Search Results (81)

Background: The Mediterranean diet is widely recognised for its health benefits and remains a key reference point in shaping dietary guidelines across populations. Despite its growing international relevance, there is a lack of validated tools assessing Mediterranean diet adherence among children and adolescents in Central and Eastern Europe. Methods: The present study aimed to adapt and validate the KIDMED 2.0 questionnaire for use in Polish children and adolescents aged 10 to 18 years (KIDMED 2.0 PL). The adaptation process involved forward–backward translation, expert consultations, and pilot testing to ensure linguistic and cultural relevance. A total of 102 participants completed the questionnaire twice over a two-week interval, and anthropometric data were collected. Results: The KIDMED 2.0 PL demonstrated high test–retest reliability (Spearman’s ρ = 0.876; p < 0.001) and strong criterion validity, with a significant negative correlation between KIDMED scores and BMI centile (ρ = −0.854; p < 0.001). Children with normal weight showed the highest adherence to the Mediterranean diet, while scores were significantly lower in overweight and obese participants. Item-level analysis indicated that fruit and vegetable consumption was relatively frequent, whereas intake of legumes, whole grains, and extra virgin olive oil remained low. Conclusions: The KIDMED 2.0 PL is a valid and reliable tool for evaluating diet quality and Mediterranean dietary adherence in the Polish pediatric population. Full article

Background: A critical gap exists in the current literature regarding pediatric-specific creatinine reference data. This study established age- and sex-stratified reference intervals and a corresponding median (Qcr) model for serum creatinine in children, providing a crucial foundation for improved diagnostic accuracy and clinical decision-making in this vulnerable population. Methods: A total of 9090 children (52.38% males and 47.65% females) who were getting regular check-ups at clinical laboratories in three regions were included in this study to establish Qcr serum and reference ranges for creatinine concentration. Results: The reference values and serum Qcr creatinine were established for children based on age and sex. Both males and females experience an incremental increase in creatinine levels with advancing age. In addition, significant differences were seen across the three areas in other age groups (p < 0.05). Conclusions: These newly established, age- and sex-stratified reference and Qcr values provide a critical resource for clinical laboratories, empowering clinicians to more accurately assess pediatric renal function and enabling more precise, individualized care for children with renal concerns. Full article

Background: Lamotrigine plays a crucial role in the treatment of epilepsy and bipolar disorder in adults and children. However, its pharmacokinetic (PK) behavior in first or long-term treatment in pediatric patients and the changes in drug exposure in patients with renal impairment are not well characterized. The purpose of the research was to build a robust physiologically based pharmacokinetic (PBPK) model of lamotrigine for the prediction of drug exposure in diverse populations to facilitate therapeutic drug monitoring (TDM) and guide dosing regimens. Methods: The physicochemical parameter values of lamotrigine were integrated to establish and validate the model in an adult population in PK-sim. This adult PBPK model can be extrapolated to children and patients with renal impairment to predict PK changes. Results: Most of the observed data were within the 5th and 95th percentile intervals of the variability around the predicted plasma concentrations. The model predicted pharmacokinetic thresholds and exposure values for clinically safe and effective doses recommended by the FDA for initial and long-term treatment of epilepsy in adults and children aged 2–12 years. Notably, patients with severe renal impairment and end-stage renal disease experienced an average increase in the area under the curve of 1.51 folds and 1.62 folds, respectively. This scenario necessitates further lamotrigine dose adjustments. Conclusions: The developed lamotrigine PBPK model offers a strategy for assisting clinicians in TDM and dose adjustment for special populations, thereby offering a reference (PK parameters, as well as peak and valley concentrations to reach a steady state) for a safer administration regimen in clinical treatment. Full article

Objectives: Our objectives were to evaluate the safety of the simultaneous vaccination of Japanese encephalitis attenuated live vaccine (JEV-L) and measles, mumps, and rubella combined attenuated live vaccine (MMR) in children and to provide a reference for the implementation of the strategy of simultaneous vaccination with the two vaccines. Methods: The data of adverse events following immunization (AEFI) and vaccination for JEV-L and MMR from 2020 to 2023 were extracted through the Guangdong Province Vaccine Distribution and Vaccination Management Information System and the Chinese National AEFI Information System (CNAEFIS). The inclusion criteria were that children were born after 1 October 2019, and received the first dose of JEV-L or MMR after 1 June 2020, in accordance with the starting age for vaccination (8 months). The study used the number of vaccine doses as the denominator to calculate and compare the reporting rates of cases and calculated the relative risk (RR) of adverse reactions and the 95% confidence interval (CI). Results: In Guangzhou, a total of 214,238 doses of JEV-L were administered to children. JEV-L and MMR were co-administered in 464,009 doses, and MMR was administered separately in 241,150 doses. The overall reporting incidence rates of AEFI (per 100,000 doses) for JEV-L, the simultaneous vaccination group, and MMR were 11.20, 53.02, and 60.96, respectively. Among children aged 8 months in Guangzhou, 57.98% (463,512/799,423) received the simultaneous administration of JEV-L and MMR. In the reported AEFI events, general reactions accounted for 87.50% in the JEV-L group, 88.21% in the simultaneous vaccination group, and 89.80% in the MMR separate group. The incidence rates of common adverse reactions were 9.80, 46.7, and 54.74, respectively. The incidence rates of rare adverse reactions were 0.93, 3.88, and 2.90, respectively. The reporting incidence rates of fever ≥38.6 °C after vaccination were 4.20, 16.16, and 17.83 for the JEV-L separate group, simultaneous vaccination group, and MMR separate group, respectively. There was a significant difference between the simultaneous vaccination group and the JEV-L separate group (RR = 3.848, 95% CI = 1.927, 7.683), while no significant difference was found compared with the MMR separate group (RR = 0.906, 95% CI = 0.623, 1.318). The simultaneous vaccination group showed no significant differences in the reporting incidence rates of local redness and induration compared with the two separate vaccination groups (RR = 1.385, 95% CI = 0.144, 13.315; RR = 0.390, 95% CI = 0.087, 1.743; RR = 0.520, 95% CI = 0.033, 8.314). No significant differences were found in the incidence rates of rare adverse reactions such as maculopapular rash, urticaria, and thrombocytopenic purpura. Conclusions: The AEFI reporting incidence rate for the first dose of the simultaneous vaccination of JEV-L and MMR in 8-month-old children in Guangzhou is between the rates of the two separate groups. Compared with the MMR separate group, the simultaneous vaccination group does not increase the risk of adverse reactions. Full article

Background/Objectives: This systematic review and meta-analysis aimed to determine whether there is an association between low-grade inflammation markers and primary hypertension (PH) in children. Methods: The MEDLINE, EMBASE, and Cochrane databases were searched up to March 2025 for cohort, cross-sectional, and case–control studies; additional references were obtained from reviewed articles. The studies needed to investigate an association between any inflammation markers and PH. Participants of the study were children (<18 years old) with PH and healthy controls. This meta-analysis included 13 studies published between 2005 and 2024, enrolling 1306 patients (745 with PH and 561 healthy controls). The data were analyzed using Review Manager. Pooled mean difference (MD) with a 95% confidence interval (95% CI) was used to assess the differences in inflammation markers. Results: There was a significant difference between hypertensive and control groups in high-sensitivity C-reactive protein (hs-RCP) concentration (mean difference (MD): 0.07 95%CI (0.04, 0.09)), intercellular adhesion molecule 1 (ICAM-1) (MD: 85.28 95%CI: (50.57–119.99)), vascular cell adhesion molecule 1 (VCAM-1) (MD: 259.78 95%CI: (22.65–496.91)), neutrophil count (MD: 0.90 95%CI (0.66–1.14)), monocyte count (MD: 0.08 95CI%: (0.04–0.11)), platelet count (MD: 20.24 95CI%: (4.27–36.21)), neutrophil-to-lymphocyte ratio (MD: 0.48 95%CI: (0.34–0.62)), and lymphocyte-to-monocyte ratio (MD: −0.52 95%CI: (−1.02–−0.02)). There was no difference in terms of interleukin 6 (IL-6), lymphocyte count, mean platelet volume (MPV), or platelet-to-lymphocyte (PLR) ratio. Conclusions: Some easily accessible markers of low-grade inflammation might be used as an additional tool for diagnosis and screening for hypertension in children. These results should be validated in large and well-conducted studies. Full article

Although the Universal Salt Iodization (USI) program has been highly successful, it remains relevant due to the continued risk of Iodine Deficiency Disorders (IDDs) in vulnerable groups, such as children and pregnant women. This program empowers the relevant authority to continuously monitor iodine levels in iodized salt. Our study reports on the use of a Salt Iodate Micro-Method Reagent (SIMR) detection kit for this purpose. The kit was validated, with a linearity of 5.0–60.0 mg/Kg, at a detection limit of 6.8 mg/Kg, with excellent recovery ranging from 93.0 to 108.3%, whereas the repeatability, intermediate precision, and reproducibility achieved a mean coefficient of variation (CV) of 5.3%, 6.8%, and 5.9%, respectively. The stability of the reagents used in the kit was tested using freshly prepared iodine standard quality control (QC) samples of 20.0 mg/Kg and 40.0 mg/Kg, all of which were observed to be stable, within the range of the mean ± 2 × (standard deviation, SD), for 10 days. The suitability of the kit was proven when no difference was found in the mean results of 70 salt samples, using a paired t-test and the Bland–Altman plot, compared to the reference method, at a 95% confidence interval (CI). Thus, the SIMR detection kit is a highly feasible alternative method for iodine monitoring, with a fast analysis time, as well as being cost effective, and environmentally friendly. Full article

Aims: To develop and evaluate a novel AI-based video analysis tool for the quantitative assessment of “Places Pegs in” and “Blue Board” tasks in the Bayley Scales of Infant Development (BSID-II). Methods: A prospective cohort study was conducted from February 2022 to December 2022, including children aged 12–42 months referred for suspected developmental delay. Participants were evaluated using the BSID-II, and their performances on the two tasks were video recorded and analyzed with the novel tool. Sensitivity and specificity were determined by comparing the tool’s results to standard BSID-II assessments by therapists. Data collected included total time, number of trials, successful trials, and time and spatial intervals for each trial. Children were classified into typically developing (TD) (MDI ≥ 85) and developmental delay (DD) (MDI < 85) groups based on their mental developmental index (MDI). Results: A total of 75 children participated in the study, and the mean values of MDI and PDI for the enrolled children were 88.9 ± 18.7 and 80.0 ± 16.7. The “Places Pegs in” had 86.5% sensitivity and 100% specificity; the “Blue Board” had 96.9% sensitivity and 89.5% specificity. Differences in cumulative successes over time were observed between age groups and TD and DD groups. The tool automatically calculated maximum successes at specific time points. Interpretation: The AI-based tool showed high predictive accuracy for BSID-II tasks in children aged 12–42 months, indicating potential utility for developmental assessments. Full article

Background/Objectives: Isoflavone (ISO) may have immunosuppressive and promoting effects. In this study, we aimed to examine the association between maternal dietary ISO intake during pregnancy and childhood allergic rhinoconjunctivitis at the age of 3 years using the Japanese Birth Cohort data. Methods: Overall, 78,549 mother–child pairs were studied. Maternal dietary ISO intake (the sum of genistein and daidzein) during pregnancy was evaluated using a food frequency questionnaire. Information on physician-diagnosed allergic rhinoconjunctivitis was collected from the caregiver-reported questionnaire. After classifying ISO intake into quartiles (Q1: reference), multivariable logistic regression analysis was employed to explore the association with allergic rhinoconjunctivitis. Results: No association was observed between maternal ISO intake and allergic rhinoconjunctivitis in any child. However, in the sex-stratified analysis, maternal ISO intake linked to allergic rhinoconjunctivitis in female children positively (Q2, adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.06–1.40; Q3, aOR: 1.17, 95% CI: 1.01–1.35; Q4, aOR: 1.24, 95% CI: 1.07–1.44). Conclusions: Maternal dietary ISO intake during pregnancy was sex-specifically linked to childhood allergic rhinoconjunctivitis in children. These findings provide insights into the need for estimating the optimal ISO consumption during pregnancy for allergy avoidance in children. Full article

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children’s referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March–27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children. Full article

Background/Objectives: Bone turnover markers (BTMs) can provide information on the bone growth of apparently healthy children and adolescents or useful results in the diagnosis and monitoring of the disease condition, comparing them with appropriate reference intervals (RIs). The aim of this study was to establish the RI for the BTM [specific bone alkaline phosphatase (BALP), carboxy-terminal cross-linked collagen type I telopeptide (CTX), N-terminal propeptide pro-collagen type I (PINP), osteocalcin (OC), resistant to acid tartrate phosphatase isoform 5b (TRAcP-5b)] on serum samples from children and adolescents. Method: 202 samples from children and adolescents (ages 1–18 years) (51.48% male), considered apparently healthy. The biomarker was analyzed on automatic immunometric equipment (TGSTA Technogenetics) and the IDS-iSYS automated system kits The RI of the studied parameters was calculated according to CLSI Guideline C28-A3 with stratification by age and sex. Evaluation of the distribution of values and the meaning of the biomarker concentrations were used to calculate general and specific RI for an age group. Results: BTM concentrations vary with pubertal growth. The pattern of change differs for each bone marker. General and age-specific RI were calculated: 1–14 years, 15–18 years for BALP and CTX; 1–13 years, 14–18 years for Oc and PINP and 1–12 years, 13–18 years for TRAcP. Discussion and Conclusions: Concentrations for biomarker studied vary with age and gender. The proof of concentrations with insignificant changes until puberty led to identification of two groups of RI relating to the covariables (age and sex) for each biomarker. Full article

Background/Objectives: Glycated albumin (GA) serves as a biomarker for short-term glycemic control (2–3 weeks), playing a role in diabetes management. Our goal was to establish reference intervals (RIs) for serum GA, and the ratios of 1,5-anhydroglucitol to GA (AGI) and GA to HbA1c in a Euro-Brazilian pediatric population (10 y, n = 299), adults (43.5 y; n = 290), and pregnant women (26 y, n = 406; 26.5 ± 3.1 gestation weeks). Methods: Receiver operating characteristic curve analysis was employed to determine RIs for type 1 diabetes (T1D) in children (n = 148) and adults (n = 81), type 2 diabetes (T2D, n = 283), and gestational diabetes mellitus (GDM, n = 177). Results: Both non-pregnant and pregnant women exhibited GA RIs of 10.0–13.3% and 10.6–14.7%, respectively. The AGI ratio varied from 1.2–4.3 in children, 0.9–3.6 in adults, and 0.8–3.1 in pregnant women. Meanwhile, the GA/HbA1c ratio ranged from 1.8–2.6 in children and adults to 2.3–3.6 in pregnant women. GA and AGI ratios accurately differentiated between T1D and T2D, demonstrating high sensitivity (>84%) and specificity (>97%), with AGI showing superior performance (AUC > 0.99). The GA/HbA1c ratio exhibited moderate discriminatory power (AUC > 0.733) but was less effective in distinguishing adult-onset T1D and T2D, suggesting its limited utility in certain groups. Conclusions: The proposed RIs are consistent with those of other Caucasian populations, affirming their relevance for Euro-Brazilian patients. The GA and AGI ratios emerge as valuable diagnostic tools for T1D and T2D, though their reduced sensitivity in diagnosing GDM warrants further investigation. Clinicians might leverage GA and AGI ratios for more tailored diabetes management, especially when HbA1c results are not optimal. Full article

Background/Objectives: Vitamin-fortified non-alcoholic beverages (VFNABs) are rising in popularity and availability. However, owing to their regulation as foods, there are also growing quality and safety concerns. Therefore, we aimed to provide an overview of the content-related quality of VFNABs on the Slovenian market. Methods: Vitamin contents in 50 VFNABs (29 waters, 5 juices, 12 energy drinks, and 4 instant drinks) were determined using validated methods based on liquid chromatography. Results: The results revealed several quality issues, which were determined in all four VFNAB types. These included an indication of at least one vitamin, present in a lower-than-significant amount, on the nutrition declaration in 64% of the tested VFNABs and vitamin contents outside the tolerance interval (65–150% of the label claim) in almost half of the cases (48.4%, n = 244). Since the disclosed quality issues are not only a reason for the misleading of consumers but may also pose safety risks for both individuals and public health, we further performed an overall assessment of the VFNABs as vitamin sources. The results revealed that the tested VFNABs not only fully cover but in several cases considerably exceed daily vitamin needs (up to 616% of the reference values), an effect which is further accentuated in children. Conclusions: The performed content-related quality control study undoubtedly highlight the need for stricter quality control and regulation and can be utilized as a foundation and recommendation for the manufacturers in terms of committing to and pursuing the production of VFNABs. Full article

Neonatal deaths, which usually occur in the first week after delivery, account for nearly 75 percent of all deaths of children under 5 years of age. Prematurity, birth difficulties, infections, and birth defects are responsible for about 40 percent of these deaths. Although mortality rates have declined since 2000, access to quality healthcare remains a major problem for mothers and infants worldwide. In perspective, the present study aimed to establish clear biological reference intervals for 17α-hydroxyprogesterone (17-OHP), immunoreactive trypsinogen (IRT), and biotinidase in Indian neonates. The statistical analysis of data from up to 3200 dried blood spot (DBS) samples of Indian newborns provided valuable information for the new cut-off values in newborn screening (NBS) programs. We applied correlation analysis to fix the relationship for NBS parameters such as 17-OHP, IRT, and biotinidase. This study provided important information about the distribution and comparison of key cut-offs for biomarkers considering body weights and gestational age in the Indian newborn population for the first time, which can help healthcare experts make easier treatment decisions. Full article

Background: the variations in a child’s overall body shape and figure among different countries are attributable to differences in genetics, environmental factors, and the interaction between these elements. This study aims to evaluate the validity, reliability, and appropriateness of applying international growth standards to Jordanian children and adolescents aged 2–19 years old. Methods: 65,828 Jordanian children and adolescents (43% males; 57% females) aged 2–19 years old were selected from the Hakeem Program database and various private schools across Jordan. Height-for-age, weight-for-age, and body mass index (BMI)-for-age were analyzed comparatively for Jordanian children and adolescents against international growth standards. The z-score for each record was computed based on international equations. Results: Mean z-scores for height-for-age, weight-for-age, and BMI-for-age for both genders showed significant deviation from international standards across most age intervals. It was found that in most age groups, Jordanian children and adolescents were shorter and lighter than CDC and WHO standards, except for females at ages ≥ 16 years, who were heavier with higher BMI-for-age values than CDC standards based on weight-for-age and BMI-for-age equations. Moreover, Jordanian males at ages ≥ 12 years had lower BMI-for-age values than CDC standards. Conclusions: Jordanian children and adolescents showed significant deviations in their measurements from international standards and growth reference values. The development of a population-specific growth chart is highly recommended to enhance the accuracy of evaluating children’s and adolescents’ wellness. Full article

The expression “twice-exceptionality” has been used to describe conditions in which giftedness and specific disorders coexist. Our study offers a retrospective analysis of clinical reports of gifted children evaluated for suspected specific learning disorders (SLD) or attention-deficit/hyperactivity disorder (ADHD). The initial sample included 456 school-aged children referred to our clinic for suspected SLD and/or ADHD over a two-year interval. The inclusion criteria were: a General Ability Index score above 120 in the cognitive assessment; age 6–18 years; and not satisfying diagnostic criteria for autism spectrum disorder. Forty children were selected for the study. We grouped patients according to the final diagnosis: neurodevelopmental disorder (SLD and/or ADHD) (n = 15), psychopathological disorder (n = 8), mixed neurodevelopmental and psychopathological (n = 13), no emerging disorder (n = 4). The study included 36 (90%) males. Mean age was 9.3 years (SD 1.62). Mean Full-Scale Intelligence Quotient was 121.7 (SD 7.77), mean General Ability Index was 130.2 (SD 6.79). Furthermore, the cognitive assessment of the different groups highlighted a non-homogeneous profile in all groups, with lower scores on working memory and processing speed indexes. Our results support the hypothesis that difficulties in gifted children’s adaptation to scholastic and social settings could be misinterpreted as a manifestation of a clear disease. Full article