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15 pages, 1223 KiB  
Article
Point-of-Care Ultrasound (POCUS) in Pediatric Practice in Poland: Perceptions, Competency, and Barriers to Implementation—A National Cross-Sectional Survey
by Justyna Kiepuszewska and Małgorzata Gałązka-Sobotka
Healthcare 2025, 13(15), 1910; https://doi.org/10.3390/healthcare13151910 - 5 Aug 2025
Abstract
Background: Point-of-care ultrasound (POCUS) is gaining recognition as a valuable diagnostic tool in various fields of medicine, including pediatrics. Its application at the point of care enables real-time clinical decision-making, which is particularly advantageous in pediatric settings. Although global interest in POCUS is [...] Read more.
Background: Point-of-care ultrasound (POCUS) is gaining recognition as a valuable diagnostic tool in various fields of medicine, including pediatrics. Its application at the point of care enables real-time clinical decision-making, which is particularly advantageous in pediatric settings. Although global interest in POCUS is growing, many European countries—including Poland—still lack formal training programs for POCUS at both the undergraduate and postgraduate levels. Nevertheless, the number of pediatricians incorporating POCUS into their daily clinical practice in Poland is increasing. However, the extent of its use and perceived value among pediatricians remains largely unknown. This study aimed to evaluate the current level of POCUS utilization in pediatric care in Poland, focusing on pediatricians’ self-assessed competencies, perceptions of its clinical utility, and key barriers to its implementation in daily practice. Methods: This cross-sectional study was conducted between July and August 2024 using an anonymous online survey distributed to pediatricians throughout Poland via national professional networks, with a response rate of 7.3%. Categorical variables were analyzed using the chi-square test of independence to assess the associations between key variables. Quantitative data were analyzed using descriptive statistics, and qualitative data from open-ended responses were subjected to a thematic analysis. Results: A total of 210 pediatricians responded. Among them, 149 (71%) reported access to ultrasound equipment at their workplace, and 89 (42.4%) reported having participated in some form of POCUS training. Only 46 respondents (21.9%) reported frequently using POCUS in their clinical routine. The self-assessed POCUS competence was rated as low or very low by 136 respondents (64.8%). While POCUS was generally perceived as a helpful tool in facilitating and accelerating clinical decisions, the main barriers to implementation were a lack of formal training and limited institutional support. Conclusions: Although POCUS is perceived as clinically valuable by the surveyed pediatricians in Poland, its routine use remains limited due to training and systemic barriers. Future efforts should prioritize the development of a validated, competency-based training framework and the implementation of a larger, representative national study to guide the structured integration of POCUS into pediatric care. Full article
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20 pages, 545 KiB  
Study Protocol
Can Dietary Supplements Be Linked to a Vegan Diet and Health Risk Modulation During Vegan Pregnancy, Infancy, and Early Childhood? The VedieS Study Protocol for an Explorative, Quantitative, Cross-Sectional Study
by Wolfgang Huber-Schneider, Karl-Heinz Wagner and Ingrid Kiefer
Int. J. Environ. Res. Public Health 2025, 22(8), 1210; https://doi.org/10.3390/ijerph22081210 - 31 Jul 2025
Viewed by 178
Abstract
As veganism becomes more popular, the number of vegan pregnant women and children is steadily increasing. During vegan pregnancy and early childhood, there is a high risk for nutrient deficiencies that may impair child development. External factors, such as healthcare advice, social networks, [...] Read more.
As veganism becomes more popular, the number of vegan pregnant women and children is steadily increasing. During vegan pregnancy and early childhood, there is a high risk for nutrient deficiencies that may impair child development. External factors, such as healthcare advice, social networks, and social environments, that affect the diet of vegan pregnant women, parents, and their children, as well as their approach towards dietary supplementation, have not yet been investigated. Various sources of information, combined with a lack of expertise, sparse food and nutritional health literacy, and qualitatively heterogeneous information provision by medical experts, unsettle vegan pregnant women and parents and affect their dietary choices and potentially the health of their children. The VedieS study aims to investigate potential connections between external influences and associated impacts on a vegan diet and the intake of dietary supplements (DS) of pregnant women and children. Two surveys are being conducted within the study: one targeting 1000 vegan pregnant women and parents, and another targeting 60 experts in each of five healthcare groups: gynecologists, pediatricians, general practitioners, pharmacists, and dietitians. This study is the first to examine how socio-economic, social, and further informational factors influence dietary practices during vegan pregnancy and childhood. It highlights the need for reliable, expert-led guidance, as current information sources are often inconsistent and may put these vulnerable groups at risk. Full article
(This article belongs to the Special Issue Holistic Approach to Pregnancy, Childbirth and Postpartum Period)
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13 pages, 1058 KiB  
Article
A Machine Learning-Based Guide for Repeated Laboratory Testing in Pediatric Emergency Departments
by Adi Shuchami, Teddy Lazebnik, Shai Ashkenazi, Avner Herman Cohen, Yael Reichenberg and Vered Shkalim Zemer
Diagnostics 2025, 15(15), 1885; https://doi.org/10.3390/diagnostics15151885 - 28 Jul 2025
Viewed by 324
Abstract
Background/Objectives: Laboratory tests conducted in community settings are occasionally repeated within hours of presentation to pediatric emergency departments (PEDs). Reducing unnecessary repetitions can ease child discomfort and alleviate the healthcare burden without compromising the diagnostic process or quality of care. The aim [...] Read more.
Background/Objectives: Laboratory tests conducted in community settings are occasionally repeated within hours of presentation to pediatric emergency departments (PEDs). Reducing unnecessary repetitions can ease child discomfort and alleviate the healthcare burden without compromising the diagnostic process or quality of care. The aim of this study was to develop a decision tree (DT) model to guide physicians in minimizing unnecessary repeat blood tests in PEDs. The minimal decision tree (MDT) algorithm was selected for its interpretability and capacity to generate optimally pruned classification trees. Methods: Children aged 3 months to 18 years with community-based complete blood count (CBC), electrolyte (ELE), and C-reactive protein (CRP) measurements obtained between 2016 and 2023 were included. Repeat tests performed in the pediatric emergency department within 12 h were evaluated by comparing paired measurements, with tests considered justified when values transitioned from normal to abnormal ranges or changed by ≥20%. Additionally, sensitivity analyses were conducted for absolute change thresholds of 10% and 30% and for repeat intervals of 6, 18, and 24 h. Results: Among 7813 children visits in this study, 6044, 1941, and 2771 underwent repeated CBC, ELE, and CRP tests, respectively. The mean ages of patients undergoing CRP, ELE, and CBC testing were 6.33 ± 5.38, 7.91 ± 5.71, and 5.08 ± 5.28 years, respectively. The majority were of middle socio-economic class, with 66.61–71.24% living in urban areas. Pain was the predominant presented complaint (83.69–85.99%), and in most cases (83.69–85.99%), the examination was conducted by a pediatrician. The DT model was developed and evaluated on training and validation cohorts, and it demonstrated high accuracy in predicting the need for repeat CBC and ELE tests but not CRP. Performance of the DT model significantly exceeded that of the logistic regression model. Conclusions: The data-driven guide derived from the DT model provides clinicians with a practical, interpretable tool to minimize unnecessary repeat laboratory testing, thereby enhancing patient care and optimizing healthcare resource utilization. Full article
(This article belongs to the Special Issue Artificial Intelligence for Health and Medicine)
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16 pages, 1635 KiB  
Article
Ventricular Subgaleal Shunt in Children Under Three Months of Age, from Diagnosis to Outcome: A Review After 11 Years of Experience in a French University Hospital
by Timothée Follin-Arbelet, Alexandra Chadie, Jean-Baptiste Muller, Sophie Curey, Julien Grosjean, Cécile Toulemonde and Stéphane Marret
Children 2025, 12(8), 983; https://doi.org/10.3390/children12080983 - 26 Jul 2025
Viewed by 249
Abstract
Background and objectives: Neurosurgical intervention on the newborn’s developing brain is a risk factor for neurodevelopmental disorders (NDDs). These patients necessarily require regular, coordinated follow-up. The ventricular subgaleal shunt (VSGS) technique has been used since 2013 at Rouen University Hospital. Like any change [...] Read more.
Background and objectives: Neurosurgical intervention on the newborn’s developing brain is a risk factor for neurodevelopmental disorders (NDDs). These patients necessarily require regular, coordinated follow-up. The ventricular subgaleal shunt (VSGS) technique has been used since 2013 at Rouen University Hospital. Like any change in practice, this technique must be evaluated. In this paper, we describe the population of patients with hydrocephalus treated by VSGS, the complications associated with the procedure, and the outcome of these patients at two and six years old. Methods: This study was an observational, descriptive, retrospective, single-center study. Children included were those less than three months old with hydrocephalus treated by VSGS at Rouen University Hospital from January 2013 to December 2023. Data were anonymized and collected using EDSaN software. A descriptive analysis was performed. Results: Thirty-two patients were included in our study. Of these, 22 (69%) were born prematurely; 16 (50%) of these 22 had postnatal intraventricular hemorrhage (IVH) requiring treatment with VSGS. A total of three patients (13.6%) died within the first year of life; twenty-four patients (75%) required definitive shunting. Twenty-two patients were over 2 years old in our study. Only 10 of them acquired the ability to walk (45%). Cerebral palsy was present in 10 (45%) patients. Fifteen patients were over 6 years old; thirteen (87%) attended school, but six (40%) had special needs (the need of an assistant, or part-time schedule). In our study, only 24 patients (82%) were followed by a pediatrician trained in neurodevelopment at Rouen University Hospital, and 27 (93%) were followed by a neurosurgeon. Conclusions: This study describes all patients with hydrocephalus treated by VSGS at Rouen University Hospital between January 2013 and December 2023, as well as their complications and their neurological outcomes. The follow-up of these children at risk of NDDs is essential. Full article
(This article belongs to the Section Pediatric Neonatology)
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14 pages, 228 KiB  
Article
Impact of Japan’s 2024 Physician Work Style Reform on Pediatricians’ Working Hours and Associated Factors
by Masatoshi Ishikawa, Ryoma Seto, Michiko Oguro and Yoshino Sato
Healthcare 2025, 13(15), 1815; https://doi.org/10.3390/healthcare13151815 - 25 Jul 2025
Viewed by 230
Abstract
Background/Objectives: Long working hours among pediatricians negatively affect their health and patient safety. In Japan, the Ministry of Health, Labour and Welfare launched the “Work Style Reform for Physicians” in 2024. However, whether these reforms have effectively reduced pediatricians’ working hours remains unclear. [...] Read more.
Background/Objectives: Long working hours among pediatricians negatively affect their health and patient safety. In Japan, the Ministry of Health, Labour and Welfare launched the “Work Style Reform for Physicians” in 2024. However, whether these reforms have effectively reduced pediatricians’ working hours remains unclear. We surveyed pediatricians and pediatric residents working in hospital pediatric departments to assess whether the reform has reduced their long working hours. Methods: A questionnaire was distributed to pediatricians in hospitals, collecting data on demographics, working hours, night shifts, and other working conditions. A multivariate logistic regression analysis identified factors associated with working ≥60 and ≥80 h on a weekly basis. Results: Questionnaires were sent to 835 hospitals, with valid responses from 815 pediatricians across 316 hospitals. Among them, 31.7% worked 50–60 h per week, 18.4% worked 60–70 h, 7.7% worked 70–80 h, and 4.9% worked >80 h. Factors associated with working >60 h included being <30 years old and working in a department with five or more physicians. Pediatricians working >80 h were more likely to have a cardiology subspecialty and work in a department with five or more physicians. Conclusions: Although the “Work Style Reform for Physicians” has reduced long working hours among pediatricians, many still experience excessive workloads. Full article
(This article belongs to the Special Issue Job Satisfaction and Mental Health of Workers: Second Edition)
13 pages, 788 KiB  
Article
Pediatricians’ Perspectives on Task Shifting in Pediatric Care: A Nationwide Survey in Japan
by Masatoshi Ishikawa, Ryoma Seto, Michiko Oguro and Yoshino Sato
Healthcare 2025, 13(14), 1764; https://doi.org/10.3390/healthcare13141764 - 21 Jul 2025
Viewed by 321
Abstract
Background/Objectives: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare’s reforms remains unclear. This study aimed to evaluate the current status and barriers of [...] Read more.
Background/Objectives: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare’s reforms remains unclear. This study aimed to evaluate the current status and barriers of task shifting in pediatric care in Japan. Methods: A questionnaire survey was conducted among pediatricians working in hospitals in Japan. The results were compared with those from 2020. Results: Questionnaires were sent to 835 hospitals, and valid responses were received from 815 pediatricians in 316 hospitals (response rate: 37.8%). The largest group (31.0%) was 40–49 years, and 34.4% of the participants were women. Among the items surveyed, most pediatricians indicated “shifted” in “Patient transfer (transporting between hospitals using an ambulance)” and “Intravenous injection of antibiotics.” Most physicians believed task shifting improved care quality; 10.3% felt it worsened. The most common estimate for daily working hour reduction due to task shifting was “1 to <2 h” (44.9%). Precisely 15.8% of pediatricians believed that task shifting had “not progressed at all,” with rural areas and non-university hospitals showing lower task-shifting implementation. National university hospitals had a higher likelihood of task shifting than public hospitals. No significant associations were observed for the total hospital bed count or the number of full-time pediatricians. Conclusions: Task shifting in pediatric care remains underdeveloped. While many pediatricians support the concept and report modest reductions in working hours, actual implementation remains limited. Future efforts must address systemic, institutional, and regulatory challenges to facilitate meaningful task redistribution and improve healthcare delivery. Full article
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16 pages, 515 KiB  
Article
Fever and Pain in Italian Children: What Pediatricians Really Do
by Giacomo Biasucci, Maria Elena Capra, Antonella Giudice, Delia Monopoli, Roberta Rotondo, Daniela Petracca, Cosimo Neglia, Beatrice Campana and Susanna Esposito
Life 2025, 15(7), 1048; https://doi.org/10.3390/life15071048 - 30 Jun 2025
Viewed by 474
Abstract
Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care [...] Read more.
Background: Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care Pediatricians (PCPs) in the management of fever and pain, and to assess their alignment with current clinical recommendations. Materials and Methods: An anonymous, cross-sectional survey consisting of 30 multiple-choice questions was administered to 900 PCPs between 1 July and 30 October 2024. The questionnaire assessed therapeutic preferences, dosing strategies, and perceived knowledge gaps. Invitations were distributed via pediatric scientific societies and regional professional networks. Results: A total of 244 PCPs completed the survey (response rate 27.1%). The majority were aged over 55 years (72.1%), worked in urban settings (71.3%), and had more than 20 years of clinical experience (74.6%). Most respondents (77%) reported managing pediatric fever or pain on a daily basis. Paracetamol was the preferred first-line treatment for fever (95.9%), primarily due to its perceived safety (82.4%). Ibuprofen was favored by 51.6% of those who selected it for its greater effectiveness. The alternating use of paracetamol and ibuprofen for fever was never adopted by 49.6%, while 31.6% employed this strategy, believing it to be more effective. For pain, 67.6% used paracetamol and 26.2% used ibuprofen as first-line treatments; 15.2% reported alternating the two drugs. Correct dosage practices were followed by 63.9% for both medications, although 40.2% did not differentiate dosages between fever and pain management. Conclusions: While general trends showed alignment with current guidelines, notable inconsistencies were observed in drug selection, dosage, and the use of alternating therapies. These findings highlight a pressing need to improve the dissemination and implementation of pediatric fever and pain management guidelines among PCPs in order to reduce unsafe practices, avoid therapeutic errors, and prevent unnecessary strain on emergency care services. Full article
(This article belongs to the Special Issue Pain and Therapy: Historical Perspectives and Future Directions)
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15 pages, 705 KiB  
Article
Survey Study to Identify the Maximum Acceptable Numbers of 2 mm and 3 mm Mini-Tablets for Short-, Middle-, and Long-Term Treatments in Acutely and Chronically Sick Children of Different Age Groups Below 18 Years
by Manfred Wargenau, Eva Mutzke, Lucas-Sebastian Spitzhorn, Sibylle Reidemeister, Ingrid Klingmann and Viviane Klingmann
Pharmaceutics 2025, 17(7), 834; https://doi.org/10.3390/pharmaceutics17070834 - 26 Jun 2025
Viewed by 336
Abstract
Background/Aims: This preference study aimed to identify the maximum number of mini-tablets of two different sizes that children and adolescents would be willing to take, and parents, nurses, and pediatricians would be willing to administer to children and adolescents. Methods: A [...] Read more.
Background/Aims: This preference study aimed to identify the maximum number of mini-tablets of two different sizes that children and adolescents would be willing to take, and parents, nurses, and pediatricians would be willing to administer to children and adolescents. Methods: A total of 336 participants (24 per cohort) were stratified into 14 cohorts: Acutely and chronically sick children/adolescents aged 6–<12 years (y) and 12–<18 y, parents of acutely and chronically sick children/adolescents aged 0–<2 y, 2–<6 y, 6–<12 y, and 12–<18 y, nurses, and pediatricians. After participants were shown seven different numbers of 2 and 3 mm mini-tablets, they were asked to assess the maximum number acceptable for short-, middle-, and long-term treatment using cohort-specific questionnaires. Results: Within all groups and treatment durations, the specified maximum accepted number of 2 mm mini-tablets was higher than the number of 3 mm mini-tablets. The maximum number of mini-tablets acceptable to the participants increased with increasing age of the children and ranged from 40–500 (30–400) for the 2 mm (3 mm) mini-tablets. With increasing duration of treatment, a lower maximum number of mini-tablets was considered tolerable. Chronically sick children were willing to take higher numbers of mini-tablets than acutely sick children. The maximum accepted numbers of mini-tablets specified by pediatric patients, parents, and healthcare professionals were similar for each age group; however, pediatricians consistently specified slightly higher numbers of mini-tablets than parents and nurses. Conclusions: The study demonstrated that even a high number of mini-tablets would be well-accepted by children during middle- or long-term treatment. Full article
(This article belongs to the Special Issue Customized Pharmaceutics: Innovations for Diverse Populations)
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9 pages, 308 KiB  
Article
Reassessing the Use of VCUG in Pediatric UTIs: Are We Overusing an Invasive Diagnostic Tool?
by Ivana Fratrić, Dragana Milutinović, Maja Samardžić Lukić and Dragana Živković
Healthcare 2025, 13(13), 1513; https://doi.org/10.3390/healthcare13131513 - 25 Jun 2025
Viewed by 371
Abstract
Background/Objective: Voiding cystourethrography is the gold-standard diagnostic tool for detecting vesicoureteral reflux and is commonly requested by pediatricians, pediatric nephrologists, emergency pediatricians, and pediatric urologists. However, VCUG is invasive, exposes patients to radiation, and carries a risk of iatrogenic urinary tract infection [...] Read more.
Background/Objective: Voiding cystourethrography is the gold-standard diagnostic tool for detecting vesicoureteral reflux and is commonly requested by pediatricians, pediatric nephrologists, emergency pediatricians, and pediatric urologists. However, VCUG is invasive, exposes patients to radiation, and carries a risk of iatrogenic urinary tract infection (UTI). This study aimed to assess the correlation between VCUG findings and factors such as age, gender, referring specialist, and clinical indication for the procedure to identify opportunities to reduce unnecessary VCUG examinations. Methods: A retrospective analysis of 197 pediatric patients who underwent VCUG over 12 months at the Institute for Child and Youth Health Care of Vojvodina was conducted. Results: The Mann–Whitney U test showed no statistically significant age difference between patients with normal (median: 2.5 years) and pathological (median: 3 years) VCUG findings (Z = −0.415, p = 0.678). The chi-square test showed that patients with a single urinary tract infection (10 patients) and other clinical indications (24 patients) had a higher chance of normal VCUG findings (0.041 and 0.011, respectively). Binary logistic regression analysis showed that patients referred by pediatric urologists were 2.06 times more likely to have pathological VCUG findings than those referred by pediatric nephrologists (p = 0.013, OR = 2.059; 95%CI: 0.166–3.634). Regarding clinical indications, the chance that VCUG findings would be normal was 2.7 times higher in patients with other indications than in patients with recurrent UTIs (p = 0.038, OR = 2.729; 95% CI: 1.055–7.059). Conclusions: Pediatric urologists tend to refer patients for VCUG more selectively than pediatric nephrologists. Avoiding VCUG in cases of a single UTI or non-specific clinical indications could significantly reduce the number of unnecessary procedures, minimizing patient exposure to radiation and potential complications. Full article
(This article belongs to the Special Issue Innovative Approaches in Pediatric Urinary Care)
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11 pages, 1531 KiB  
Article
Mortality Associated with Orofacial Clefts in Brazil
by Amanda de Andrade Costa, Hildeth Maisa Torres Farias, Daniella Reis B. Martelli, Verônica Oliveira Dias, Brazilian Oral Cleft Group, Ricardo D. Coletta and Hercílio Martelli Junior
Dent. J. 2025, 13(7), 282; https://doi.org/10.3390/dj13070282 - 23 Jun 2025
Viewed by 370
Abstract
Background/Objectives: Orofacial clefts are congenital anomalies that cause substantial morbidity and mortality. This study aimed to investigate temporal and geographic trends in mortality among Brazilian individuals with orofacial clefts listed as the underlying cause of death on death certificates. Methods: A retrospective cross-sectional [...] Read more.
Background/Objectives: Orofacial clefts are congenital anomalies that cause substantial morbidity and mortality. This study aimed to investigate temporal and geographic trends in mortality among Brazilian individuals with orofacial clefts listed as the underlying cause of death on death certificates. Methods: A retrospective cross-sectional study was conducted using data from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from 1996 to 2023. Results: The mortality information system registered 987 deaths related to orofacial clefts, with 880 patients under 1 year of age. There was a downward trend in annual mortality rates from 1996 to 2019, followed by an increase from 2020 to 2023. The main associated cause of death was respiratory and cardiovascular disorders. The mortality rate for infants under 1 year with orofacial clefts showed greater variation than did the mortality rate of children who died of other causes. The reduction in mortality rates from 1996 to 2019 occurred during the expansion and strengthening of DATASUS and its coordination with other levels of healthcare. The rise in mortality between 2020 and 2023 coincided with a reduction in surgical procedures due to the COVID-19 pandemic. Conclusions: This study revealed a decline in deaths from orofacial clefts in Brazil over several decades. These findings emphasize the importance of addressing preventable causes of death, including respiratory infections and malnutrition. High mortality within the first year of life—particularly among newborns under 28 days—highlights a critical shortage of pediatricians and its impact on care for individuals with craniofacial anomalies. Full article
(This article belongs to the Special Issue Trends in Orofacial Cleft Research)
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8 pages, 331 KiB  
Article
The Relationship Between Prematurity and Mode of Delivery with Disorders of Gut–Brain Interaction in Children
by Carlos Alberto Velasco-Benitez, Daniela Alejandra Velasco-Suarez, Natalia Palma, Samantha Arrizabalo and Miguel Saps
Children 2025, 12(6), 799; https://doi.org/10.3390/children12060799 - 18 Jun 2025
Viewed by 379
Abstract
Background: Disorders of gut–brain interaction (DGBI) are multifactorial. Early-life events are proposed as factors involved in their etiopathogenesis. The relationship between mode of delivery, prematurity, and DGBI development remains unclear. This study examines whether cesarean delivery and prematurity contribute to early childhood DGBI. [...] Read more.
Background: Disorders of gut–brain interaction (DGBI) are multifactorial. Early-life events are proposed as factors involved in their etiopathogenesis. The relationship between mode of delivery, prematurity, and DGBI development remains unclear. This study examines whether cesarean delivery and prematurity contribute to early childhood DGBI. Methods: Caregivers of children aged 1 month to 4 years from four Colombian cities participated in a cross-sectional study. Pediatricians completed the Spanish-validated Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV). Data of children born by cesarean delivery and prematurity were compared with controls. Categorical data were analyzed using Fisher’s exact test, and odds ratios (ORs) with 95% confidence intervals (CIs). Results: DGBIs were identified in 26.6% of children, with functional constipation (FC) being the most prevalent (22.3%). Among children born via cesarean section (54.3%), 30.4% of them had a DGBI (OR = 1.54, 95% CI = 1.20–1.96, p = 0.00), and 26.3% had FC (OR = 1.67, 95% CI = 1.29–2.18, p = 0.00). Prematurity was observed in 12.6% of children and was associated with a higher prevalence of DGBI (35.7%, (OR = 1.64, 95% CI = 1.16–2.29, p = 0.00), with FC affecting 30.8% (OR = 1.66, 95% CI = 1.16–2.35, p = 0.00). Conclusions: Cesarean delivery and prematurity were found to be associated with DGBI in early childhood, particularly FC. These findings highlight the need for further research to explore potential mechanisms and confirm these associations. Full article
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17 pages, 3394 KiB  
Review
Sinusitis Complications—A Comprehensive Review of Management from the Primary to the Tertiary Level
by Domen Vozel
Sinusitis 2025, 9(1), 11; https://doi.org/10.3390/sinusitis9010011 - 18 Jun 2025
Viewed by 829
Abstract
The paranasal sinuses are in close anatomical contact with the nasal and oral cavities, the orbit, the skull base, the brain, and important neurovascular structures, so complications of sinusitis can have serious and life-threatening consequences. Roughly, complications are divided into extracranial and intracranial. [...] Read more.
The paranasal sinuses are in close anatomical contact with the nasal and oral cavities, the orbit, the skull base, the brain, and important neurovascular structures, so complications of sinusitis can have serious and life-threatening consequences. Roughly, complications are divided into extracranial and intracranial. Of the extracranial complications, orbital complications are the most common. In addition to clinical examination and immediate referral to hospital, diagnostic imaging methods, particularly CT, are important in the diagnosis of complications. The treatment of complications of sinusitis is mainly multidisciplinary and may involve pediatricians, family physicians, emergency physicians, otorhinolaryngologists, neurologists, neurosurgeons, ophthalmologists, neuroradiologists, and infectious disease specialists. The cornerstone of treatment is early targeted antimicrobial therapy and surgery for abscess, visual impairment, or involvement of critical neurovascular structures. This paper reviews sinusitis complications and provides study material for physicians who manage this disease. Full article
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15 pages, 249 KiB  
Article
Mouth Breathing and Orthodontic Referral in Pediatric Practice: A Cross-Sectional Survey
by Tulca Büyükpatır Türk, Barış Erkut Türk and Yeşim Kaya
Children 2025, 12(6), 790; https://doi.org/10.3390/children12060790 - 17 Jun 2025
Viewed by 424
Abstract
Objectives: Mouth breathing in children may lead to craniofacial anomalies such as maxillary constriction. Pediatricians play a crucial role in recognizing early signs and making timely referrals. This study aimed to evaluate the awareness of pediatricians regarding mouth breathing and its orthodontic [...] Read more.
Objectives: Mouth breathing in children may lead to craniofacial anomalies such as maxillary constriction. Pediatricians play a crucial role in recognizing early signs and making timely referrals. This study aimed to evaluate the awareness of pediatricians regarding mouth breathing and its orthodontic implications and to assess the impact of their treatment attitudes and clinical experience on referral practices. Methods: A 20-item online questionnaire was completed by 110 volunteer pediatricians from various regions of Türkiye via professional networks. The survey included items on awareness, treatment attitudes, referral behaviors, and demographics. Composite scores for awareness and orthodontic treatment attitude were calculated and included in the analysis. Data were analyzed using chi-square tests, Spearman correlation, and binary logistic regression. Results: Most pediatricians were aware of the link between mouth breathing and craniofacial issues (awareness rate: 73.6%), yet only 14.5% were familiar with specific orthodontic treatment approaches such as maxillary expansion. Although 70.9% expressed a desire for further training, only 25.5% reported frequently referring patients for orthodontic evaluation. Referral behavior was significantly associated with both clinical experience (p = 0.004) and orthodontic treatment attitude scores (p = 0.004) but not with awareness scores (p = 0.12). Conclusions: Although pediatricians in Türkiye demonstrate relatively high awareness regarding the consequences of mouth breathing, referral practices remain limited. Attitudinal orientation toward orthodontic treatment may play a more influential role in referral behavior than awareness alone. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
7 pages, 571 KiB  
Article
Evaluation of Cystic Fibrosis Newborn Screening and Follow-Up Process in Georgia (2022–2023)
by Nino Vardosanidze, Nani Kavlashvili, Lali Margvelashvili, Oleg Kvlividze, Mikheil Diakonidze, Saba Iordanishvili and Dodo Agladze
Int. J. Neonatal Screen. 2025, 11(2), 43; https://doi.org/10.3390/ijns11020043 - 4 Jun 2025
Viewed by 659
Abstract
Cystic fibrosis (CF) is a chronic, autosomal-recessive disorder caused by mutations in the CFTR gene, leading to thickened secretions that affect multiple organ systems. This study examines the effectiveness of Georgia’s national CF screening program, which was initiated in 2012 and includes the [...] Read more.
Cystic fibrosis (CF) is a chronic, autosomal-recessive disorder caused by mutations in the CFTR gene, leading to thickened secretions that affect multiple organ systems. This study examines the effectiveness of Georgia’s national CF screening program, which was initiated in 2012 and includes the measurement of immunoreactive trypsinogen (IRT) levels at birth. An analysis of data from 2022 and 2023 revealed a decrease in follow-up attendance for sweat chloride testing among newborns with elevated IRT levels, from 59.9% to 51.2%. The birth prevalence of cystic fibrosis in Georgia varied, suggesting a need to improve both the accessibility of free testing and the quality of follow-up care. Identified barriers include limited access to screening results for pediatricians and the cost of follow-up tests. Recommendations include incorporating free sweat chloride and genetic testing into the national program, as well as improving community education and coordination with social agencies. The identification of 29 CFTR mutations in patients underscores the importance of continued genetic counseling. Overall, while the screening program shows promise, addressing these barriers is essential to improve outcomes and ensure the timely diagnosis and management of cystic fibrosis in Georgia. Full article
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13 pages, 488 KiB  
Article
Use of Probiotics During Antibiotic Therapy in Pediatrics: A Cross-Sectional Survey of Italian Primary Care Pediatricians
by Giacomo Biasucci, Maria Elena Capra, Antonella Giudice, Delia Monopoli, Brigida Stanyevic, Roberta Rotondo, Alessandro Mucci, Cosimo Neglia, Beatrice Campana and Susanna Esposito
Antibiotics 2025, 14(6), 577; https://doi.org/10.3390/antibiotics14060577 - 4 Jun 2025
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Abstract
Background: Antibiotic-associated diarrhea (AAD) is a common adverse effect of pediatric antibiotic therapy, often linked to gut microbiota disruption. Probiotics may help prevent AAD when appropriately selected and dosed. Methods: We conducted a cross-sectional survey to assess the attitudes and prescribing habits [...] Read more.
Background: Antibiotic-associated diarrhea (AAD) is a common adverse effect of pediatric antibiotic therapy, often linked to gut microbiota disruption. Probiotics may help prevent AAD when appropriately selected and dosed. Methods: We conducted a cross-sectional survey to assess the attitudes and prescribing habits of Italian Primary Care Pediatricians (PCPs) regarding the use of probiotics during antibiotic treatment. A digital questionnaire comprising 23 mandatory multiple-choice items was distributed to 980 PCPs across Italy between July and October 2024. The survey explored probiotic prescribing frequency, indications, strains used, dosage, duration, and sources of information. Descriptive statistics and subgroup analyses by years of clinical experience were performed. Results: A total of 279 PCPs (response rate: 28%) completed the survey; 66.7% were female, and 77.1% had over 20 years of clinical experience. Probiotics were prescribed primarily to restore microbiota balance (81.1%) and prevent AAD (47.3%). The most common barriers included additional cost (35.1%) and perceived lack of evidence (26.5%). Lactobacillus rhamnosus GG (91.8%) and Saccharomyces boulardii (41.9%) were the most frequently recommended strains. Daily doses of 5–10 billion CFU were preferred by 44.4% of respondents, with typical durations of 1–2 weeks (40.1%) or one week (31.2%). Conclusions: Probiotics are widely used by Italian PCPs during antibiotic therapy, especially for microbiota support and AAD prevention. However, variability in practice underscores the need for clearer, evidence-based guidelines regarding probiotic strain selection, dosing, and treatment duration. Full article
(This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship)
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