feasible, and tolerable. Our results support larger, sham-controlled efficacy trials and provide a foundation for the development of safe and effective at-home stimulation therapeutics that may offer targeted improvement of neurocognitive symptoms in children. Full article