Children

12 pages, 1284 KiB

Open AccessCase Report

Mesenchymal Stem Cell Therapy for Hutchinson–Gilford Progeria: Improvements in Arterial Stiffness and Bone Mineral Density in a Single Case

by Eun-Young Joo, Ji-Sun Park, Hyun-Tae Shin, Myungji Yoo, Su-Jin Kim, Ji-Eun Lee and Gwang-Seong Choi

Children 2025, 12(4), 523; https://doi.org/10.3390/children12040523 - 18 Apr 2025

Abstract

Background/Objectives: Hutchinson–Gilford progeria syndrome (HGPS) is a rare genetic disorder that cause premature aging due to LMNA mutations and progerin accumulation. Although lonafarnib, an FDA-approved farnesyltransferase inhibitor, offers modest extension of life, the disease remains progressive. As progeria is associated with stem cell [...] Read more.

Background/Objectives: Hutchinson–Gilford progeria syndrome (HGPS) is a rare genetic disorder that cause premature aging due to LMNA mutations and progerin accumulation. Although lonafarnib, an FDA-approved farnesyltransferase inhibitor, offers modest extension of life, the disease remains progressive. As progeria is associated with stem cell depletion and mesenchymal stem cell (MSC) therapy has shown efficacy in treating atherosclerosis, we aimed to evaluate its efficacy and safety in HGPS. Methods: A 7-year-old male with classic HGPS and preexisting severe cerebrovascular disease received four intravenous infusion of bone marrow-derived MSCs (2.5 × 10⁵ cells/kg) over 8 months. Growth, metabolic, cardiovascular, musculoskeletal, auditory, and inflammatory cytokines were monitored throughout the study. Prophylactic enoxaparin was administered to prevent vascular complications. Results: MSC therapy was associated with improved lean body mass (11.5%), bone mineral density (L-spine z-score: 0.55 → 2.03), reduced arterial stiffness (9.98% reductionin pulse wave velocity), joint range of motion, dentition, and decreased sICAM-1 levels. However, Cardiovascular deterioration continued, and the patient passed away 10 months after the fourth dose, likely due to progression of the underlying vascular disease. No severe adverse effects were attributed to MSC therapy. Conclusions: MSC therapy may offer short-term benefits in arterial stiffness, bone health and inflammation in HGPS without notable safety concerns. Further studies are warranted to validate these findings, explore earlier intervention, and determine long-term efficacy and optimal dosing strategies. Full article

(This article belongs to the Section Translational Pediatrics)

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22 pages, 10717 KiB

Open AccessArticle

ChildWeCare: An Innovative System for the Surveillance and Care of Early Childhood Development Disorders in Thailand

by Duangkamol Tangviriyapaiboon, Chayut Owatsakul, Patrinee Traisathit, Salinee Thumronglaohapun and Pimwarat Srikummoon

Children 2025, 12(4), 522; https://doi.org/10.3390/children12040522 - 18 Apr 2025

Abstract

Background: A structure survey conducted by the Department of Health on early childhood development in Thailand indicates that 27.20–32.50% of preschool children have developmental delays. These children require appropriate care and constant stimulation to help them develop normally. Methods: The ChildWeCare innovation system [...] Read more.

Background: A structure survey conducted by the Department of Health on early childhood development in Thailand indicates that 27.20–32.50% of preschool children have developmental delays. These children require appropriate care and constant stimulation to help them develop normally. Methods: The ChildWeCare innovation system for monitoring children and providing appropriate care for those with developmental delays from birth to 5 years of age has been developed. This is accompanied by qualified personnel providing assistance to parents for their child’s development. Enrollment of participants and provision of services via the system were implemented. Appropriate intervention from the ChildWeCare system will be provided for each specific child, and each parent will be assigned homework for training their children. Results: The database of the ChildWeCare system was developed using MySQL, which can store information about the child, parent, homework, and log usage system, as well as data on each parent’s homework assignments. Our pilot testing shows that parents were satisfied with the ChildWeCare system. Conclusions: The ChildWeCare system could provide guidance on suitable stimulation techniques and strategies for each child’s specific needs. These preliminary results could indicate the advantages of further plans for the system’s implementation in other settings in Health Region 1 or nationwide. Full article

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

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6 pages, 1191 KiB

Open AccessBrief Report

In Vivo Anatomical Variations in the Lateral Femoral Cutaneous Nerve in Children

by Lise Langeland Larsen, Line Kjeldgaard Pedersen, Ole Rahbek and Bjarne Møller-Madsen

Children 2025, 12(4), 521; https://doi.org/10.3390/children12040521 - 17 Apr 2025

Abstract

Background: The anatomic pathways of the lateral femoral cutaneous nerve (LFCN) have primarily been reported in adult in vitro populations with limited branching patterns. Children with hip disorders may require surgical treatment with an anterior approach, and the LFCN is a structure at [...] Read more.

Background: The anatomic pathways of the lateral femoral cutaneous nerve (LFCN) have primarily been reported in adult in vitro populations with limited branching patterns. Children with hip disorders may require surgical treatment with an anterior approach, and the LFCN is a structure at risk. The aim of our study was to photographically verify the initial six-centimeter pathway of the LFCN in children measured from its appearance at the anterior superior iliac spine (ASIS). Method: A total of 31 children underwent pelvic osteotomy, including three bilateral. The nerve was identified and isolated in the subcutaneous layer. Standardized photographs were obtained. Our outcome parameters were type of pelvic exit, branching pattern, distance from the pelvic exit to the ASIS, and nerve thickness and appearance, categorized as straight or curved. Results: 91.3% of nerves passed medially to the ASIS. A total of 74% of the nerves showed a splitting branching pattern, and 9% had a branching pattern of more than four. The mean distance from pelvic exit to the ASIS was 17 mm, and the mean nerve thickness was 2.7 mm. Conclusions: In contrast to adult anatomy, our study shows that the LFCN has two or more branches in 74% of patients. Thus, based on our observations, surgeons should carefully dissect the subcutaneous tissue around the LCFN due to the numerous anatomical variations to avoid iatrogenic damage to the nerve. Full article

(This article belongs to the Section Pediatric Surgery)

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13 pages, 563 KiB

Open AccessReview

The Predictive Role of Bladder Ultrasound in Children with Nocturnal Enuresis: A Comprehensive Overview

by Ignazio Cammisa and Pietro Ferrara

Children 2025, 12(4), 520; https://doi.org/10.3390/children12040520 - 17 Apr 2025

Abstract

Background/Objectives: Nocturnal enuresis (NE) is a common condition in children, affecting more than 10% of 6-year-olds and typically characterized by involuntary bedwetting during sleep. Although the exact causes remain unclear, ultrasound has emerged as a valuable tool for assessing bladder function and [...] Read more.

Background/Objectives: Nocturnal enuresis (NE) is a common condition in children, affecting more than 10% of 6-year-olds and typically characterized by involuntary bedwetting during sleep. Although the exact causes remain unclear, ultrasound has emerged as a valuable tool for assessing bladder function and predicting therapy response and relapse, with several studies linking urological abnormalities like reduced bladder capacity and increased wall thickness to treatment outcomes. Methods: We performed a literature review utilizing five distinct search queries on PubMed with the following keywords: “enuresis & ultrasound”, “enuresis & bladder ultrasound”, “enuresis & bladder wall”, “enuresis & bladder capacity”, and “enuresis & bladder thickness”. We reviewed each article that met the eligibility criteria, and after a thorough selection, we included 17 studies. Results: Bladder ultrasound is a valuable tool for assessing bladder function and structure in children with NE, providing crucial insights into bladder capacity, wall thickness, and the bladder wall thickness index (BVWI). These ultrasound measurements correlate with the severity of NE and treatment success, aiding in personalized therapy, particularly for children with smaller bladder capacities and thicker bladder walls. Although studies have explored the link between ultrasound findings and treatment response, further research is needed to standardize methods and confirm these connections. Conclusions: The review highlights the predictive role of ultrasound in enuresis management, focusing on the response rate and choice of therapy. Future studies should investigate how bladder imaging can predict both short-term and long-term treatment outcomes, with current evidence supporting its use in customizing NE treatment for improved results. Full article

(This article belongs to the Section Pediatric Radiology)

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10 pages, 530 KiB

Open AccessArticle

The Efficacy of Transcanal Endoscopic Ear Surgery in Children Compared to Adults

by Wan-Hsuan Sun, Chia-Ho Chen, Chao-Yin Kuo, Sheng-Yao Cheng and Tzu-Chin Huang

Children 2025, 12(4), 519; https://doi.org/10.3390/children12040519 - 17 Apr 2025

Abstract

Background/Objectives: Using transcanal endoscopic ear surgery to manage middle ear disease in children remains a controversial topic. The aim of this study was to compare the efficacy of transcanal endoscopic ear surgery between children and adults. Methods: The aim of this [...] Read more.

Background/Objectives: Using transcanal endoscopic ear surgery to manage middle ear disease in children remains a controversial topic. The aim of this study was to compare the efficacy of transcanal endoscopic ear surgery between children and adults. Methods: The aim of this study was to compare the efficacy of transcanal endoscopic ear surgery between children and adults. Results: We observed no significant difference between pediatric and adult patients with regard to the rates of surgical success, postoperative hearing gain, and postoperative complications in all surgical procedures. As for ventilation tube insertion, the pediatric patients had shorter surgical times compared to adult patients. With respect to tympanoplasty, the pediatric group had a longer surgical time than adults did. Conclusions: Our study showed that transcanal endoscopic ear surgery can be successfully applied to manage various middle ear diseases in children. Full article

(This article belongs to the Section Pediatric Otolaryngology)

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11 pages, 681 KiB

Open AccessArticle

The Impact of Ivy Leaf Dry Extract EA 575 on Subsequent Antibiotic Use and Its Therapeutic Value in Children and Adolescents with the Common Cold: A Retrospective Prescription Database Analysis

by Christian Vogelberg, Georg Seifert, Simon Braun, Rebecca Zingel and Karel Kostev

Children 2025, 12(4), 518; https://doi.org/10.3390/children12040518 - 17 Apr 2025

Abstract

Background: Dried ivy leaf extract EA 575^® (Prospan^®) is commonly used to treat coughs and may help reduce inappropriate antibiotic use for the common cold. This retrospective study investigated whether prescribing EA 575 is associated with reduced subsequent antibiotic use [...] Read more.

Background: Dried ivy leaf extract EA 575^® (Prospan^®) is commonly used to treat coughs and may help reduce inappropriate antibiotic use for the common cold. This retrospective study investigated whether prescribing EA 575 is associated with reduced subsequent antibiotic use in children and adolescents with the common cold. Repeated EA 575 prescriptions were also analyzed to estimate treatment satisfaction. Methods: Data were sourced from the IQVIA Disease Analyzer database, including patients under 18 diagnosed with a common cold and prescribed either EA 575 or antibiotics between 2017 and 2020 (index date). Propensity score matching controlled for confounding factors. Antibiotic prescriptions were assessed 4–30 and 31–365 days after the index date, along with bacterial infections 4–40 days post-index. Repeated EA 575 prescriptions 2–5 years post-index were analyzed as a proxy for treatment satisfaction. Results: Overall, 10,390 children and adolescents were included in each matched cohort. Compared to antibiotics, EA 575 prescriptions were associated with significantly lower odds of antibiotic use 4–30 days (OR: 0.56; 95% CI: 0.49–0.64; p < 0.001) and 31–365 days (OR: 0.58; 95% CI: 0.54–0.62; p < 0.001) after the index date. The odds of bacterial infection 4–30 days after EA 575 prescription were also lower (OR: 0.67; 95% CI: 0.45–0.99; p = 0.047). Of the 42,677 patients in the EA 575 analysis, 50.5% had at least one repeated prescription, with the highest rates among children aged 0–2 years (54.7%) and the lowest in those aged 13–17 years (19.9%). Conclusions: EA 575 prescription was associated with reduced subsequent antibiotic use in children and adolescents with common colds. Frequent repeated prescription rates emphasize the therapeutic value of EA 575 as a treatment option for cold symptoms, especially in younger children. Full article

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

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15 pages, 3033 KiB

Open AccessArticle

Tips and Tricks in the Laparoscopic Treatment of Type I Duodenal Atresia: Description of a Technique

by Salvatore Fabio Chiarenza, Maria Luisa Conighi, Valeria Bucci and Cosimo Bleve

Children 2025, 12(4), 517; https://doi.org/10.3390/children12040517 - 17 Apr 2025

Abstract

Introduction: Congenital duodenal atresia (DA) (Type I) with a fenestrated web can be characterized by a late presentation with a delayed diagnosis. It is even rarer and usually associated with proximal duodenomegaly. Conventional management involves web resection and duodeno–duodeno anastomosis with or without [...] Read more.

Introduction: Congenital duodenal atresia (DA) (Type I) with a fenestrated web can be characterized by a late presentation with a delayed diagnosis. It is even rarer and usually associated with proximal duodenomegaly. Conventional management involves web resection and duodeno–duodeno anastomosis with or without duodenoplasty. We describe our mininvasive surgical strategy and management, detailing the aspects of laparoscopic techniques. Material and Methods: We retrospectively reviewed the medical records of five patients affected by fenestrated duodenal web (DA) with a delayed onset of symptoms and diagnosis who were managed in our Department over a period of 10 years (2013–2023). We analyzed the age of patients at diagnosis, clinical signs and symptoms, associated congenital anomalies, radiological and intraoperative findings, surgical treatment, and outcomes. Diagnostic examinations included ultrasound (US), Upper-Gastrointestinal Study (UGI), and Esophagogastroduodenoscopy (EGDS). Results: Three boys and two girls, median age of 5.5 months (range 3–11 months), were included in this study. Three underwent previous surgery for long-gap esophageal atresia (EA), two of Type A, and one of Type C, requiring a gastrostomy immediately after birth (delayed esophageal repair for prematurity in Type C) and subsequent delayed primary anastomosis. Major associated anomalies were EA (3), anterior ectopic anus (1), cloaca (1), and Type IV laryngeal web (1). An antenatal diagnostic suspicion of duodenal atresia (obstruction) on ultrasound was described in two patients. UGI suggested a fenestrated duodenal web, visualized at ultrasound in two patients. Duodenal dilation was associated in two cases. The symptoms were feeding difficulties, nonbilious vomiting, upper abdominal distension, and poor growth. All presented with a pre-ampullary obstruction. Endoscopic confirmation was only possible in one patient. The older patient underwent an endoscopic resection of a duodenal web. In the other four, we performed a laparoscopic longitudinal antimesenteric duodenal incision, web resection (excision), and transverse suture (closure was performed) without duodenoplasty. Intraduodenal Indocyanine Green (ICG) visualization (under near-infrared light) was used in the last two cases. No postoperative complications were recorded, with a mean hospital stay of 8 days. A contrast study performed at 4 weeks demonstrated an improved proximal duodenal profile; patients tolerated a full diet and remained symptom-free. Conclusions: According to our experience with minimally invasive techniques, laparoscopy and endoscopy are effective and safe, supporting web resection for the management of a duodenal web without tapering of the proximal duodenum. They require advanced technical skills. Intraduodenal-ICG injection during laparoscopic treatment of Type 1 DA allows localization of the duodenal web, confirmation of bowel patency (bowel canalization) and the tightness of suture. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 3rd Edition)

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10 pages, 6134 KiB

Open AccessCase Report

The Complex Consequences of Severe Polytrauma with Traumatic Brain Injuries Caused by a Traffic Accident in a Child: A Case Report

by Liliana Anghelina, Lucrețiu Radu, Cristian Gheonea, Vlăduț Teică, Adelina-Maria Anghelina and Mirela Anişoara Siminel

Children 2025, 12(4), 516; https://doi.org/10.3390/children12040516 - 17 Apr 2025

Abstract

Background. Polytrauma is one of the three leading causes of mortality worldwide and a major contributor to psychosocial morbidity and disability. Concomitant traumatic brain injuries further increase this risk. Methods. We present the case of a 6-year-old child who sustained significant trauma in [...] Read more.

Background. Polytrauma is one of the three leading causes of mortality worldwide and a major contributor to psychosocial morbidity and disability. Concomitant traumatic brain injuries further increase this risk. Methods. We present the case of a 6-year-old child who sustained significant trauma in a road accident, resulting in injuries to multiple anatomical regions, including the central nervous system. Results. Two years after the accident, the child experiences brief episodes of decreased visual acuity, dizziness, nausea, pallor, and headaches, along with occasional migraines that resolve spontaneously. Additionally, the child struggles with school adjustment. Brain injuries associated with polytrauma are crucial prognostic factors in both the short and long term, influenced by the brain’s reactivity and recovery capacity. There is also an increased risk of developing syncopal episodes, seizures, and other neurological manifestations. Conclusions. The direct and secondary effects of the trauma have contributed to psychosocial disabilities, necessitating complex medical care and family-centered interventions. Full article

(This article belongs to the Section Pediatric Mental Health)

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19 pages, 1456 KiB

Open AccessReview

Advancing Pediatric Surgery with Indocyanine Green (ICG) Fluorescence Imaging: A Comprehensive Review

by Marco Di Mitri, Annalisa Di Carmine, Benedetta Zen, Edoardo Collautti, Cristian Bisanti, Simone D’Antonio, Michele Libri, Tommaso Gargano and Mario Lima

Children 2025, 12(4), 515; https://doi.org/10.3390/children12040515 - 16 Apr 2025

Abstract

Background: Indocyanine green (ICG) fluorescence imaging has revolutionized pediatric surgery by enhancing precision, safety, and outcomes across various specialties. In recent years, its use has spread through the framework of pediatric surgery, where its ability to illuminate anatomical structures and pathological conditions has [...] Read more.

Background: Indocyanine green (ICG) fluorescence imaging has revolutionized pediatric surgery by enhancing precision, safety, and outcomes across various specialties. In recent years, its use has spread through the framework of pediatric surgery, where its ability to illuminate anatomical structures and pathological conditions has improved surgical outcomes. Methods: We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was performed using the term “Indocyanine green” in all fields, including papers about pediatric patients (aged 0–18 years) published between January 2014 and July 2024. Results: This review systematically explores ICG applications, dosing regimens, timing of administration, and integration into modern surgical technologies, including robotics and minimally invasive platforms. ICG resulted in an excellent safety profile and enables the real-time visualization of anatomical structures and pathological conditions, proving invaluable in pediatric cases characterized by smaller anatomical dimensions and congenital anomalies. Conclusions: This review highlights ICG fluorescence imaging as an indispensable tool in pediatric surgery, offering transformative potential for improving surgical outcomes and patient safety. Despite its advantages, it is necessary to standardize dosing and timing protocols to maximize its utility. The aim of this review is to explore the various applications of ICG in pediatric surgery, report the dosage and administration times across different surgical fields, and establish best practices to guide its future use. Full article

(This article belongs to the Special Issue Standardization of Surgical Practice in Pediatric Surgery: Challenges and Future Lines of Action)

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10 pages, 2258 KiB

Open AccessArticle

Venous Malformations as a Rare Cause of Knee Joint Pain in Children and Young Adults: Clinical and Radiological Manifestations

by Adam Dobek, Marcin Strzelczyk, Ludomir Stefańczyk, Dobromiła Barańska, Jan Sokal and Przemysław Przewratil

Children 2025, 12(4), 514; https://doi.org/10.3390/children12040514 - 16 Apr 2025

Abstract

Background: Venous malformations (VMs) are congenital vascular abnormalities characterized by tortuosity, slow blood flow, and gradual growth. Intra-articular venous malformations (IAVMs) of the knee are rare and often present with symptoms similar to juvenile idiopathic arthritis (JIA) or late sequelae of trauma. [...] Read more.

Background: Venous malformations (VMs) are congenital vascular abnormalities characterized by tortuosity, slow blood flow, and gradual growth. Intra-articular venous malformations (IAVMs) of the knee are rare and often present with symptoms similar to juvenile idiopathic arthritis (JIA) or late sequelae of trauma. VM in children is commonly misdiagnosed as hemangioma. This study aims to analyze the clinical and MRI features of IAVM in the knee joint. Methods: This retrospective study analyzed patients from a reference unit for the treatment of vascular malformations in the Pediatric Surgery Department. The group was collected starting from the year 2014 until the 100th patient was identified in the year 2018, all with MRI-confirmed VM based on a predefined protocol. From this group, 19 patients with lower limb symptoms were identified, and 9 patients with VM involving the knee joint were selected for further analysis. Results: The most common symptoms in IAVM patients were pain and swelling, chronic in five (55%) and intermittent in four (45%). Four (45%) reported worsening pain during or after physical activity. A history of intra-articular bleeding was noted in five (55%), leading to mild knee contracture (10° reduction in extension) and decreased mobility. Limb deformities were observed in eight (89%). Diffuse VMs, affecting both intra- and extra-articular tissues, were present in eight (89%), involving the thigh in seven (78%), crus in five (56%), gluteal muscles in three (33%), and foot tissues in one (11%). The suprapatellar recess and Hoffa’s fat pad were involved in all patients (100%). Conclusions: IAVMs are rare causes of knee dysfunction in children and young adults, particularly in cases of unexplained pain, swelling, or instability. They should be considered in the differential diagnosis of hemophilic arthropathy, JIA, or late post-traumatic sequelae. Untreated IAVMs can lead to intra-articular bleeding, cartilage degeneration, and disability. Early diagnosis via MRI and ultrasound is crucial to identifying IAVMs and preventing joint degeneration. Timely treatment helps avoid further damage and long-term disability. Full article

(This article belongs to the Section Pediatric Surgery)

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11 pages, 418 KiB

Open AccessArticle

Exploring the Acute Effects of Sedentary Behaviors on Cardiometabolic Risk in Hispanic Adolescents with Obesity: A Randomized Crossover Study

by Erica G. Soltero, Osamah Salim, Yiming Mirabile and Salma M. Musaad

Children 2025, 12(4), 513; https://doi.org/10.3390/children12040513 - 16 Apr 2025

Abstract

Background/Objectives: Time spent in sedentary pursuits is associated with adverse metabolic profiles. Adolescents spend 65–75% of their day in sedentary pursuits; however, evidence among youth is less conclusive. This study examined the effects of an acute 4 h bout of sedentary behaviors [...] Read more.

Background/Objectives: Time spent in sedentary pursuits is associated with adverse metabolic profiles. Adolescents spend 65–75% of their day in sedentary pursuits; however, evidence among youth is less conclusive. This study examined the effects of an acute 4 h bout of sedentary behaviors on cardiometabolic outcomes and energy expenditure in Hispanic adolescents (12–16 years old) with obesity (BMI% ≥ 95th). Methods: This study used a randomized cross-over design to engage participants (N = 12) in two sedentary conditions, an active condition where youth were engaged in two hours of ‘active’ sitting activities (e.g., reading and puzzles) and two hours of passive movie-watching. Whole-room calorimetry was used to assess energy expenditure. Fasting measures of insulin, adiponectin, leptin, and TNF-alpha were collected, followed by post-prandial measures 30 min, 2 h, and 4 h after a standardized meal. Adiposity was assessed using DXA. Results: There was no overall impact of the 4 h sedentary bout on energy expenditure or cardiometabolic risk factors; however, energy expenditure in the active sedentary condition was higher compared to the passive sedentary condition (p = 0.0635, ß estimate = 0.1538). Sex and adiposity did not moderate the relationships among sedentary time, cardiometabolic outcomes, and energy expenditure. Conclusions: Due to power limitations, these results are exploratory; however, they suggest that different types of sedentary behaviors may be more deleterious than others. More studies are needed to understand the context in which sedentary activities occur and the mechanisms by which sedentary pursuits contribute to the development of cardiometabolic disease. Full article

(This article belongs to the Special Issue Screen Time, Adverse Childhood Experiences and Childhood Mental Health on Child and Adolescent Development: Current Research and Future Directions)

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7 pages, 168 KiB

Open AccessArticle

Clinical Utility of Anorectal Manometry in Children with Functional Constipation: Can Anorectal Manometry Help Predict the Therapeutic Response?

by Dhiren Patel, Courtney Decker and Leonel Rodriguez

Children 2025, 12(4), 512; https://doi.org/10.3390/children12040512 - 16 Apr 2025

Abstract

Background: Anorectal Manometry (ARM) plays a crucial role in diagnosing potential motility disorders of anorectum in pediatric gastroenterology. Despite its prevalence, the predictive utility of ARM in guiding therapeutic response remains poorly characterized. Objectives: This study aims to evaluate the effectiveness [...] Read more.

Background: Anorectal Manometry (ARM) plays a crucial role in diagnosing potential motility disorders of anorectum in pediatric gastroenterology. Despite its prevalence, the predictive utility of ARM in guiding therapeutic response remains poorly characterized. Objectives: This study aims to evaluate the effectiveness of ARM in predicting therapeutic responses among children with functional constipation. Methods: A retrospective chart review was conducted at two tertiary centers examining pediatric patients who underwent ARM between January 2018 and July 2022. Key ARM parameters were analyzed, including anal resting pressure, recto-anal inhibitory reflex (RAIR), first rectal sensation, and bear-down maneuver (BDM). Therapeutic responses were assessed post-ARM, with success defined as an increase in bowel movement frequency and/or a decrease in fecal incontinence. In addition, we also intended to evaluate the eventual need for surgical intervention as another outcome. Results: The study included 327 patients, with a median age of 8.2 years. The overall therapeutic response rate was 40.7%, with stimulant laxatives showing a 48% response. Notably, lower anal resting pressures and delayed rectal sensations were associated with better therapeutic outcomes. Abnormal BDM correlated with a lack of response to therapies, while the presence of abnormal RAIR was linked to a higher eventual need for surgical intervention. Conclusions: ARM is instrumental in predicting therapeutic responses in pediatric patients with functional constipation. In addition to diagnosing HD, ARM could be an instrumental tool in identifying patients with dyssynergic defecation for early intervention with targeted therapy in age-appropriate patients. Full article

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

20 pages, 3036 KiB

Open AccessSystematic Review

Effectiveness of Dental Restorative Materials in the Atraumatic Treatment of Carious Primary Teeth in Pediatric Dentistry: A Systematic Review

by Gianna Dipalma, Angelo Michele Inchingolo, Lucia Casamassima, Paola Nardelli, Danilo Ciccarese, Paolo De Sena, Francesco Inchingolo, Andrea Palermo, Marco Severino, Cinzia Maria Norma Maspero and Alessio Danilo Inchingolo

Children 2025, 12(4), 511; https://doi.org/10.3390/children12040511 - 16 Apr 2025

Abstract

Aim: This systematic review evaluates the effectiveness and clinical outcomes of Atraumatic Restorative Treatment (ART) in pediatric dentistry, comparing it with other restorative techniques, analyzing material performance, assessing cost-effectiveness, and exploring the long-term success in managing dental caries. Background: ART is a minimally [...] Read more.

Aim: This systematic review evaluates the effectiveness and clinical outcomes of Atraumatic Restorative Treatment (ART) in pediatric dentistry, comparing it with other restorative techniques, analyzing material performance, assessing cost-effectiveness, and exploring the long-term success in managing dental caries. Background: ART is a minimally invasive approach that removes decayed tissue using hand instruments and restores teeth with adhesive materials like glass ionomer cement (GIC). ART is particularly valuable in pediatric dentistry due to its simplicity, reduced discomfort, and suitability for resource-limited settings. It eliminates the need for anesthesia and expensive dental equipment, making it accessible in remote and underserved areas. Studies have shown its effectiveness in providing durable restorations while improving patient comfort. Materials and Methods: This systematic review follows the PRISMA guidelines. PubMed, Web of Science, and Scopus were searched for studies published in the last ten years. The inclusion criteria included in vivo studies on children, randomized controlled trials, and case–control studies assessing ART’s effectiveness. Quality and risk of bias were evaluated using the ROBINS-I tool. Results: Eighteen studies met the inclusion criteria. ART effectively managed dental caries, especially with high-viscosity GIC. Comparisons with the Hall Technique and Papacarie showed that ART remains a viable, cost-effective option. Conclusions: ART is a reliable, minimally invasive technique for pediatric restorative dentistry. Its accessibility and cost-effectiveness make it suitable for low-resource settings. High-quality materials and technique modifications further enhance restoration longevity. Full article

(This article belongs to the Collection Advance in Pediatric Dentistry)

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9 pages, 662 KiB

Open AccessArticle

The Clinical Value of Capillary Blood Cartridge-Based Testing in Neonatal Jitteriness: A Re-Evaluation of the Diagnostic Approach

by Assaf Regev, Rasha Srour, Laurence Mangel, Dror Mandel, Jacky Herzlich, Anat Lavie and Ronella Marom

Children 2025, 12(4), 510; https://doi.org/10.3390/children12040510 - 16 Apr 2025

Abstract

Objective: This study assessed the utility of capillary blood cartridge-based analysis in evaluating neonatal jitteriness (NJ). Methods: In this retrospective study, we compared outcomes between neonates (37–41 weeks of gestation) diagnosed with neonatal jitteriness (NJ) within the first 72 h of life and [...] Read more.

Objective: This study assessed the utility of capillary blood cartridge-based analysis in evaluating neonatal jitteriness (NJ). Methods: In this retrospective study, we compared outcomes between neonates (37–41 weeks of gestation) diagnosed with neonatal jitteriness (NJ) within the first 72 h of life and a control group of healthy neonates (GA 37–41 weeks) with an uneventful perinatal course and no signs of jitteriness. Results: Each group included 101 neonates. Jittery neonates had a higher proportion of males (70.3% vs. 50.5%, p = 0.004), a lower mean gestational age (38.8 vs. 39.2 weeks, p = 0.002), and a higher rate of emergency cesarean deliveries (14.9% vs. 3.0%, p = 0.003). The logistic regression identified male sex (OR = 2.5, p = 0.007) and in utero selective serotonin reuptake inhibitor (SSRI) exposure (OR = 9.0, p = 0.005) as significant risk factors for NJ. The capillary blood parameters, except glucose levels, did not differ significantly between the neonates admitted to the NICU and those discharged. Hypoglycemic jittery neonates were 10 times more likely to require NICU admission compared to their non-hypoglycemic counterparts (OR = 10.9, 95% CI: 2–59.5, p = 0.006). Conclusions: Point-of-care glucose testing using a bedside glucometer may be sufficient for the evaluation of neonatal jitteriness, as capillary blood cartridge-based testing did not offer an additional diagnostic value. What is Known: NJ is often viewed as a self-resolving benign phenomenon; however, in certain cases, it can be an indicator of an underlying pathology. There is substantial evidence linking the maternal use of SSRIs or SNRIs during pregnancy with the occurrence of NJ in newborns as well as an association between hypoglycemia and NJ. What is New: This study is the first to evaluate the clinical utility of systematic capillary blood cartridge-based testing in jittery neonates using a relatively large cohort. Male neonates were disproportionately represented among cases of NJ. Healthy neonates with jitteriness had normal electrolytes, with hypoglycemia as the only concern. A glucometer test may suffice for evaluation, but those who are small for their gestational age or have initial hypoglycemia require a routine follow-up due to a higher risk of NICU admission. Full article

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 3278 KiB

Open AccessArticle

Are the Risk Factors for Bronchopulmonary Dysplasia and Retinopathy of Prematurity in Very Low-Birth-Weight Infants the Same?

by Hui Wu, Juan Zhang, Jing Zhang, Yanhong Yu, Hua Zhang and Tongyan Han

Children 2025, 12(4), 509; https://doi.org/10.3390/children12040509 - 15 Apr 2025

Abstract

Background/Objectives: Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) affect the prognosis of preterm infants, and their coexistence is a risk factor for poor long-term outcomes in very low-birth-weight infants. However, there has been limited in-depth assessment of common and independent risk [...] Read more.

Background/Objectives: Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) affect the prognosis of preterm infants, and their coexistence is a risk factor for poor long-term outcomes in very low-birth-weight infants. However, there has been limited in-depth assessment of common and independent risk factors for BPD and ROP within the same cohort. Therefore, we aimed to investigate the risk factors for BPD and ROP in very low-birth-weight infants born at ≤32 weeks of gestation and to explore the interaction between these two diseases. Methods: The participants were divided into four groups: BPD+ROP+, BPD-ROP-, BPD+ROP-, and BPD-ROP+. Gestational age, birth weight, maternal pregnancy complications, birth and postnatal diseases, and treatment conditions were compared among the groups. Subsequently, univariate and multivariate binary logistic regression analyses were conducted to explore the independent risk factors for BPD and ROP. Results: Common risk factors of BPD and ROP included gestational age and prolonged oxygen therapy. The multivariate analysis revealed that gestational age (OR: 4.44; 95% CI: 3–6.57), intubation resuscitation (OR: 2.35; 95% CI: 1.09–5.05), mechanical ventilation duration ≥ 7 days (OR: 1.01; 95% CI: 1.01–1.01), and prolonged total oxygen therapy (OR: 3.13; 95% CI: 1.28–7.64) were independent risk factors for BPD. Additionally, gestational age (OR: 0.66; 95% CI: 0.54–0.81) and prolonged oxygen therapy (OR: 1.02; 95% CI: 1–1.03) were independent risk factors for ROP. Conclusions: The proper control of the duration and concentration of oxygen therapy, along with the minimization of mechanical ventilation time, is crucial for reducing the incidence of both BPD and ROP. Full article

(This article belongs to the Special Issue Pediatric Respiratory Diseases: Diagnosis, Treatment, and Prevention)

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15 pages, 703 KiB

Open AccessArticle

Movement-Based Priming: A Clinical Trial on the Effect of Cross-Training on Locomotor Abilities of Children with Unilateral Cerebral Palsy

by Tamer M. Elsaeed, Ragab K. Elnaggar, Mohammed F. Elbanna, Mshari Alghadier, Aziza M. Kamel, Ahmed M. Aboeleneen, Fahad A. Qissi and Marwa M. Ismaeel

Children 2025, 12(4), 508; https://doi.org/10.3390/children12040508 - 15 Apr 2025

Abstract

Background: Children with unilateral cerebral palsy (UCP) frequently experience limitations in locomotor abilities, attributable to a complex interplay of factors including muscle weakness and reduced joint mobility. Movement-based priming, such as cross-training (CT), has emerged as a potential intervention to enhance motor function [...] Read more.

Background: Children with unilateral cerebral palsy (UCP) frequently experience limitations in locomotor abilities, attributable to a complex interplay of factors including muscle weakness and reduced joint mobility. Movement-based priming, such as cross-training (CT), has emerged as a potential intervention to enhance motor function in children with UCP. However, evidence of its efficacy remains limited. Objective: This study aimed to investigate the effect of CT—specifically, a strengthening-based unilateral priming protocol—on muscle strength, joint mobility, and locomotor abilities in children with UCP. Methods: Thirty-six children with UCP were enrolled in a randomized controlled trial. Participants were randomized into two groups: the control group (n = 18; underwent a tailored physical rehabilitation program) and the CT group (n = 18; participated in a CT program incorporating unilateral priming exercises targeting the less-affected lower followed by the same rehabilitation program administered to the control group). Dorsiflexor strength, ankle joint mobility, and locomotor ability assessed via the 10 m walk test (10 mWT), 6 min walk test (6 MWT), and timed up-and-go test (TUG) were evaluated pre- and post-intervention. Results: Significant moderate-to-large between-group differences were observed in dorsiflexor strength (p = 0.032, partial η² = 0.128), ankle mobility (p = 0.016, partial η² = 0.159), and locomotor ability (10 mWT [p = 0.017, partial η² = 0.157]; 6 MWT [p = 0.004, partial η² = 0.222]; TUG [p = 0.047, partial η² = 0.111]). The CT group demonstrated superior improvements concerning all outcomes. Conclusions: Unilateral priming through strengthening-based CT is a viable intervention for enhancing motor function in children with UCP, providing a promising complement to the current rehabilitation protocols. Full article

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

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11 pages, 227 KiB

Open AccessArticle

Twenty-Four Hour Ambulatory Blood Pressure Monitoring in Offspring Conceived Through Assisted Reproductive Technologies

by Felix Sebastian Oberhoffer, Pengzhu Li, Magdalena Langer, Theresa Vilsmaier, Marie Kramer, Franziska Sciuk, Brenda Kolbinger, André Jakob, Nina Rogenhofer, Robert Dalla-Pozza, Christian Thaler and Nikolaus Alexander Haas

Children 2025, 12(4), 507; https://doi.org/10.3390/children12040507 - 15 Apr 2025

Abstract

Background: One in fifty infants is conceived through assisted reproductive technologies (ART). To date, data on the cardiovascular morbidity of ART individuals is ambiguous. This study investigated the vascular function of young ART subjects using 24 hour ambulatory blood pressure monitoring (24 h [...] Read more.

Background: One in fifty infants is conceived through assisted reproductive technologies (ART). To date, data on the cardiovascular morbidity of ART individuals is ambiguous. This study investigated the vascular function of young ART subjects using 24 hour ambulatory blood pressure monitoring (24 h ABPM). Methods: ART subjects and spontaneously conceived controls matched in age as well as sex were enrolled. A 24 h blood pressure profile including pulse wave analysis was executed in all study participants. Blood pressure readings were assessed every 15 min during daytime and every 30 min during nighttime. The 24 h systolic/diastolic blood pressure (SBP/DBP) as well as central blood pressure, nocturnal blood pressure decrease, and 24 h pulse wave velocity (PWV) were analyzed. Results: A total of 41 ART individuals and 46 spontaneously conceived peers were included in the final analysis (mean age: 15.37 ± 5.46 years vs. 16.48 ± 5.23 years, p = 0.338). The 24 h SBP (112.74 ± 9.24 mmHg vs. 112.73 ± 6.70 mmHg, p = 0.997), 24 h DBP (65.61 ± 7.98 mmHg vs. 66.57 ± 7.03 mmHg, p = 0.550), 24 h central blood pressure, nocturnal blood pressure decrease, and 24 h PWV did not demonstrate significant differences between the ART and control group. Conclusions: In contrast to previous studies, no significant differences in 24 h blood pressure were demonstrated between ART subjects and spontaneously conceived peers. Hence, the results of this study do not indicate an unfavorable blood pressure profile in ART offspring. Larger multi-centric studies are needed to validate these results in the future. Full article

(This article belongs to the Special Issue Prevention of Cardiovascular Diseases in Children and Adolescents)

24 pages, 303 KiB

Open AccessArticle

Parents’ Educational Background and Child’s Learned Skills Are More Predictive for a Positive School Career than Earlier Parenting Behavior or Child’s Mental Health—Results from an 18-Year Longitudinal Observation Study

by Beate Muschalla, Ann-Katrin Job and Wolfgang Schulz

Children 2025, 12(4), 506; https://doi.org/10.3390/children12040506 - 15 Apr 2025

Abstract

Background/Objectives: Developmental research has shown that mental health and functioning is determined by social background and child and family characteristics. Until now, there have been few longitudinal studies which considered several aspects at the same time and observed children’s development over ten [...] Read more.

Background/Objectives: Developmental research has shown that mental health and functioning is determined by social background and child and family characteristics. Until now, there have been few longitudinal studies which considered several aspects at the same time and observed children’s development over ten or more years. Methods: The aim of this 18-year-longitudinal study is to find out to which degree different child, family, and socioeconomic factors during early childhood (4 years of age) are associated with educational and professional outcomes in young adulthood (22 years of age). Of the initial sample of 280 participating families, 225 could again be investigated with standardized interviews and questionnaires at the 18 years follow-up (retention rate: 80%). Results: Educational degree of the parents was predictive of the child’s school success (β = −0.267, p < 0.001, in regression analysis). Maternal mental health (β = −0.005, p = 0.953), parenting behavior (β = −021, p = 0.782), and early child mental health problems (β = 0.071, p = 0.551) only had a low impact. The child’s sex did not predict school success. Better early learned skills (i.e., crystalline intelligence), but not cognitive skills, as measured by the child-specific intelligence test K-ABC, made children more likely to achieve good school-leaving grades (β = −0.240, p = 0.008). Children’s early mental health problems had no relevant impact on school degree (d = 0.00, p = 0.934/d = 0.02, p = 0.52 3) or professional status (d = 0.04, p = 0.157/d = −0.02, p = 0.299) at age 22. Conclusions: Besides the not-changeable parental education level, (learnable) competency aspects may be more predictive of a child’s educational success until young adulthood than earlier mental health problems in parents and children. This is good news as it supports the idea that mental health deficits can be compensated for through learning and competency training. Full article

(This article belongs to the Special Issue Children’s Well-Being and Mental Health in an Educational Context)

21 pages, 617 KiB

Open AccessArticle

McLean OCD Institute for Children and Adolescents: Overview, Rationale, and Description of Symptomatology and Functional Impairment

by Alyssa L. Faro, Rebecca A. Wolenski, Chun W. Lee, Perihan Esra Guvenek-Cokol, Daniel P. Dickstein and Maria G Fraire

Children 2025, 12(4), 505; https://doi.org/10.3390/children12040505 - 15 Apr 2025

Abstract

Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of [...] Read more.

Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of adolescent patients utilizing this level of care. As a result, residential treatment may be poorly understood by patients, their families, and referring providers, which may delay appropriate treatment for adolescents with OCD. Here, we characterize the patient population at an intensive residential treatment center (RTC) and partial hospitalization program (PHP) for adolescents (Mage = 15.23) with a primary diagnosis of OCD. Methods: We examine quantitative data collected from 168 adolescents admitted to the McLean OCD Institute for Children and Adolescents for the treatment of primary OCD or a related disorder over a three-year period. We also conduct analyses on a subset of patients (n = 120) who participated in the Child and Adolescent Routine Evaluation (CARE) Initiative (McLean Child Division-Wide Measurement-Based Care Program) to further characterize this patient population with a lens toward additional comorbidities and factors impacting prognosis. Results: The current paper describes the severity of symptom presentation, comorbidities, psychotropic medication profiles, and disruption to personal and family functioning. Analyses also include the prevalence of OCD subtypes and co-occurrence among varied presentations. Conclusions: In addition to identifying common clinical presentations in an RTC/PHP, this paper further aims to detail best practices and clinical rationale guiding a specialty RTC/PHP to inform families, providers, and payors about the individuals that most benefit from this level of care. Full article

(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)

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