Children

11 pages, 530 KiB

Open AccessArticle

Parapneumonic Effusion Versus Pulmonary Empyema in Children: Analysis of Risk Factors and Laboratory Predictors Through a Single Center Experience

by Marta Improta, Francesca Morlino, Roberta Ragucci, Carolina D’Anna, Stefania Muzzica, Vincenzo Tipo, Antonietta Giannattasio and Marco Maglione

Children 2025, 12(8), 1103; https://doi.org/10.3390/children12081103 - 21 Aug 2025

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Abstract

Background: Parapneumonic effusion is a common complication of community-acquired pneumonia and can range from a simple inflammatory transudate to an organized purulent collection, known as empyema. Progression to empyema significantly worsens the prognosis, leading to increased morbidity, longer hospital stays, and a greater [...] Read more.

Background: Parapneumonic effusion is a common complication of community-acquired pneumonia and can range from a simple inflammatory transudate to an organized purulent collection, known as empyema. Progression to empyema significantly worsens the prognosis, leading to increased morbidity, longer hospital stays, and a greater need for invasive interventions. Several risk factors for pleural effusion and progression to empyema have been identified, but the absence of standardized criteria underline the need for better risk stratification. We analyzed clinical and laboratory data from a cohort of children hospitalized with pneumonia associated with pleural effusion or empyema, to identify predictive risk factors associated with these complications. Methods: We retrospectively analyzed clinical and laboratory data from patients admitted to our Pediatric Emergency Department with pneumonia complicated by pleural effusion and compared patients with simple effusion to those with empyema. Results: Seventeen children with simple pleural effusion and eighteen with empyema were enrolled. Patients with empyema had higher absolute neutrophil count, higher levels of C-reactive protein, procalcitonin, and ferritin, and lower serum albumin levels. Furthermore, they took a longer time for normalization of inflammatory markers when compared with those with pleural effusion. Invasive interventions, such as pleural drainage, and the need for intensive care were more frequent in the empyema group. Conclusions: Pleural effusion and empyema are two common complications of pediatric community-acquired pneumonia. Children developing pleural empyema have higher inflammatory markers and lower levels of serum albumin compared to patients with simple pleural effusion. Morbidity is significantly worse in children with empyema as they are more prone to require invasive interventions and intensive care. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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14 pages, 335 KiB

Open AccessArticle

Clinical and Molecular Characterizations of Mitochondrial Disorders: A Tertiary-Care Center Experience

by Mohammed Almuqbil, Najla Binsabbar, Shahad Alsaif, Sulaiman Almasoud, Talah Albasry, Duaa Baarmah, Waleed Altwaijri and Ahmed Alrumayyan

Children 2025, 12(8), 1102; https://doi.org/10.3390/children12081102 - 21 Aug 2025

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Abstract

Background: Given the limited research on mitochondrial diseases in our area, specifically regarding their genetic variability and diverse clinical manifestations, and considering the significant number of consanguineous marriages in our region, we aimed to investigate the clinical and molecular characteristics of patients with [...] Read more.

Background: Given the limited research on mitochondrial diseases in our area, specifically regarding their genetic variability and diverse clinical manifestations, and considering the significant number of consanguineous marriages in our region, we aimed to investigate the clinical and molecular characteristics of patients with mitochondrial disorders in Saudi Arabia. Methods: This retrospective cross-sectional cohort study involved a chart review of patients diagnosed with mitochondrial disorders at the Ministry of National Guard Health Affairs tertiary health care centers in Saudi Arabia between 2013 and 2022. Results: The study population comprised 116 patients with a mean age of 10 years (±7 SD). Among the study cohort, 34.5% (n = 40) had died. The primary cause of death was cardiopulmonary arrest (55.0%, n = 22). The most prevalent condition was developmental delay (67.9%). Around 56.9% were diagnosed using Whole Exome Sequencing (WES), 10.3% by Whole Genome Sequencing due to negative WES, 23.3% through a single-gene approach, 7.8% were analyzed through a mitochondrial panel, and 1.7% via a gene panel. The distributions of current age and age at diagnosis were significantly different between the nuclear and mitochondrial gene types. Notably, the diagnostic delay time (time taken from symptom onset to genetic diagnosis) averaged 1.5 years for nDNA variants compared to an average of 10 years for mDNA variants. Conclusions: This study shows that gene type affects clinical characteristics, highlighting the importance of genetic studies in disease manifestation. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

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18 pages, 1354 KiB

Open AccessArticle

Plasma Thrombospondin-1 in Etiology-Specific Associations with Proteinuria Events in Pediatric Chronic Kidney Disease

by Pei-Chen Lu, Wei-Ting Liao, Chien-Ning Hsu, You-Lin Tain and Chia-An Chou

Children 2025, 12(8), 1101; https://doi.org/10.3390/children12081101 - 21 Aug 2025

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Abstract

Background: Thrombospondin-1 (TSP-1) is a matricellular protein involved in kidney fibrosis, potentially influencing the progression of proteinuria. However, its potential as a predictive biomarker for proteinuria events in children with chronic kidney disease (CKD), particularly across different etiological subgroups, such as congenital anomalies [...] Read more.

Background: Thrombospondin-1 (TSP-1) is a matricellular protein involved in kidney fibrosis, potentially influencing the progression of proteinuria. However, its potential as a predictive biomarker for proteinuria events in children with chronic kidney disease (CKD), particularly across different etiological subgroups, such as congenital anomalies of the kidney and urinary tract (CAKUT) and non-CAKUT, has not been fully explored. Methods: In this prospective study of 60 children with CKD, we assessed baseline plasma TSP-1 and tracked proteinuria events over one year. Participants were stratified into CAKUT and non-CAKUT groups. Results: In total, 5 of 60 participants had proteinuria events. Plasma TSP-1 was significantly lower in patients with events (21.18 vs. 36.28 μg/mL, p = 0.0364). In multivariable analysis, TSP-1 lost significance overall but remained predictive in the non-CAKUT subgroup (AUC = 0.79, p = 0.064; OR = 0.93, p = 0.028). Conclusions: Plasma TSP-1 may serve as an etiology-specific biomarker for proteinuria events in pediatric CKD, particularly among non-CAKUT patients, and warrants further investigation for personalized risk assessment. Full article

(This article belongs to the Special Issue Renal Diseases in Children: The Present and a Challenge for the Future)

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18 pages, 714 KiB

Open AccessArticle

Parental Knowledge, Attitude and Practices Toward Cariogenic Potential of Pediatric Oral Medications

by Reham M. Al-Amoudi, Heba Mohamed Elkhodary, Shahad N. Abudawood, Azza El-Housseiny and Osama M. Felemban

Children 2025, 12(8), 1100; https://doi.org/10.3390/children12081100 - 21 Aug 2025

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Abstract

Background/Objectives: Sugar added to pediatric oral medications may increase the risk of dental caries and erosion. Parental awareness and practices play a crucial role in minimizing the oral health risks associated with such medications. Therefore, the aim was to assess parents’ knowledge, [...] Read more.

Background/Objectives: Sugar added to pediatric oral medications may increase the risk of dental caries and erosion. Parental awareness and practices play a crucial role in minimizing the oral health risks associated with such medications. Therefore, the aim was to assess parents’ knowledge, attitudes, and practices regarding the cariogenic potential of pediatric oral medications in the Kingdom of Saudi Arabia. Methods: A cross-sectional study was conducted using an online questionnaire. Parents who had at least one child between 2 and 12 years old were included. Participants were categorized into three groups based on the long-term intake of medications and their child’s health status. Group 1: Parents of children with chronic diseases on long-term medications. Group 2: Parents of healthy children on long-term medications. Group 3: Parents of healthy children not on long-term medications. Results: A total of 2195 responses were collected. The majority of parents were aged 31–40 years. More than half of the mothers and fathers had a diploma or a university degree (59% and 54.3%, respectively). Although a high proportion of the parents (78–83%) were aware that medications often contained sugar, only 46–50% were aware of their cariogenic potential, while 27–38% speculated about their erosive potential. In terms of practices, most parents encouraged their children to drink water (70–71%) or rinse their mouths (14–20%) after medication intake. Conclusions: While most parents were aware that pediatric oral medications may contain sugar, there was a lack of proactive measures to mitigate their negative impact on oral health. Further studies are still needed to evaluate and improve public awareness and practices regarding the oral health risks associated with pediatric medications. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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14 pages, 1201 KiB

Open AccessArticle

A 10-Year Review of the Efficacy of Cranial Remolding Orthosis Treatment and Factors That Influence Outcomes for Infants with Isolated Deformational Plagiocephaly

by Anna L. Trebilcock, Jill L. Findley, J. Suzanne Cherry, Jeffrey A. Kasparek, Melody M. Gordon, Stephen P. Beals and Timothy R. Littlefield

Children 2025, 12(8), 1099; https://doi.org/10.3390/children12081099 - 21 Aug 2025

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Abstract

Background/objectives: The purpose of this study was to examine the overall efficacy and treatment outcomes of CROs in the treatment of isolated deformational plagiocephaly and investigate the variables that influence treatment efficacy. Methods: This was a 10-year retrospective review of N = 27, [...] Read more.

Background/objectives: The purpose of this study was to examine the overall efficacy and treatment outcomes of CROs in the treatment of isolated deformational plagiocephaly and investigate the variables that influence treatment efficacy. Methods: This was a 10-year retrospective review of N = 27, 990 infants with Isolated Deformational Plagiocephaly (IDP) who completed Cranial Remolding Orthosis (CRO) treatment between 3 and 18 months of age. Results: There was a significant overall mean change in CVAI(S) of −3.42 ± 0.011 (p < 0.001), and a significant improvement in CVAI(S) in all age groups, even in older babies (i.e., >11 months). Up to 96% of infants aged 4–6 months at initiation of treatment achieved a “good” or “great” outcome rating, and up to 77.6% of infants over 11 months exited with a similar outcome. The following were identified as significant predictors of greater change in CVAI(S): (1) younger entry age (p < 0.001, β = 0.01), (2) larger initial CVAI(S) scores (p <0.001, β = −0.43), (3) left plagiocephaly (p < 0.001, β = −0.36), and (4) and the absence of torticollis (p < 0.001, β = −0.17). Conclusions: CROs are an effective, research-supported treatment for IDP. Pediatric health care providers and parents should be aware of the efficacy of CRO therapy across age groups and severity ratings, the risk factors that may influence CRO outcomes, and the benefits of an early referral at a young age. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

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32 pages, 1140 KiB

Open AccessArticle

Anxiety in Young Children with Williams Syndrome: A Longitudinal Study

by Jessica L. Reeve and Melanie A. Porter

Children 2025, 12(8), 1098; https://doi.org/10.3390/children12081098 - 21 Aug 2025

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Abstract

Background/Objectives: Anxiety is a hallmark feature of Williams syndrome (WS), with very high prevalence rates of generalised anxiety disorder (GAD) and specific phobias in both school-aged children and adults, yet a relatively lower prevalence of social phobia. There is very limited research [...] Read more.

Background/Objectives: Anxiety is a hallmark feature of Williams syndrome (WS), with very high prevalence rates of generalised anxiety disorder (GAD) and specific phobias in both school-aged children and adults, yet a relatively lower prevalence of social phobia. There is very limited research on anxiety in very young children with WS, and no study to date has examined the early prevalence and development of different anxiety disorders in WS. The present research provides a comprehensive assessment of the prevalence and longitudinal profile of anxiety symptomology in very young children with WS. Potential environmental and demographic correlates of anxiety symptomology were also explored. Methods: Participants included 19 young children with WS, aged between 2 and 5 years (at initial testing), who completed a comprehensive developmental assessment. Parents/guardians also completed the Spence Children’s Anxiety Scale (SCAS; Spence, 1997 & Spence et al., 2001), a standardised, psychometrically robust anxiety questionnaire (commonly utilised in research and clinical settings) that measures anxiety symptomology for various anxiety disorders present in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013). Results: The present research found anxiety symptomology to be highly prevalent in very young children with WS, particularly GAD and specific phobia. Moreover, the prevalence of anxiety symptomology increased with age and over time, with many children developing comorbid anxiety disorder symptoms approximately 3.5 years later, at Time 2. Chronological age, sex, and developmental/intellectual capabilities were also found to impact on the developmental trajectory of anxiety in young children with WS. Conclusions: The longitudinal findings provide evidence for the contribution of environmental factors on the nature, developmental course, and maintenance of anxiety. Considerable individual variability was apparent, confirming the importance of individual assessments and developing individualised treatment programmes for those with WS. Full article

(This article belongs to the Section Pediatric Mental Health)

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12 pages, 1776 KiB

Open AccessArticle

Effect of Midazolam Premedication on Salivary Cortisol Levels in Pediatric Patients with Negative Frankl Behavior: A Pilot Study

by Juan Ignacio Aura-Tormos, Laura Marqués-Martínez, Esther Garcia-Miralles, Isabel Torres-Cuevas, Bianca Quartararo and Clara Guinot-Barona

Children 2025, 12(8), 1097; https://doi.org/10.3390/children12081097 - 20 Aug 2025

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Abstract

Background/Objectives: This pilot study aimed to evaluate stress levels in pediatric patients classified as definitely negative according to the Frankl scale by measuring salivary cortisol concentrations. Additionally, the study assessed the impact of Midazolam premedication on stress reduction during dental procedures. Methods. Children [...] Read more.

Background/Objectives: This pilot study aimed to evaluate stress levels in pediatric patients classified as definitely negative according to the Frankl scale by measuring salivary cortisol concentrations. Additionally, the study assessed the impact of Midazolam premedication on stress reduction during dental procedures. Methods. Children and adolescents attending the Pediatric Dentistry Master’s program at the Catholic University of Valencia participated in the study. Salivary cortisol levels were measured before and after dental treatments, differentiating between invasive and non-invasive procedures. Patients were divided into two groups: those receiving Midazolam premedication and those who did not. Results. Findings showed a significant increase in cortisol levels following invasive dental treatments (0.991), whereas non-invasive treatments (0.992) did not lead to notable changes (p < 0.001). Patients premedicated with Midazolam exhibited significantly lower post-treatment cortisol levels compared to those who did not receive the medication (p < 0.05). Conclusions. These preliminary findings suggest that Midazolam-based management in children with definitely negative behavior may be associated with reduced physiological stress responses. As a pilot study with a limited sample and inherent group-allocation bias, the results should be interpreted with caution. The methodology proved feasible and supports the use of salivary cortisol in future, larger-scale studies designed to disentangle behavioral and pharmacological effects. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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23 pages, 1403 KiB

Open AccessSystematic Review

Perinatal and Childhood Risk Factors of Adverse Early Childhood Developmental Outcomes: A Systematic Review Using a Socioecological Model

by Kendalem Asmare Atalell, Gavin Pereira, Bereket Duko, Sylvester Dodzi Nyadanu and Gizachew A. Tessema

Children 2025, 12(8), 1096; https://doi.org/10.3390/children12081096 - 20 Aug 2025

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Abstract

Background: Adverse early childhood developmental outcomes across physical, cognitive, language, communication, and socioemotional domains are major global health concerns. This systematic review aimed to synthesise perinatal and childhood risk factors using a socioecological model. Methods: We searched six databases for cohort, case–control, and [...] Read more.

Background: Adverse early childhood developmental outcomes across physical, cognitive, language, communication, and socioemotional domains are major global health concerns. This systematic review aimed to synthesise perinatal and childhood risk factors using a socioecological model. Methods: We searched six databases for cohort, case–control, and cross-sectional studies published between January 2000 and January 2024. Studies reporting risk factors for adverse developmental outcomes were included. Findings were organised across individual, interpersonal, community, and societal levels using a socioecological model. The protocol was registered in PROSPERO (CRD42023447352). Results: A total of 175 studies were included. Individual-level risk factors, including preterm birth, low birth weight, male sex, chronic illness, undernutrition, and excessive screen use, were associated with adverse developmental outcomes, while exclusive breastfeeding, reading books, and storytelling were protective factors. Interpersonal risks included maternal age, education, mental health, and pregnancy complications. Community and societal risks include environmental pollution, access to education, conflict, and healthcare access. Conclusions: Improving early childhood developmental outcomes may require intervention at multiple levels. Future studies may need to focus on the influence of culturally and linguistically diverse backgrounds and environmental exposures on early childhood developmental outcomes. Full article

(This article belongs to the Section Pediatric Mental Health)

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21 pages, 410 KiB

Open AccessSystematic Review

Parental Psychological Response to Prenatal Congenital Heart Defect Diagnosis

by Cristina Tecar, Lacramioara Eliza Chiperi and Dafin Fior Muresanu

Children 2025, 12(8), 1095; https://doi.org/10.3390/children12081095 - 20 Aug 2025

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Abstract

Background: This systematic review aims to summarize the most recent data from the literature on the psychological aspects of parents of children prenatally diagnosed with congenital heart defects (CHDs). Methods: A comprehensive literature search was conducted to identify relevant studies on the psychological [...] Read more.

Background: This systematic review aims to summarize the most recent data from the literature on the psychological aspects of parents of children prenatally diagnosed with congenital heart defects (CHDs). Methods: A comprehensive literature search was conducted to identify relevant studies on the psychological issues faced by parents of children prenatally diagnosed with CHD. Searches were performed in multiple scientific databases, including PubMed, Science direct, Embase, Scopus, Medline, Clarivate, to ensure the broad coverage of the literature. The search was limited to studies published up until February 2025. The search strategy included the following terms and combinations: “congenital heart defect” OR “CHD” AND “prenatal diagnosis” AND “psychological impact” OR “parental distress” OR “coping”. Results: Eighteen studies involving the 673 parents of fetuses diagnosed with congenital heart defects were included. Studies spanned four continents and employed both qualitative (n = 14) and quantitative (n = 4) designs. Key psychological outcomes reported were anxiety, depression, stress, post-traumatic stress, coping strategies, maternal–fetal attachment, and life satisfaction. Anxiety and depression were the most frequent issues, with maternal anxiety reaching 65% and depression up to 45.7%. Stress related to diagnostic uncertainty was common. While some parents used adaptive coping (social support, emotional regulation), others experienced maladaptive patterns such as avoidance. One study reported increased maternal–fetal attachment following prenatal CHD diagnosis. Predictors of psychological distress included time of diagnosis, parental gender, education level, social support, and severity of the defect. Recommended interventions included early psychological screening, empathetic communication, structured counseling, and long-term emotional support. Despite heterogeneity in design and moderate overall bias, findings highlight a consistent psychological burden among parents, underscoring the need for integrated psychosocial care following a prenatal CHD diagnosis. Conclusions: Parents whose children have been prenatally diagnosed with a congenital heart defect are at an increased risk for psychological distress. To improve the quality of care, a multidisciplinary team is needed to provide parents with the necessary information on diagnosis, interventions, and potential outcomes. Full article

(This article belongs to the Section Pediatric Cardiology)

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18 pages, 494 KiB

Open AccessArticle

Competitive Anxiety, Sports Injury, and Playing Category in Youth Soccer Players

by Rafael Sánchez-Ruiz, Laura Gil-Caselles, Alejo García-Naveira, Félix Arbinaga, Roberto Ruiz-Barquín and Aurelio Olmedilla-Zafra

Children 2025, 12(8), 1094; https://doi.org/10.3390/children12081094 - 20 Aug 2025

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Abstract

Background: Adolescence is a critical period of physical, psychological, and social development, during which athletes are particularly vulnerable to stress and injuries. Competitive anxiety has been identified as a psychological factor that may increase injury risk; however, its role among young soccer players [...] Read more.

Background: Adolescence is a critical period of physical, psychological, and social development, during which athletes are particularly vulnerable to stress and injuries. Competitive anxiety has been identified as a psychological factor that may increase injury risk; however, its role among young soccer players remains underexplored. Objectives: This study aimed to analyse the association between competitive anxiety and injury vulnerability in young male soccer players aged 10 to 15 years. Methods: A total of 322 male soccer players from youth categories (Alevin, Infantil, and Cadete) participated. Competitive anxiety was assessed using the Sport Anxiety Scale-2 (SAS-2), and injury data were collected via a self-reported questionnaire covering the 2024–2025 season. Descriptive, comparative, and correlational analyses were conducted using non-parametric tests. Results: A high incidence of injuries was observed, increasing progressively with age category. In the overall sample, injuries were associated with higher levels of Somatic Anxiety, as well as with age and sporting experience, variables also linked to increased Worry and reduced Distraction. When analysed by category, no significant associations between anxiety and injury were found in Alevin players. In the Infantil group, injury incidence showed a slight increase with age and experience, but no association with anxiety was detected. Among Cadete players, injuries were positively related to Somatic Anxiety and Distraction, highlighting the influence of psychological factors at this developmental stage. Conclusions: These findings underscore the relevance of competitive anxiety, particularly Worry and Distraction, as risk factors for injury in youth soccer. The implementation of preventive psychological interventions and ongoing monitoring is recommended to reduce anxiety levels and injury vulnerability, thereby promoting safer and healthier athletic development among young soccer players. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

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11 pages, 857 KiB

Open AccessArticle

Assessment of Azathioprine-Associated Lymphopenia Incidence Rates in Polish Children with Inflammatory Bowel Disease and Autoimmune Hepatitis: A Retrospective Study

by Katarzyna Bąk-Drabik, Anna Kaput, Anna Jarzumbek, Katarzyna Górowska-Kowolik, Agnieszka Szymlak, Agnieszka Krzywicka, Piotr Adamczyk and Jarosław Kwiecień

Children 2025, 12(8), 1093; https://doi.org/10.3390/children12081093 - 20 Aug 2025

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Abstract

Background and objective: Thiopurines (azathioprine (AZA) and 6-mercaptopurine (6-MP)), used to maintain remission in inflammatory bowel diseases (Crohn’s disease (CD), ulcerative colitis (CU)) and autoimmune hepatitis (AIH), are responsible for a number of adverse effects. One is leukopenia, mainly due to neutropenia and [...] Read more.

Background and objective: Thiopurines (azathioprine (AZA) and 6-mercaptopurine (6-MP)), used to maintain remission in inflammatory bowel diseases (Crohn’s disease (CD), ulcerative colitis (CU)) and autoimmune hepatitis (AIH), are responsible for a number of adverse effects. One is leukopenia, mainly due to neutropenia and less known lymphopenia. This study aimed to assess the incidence rate of lymphopenia in pediatric patients with CD, CU, and AIH treated with azathioprine (AZA) and to evaluate the impact of lymphopenia on the occurrence of opportunistic infections and its relationship with disease activity, treatment, and nutritional status. Materials and methods: A retrospective analysis was carried out in ninety-eight (98) paediatric patients, suffering from CD, CU, or AIH and treated with AZA, in order to assay blood cell count and thiopurine metabolite levels, assess the mean AZA dose, measure the anthropometric parameters, evaluate disease activity vs. the treatment administered, and to find out concomitant infections. Results: Lymphopenia was diagnosed in twenty-two (22) children and evaluated as severe in two (2) cases, which were associated with treatment discontinuation. The percentage of patients with lymphopenia in the CD group (34.5%) was significantly higher vs. the CU (3.7%) and AIH (7.7%) groups. The prevalence rates of the patients with low and moderate-to-high disease activity were 13.9% and 46.1%, respectively. The patients with lymphopenia demonstrated higher prevalence rates of mild respiratory tract and skin infections (identified in 32%). No cases of opportunistic infections were reported. Conclusions: Lymphopenia affected approximately one-quarter of the patients observed, the condition being transient in most cases and not demanding any therapy modifications. In no case was it associated with the occurrence of any opportunistic infections. It was significantly more common in the patients with Crohn’s disease and the subgroup with a more intense course of the disease, obviously suggesting a need for more frequent follow-up of the patients in those subgroups. The AZA therapy did not seem to be associated with lymphopenia occurrence in any significant way. Full article

(This article belongs to the Section Pediatric Gastroenterology and Nutrition)

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8 pages, 184 KiB

Open AccessCommunication

The Role of Biologic Therapy Switching to Optimize the Treatment of Severe Pediatric Asthma: Tezepelumab Is a New Therapeutic Alternative for Adolescents

by María Erroz Ferrer, Miren Paniagua García, Natividad Viguria Sánchez and Laura Moreno-Galarraga

Children 2025, 12(8), 1092; https://doi.org/10.3390/children12081092 - 20 Aug 2025

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Abstract

Background/Objectives: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability [...] Read more.

Background/Objectives: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability of the selected biologic, considering evolving patient characteristics and the growing availability of treatment options. This article aims to highlight the importance of individualized decision making in the long-term management of pediatric patients receiving biologic therapy, exploring the various reasons that may justify switching biologic treatment. Methods: We present a case to illustrate this approach: a 14-year-old adolescent girl with severe allergic asthma who initially received Omalizumab, achieving clinical, laboratory, and functional improvements. Despite this positive response, the patient reported low-level satisfaction due to the frequency of injections and hospital visits, leading to poor adherence. After a comprehensive reassessment, the treatment was switched to Tezepelumab. Results: Following the switch, the patient maintained stable disease control with a slight improvement in lung function, while adherence, satisfaction, and quality of life improved significantly. The number of hospital visits was reduced from 24 to 12 per year, and the number of injections decreased from 104 to 12 annually. The patient reported high-level satisfaction with the new treatment plan, and the economic burden of therapy was also substantially reduced. We present a table summarizing the essential and secondary factors to consider when initiating or switching biologic therapy. Conclusions: This case highlights the need to go beyond the traditional criteria, such as lack of efficacy and adverse reactions, when evaluating a switch in biologic therapy for pediatric asthma. Factors such as comorbidities, injection frequency and number, route of administration, and cost should also be considered, as they can directly influence adherence and the clinical outcomes in children and adolescents. As the therapeutic options expand, regular reassessment and personalized adjustments remain essential. Full article

(This article belongs to the Special Issue The Pediatric Formulations: The Present and a Challenge for Future)

16 pages, 288 KiB

Open AccessArticle

Hospital-Based Perinatal Practices and Duration of Exclusive Breastfeeding in Mexican Mothers

by Citlalli de los Ángeles Chávez-López, Clío Chávez-Palencia, Claudia Hunot-Alexander, Alfredo Larrosa-Haro, Anel Ibarra-Ortega, Sara Nayeli Acosta-Real and Edgar Manuel Vásquez-Garibay

Children 2025, 12(8), 1091; https://doi.org/10.3390/children12081091 - 20 Aug 2025

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Abstract

Background/Objectives: The initiation and maintenance of breastfeeding depend on internal and external factors that can either support or hinder its success. This study aimed to examine the association between hospital-based perinatal practices and the duration of exclusive breastfeeding among Mexican mothers of infants [...] Read more.

Background/Objectives: The initiation and maintenance of breastfeeding depend on internal and external factors that can either support or hinder its success. This study aimed to examine the association between hospital-based perinatal practices and the duration of exclusive breastfeeding among Mexican mothers of infants under one year of age. Methods: An analytical cross-sectional study was conducted in Guadalajara, Mexico, using a structured questionnaire developed in Google Forms and distributed via social media managed by healthcare professionals. Elegible participants were mothers of infants aged 6 to 12 months. Data were collected between March and November 2022 and included information on infant feeding at six months, sociodemographic and obstetric characteristics, breastfeeding education, hospital-based practices, and professional support during birth. A sample size of 323 participants was estimated on a 95% confidence level, 30% expected prevalence, and 5% margin of error. Statistical analyses included chi-square tests, odds ratios, Mann–Whitney U tests, and multivariate analyses. Results: A total of 326 mothers participated. Exclusive breastfeeding lasted less than six months for 63.5% of infants, while 36.5% were exclusively breastfed from birth to six months. Bottle use in the hospital, provision of human milk substitutes during the hospital stay, and at discharge were significantly associated with shorter exclusive breastfeeding duration (p < 0.001). Predictors of not achieving six months of exclusive breastfeeding included primiparity, delayed initiation beyond the first postpartum hour, and lack of continuous rooming-in. Conclusions: Hospital-based practices significantly influence exclusive breastfeeding duration. Strengthening maternity care policies may improve adherence to recommended feeding practices. Full article

(This article belongs to the Special Issue Promoting Breastfeeding and Human Milk in Infants (2nd Edition))

11 pages, 656 KiB

Open AccessArticle

Evaluation of Serum Complement Components in Pediatric IgA Vasculitis: A Case-Control Study

by Raziye Burcu Taşkın, Güzide Aksu, Sait Şen, Gülden Hakverdi, Burçe Emine Dörtkardeşler and Secil Conkar Tunçay

Children 2025, 12(8), 1090; https://doi.org/10.3390/children12081090 - 20 Aug 2025

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Abstract

Background: IgA vasculitis (IgAV) represents the most frequently seen form of vasculitis among children. Although it often resolves without intervention, renal involvement (IgAV nephritis) poses a risk for long-term complications. Although the lectin and alternative complement pathways are possible causes in its development, [...] Read more.

Background: IgA vasculitis (IgAV) represents the most frequently seen form of vasculitis among children. Although it often resolves without intervention, renal involvement (IgAV nephritis) poses a risk for long-term complications. Although the lectin and alternative complement pathways are possible causes in its development, dependable serum biomarkers for the early identification of nephritis remain unavailable. Methods: In this prospective case-control study, we examined how the serum levels of a membrane attack complex (sC5b-9), complement factor H (CFH), mannose-binding lectin (MBL), and mannose-binding lectin-associated serine protease-1 (MASP-1) relate to renal involvement in IgAV. These complement proteins were measured in children diagnosed with IgAV and compared to levels in healthy controls (HCs) matched for age and sex. Results: The study cohort comprised 44 IgAV patients with a median age of 8 years and 34 HCs. The CFH levels were reduced significantly in the patient group (median: 357.31 ng/mL; IQR: 228.32) relative to the controls (median: 543.08 ng/mL; IQR: 504.05) (p < 0.001). This decrease was observed irrespective of the presence of nephritis. There were no significant differences in serum sC5b-9, MBL, or MASP-1 levels between the patients and controls. Furthermore, no correlation emerged between these complement components and renal involvement. Conclusion: The data suggest that lower CFH levels may signal systemic dysregulation of the alternative pathway in IgAV. In contrast, the serum levels of sC5b-9, MBL, and MASP-1 appear inadequate as markers for predicting renal involvement. Further research with larger cohorts that includes genetic analyses and examination of kidney tissue is needed to better define the contribution of complement activation in IgAV-related nephritis. Full article

(This article belongs to the Section Pediatric Allergy and Immunology)

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15 pages, 1243 KiB

Open AccessArticle

Value of 18F-FDG PET/CT Scans in Staging and Follow-Up of Pediatric Langerhans Cell Histiocytosis: Comparison to CT and/or MRI

by Maria F. Dien Esquivel, Abdullah AlMutawa, Afsaneh Amirabadi, Sheila Weitzman, Ilia Buhtoiarov, Andrea S. Doria, Amer Shammas, Oussama Abla and Reza Vali

Children 2025, 12(8), 1089; https://doi.org/10.3390/children12081089 - 20 Aug 2025

Viewed by 268

Abstract

Background/Objectives: The purpose of this study is to determine the added value of 18F-FDG PET/CT scan in pediatric LCH compared to other imaging modalities (CT and MRI) at initial staging, during assessment of disease reactivation, and after treatment. Methods: This is a [...] Read more.

Background/Objectives: The purpose of this study is to determine the added value of 18F-FDG PET/CT scan in pediatric LCH compared to other imaging modalities (CT and MRI) at initial staging, during assessment of disease reactivation, and after treatment. Methods: This is a retrospective study of children diagnosed with LCH between 1 June 2007 and 8 December 2022 who met the inclusion criteria. 18F-FDG PET CT imaging was compared to CT and/or MRI when available. The interclass correlation coefficient (ICC) was used to assess the agreement between methods. p-Values of less than 0.05 were considered statistically significant. Results: A total of 39 children had undergone 18F-FDG PET/CT studies. Median (range) age at presentation was 10 years (1.3–17 y), with a female-to-male ratio of 0.7:1. Excellent concordance (ICC = 1; p < 0.0001) between 18F-FDG PET/CT and other imaging methods was found. Median SUVmax of the positive FDG-avid lesions at initial staging was 2.7 [range 1.3–16.7]. Conclusions: 18F-FDG PET/CT has been shown to be complementary to diagnostic CT and MRI, with the advantage of demonstrating additional metabolic information at initial staging, during assessment of disease reactivation, and to assess interval changes post therapy. These preliminary findings warrant further investigation. Full article

(This article belongs to the Section Pediatric Radiology)

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16 pages, 1083 KiB

Open AccessArticle

Health Technology Assessment of Continuous Glucose Monitoring Systems for Paediatric Patients

by Martina Andellini, Riccardo Schiaffini, Massimiliano Angelini, Leandro Pecchia and Matteo Ritrovato

Children 2025, 12(8), 1088; https://doi.org/10.3390/children12081088 - 19 Aug 2025

Viewed by 231

Abstract

Objectives: Type1 diabetes (T1D) is one of the most common chronic diseases in pediatric age. Continuous glucose monitoring (CGM) has been shown to improve glycaemic control in adults compared to self-monitoring of blood glucose (SMBG); however, evidence about its use in the pediatric [...] Read more.

Objectives: Type1 diabetes (T1D) is one of the most common chronic diseases in pediatric age. Continuous glucose monitoring (CGM) has been shown to improve glycaemic control in adults compared to self-monitoring of blood glucose (SMBG); however, evidence about its use in the pediatric field is limited and fragmented and needs to be improved. This paper aims to address all the critical aspects linked to the use of CGM in a pediatric population while also describing a methodology for conducting health technology assessment (HTA) to support the decision-making process. Methods: The use of CGM and SMBG in a pediatric population was compared by using a decision-making support tool (DoHTA method). Twenty-seven Key Performance Indicators (KPIs) were identified, defining safety, clinical effectiveness, organizational, patient perspective, and economic aspects. Performance scores for both monitoring systems were assessed based on these KPIs, leading to a final comparative ranking. Results: CGM demonstrated a 29.3% performance advantage over SMBG, highlighting its benefits in terms of clinical effectiveness, patient perspectives, safety, and economic evaluation. No substantial differences were identified in terms of organizational aspects. Conclusions: This study critically evaluates the benefits and drawbacks of the use of CGM in a pediatric population. It integrates the assessment of the clinical effectiveness with the organizational aspects, the cost, the patient perspective, and the safety, providing a valuable proof of evidence as well as a reliable and transferable method for conducting decision-making processes in a hospital setting. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

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13 pages, 606 KiB

Open AccessArticle

Nurse-Initiated Improvement for Documentation of Penicillin Adverse Drug Reactions in Pediatric Urgent Care Clinics

by Elizabeth Monsees, Diane Petrie, Rana E. El Feghaly, Sarah Suppes, Brian R. Lee, Megan Whitt and Amanda Nedved

Children 2025, 12(8), 1087; https://doi.org/10.3390/children12081087 - 19 Aug 2025

Viewed by 208

Abstract

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI [...] Read more.

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI interventions included a survey to assess prescriber and nurse confidence, an online educational module, and an algorithm to aid in clarifying PALs. We measured the percentage of PALs with a clarified reaction severity as our primary outcome using annotated control charts. Descriptive and inferential statistics evaluated survey responses between nurses and prescribers. Results: Clarified PAL reaction severity had a sustained upward shift from 58.5% to 63.3% following implementation of our interventions. Of 129 nurses and prescribers, 87 (67.4%) respondents completed the survey. Prescribers and nurses reported feeling knowledgeable about PALs but experienced different challenges to clarifying PAL documentation. Prescribers reported time pressures as a barrier to PAL clarification more often than nurses (IQR [3, 4], p = 0.001). Nurses reported higher confidence in ability to document a PAL compared to prescribers (IQR [3.25, 5], p = 0.010). Respondents requested family education and practice guidance to aid PAL clarification. No consistent differences were noted in PAL documentation by sociodemographic characteristics. Conclusions: The nurse-initiated QI approach demonstrated improved PAL documentation in PUCs. Engaging nurses in antibiotic stewardship initiatives can provide new perspectives and broaden the approach to intervention design and implementation. Future efforts should focus on improving electronic health record and interprofessional workflow processes to build on these improvements. Full article

(This article belongs to the Special Issue Antibiotic Prescribing Practices and Stewardship in Pediatrics)

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10 pages, 495 KiB

Open AccessArticle

Evidence for Extracellular Superoxide Dismutase (SOD3), Glutathione and Redox Dynamics in Amniotic Fluid Throughout Gestation

by Leah Knieps, Ebru Aileen Alsat, Tamene Melaku, Andreas Mueller and Soyhan Bagci

Children 2025, 12(8), 1086; https://doi.org/10.3390/children12081086 - 19 Aug 2025

Viewed by 182

Abstract

Introduction: Amniotic fluid (AF) plays a pivotal role in foetal gastrointestinal development by delivering bioactive factors that support intestinal maturation. However, the redox environment of AF and its potential contribution to foetal intestinal homeostasis remain insufficiently characterised. This study aimed to quantify key [...] Read more.

Introduction: Amniotic fluid (AF) plays a pivotal role in foetal gastrointestinal development by delivering bioactive factors that support intestinal maturation. However, the redox environment of AF and its potential contribution to foetal intestinal homeostasis remain insufficiently characterised. This study aimed to quantify key antioxidant markers—superoxide dismutase isoforms (SOD1, SOD3), glutathione (GSH), and the oxidative DNA damage marker 8-hydroxy-2-deoxyguanosine (8-OHdG)—in AF across gestational ages and compare them with those in human milk (HM). Methods: AF samples (n = 60) were collected from pregnancies between 15 and 40 weeks of gestation, grouped into preterm (<37 weeks) and term (≥37 weeks). SOD1, SOD3, GSH, and 8-OHdG concentrations were quantified using ELISA. HM samples (n = 45) were similarly analysed. Results: SOD1 and SOD3 in AF concentrations decreased significantly with gestational age (GA) (p < 0.001), while 8-OHdG levels increased (p < 0.001). SOD3 showed a negative correlation with 8-OHdG (p = 0.004). HM contained significantly higher levels of both SOD isoforms compared to AF (AF vs. HM: 35.6 (1.9–172.3) vs. 267.9 (54.6–843.8), p < 0.001 for SOD1 and 1.2 ng/mL (0.1–26.5) vs. 5.5 ng/mL (0.1–300.0), p < 0.001 for SOD3), regardless of GA. Conclusions: Our findings highlight the dynamic nature of the redox environment in AF and its potential importance for foetal GIT development. The disruption of redox balance by preterm birth or inadequate AF intake during foetal life may have long-term consequences for intestinal development and function. These insights provide a foundation for future clinical studies aimed at enhancing neonatal feeding regimens, particularly for preterm infants and those with congenital gastrointestinal disorders. Full article

(This article belongs to the Special Issue Advances in Nutritional and Feeding Approaches in the Very Extreme Preterm Infant Born Under 27 Weeks Gestation)

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14 pages, 456 KiB

Open AccessArticle

Impact of COVID-19 Lockdown on the Incidence of Common Pregnancy Complications—Is the Diagnosis of FGR Made Too Generously?

by Maximilian Rauh, Silvia Suttner, Claudia Bartl, Marco Weigl, Sven Wellmann, Maurice Kappelmeyer, Börge Schmidt, Maria Emilia Solano and Angela Köninger

Children 2025, 12(8), 1085; https://doi.org/10.3390/children12081085 - 19 Aug 2025

Viewed by 158

Abstract

Purpose: In 2020, a lockdown due to COVID-19 was ordered by the German government, resulting in population-wide restrictions. In this retrospective study, we question the extent to which health policy restrictions have influenced medical diagnoses. Methods: The incidence rates of relevant pregnancy complications [...] Read more.

Purpose: In 2020, a lockdown due to COVID-19 was ordered by the German government, resulting in population-wide restrictions. In this retrospective study, we question the extent to which health policy restrictions have influenced medical diagnoses. Methods: The incidence rates of relevant pregnancy complications during all trimesters of pregnancy were evaluated for a 6-month pre-pandemic period (April–September 2019), in comparison to the same period during the lockdown in 2020. Mothers and newborns who presented at the University Hospital St. Hedwig, Regensburg, Germany, were included in the study. The incidence rates of preeclampsia and suspected FGR (fetal growth retardation), as relevant obstetric diseases, were further compared with those in a post-pandemic period (April–September 2023). Results: A total of 5137 newborns were included, with 1709 born during the 6-month pre-pandemic period, 1806 during the 6-month lockdown period and 1687 during the 6-month post-pandemic period. During the pandemic period, significantly fewer patients were hospitalized due to hyperemesis gravidarum (1.8% vs. 0.9%, p = 0.04). No differences were observed concerning the incidence of miscarriages before and after 14 weeks of gestation (WG), preterm deliveries (<37 WG), gestational age at preterm birth and birth weight. Likewise, within the group of preterm-born babies, no difference was observed in preeclampsia among the two periods. However, in the pandemic period, the frequency of preterm-born babies with suspected FGR was significantly lower than in the pre-pandemic period (1.5% and 0.6%, p = 0.01). Regarding this point, we analyzed data of all newborns in a comparative post-pandemic period in 2023 (n = 1687). This group presented a significantly increased FGR incidence compared to that during the pandemic, therefore returning to the pre-pandemic level (1.5% and 1.4%, p = 0.145). Conclusions: During the COVID-19 pandemic, there were significantly fewer deliveries with suspected FGR. After all specific restrictions on elective and outpatient services were lifted, the incidence of suspected FGR returned to its initial level, suggesting that the diagnosis—as a solely machine-dependent and not symptom-based diagnosis—was partly exaggerated in both the pre-and post-pandemic periods. Full article

(This article belongs to the Section Pediatric Neonatology)

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11 pages, 739 KiB

Open AccessArticle

Knowledge of Physical Activity Guidelines and Its Association with Meeting Physical Activity and Sedentary Behavior Recommendations in Adolescents

by André de Araújo Pinto, Guilherme José Silva Ribeiro and Andreia Pelegrini

Children 2025, 12(8), 1084; https://doi.org/10.3390/children12081084 - 19 Aug 2025

Viewed by 211

Abstract

Background/Objectives: Despite global efforts to promote moderate-to-vigorous physical activity (MVPA) among youth, limited evidence exists regarding adolescents’ knowledge of official physical activity (PA) guidelines. The aim of this study was to assess adolescents’ knowledge of MVPA guidelines and examine its potential association with [...] Read more.

Background/Objectives: Despite global efforts to promote moderate-to-vigorous physical activity (MVPA) among youth, limited evidence exists regarding adolescents’ knowledge of official physical activity (PA) guidelines. The aim of this study was to assess adolescents’ knowledge of MVPA guidelines and examine its potential association with meeting PA recommendations and levels of sedentary behavior. Methods: This cross-sectional study was conducted in 2025 with a sample of 1032 adolescents (50.5% boys) from northernmost Brazil. Data were collected using a self-administered questionnaire and included information on knowledge of PA guidelines, PA levels, sedentary behavior duration, and sociodemographic characteristics. Associations were tested using logistic regression models. Results: Only 11.7% of adolescents accurately identified all components of the PA recommendations. Boys who met PA guidelines were 15.76 times more likely to be aware of the official recommendations (95% CI: 7.14–24.48), while girls had 10.05 times higher odds (95% CI: 4.43–16.67). Adolescents who were less sedentary (<3 h/day) were significantly more likely to know the guidelines, both among boys (OR = 2.00; 95% CI: 1.08–3.70) and girls (OR = 3.13; 95% CI: 1.12–8.33). Conclusions: The low level of awareness regarding official PA guidelines among adolescents is concerning, particularly given the strong association between such knowledge and the adoption of more active and less sedentary behaviors. Public health and educational strategies should prioritize health literacy in school curricula and community-based programs to promote more active lifestyles and reduce sedentary behavior among youth. Future studies should use longitudinal designs to clarify causal links and test practical interventions. Full article

(This article belongs to the Special Issue Physical Activity and Sedentary Behaviors in Children and Adolescents)

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11 pages, 1225 KiB

Open AccessArticle

Prediction of Children’s Subjective Well-Being from Physical Activity and Sports Participation Using Machine Learning Techniques: Evidence from a Multinational Study

by Josivaldo de Souza-Lima, Gerson Ferrari, Rodrigo Yáñez-Sepúlveda, Frano Giakoni-Ramírez, Catalina Muñoz-Strale, Javiera Alarcon-Aguilar, Maribel Parra-Saldias, Daniel Duclos-Bastias, Andrés Godoy-Cumillaf, Eugenio Merellano-Navarro, José Bruneau-Chávez and Pedro Valdivia-Moral

Children 2025, 12(8), 1083; https://doi.org/10.3390/children12081083 - 18 Aug 2025

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Abstract

Background/Objectives: Traditional models like ordinary least squares (OLS) struggle to capture non-linear relationships in children’s subjective well-being (SWB), which is associated with physical activity. This study evaluated machine learning (ML) for predicting SWB, focusing on sports participation, and explored theoretical prediction limits [...] Read more.

Background/Objectives: Traditional models like ordinary least squares (OLS) struggle to capture non-linear relationships in children’s subjective well-being (SWB), which is associated with physical activity. This study evaluated machine learning (ML) for predicting SWB, focusing on sports participation, and explored theoretical prediction limits using a global dataset. It addresses a gap in understanding complex patterns across diverse cultural contexts. Methods: We analyzed 128,184 records from the ISCWeB survey (ages 6–14, 35 countries), with self-reported data on sports frequency, emotional states, and family support. To ensure cross-country generalizability, we used GroupKFold CV (grouped by country) and leave-one-country-out (LOCO) validation, yielding mean R² = 0.45 ± 0.05, confirming robustness beyond cultural patterns, SHAP for interpretability, and bootstrapping for error estimation. No pre-registration was required for this secondary analysis. Results: XGBoost and LightGBM outperformed OLS, achieving R² up to 0.504 in restricted datasets (sensitivity excluding affective leakage: R² = 0.35), with sports-related variables (e.g., exercise frequency) associated positively with SWB predictions (SHAP values: +0.15–0.25; incremental ΔR² = 0.06 over demographics/family/school base). Using test–retest reliability from literature (r = 0.74), the estimated irreducible RMSE reached 0.941; XGBoost achieved RMSE = 1.323, approaching the predictability bound with 68.1% of explainable variance captured (after noise adjustment). Partial dependence plots showed linear associations with exercise without satiation and slight age decline. Conclusions: ML improves SWB prediction in children, highlighting associations with sports participation, and approaches predictable variance bounds. These findings suggest potential for data-driven tools to identify patterns, such as through physical literacy pathways, informing physical activity interventions. However, longitudinal studies are needed to explore causality and address cultural biases in self-reports. Full article

(This article belongs to the Special Issue Lifestyle and Children's Health Development)

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14 pages, 1100 KiB

Open AccessArticle

Impact of Heart Rate Monitoring Using Dry-Electrode ECG Immediately After Birth on Time to Start Ventilation: A Randomized Trial

by Siren Rettedal, Amalie Kibsgaard, Frederikke Buskov, Joar Eilevstjønn, Vilde Kolstad, Jan Terje Kvaløy, Peder Aleksander Bjorland, Hanne Pike, Joanna Haynes, Thomas Bailey Tysland, Peter G. Davis and Hege Ersdal

Children 2025, 12(8), 1082; https://doi.org/10.3390/children12081082 - 18 Aug 2025

Viewed by 187

Abstract

Background/Objectives: Newborn heart rate is an integral part of resuscitation algorithms, but the impact of ECG monitoring on resuscitative interventions and clinical outcomes has been identified as a knowledge gap. The objective was to evaluate the impact of routine use of dry-electrode ECG [...] Read more.

Background/Objectives: Newborn heart rate is an integral part of resuscitation algorithms, but the impact of ECG monitoring on resuscitative interventions and clinical outcomes has been identified as a knowledge gap. The objective was to evaluate the impact of routine use of dry-electrode ECG in all newborns immediately after birth on time to start positive pressure ventilation (PPV) when indicated. Methods: We conducted a randomized clinical trial from June 2019 to November 2021 at Stavanger University Hospital, Norway. Dry-electrode ECG sensors were applied immediately after birth to all newborns ≥ 34 weeks’ gestation. Randomization determined whether the heart rate display was visible or masked. Time of birth was registered in an observation app. Time to start ventilation was calculated from video recordings. Results: In total, 7343 newborns ≥ 34 weeks’ gestation were enrolled, 4284 in the intervention and 3059 in the control group, and 3.7% and 3.8% received ventilation, respectively. In 171/275 (62%) of the newborns the exact time of birth and a video of the resuscitation were available, for 98 in the intervention and 73 in the control group. Ventilation was provided within 60 s to 44/98 (45%) in the intervention and 24/73 (33%) in the control group, p = 0.12. Time from birth to start of PPV was a median of 66 (44, 102) s in the intervention and 84 (49, 148) s in the control group, p = 0.058. Resuscitated newborns were apneic (74%) or breathing ineffectively (26%) at the start of PPV, and only 36% had a heart rate < 100 beats per minute. Conclusions: The use of dry-electrode ECG heart rate monitoring did not change the proportion of newborns that received ventilation within 60 s after birth, but early termination due to employee protests to video recordings rendered the trial inadequately powered to detect a difference. Breathing status was likely a more important determinant of starting ventilation than bradycardia. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

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11 pages, 2058 KiB

Open AccessCase Report

Managing Neonatal Varicella: A Case Series Highlighting the Effectiveness of Antiviral Therapy Without IVIG

by Filla Reviyani Suryaningrat, Sindy Irenewati, Devatri Hudayari, Fiva Aprilia Kadi, Aris Primadi and Tetty Yuniati

Children 2025, 12(8), 1081; https://doi.org/10.3390/children12081081 - 18 Aug 2025

Viewed by 229

Abstract

Background: Chicken pox is a rare but serious condition in neonates—often regarded as a common childhood illness with mild symptoms—yet it can lead to severe complications, especially in the perinatal period. Neonatal varicella may present with fever occurring within the first 5–10 days [...] Read more.

Background: Chicken pox is a rare but serious condition in neonates—often regarded as a common childhood illness with mild symptoms—yet it can lead to severe complications, especially in the perinatal period. Neonatal varicella may present with fever occurring within the first 5–10 days of life, followed by a generalized vesicular eruption. The syndrome is uncommon, largely due to the widespread immunity in women of childbearing age, acquired through prior chicken pox infection or varicella immunization. However in Indonesia, a developing country without a national mandatory varicella vaccination program, the disease burden remains significant, and cases of neonatal varicella are still encountered. Neonates are at high risk of severe varicella infection, which, if untreated, has a reported mortality rate of up to 30%. Although varicella is rare in neonates, there are limited studies that have reported it. This study highlights the clinical presentations upon admission, diagnostic investigations, therapeutic management strategies, and potential complications of neonatal varicella. Methods: This study presents two cases of neonatal varicella that were managed at Hasan Sadikin General Hospital in West Java, Indonesia. Each patient underwent a clinical assessment and diagnostic evaluation upon arrival, followed by therapeutic management strategies, including the management of any complications that emerged during treatment. Results: The two cases of neonates presented with classic clinical features of neonatal varicella, including a generalized vesicular rash followed by fever within the first 10 to 12 days of life, without dermatological lesions or congenital malformations at birth. In both cases, maternal chicken pox developed within the first few days postpartum, suggesting postnatal transmission as the likely source of infection. Complications observed included respiratory failure and pneumonia, requiring respiratory support. However, both neonates recovered successfully without the administration of IVIG. Conclusions: Early initiation of antiviral therapy, timely administration of antibiotics, comprehensive supportive care, and monitoring for potential complications play a crucial role in managing neonatal varicella, even in the absence of IVIG. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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11 pages, 221 KiB

Open AccessArticle

Comparison of Quality of Life, Anxiety, and Depression Levels in Celiac Patients With Children Without Chronic Illnesses

by Erkan Akkuş, Aylin Yücel, Ayhan Bilgiç and Hasan Ali Yüksekkaya

Children 2025, 12(8), 1080; https://doi.org/10.3390/children12081080 - 17 Aug 2025

Viewed by 291

Abstract

Background: Celiac disease (CD) is a chronic, immune-mediated condition requiring lifelong adherence to a gluten-free diet. In children, CD can negatively impact not only physical health but also psychological well-being and quality of life. The burden of dietary restrictions, social limitations, and emotional [...] Read more.

Background: Celiac disease (CD) is a chronic, immune-mediated condition requiring lifelong adherence to a gluten-free diet. In children, CD can negatively impact not only physical health but also psychological well-being and quality of life. The burden of dietary restrictions, social limitations, and emotional stress may lead to increased anxiety and depressive symptoms. This study aims to compare the quality of life, anxiety, and depression levels in children with celiac disease to those of healthy peers without chronic illness. Methods: The research involved a total of 129 individuals aged 8–18 years (64 with celiac disease and 65 healthy volunteers) and their parents. To assess children with celiac disease and healthy children, we used a sociodemographic form that we created, along with the State-Trait Anxiety Inventory (STAI), Trait Anxiety Inventory (TAI), Children’s Depression Inventory (CDI), Pediatric Quality of Life Inventory (PedsQL), and Parent Quality of Life Inventory tests. Results: Celiac patients’ diet adherence, parental education level, and family income were found to be significantly associated with quality of life, as well as levels of depression and anxiety. (p < 0.037, p < 0.04, p < 0.004, respectively). Celiac patients had significantly lower BMI SDS (mean −0.55 ± 1.13, p < 0.001) and height SDS scores (mean −0.49 ± 1.28, p < 0.017). Key factors negatively affecting the quality of life in individuals with celiac disease were difficulty adhering to the diet and low family income levels. Conclusions: Elevated anxiety with reduced quality of life highlights the importance of integrating psychosocial support into the routine care of children with celiac disease. A holistic treatment approach that considers the psychosocial well-being of children can significantly improve their quality of life. Full article

(This article belongs to the Section Pediatric Mental Health)

17 pages, 503 KiB

Open AccessArticle

Analysis of Determinant Factors and Mechanisms in Early Childhood Care Services: A Qualitative Study in the Asturian Context (Spain)

by Yara Casáis-Suárez, José Antonio Llosa, Sara Menéndez-Espina, Alba Fernández-Méndez, José Antonio Prieto-Saborit and Estíbaliz Jiménez-Arberas

Children 2025, 12(8), 1079; https://doi.org/10.3390/children12081079 - 17 Aug 2025

Viewed by 271

Abstract

Diverse realities challenge the management capacity of public and private systems to ensure equitable quality and efficient access to resources, in line with the 2030 Agenda and the Sustainable Development Goals, which aim to close gaps in essential services and ensure quality of [...] Read more.

Diverse realities challenge the management capacity of public and private systems to ensure equitable quality and efficient access to resources, in line with the 2030 Agenda and the Sustainable Development Goals, which aim to close gaps in essential services and ensure quality of life. The reality in Spain, and more specifically in the Principality of Asturias, is that most resources are concentrated in urban areas rather than rural ones, partly due to the region’s geography. Background/Objectives: This study aimed to explore the perspectives of various stakeholders on the early childhood care system in the Principality of Asturias (Spain), with the purpose of analyzing the mechanisms and determinants involved in its functioning and identifying opportunities for improvement. Methods: A qualitative study was conducted using the theoretical framework of the National Institute on Minority Health and Health Disparities (NIMHD) as a conceptual basis. Semi-structured interviews were carried out with 24 participants selected based on their relationship with early childhood care systems, encompassing different levels of responsibility and operational roles. Data were analyzed using a phenomenological approach, employing inductive and deductive coding to identify recurring patterns and code co-occurrences within ATLAS.ti software. Conclusions: This study reveals major barriers to equitable early childhood intervention (ECI) in rural areas, such as geographic isolation, lack of specialists, long waiting times, and poor transport. Six key themes emerged, including the need for standardized system management, better family support, and digital tools like centralized electronic health records. Rural areas are directly limited regarding their access to services, highlighting the need for fair territorial planning and a holistic, inclusive care model. Improving coordination, accessibility, and technology is vital. Full article

(This article belongs to the Section Global Pediatric Health)

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12 pages, 222 KiB

Open AccessReview

The Impact of Anime on Children with Autism Spectrum Disorder (ASD)

by Efthalia Tzila, Eleni Panagouli, Maria Tsouka, Stavroula Oikonomou, Aikaterini Koumparelou and Maria Tsolia

Children 2025, 12(8), 1078; https://doi.org/10.3390/children12081078 - 17 Aug 2025

Viewed by 343

Abstract

Autism Spectrum Disorder (ASD) presents unique challenges in social interaction, communication and emotional regulation. Recent research has explored the potential influence of anime consumption among children with ASD, and the current findings suggest both beneficial and adverse effects. This review examines the role [...] Read more.

Autism Spectrum Disorder (ASD) presents unique challenges in social interaction, communication and emotional regulation. Recent research has explored the potential influence of anime consumption among children with ASD, and the current findings suggest both beneficial and adverse effects. This review examines the role of anime in fostering social learning, emotional resilience, and cognitive engagement while also addressing concerns regarding its cultivation of social withdrawal, unrealistic expectations, and over-reliance on fictional narratives. By analyzing existing literature, this paper provides insights into the nuanced relationship between anime and ASD, highlighting the possibility that patterns of engagement may be associated with both positive and negative outcomes. Understanding these dynamics is crucial for parents, educators, and clinicians seeking to support the well-being and development of children with ASD. Full article

15 pages, 960 KiB

Open AccessArticle

A Single-Button Mobility Platform for Cause–Effect Learning in Children with Cerebral Palsy: A Pilot Study

by Alberto J. Molina-Cantero, Félix Biscarri-Triviño, Alejandro Gallardo-Soto, Juan M. Jaramillo-Pareja, Silvia Molina-Criado, Azahara Díaz-Rodríguez and Luisa Sierra-Martín

Children 2025, 12(8), 1077; https://doi.org/10.3390/children12081077 - 16 Aug 2025

Viewed by 260

Abstract

Background: Mobility plays a fundamental role in causal reasoning (causal inference or cause–effect learning), which is essential for brain development at early ages. Children naturally develop causal reasoning through interaction with their environment. Therefore, children with severe motor disabilities (GMFCS levels IV–V), who [...] Read more.

Background: Mobility plays a fundamental role in causal reasoning (causal inference or cause–effect learning), which is essential for brain development at early ages. Children naturally develop causal reasoning through interaction with their environment. Therefore, children with severe motor disabilities (GMFCS levels IV–V), who face limited opportunities for interaction, often show delays in causal reasoning. Objective: This study investigates how a wheelchair-mounted, semi-autonomous mobility platform operated via a simple switch may enhance causal learning in children with severe disabilities, compared with traditional therapies. However, due to the scarcity of participants who meet the inclusion criteria and the need for long-term evaluation, recruitment poses a significant challenge. This study aims to provide an initial assessment of the platform and collect preliminary data to estimate the required sample size and number of sessions for future studies. Methods: We conducted a pilot randomized controlled trial (RCT) to assess platform usability and its effect on reaction time and keystroke accuracy. Four children, aged 8.5 ± 2.38, participated in seven 30 min sessions. They were randomly assigned in equal numbers, with two participants in the intervention group (using the platform) and two in the control group (receiving standard therapy). Usability was evaluated through a questionnaire completed by two therapists. Key outcome measures included the System Usability Scale (SUS), reaction time (RT), and keystroke accuracy (NIS). Results: Despite the small sample size and recruitment challenges, the data allowed for preliminary estimates of the sample size and number of sessions required for future studies. Therapists reported positive usability scores. Children using the platform showed promising trends in RT and NIS, suggesting improved engagement with cause–effect tasks. Conclusions: The findings support the feasibility and usability of the mobility platform by therapists, although some improvements should be implemented in the future. No conclusive evidence was found regarding the platform’s effectiveness on causal learning, despite a positive trend over time. This pilot study also provides valuable insights for designing larger, statistically powered trials, particularly focused on NIS. Full article

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36 pages, 1752 KiB

Open AccessArticle

Obstetric Ultrasound Screening in Lebanon for Fetal Diagnosis and Associated Factors of Congenital Abnormalities

by Rita Chebl, Ingrid Nader, Michel Saba, Cecile Z. Attieh, Ogarite Kattan, Lea Nohra, Anna-Maria A. Henaine, Sarah El Khoury, Malek N. Nassar, Pierre Nakhel, Béchara El Asmar and Mirna N. Chahine

Children 2025, 12(8), 1076; https://doi.org/10.3390/children12081076 - 15 Aug 2025

Viewed by 248

Abstract

Background and Objectives: Congenital abnormalities are a leading cause of neonatal morbidity and mortality and are frequently detectable through prenatal ultrasound. While widely implemented in high-income countries, such screening remains inconsistently applied in low- and middle-income regions. This study aimed to estimate [...] Read more.

Background and Objectives: Congenital abnormalities are a leading cause of neonatal morbidity and mortality and are frequently detectable through prenatal ultrasound. While widely implemented in high-income countries, such screening remains inconsistently applied in low- and middle-income regions. This study aimed to estimate the prevalence of congenital abnormalities identified via prenatal ultrasound in Lebanon and to explore associated maternal, obstetric, and psychosocial factors. Methods: A multicenter retrospective observational study, supplemented by follow-up interviews, was conducted in five Order of Malta medical centers. Pregnant women in their second trimester underwent an obstetric ultrasound, and data were collected through structured questionnaires and follow-up phone interviews. Variables included maternal demographics, obstetric history, anxiety levels (GAD-7 scores), and ultrasound findings. Results: A total of 426 pregnant women were enrolled (mean age: 28.8 ± 5.9 years). The overall prevalence of congenital abnormalities was 13.1%. Growth abnormalities were observed in 8.5% of fetuses and were significantly associated with obstetric complications and the presence of multiple abnormalities. Morphological malformations were found in 10.1% of cases and were more common among women of advanced maternal age, those with a history of anomalies, and those reporting elevated anxiety scores. Combined abnormalities, as well as growth and morphological malformations, were significantly associated with higher parity, prior anomalies, and current pregnancy complications. Conclusions: Prenatal ultrasound is essential for early detection of congenital abnormalities, facilitating timely intervention and improved neonatal outcomes. These findings emphasize the need to integrate systematic screening into prenatal care in Lebanon and for ongoing research to identify context-specific risk factors. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 246 KiB

Open AccessArticle

Risk Factors Associated with Early and Late Postoperative Complications in Neonatal Patients with Esophageal Atresia

by Misela Raus, Luka Zekovic, Sanja Sindjic-Antunovic, Predrag Rodic, Biljana Medjo, Ivana Bosiocic, Aleksandar Dimitrijevic and Dejan Nikolic

Children 2025, 12(8), 1075; https://doi.org/10.3390/children12081075 - 15 Aug 2025

Viewed by 201

Abstract

Background and Aim: Atresia is the most common congenital anomaly of the esophagus, with an increased risk of complications after surgical correction. The aim of our study was to evaluate the risk factors associated with early and late postoperative complications in neonatal patients [...] Read more.

Background and Aim: Atresia is the most common congenital anomaly of the esophagus, with an increased risk of complications after surgical correction. The aim of our study was to evaluate the risk factors associated with early and late postoperative complications in neonatal patients with esophageal atresia. Methods: The study sample comprised 109 neonatal patients aged between 0 and 27 days of life who were prenatally diagnosed with esophageal atresia or diagnosed at birth. For the purpose of this study, neonatal and perinatal factors and factors associated with the mother’s medical condition were analyzed. Complications after surgical intervention were classified as early and late. Results: Patients with early postoperative complications experienced significantly more frequent complications during delivery (p = 0.002), asphyxia (p = 0.038), and postoperative sepsis (p = 0.045) and were more likely to have received medicamentous therapy (p = 0.035). Patients with late postoperative complications had significantly more frequent complications during delivery (p = 0.025), respiratory distress (p = 0.043), and postoperative sepsis (p = 0.010), were more likely to have received preoperative mechanical ventilation (p = 0.014), and showed a significantly different frequency distribution among the different classes of the Spitz classification (p = 0.008). A risk factor for early postoperative complications in patients with atresia in the upper part was complications during delivery (OR-3.09; p = 0.007). The risk factors for late postoperative complications for patients with upper atresia were preoperative mechanical ventilation (OR: 2.77; p = 0.041), postoperative sepsis (OR: 2.60; p = 0.028), and belonging to relatively high- and high-risk groups according to the Spitz classification (OR: 3.50; p = 0.022). Conclusions: In neonates who have undergone surgical intervention for esophageal atresia, a risk factor for early postoperative complications is complications during delivery, while the risk factors for late postoperative complications are preoperative mechanical ventilation, postoperative sepsis, and belonging to relatively high- and high-risk groups according to the Spitz classification. Therefore, a multidisciplinary approach and continuous monitoring are essential to reduce morbidity and mortality, as well as to improve quality of life, in these patients. Full article

(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis, Management and Surgical Treatment)

16 pages, 1942 KiB

Open AccessArticle

Relationship of Melatonin Levels in Blood and Urine with Sleep Quality in Children Admitted to Pediatric Intensive Care Unit

by Miriam García-San Prudencio, Gema Manrique, Raquel Cieza, Cristina Corraliza, Patricia Arias, Elena Medina, Jesús López-Herce and Santiago Mencía

Children 2025, 12(8), 1074; https://doi.org/10.3390/children12081074 - 15 Aug 2025

Viewed by 319

Abstract

Objectives: Melatonin regulates the sleep–wake cycle, which may be altered in children admitted to the pediatric intensive care unit (PICU). The aim is to analyze whether blood and urine melatonin levels are related to sleep quality in children admitted to the PICU. Methods: [...] Read more.

Objectives: Melatonin regulates the sleep–wake cycle, which may be altered in children admitted to the pediatric intensive care unit (PICU). The aim is to analyze whether blood and urine melatonin levels are related to sleep quality in children admitted to the PICU. Methods: A single-center, prospective observational study was conducted at the PICU in a tertiary referral center in Madrid, Spain. It included patients (1 month–16 years) admitted to the PICU. Results: A total of 40 children were included in the study (52.5% male), analyzing 2 days for each patient (80 total study days). The median age of the patients was 34.5 months. The median number of hours of sleep over the whole day was 9.9 h (IQR 8.4–12.6); nighttime was 7.5 h (IQR 6.5–9) and daytime was 2.5 h (IQR 1.4–5.7). Only 8.5% of patients slept the appropriate number of hours of nighttime sleep for their age. High serum melatonin levels in the morning were correlated with more nocturnal awakenings (r = 0.35, p = 0.01) and less continuous sleep time (r = −0.29, p = 0.03). Altered urine levels in the morning correlated with shorter 24 h total sleep time (r = −0.43, p = 0.01). Inadequate urine levels at 7 pm correlated with a shorter duration of continuous nocturnal sleep (r = −0.37, p = 0.03). Conclusions: Children admitted to the PICU often do not achieve the recommended hours of sleep for their age. A significant percentage of these children exhibit an altered melatonin secretion pattern, which is associated with shorter nighttime sleep duration and longer daytime sleep duration. Full article

(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)

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Children, Volume 12, Issue 8 (August 2025) – 145 articles

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