Pediatric Reports

16 pages, 432 KB

Open AccessBrief Report

Early Upper Limb Function in Infants Under Three Months: Associations with Shoulder Biomechanics and General Movement Patterns

by Lucía Fernanda Flores-Santy, Daniela Celi-Lalama and Juan Pablo Hervás-Pérez

Pediatr. Rep. 2025, 17(6), 131; https://doi.org/10.3390/pediatric17060131 - 3 Dec 2025

Abstract

Early identification of neurodevelopmental trajectories is essential for timely intervention in infancy. While joint mobility is often seen as an indicator of motor capacity, its link to early functional performance remains unclear. This study examined whether active shoulder range of motion and the [...] Read more.

Early identification of neurodevelopmental trajectories is essential for timely intervention in infancy. While joint mobility is often seen as an indicator of motor capacity, its link to early functional performance remains unclear. This study examined whether active shoulder range of motion and the quality of spontaneous movement quality relate to early upper limb function in infants under three months. Thirty-two healthy infants participated in a cross-sectional assessment. Video recordings analyzed with the General Movements Assessment classified movements as Fidgety or Writhing. Fine motor performance was evaluated using five items from the Denver II Screening Test. Active shoulder abduction was measured via two-dimensional frontal-plane analysis with Kinovea^®. Data analysis involved t-tests and Pearson correlations. Results showed that infants with Fidgety movements scored higher on fine motor tests than those with Writhing movements. Shoulder range of motion was slightly higher in infants with Writhing movements, but not significantly. No sex differences were found. Weak, nonsignificant correlations existed between shoulder range of motion and fine motor performance. The findings suggest movement quality, rather than limb mobility, is more connected to early motor function. Combining movement quality assessments with simple tests may improve early detection of subtle neuromotor issues and guide early stimulation strategies. Full article

► Show Figures

Graphical abstract

17 pages, 255 KB

Open AccessArticle

Early Childhood Oral Health: Insights into Knowledge, Preventive Practices, and Risk Awareness from a Croatian Cross-Sectional Study

by Marija Matijević, Marija Badrov, Lidia Gavić and Antonija Tadin

Pediatr. Rep. 2025, 17(6), 130; https://doi.org/10.3390/pediatric17060130 - 3 Dec 2025

Abstract

Aim: Early childhood caries (ECC) is a widespread and multifactorial oral disease that affects children globally. Parents’ knowledge, attitudes, and behaviors are crucial in preventing ECC and supporting oral health. This study evaluated Croatian parents’ understanding of children’s oral health, their awareness of [...] Read more.

Aim: Early childhood caries (ECC) is a widespread and multifactorial oral disease that affects children globally. Parents’ knowledge, attitudes, and behaviors are crucial in preventing ECC and supporting oral health. This study evaluated Croatian parents’ understanding of children’s oral health, their awareness of ECC risk factors, and their oral hygiene practices. Materials and methods: A cross-sectional study was conducted using an anonymous and voluntary online questionnaire from October to December 2024 among 948 parents of children aged 1–7 years across Croatia. The study assessed parents’ knowledge of oral health, their understanding of the relationship between risk factors and early childhood caries, habits related to oral hygiene care, children’s experiences with oral health problems, parents’ self-assessment of their knowledge, as well as both their own and their children’s general and oral health and hygiene practices. Data were analyzed using descriptive statistics, Chi-square test, Mann–Whitney U test, and Kruskal–Wallis test. Results: Overall parental knowledge was moderate, with significantly higher scores among older parents, those with university education, healthcare workers, and families with higher incomes (p < 0.05). Parents demonstrated good awareness of the importance of supervising tooth brushing until age seven (93.8%) and fluoride use (81.8%); yet gaps persisted regarding bacterial transmission, tooth eruption, and early orthodontic evaluation. Preventive dental visits were frequently delayed, and only 25.0% of parents reported using interdental cleaning aids. Caries was the most common oral health issue among children (22.3%). Conclusions: Despite moderate awareness and some adherence to preventive measures, significant knowledge and practice gaps remain among Croatian parents. Targeted educational interventions and nationwide preventive strategies are necessary to strengthen oral health literacy and reduce ECC prevalence. Full article

15 pages, 936 KB

Open AccessArticle

Parental Knowledge and Acceptance of Pediatric Lumbar Puncture in Northern Saudi Arabia: Implications for Clinical Practice and Education: A Cross-Sectional Study

by Dana Faez K. Alenezi, Rahaf Maqil T. Alanazi, Fai Fihat S. Almatrafi, Reema Mubarak O. Alanazi, Nouf Swilim K. Alenezy, Dalia Aqeel J. Alanazi, Shahad Wadi A. Alanazi, Rahaf Salman Z. Alanazi, Ayman Hamed Alenezi, Baraah Abu Alsel, Hanaa E. Bayomy, Safya E. Esmaeel and Manal S. Fawzy

Pediatr. Rep. 2025, 17(6), 129; https://doi.org/10.3390/pediatric17060129 - 2 Dec 2025

Abstract

Background/Objectives: Lumbar puncture (LP) remains a vital pediatric procedure for diagnosing neurological and systemic conditions. Despite its clinical significance, parental hesitation to authorize pediatric LP often impedes early diagnosis and care. This study aims to evaluate parental knowledge and attitudes regarding pediatric [...] Read more.

Background/Objectives: Lumbar puncture (LP) remains a vital pediatric procedure for diagnosing neurological and systemic conditions. Despite its clinical significance, parental hesitation to authorize pediatric LP often impedes early diagnosis and care. This study aims to evaluate parental knowledge and attitudes regarding pediatric LP in the Northern Border Region of Saudi Arabia, offering insights to inform targeted education strategies. Methods: A cross-sectional survey was conducted between February and August 2025 using a validated online questionnaire distributed via social media. The survey captured sociodemographic data and assessed awareness and attitudes toward pediatric LP. Univariate and multivariate logistic regression analyses examined factors associated with knowledge and consent. Results: Among 703 respondents, 60.6% were mothers and 95.6% were Saudi nationals. While 64.6% acknowledged the importance of aseptic technique, just 38.1% considered LP a safe practice. Knowledge levels were highest in parents aged 18–25 years (p < 0.001). Physician recommendation was the key factor in parental consent (87.0%), with 59.2% willing to approve the procedure following advice. Parents aged 26–35 years showed greater acceptance (OR = 1.54, 95% CI: 1.02–2.32, p = 0.04), whereas those older than 46 years were less receptive (OR = 0.51, 95% CI: 0.30–0.86, p = 0.01). Conclusions: Overall, parental knowledge regarding pediatric LP is limited. Targeted health education campaigns are needed to improve parental understanding of the procedure’s safety, importance, and benefits. Full article

► Show Figures

Figure 1

16 pages, 1653 KB

Open AccessCase Report

Immunological Profile in Atypical Kawasaki Disease: A Case Report Highlighting the Diagnostic Utility of Cytokine Analysis by qRT-PCR

by Margarita L. Martinez-Fierro, Idalia Garza-Veloz, Felipe D. Marrufo-Garcia, Manuel Gonzalez-Plascencia, Rocio C. Calderon-Zamora, Claudia Sifuentes-Franco and Monica Rodriguez-Borroel

Pediatr. Rep. 2025, 17(6), 128; https://doi.org/10.3390/pediatric17060128 - 1 Dec 2025

Abstract

Background: Kawasaki Disease (KD) is an acute vasculitis affecting children under five years of age, with atypical presentations posing diagnostic challenges and a higher risk of coronary complications when untreated. Methods: We report on a 2-year-old girl with persistent fever, limb edema, erythema, [...] Read more.

Background: Kawasaki Disease (KD) is an acute vasculitis affecting children under five years of age, with atypical presentations posing diagnostic challenges and a higher risk of coronary complications when untreated. Methods: We report on a 2-year-old girl with persistent fever, limb edema, erythema, and non-purulent conjunctivitis, without cervical lymphadenopathy or the typical rash. Inflammatory markers were assessed, and a cytokine expression profile was obtained using qRT-PCR. Results: Laboratory analysis showed elevated C-reactive protein (11.1 mg/dL), high fibrinogen (468 mg/dL), borderline D-dimer (484 ng/mL), and a normal platelet count. The cytokine profile revealed marked upregulation of IFN-α, IFN-β, IFN-γ, IL-1α, IL-1β, IL-5, IL-8, and IL-12, with downregulation of IL-2 and IL-4, as well as low TNF-α levels. These findings, although not pathognomonic, were consistent with an inflammatory profile compatible with atypical KD, in which a preceding viral infection may have played a role, although causality cannot be established. Conclusions: This case highlights the diagnostic utility of cytokine profiling in suspected atypical KD, particularly when clinical criteria are incomplete. The integration of immunological data may aid in earlier recognition and therapeutic intervention, thereby helping to prevent cardiovascular sequelae. Cytokine analysis may serve as a promising adjunct for atypical KD diagnosis, although confirmation in larger cohorts is needed. Full article

► Show Figures

Figure 1

13 pages, 1331 KB

Open AccessCase Report

Two Rare Cases of Bilateral Diaphragmatic Paralysis in Neonates

by Sara Ronci, Chiara Maddaloni, Stefano Caoci, Stefano Pro, Daniela Longo, Andrea Conforti, Andrea Dotta and Francesca Campi

Pediatr. Rep. 2025, 17(6), 127; https://doi.org/10.3390/pediatric17060127 - 1 Dec 2025

Abstract

Diaphragmatic paralysis (DP) in neonates is a rare yet potentially life-threatening cause of respiratory distress, often resulting from obstetric trauma or cardiac surgery. This report presents two distinct cases of bilateral DP: one following a dystocic delivery with associated brachial plexus involvement, and [...] Read more.

Diaphragmatic paralysis (DP) in neonates is a rare yet potentially life-threatening cause of respiratory distress, often resulting from obstetric trauma or cardiac surgery. This report presents two distinct cases of bilateral DP: one following a dystocic delivery with associated brachial plexus involvement, and the other linked to a genetic mutation (SYNGAP1) in a neonate with no birth trauma. Diagnosis was established through imaging, fluoroscopy, electromyography, and genetic testing. In both cases, conservative management was initially pursued; however, due to persistent respiratory failure, invasive interventions were required. The first patient underwent bilateral diaphragmatic plication with favorable outcomes, while the second required tracheostomy due to poor response to non-invasive ventilation with good outcome. These cases highlight the diagnostic and therapeutic challenges of neonatal DP, emphasizing the need for individualized treatment strategies in the absence of standardized guidelines. Early diagnosis and a multidisciplinary approach are crucial to optimize respiratory outcomes and reduce complications from prolonged mechanical ventilation. Full article

► Show Figures

Figure 1

20 pages, 4364 KB

Open AccessArticle

Patterns of Segmental Strain of the Left Ventricle in Extremely Premature Infants

by Tatiana Chumarnaya, Evgeniya Gusarova, Natalya Kosovtsova, Svetlana Koltashova and Olga Solovyova

Pediatr. Rep. 2025, 17(6), 126; https://doi.org/10.3390/pediatric17060126 - 1 Dec 2025

Abstract

Extremely premature newborns are predisposed to cardiovascular complications due to a number of factors, including myocardial immaturity, hemodynamic changes, and iatrogenic effects. There are few studies on myocardial strain in extremely premature infants during the early neonatal period. The objective of study was [...] Read more.

Extremely premature newborns are predisposed to cardiovascular complications due to a number of factors, including myocardial immaturity, hemodynamic changes, and iatrogenic effects. There are few studies on myocardial strain in extremely premature infants during the early neonatal period. The objective of study was to assess the left ventricular (LV) segmental strain in extremely premature newborns during the early neonatal period by employing speckle-tracking echocardiography (STE). This prospective study examined 65 newborns with no signs of hemodynamic impairment during the first 72 h of life. The cohort had a range of birth weights (600–1500 g) and gestational ages (24–35 weeks). The peak strain in 18 LV segments during systole (peak S and time to peak S), and throughout the cardiac cycle (peak G and time to peak G), and during early systolic pre-stretch (peak P and time to peak P) were assessed in the longitudinal, circumferential, and radial directions. We obtained percentile tables of segmental strain characteristics in the longitudinal, circumferential, and radial directions. No dependence of segmental strain on the birth weight, gestational age, or arterial duct closure was found. A positive gradient of the longitudinal strain magnitude was observed from the base to the apex. The highest circumferential and radial strain were observed in LV septum. This study is the first to register and compare the longitudinal, circumferential, and radial LV strain using STE in extremely premature infants with no signs of hemodynamic disturbances during the first 72 h of life. Reference values for segmental strain were established. Full article

(This article belongs to the Special Issue Global Neonatal Screening: Expanding Horizons in Diagnostic Technologies)

► Show Figures

Figure 1

9 pages, 855 KB

Open AccessArticle

Influence of Neonatal Exposure to Hyperoxia on Skeletal Muscle in a Rat Model

by Kentaro Awata, Irena Santosa, Yoshiteru Arai, Mayu Nakagawa, Hiroki Suganuma and Hiromichi Shoji

Pediatr. Rep. 2025, 17(6), 125; https://doi.org/10.3390/pediatric17060125 - 14 Nov 2025

Abstract

Background/Objectives: Premature births below 32 weeks of gestation generally require respiratory oxygen support, leading to a relatively hyperoxic environment compared to in utero conditions. Transient hyperoxia exposure has been linked to an elevated risk of chronic lung disease and retinopathy of prematurity; [...] Read more.

Background/Objectives: Premature births below 32 weeks of gestation generally require respiratory oxygen support, leading to a relatively hyperoxic environment compared to in utero conditions. Transient hyperoxia exposure has been linked to an elevated risk of chronic lung disease and retinopathy of prematurity; however, its effects on skeletal muscles remain elusive. This study aimed to investigate the effects of hyperoxic exposure in rats as a model of premature infants receiving supplemental oxygen (30–60% O₂ for several weeks). We hypothesized that rats exposed to postnatal hyperoxia would exhibit muscle fiber atrophy and alterations in fiber type. Methods: We used a rat model in which newborns were exposed to 80% oxygen from birth until postnatal day 12. We assessed the gastrocnemius muscles of rat legs at 12 weeks. Results: Rats exposed to hyperoxia showed substantially increased protein expression of Atrogin-1, along with elevated levels of adipophilin, myogenic differentiation factor 1, and myogenin. No significant changes were observed in the expression of slow or fast myosin heavy chain proteins. However, myofiber size in the gastrocnemius muscle was reduced in the hyperoxia-exposed group compared to the control group. Conclusions: Thus, transient hyperoxia exposure during early life can impede skeletal muscle development, potentially extending into adulthood. Full article

► Show Figures

Figure 1

16 pages, 1853 KB

Open AccessSystematic Review

Minimally Invasive Versus Open Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis: Insights from an Updated Systematic Review and Meta-Analysis

by Amani N. Al-Ansari, Sagar Ahammed, Ahmed A. Sofy and Somaya Shokry Tawfik

Pediatr. Rep. 2025, 17(6), 124; https://doi.org/10.3390/pediatric17060124 - 10 Nov 2025

Abstract

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and [...] Read more.

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and safe alternative to the open technique. We aimed to compare the surgical outcomes of both approaches and determine which approach is superior to the other. Methods: We searched for relevant articles by searching Scopus, Web of Science, PubMed, and the Cochrane Library until January 2025. The Cochrane risk of bias tool was utilized to assess the quality of the clinical trials, whereas the ROBINS-I tool was used in the observational studies. Our primary outcomes were operation time, length of hospital stay, time needed for full feeding, incidence of incomplete pyloromyotomy, mucosal perforation, wound infection, postoperative vomiting, postoperative incisional hernia, postoperative seroma or hematoma formation, need for reoperation, and rate of conversion to P in the laparoscopic group. Results: We included 12 eligible articles that compared laparoscopic pyloromyotomy with open pyloromyotomy in infants with hypertrophic pyloric stenosis. Our analysis revealed comparable results for both procedures in terms of operation time (p = 0.83), hospitalization duration (p = 0.06), mucosal perforation (p = 0.49), postoperative complications such as vomiting (p = 0.10), incisional hernia (p = 0.60), seroma (p = 0.52), and reoperation rates (p = 0.17). Patients who underwent LP achieved full feeding in less time (p = 0.007) and had fewer wound infections (p = 0.01) compared to OP. However, the incidence of incomplete pyloromyotomy was lower in the OP group than in the LP group (p = 0.03). Conclusions: Both open and laparoscopic pyloromyotomy are effective for treating hypertrophic pyloric stenosis. The laparoscopic approach offers the advantages of a faster return to full feeding and lower wound infection rates but increases the risk of incomplete pyloromyotomy compared to the open technique. Surgeon preference and experience play crucial roles in surgical outcomes, provided that there is a thorough understanding of the benefits and limitations of both techniques. Full article

► Show Figures

Figure 1

12 pages, 994 KB

Open AccessCase Report

Clinical Experience with Inosine Pranobex in Pediatric Acute Respiratory Infections with Comorbidities: A Case Series from a Specialised Centre

by Peter Kunč, Jaroslav Fábry, Katarína Ištvánková, Renata Péčová and Miloš Jeseňák

Pediatr. Rep. 2025, 17(6), 123; https://doi.org/10.3390/pediatric17060123 - 10 Nov 2025

Abstract

Background: Acute respiratory infections (ARIs) pose a significant clinical challenge in paediatric populations, especially in children with comorbidities who may exhibit underlying immune dysregulation. Inosine pranobex (IP) is an immunomodulatory agent that enhances T-lymphocyte and Natural Killer (NK) cell function, offering a targeted [...] Read more.

Background: Acute respiratory infections (ARIs) pose a significant clinical challenge in paediatric populations, especially in children with comorbidities who may exhibit underlying immune dysregulation. Inosine pranobex (IP) is an immunomodulatory agent that enhances T-lymphocyte and Natural Killer (NK) cell function, offering a targeted therapeutic rationale for such cases. Objective: This study aimed to retrospectively describe the clinical characteristics, immunological profiles, and outcomes of paediatric patients with complex, PCR-confirmed viral ARIs and significant comorbidities, for whom adjunctive therapy with IP was initiated based on clinical judgment. Methods: This retrospective case series analysed data from 14 paediatric patients hospitalised at a specialised centre (National Institute of Paediatric Tuberculosis and Respiratory Diseases in Dolny Smokovec, Slovakia). Cases were selected based on PCR-confirmed viral ARI, a history of recurrent infections, significant comorbidities, and initiation of IP therapy. The indication for IP was guided by the treating physician in cases of severe, prolonged, or recurrent disease course, where immune dysregulation was suspected, often supported by prior immunophenotyping. Results: A frequent observation in this cohort was the presence of baseline cellular immune alterations with a frequent observation of baseline cellular immune alterations, most notably the depletion of natural killer (NK) cells. NK cell depletion was identified in half of the patients (7/14). Following the initiation of treatment regimens that included adjunctive IP, clinical stabilisation or improvement was observed in all 14 patients included in the study. The therapy was well tolerated, with no reported adverse events attributable to IP. Conclusions: This case series highlights the common presence of cellular immune alterations in children with complex ARIs. While the observational nature of this study precludes any conclusions about causality, the favourable clinical course, safety profile, and strong immunological rationale support the need for prospective controlled trials to evaluate the role of IP in this specific high-risk paediatric population. Full article

(This article belongs to the Special Issue Infectious Diseases in Children and Adolescents)

► Show Figures

Figure 1

11 pages, 309 KB

Open AccessArticle

Comparison of Serum Sodium Levels Following Intravenous Administration of Isotonic and Hypotonic Solutions in Young Children: A Randomized Controlled Trial

by Nisara Chongcharoen, Yupaporn Amornchaichareonsuk, Suwanna Pornrattanarungsi and Ornatcha Sirimongkolchaiyakul

Pediatr. Rep. 2025, 17(6), 122; https://doi.org/10.3390/pediatric17060122 - 6 Nov 2025

Abstract

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis. Methods: This double-blind, randomized controlled trial involved children aged 3 months to [...] Read more.

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis. Methods: This double-blind, randomized controlled trial involved children aged 3 months to 5 years who were admitted to a general ward between November 2020 and September 2022 and required IVF. We randomly assigned patients (1:1) to receive either an isotonic solution (D₅0.9%NaCl) or hypotonic solution (D₅0.45%NaCl). Serum electrolyte and venous blood gas levels were obtained at the time of IVF administration and 24 and 48 h after IVF administration. During this study, all participants were monitored for vital signs, body weight, fluid intake and output, and clinical symptoms of dysnatremia. Results: Totals of 69 and 68 patients received isotonic and hypotonic solutions, respectively. The mean age was 1.95 ± 1.25 years in the isotonic group and 1.91 ± 1.32 years in the hypotonic group. The initial degrees of dehydration and biochemical indicators were not different. The change in serum sodium level at 24 h was 2.97 (2.32–3.62) mmol/L in the isotonic group and 2.19 (1.54–2.84) mmol/L in the hypotonic group. In both groups, no significant hyponatremia nor hypernatremia occurred. The incidence of hyperchloremic metabolic acidosis was not different between the groups. Neither group showed any complications. Conclusions: Isotonic fluids may be a preferred option for IVFs in pediatric patients under 5 years of age with medical conditions on a general ward, especially within 24 h, due to their potential to better maintain serum sodium levels without increasing the risk of fluid overload or electrolyte complication. Full article

► Show Figures

Figure 1

25 pages, 12887 KB

Open AccessArticle

Spatial Epidemiology of Pediatric Cancer in Romania: A Decade of Persistence, Continuity, and Localized Hotspots (Temporal Trend 2008–2017)

by Iulia Daniela Nedelcu, Ion Andronache, Ioannis Liritzis, Helmut Ahammer, Herbert Franz Jelinek, Andreea Karina Gruia, Daniel Peptenatu and Marko Radulovic

Pediatr. Rep. 2025, 17(6), 121; https://doi.org/10.3390/pediatric17060121 - 5 Nov 2025

Abstract

Objective: Pediatric cancer, though less prevalent than adult malignancies, constitutes a significant public health concern due to its long-term effects on survival, development, and quality of life. This study aimed to investigate spatial patterns and temporal trends of pediatric cancer in Romania over [...] Read more.

Objective: Pediatric cancer, though less prevalent than adult malignancies, constitutes a significant public health concern due to its long-term effects on survival, development, and quality of life. This study aimed to investigate spatial patterns and temporal trends of pediatric cancer in Romania over a ten-year period (2008–2017), identifying persistent and emerging geographic hotspots using Geographic Information Systems (GIS)–based modelling and spatial statistics. Methods: A national pediatric cancer registry provided by the Ministry of Health was analyzed for cases among individuals aged 0–18 years, categorized by administrative-territorial units (ATUs), ICD-10 codes, sex, and year. Spatial indicators of persistence (recurrent prevalence across multiple years) and continuity (uninterrupted recurrence) were computed. Hotspot analysis was conducted using Local Moran’s I, and trend patterns were assessed through temporal modeling. Additionally, fractal and complexity metrics were applied to characterize the spatial structure and heterogeneity of cancer persistence and continuity across regions. Results: Although national pediatric cancer prevalence exhibited a modest decline from 3.57‰ in 2008 to 3.44‰ in 2017, GIS-based spatial modeling revealed stable high-risk clusters in Central and South-Eastern Romania, particularly in historically industrialized counties such as Hunedoara, Prahova, and Galați. These correspond to regions with past heavy industry and chemical pollution. Male children presented a higher frequency of malignant tumors (48,502 cases in males vs. 36,034 in females), while benign and uncertain-behavior neoplasms increased more prominently among females (from 3847 to 4116 cases, compared with 3141 to 3199 in males). Several rural localities showed unexpected prevalence spikes, potentially associated with socioeconomic deprivation, limited health literacy, and reduced access to pediatric oncology services. Regional disparities in diagnostic and reporting capacities were also evident. Conclusion: GIS-based spatial epidemiology proved effective in revealing localized, sex-specific, and persistent disparities in pediatric cancer across Romania. The integration of spatial indicators and complexity metrics into national cancer control programs could strengthen early detection, optimize resource allocation, and reduce health inequities. These findings highlight the value of combining geospatial analysis and fractal modeling to guide evidence-based public health strategies for pediatric oncology. Full article

► Show Figures

Figure 1

13 pages, 898 KB

Open AccessArticle

Healthcare and School Professionals’ Satisfaction with Implementation of Finnish Smart Family Practice in Poland

by Justyna Nowak, Agata Szymczak, Marta Morawska, Heli Kuusipalo, Emma Koivurinta, Kati Kuisma, Päivi Mäki, Taina Sainio, Nella Savolainen and Katarzyna Brukało

Pediatr. Rep. 2025, 17(6), 120; https://doi.org/10.3390/pediatric17060120 - 5 Nov 2025

Abstract

Background: Poland is one of six countries implementing the Finnish Smart Family practice under the Joint Action Health4EUKids, aimed at supporting families in adopting lifestyle counseling methods and preventing childhood obesity across the European Union. Material and method: Since March 2024, Poland has [...] Read more.

Background: Poland is one of six countries implementing the Finnish Smart Family practice under the Joint Action Health4EUKids, aimed at supporting families in adopting lifestyle counseling methods and preventing childhood obesity across the European Union. Material and method: Since March 2024, Poland has implemented Smart Family tools through training sessions for professionals who work or will work with families of children with excess body weight. A total of 295 individuals have been trained, including 52.2% dietitians, 34.9% nurses, and 12.9% school staff such as teachers, school counselors, and psychologists. Before and after the training sessions, participants completed a survey assessing their knowledge of the Smart Family Practice, and familiarity with supportive tools. Results: Among 295 participants, nearly half reported no prior experience with family-based lifestyle change interventions. Post-training, over 70% expressed readiness to implement the SMART FAMILY method, with high interest (80.7%), motivation (76.5%), and satisfaction (83.6%). Most recognized its potential to support healthy lifestyles and parental engagement (>85%). Key barriers included lack of family cooperation (87.8%), staff shortages (81.0%), limited training (78.4%), and insufficient resources (43%). Conclusions: A high level of acceptance and motivation among participants indicates that the SMART FAMILY method has the potential for effective adaptation in Poland. Its implementation requires strengthening specialists’ skills and providing appropriate organizational resources. Overcoming barriers such as lack of experience, limited time, and difficulties in engaging families is crucial to achieving lasting intervention outcomes. Full article

► Show Figures

Figure 1

12 pages, 216 KB

Open AccessArticle

Implementation of an Early Mobility Initiative in a Pediatric Bone Marrow Transplant Unit

by Anne Swanson, Kylie James, Kimberly Fan, Akshay Sharma, Xiaomeng Yuan, Haitao Pan, Gabriela Maron, Hana Hakim and Saad Ghafoor

Pediatr. Rep. 2025, 17(6), 119; https://doi.org/10.3390/pediatric17060119 - 5 Nov 2025

Abstract

Background/Objectives: Children who have received hematopoietic cell transplants (HCTs) often face complex clinical courses and complications that increase their risk of functional impairments. Because of this, pediatric HCT recipients may benefit from early mobilization efforts to reduce long-term functional issues. However, early ambulation [...] Read more.

Background/Objectives: Children who have received hematopoietic cell transplants (HCTs) often face complex clinical courses and complications that increase their risk of functional impairments. Because of this, pediatric HCT recipients may benefit from early mobilization efforts to reduce long-term functional issues. However, early ambulation can be limited by clinical complexity and concerns about infectious transmission in HCT patients. Some patients are under contact precautions due to colonization with bacteria that produce extended-spectrum beta-lactamase (ESBL) enzymes. Our goal was to significantly increase ambulation in pediatric HCT recipients at our institution within three months of the intervention. We aimed to raise the number of ambulation events per day, the number of physical therapy (PT) visits per week, and the distance patients walked with PT per session. Methods: From January to October 2022, data on mobilization, demographics, and clinical characteristics were retrospectively collected from electronic health records. Starting in June 2022, we permitted ESBL-colonized patients to leave their rooms while wearing personal protective equipment (PPE), and we trained clinical staff about this in our QI initiative. Results: In Group 1, the ambulation rate was 1.36 times higher before the intervention than after, with an effect size of 0.3042 (p = 0.004 *). The ambulation rate in Group 2, admitted before the intervention, was 1.33 times higher than in Group 3, admitted after the intervention, with an effect size of 0.2856 (p = 0.016 *). Conclusions: The initiative did not increase ambulation among the targeted group. Patients ambulated more before the intervention, though these results lack statistical power. The lack of success of the intervention may be due to various factors, including the short monitoring period, retrospective data collection, difficulties with PPE use among young patients, and uncollected confounding variables related to clinical status. Full article

12 pages, 247 KB

Open AccessArticle

Exploring the Association Between Medically Assisted Reproduction and Autism Spectrum Disorder: Clinical Correlations from a Retrospective Cohort

by Federica Gigliotti, Maria Eugenia Martelli, Silvia Foglietta, Alessia Balestrini and Carla Sogos

Pediatr. Rep. 2025, 17(6), 118; https://doi.org/10.3390/pediatric17060118 - 4 Nov 2025

Abstract

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. [...] Read more.

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. This study aimed to compare the frequency of ART-conceived children between those diagnosed with ASD and those with other neurodevelopmental disorders (nASD), and to examine differences in prenatal, perinatal and medical histories of ART- and spontaneously (non-ART)-conceived children within an ASD group. Methods: We retrospectively analyzed data from 507 children with a neurodevelopmental disorders (NDDs) diagnosis, classified into ASD (n = 234) and nASD (n = 273) groups. Subsequent analyses focused on the ASD group, further divided into an ART and non-ART group according to the conception mode. Results: ART-conceived children were more frequent in the ASD group than in the nASD group. Moreover, within ASD, ART was significantly associated with potential risk factors such as twin pregnancy, cesarean delivery, low birth weight and parental age. Logistic Binary Regression confirmed these results, suggesting that ART co-occurs with a cluster of perinatal and familial risk factors. Conclusions: Our results indicate that ART is not an independent causal exposure; however, given the retrospective design and the absence of a general population control group, causal inference cannot be drawn. The observed association with ASD appears to be mediated by perinatal and parental variables. These findings underscore the importance of improving obstetric management and care, and ensuring early developmental monitoring for ART-conceived children. Full article

► Show Figures

Graphical abstract

6 pages, 642 KB

Open AccessCase Report

Successful Treatment of Multilevel Tracheal Stenosis Post Blunt Chest Trauma in a Child by Early Bronchoscopic Balloon Dilatation: A Case Report

by Badar Al Dhouyani, Atqah AbdulWahab, Muna Maarafiya, Bilal Kabbara and Mutasim Abu-Hasan

Pediatr. Rep. 2025, 17(6), 117; https://doi.org/10.3390/pediatric17060117 - 4 Nov 2025

Abstract

Background: Tracheal stenosis in children is a rare but potentially life-threatening condition. We report a case of multilevel tracheal stenosis in a child who sustained blunt chest trauma in a car accident. Case Presentation: The patient is an 11-year-old previously healthy boy who [...] Read more.

Background: Tracheal stenosis in children is a rare but potentially life-threatening condition. We report a case of multilevel tracheal stenosis in a child who sustained blunt chest trauma in a car accident. Case Presentation: The patient is an 11-year-old previously healthy boy who presented to the pediatric emergency room unconscious after being rolled over while seated unstrained inside a vehicle. A chest CT scan showed bilateral pulmonary contusions. He required intubation and mechanical ventilation initially but was noted to have biphasic stridor after extubation. He presented to the pediatric pulmonary clinic 2 weeks after discharge from the hospital with persistent stridor and shortness of breath on exertion. Spirometry revealed flattening of the inspiratory and expiratory limbs of the flow-volume loop, suggestive of fixed large airway obstruction. Direct laryngoscopy and bronchoscopy were performed and revealed multilevel tracheal stenosis. He was successfully treated with repeated bronchoscopic balloon dilatation with sustained improvement in symptoms and spirometry findings 8 months post final procedure. Conclusion: Tracheal stenosis should be suspected in children who sustain blunt chest trauma. Early recognition and treatment with bronchoscopic balloon dilatation can prevent long-term complications. Full article

(This article belongs to the Collection Recent Advances and Critical Issues in Pediatrics: a Collection of Feature Papers)

► Show Figures

Figure 1

12 pages, 668 KB

Open AccessCase Report

Can Milrinone Be a Therapeutic Alternative in Persistent Pulmonary Hypertension of the Newborn? A Case Series and Narrative Review

by Eliza Wasilewska, Norbert Dera, Łukasz Minarowski, Łukasz Osiński, Anna Doboszynska, Sławomir Szajda and Alina Minarowska

Pediatr. Rep. 2025, 17(6), 116; https://doi.org/10.3390/pediatric17060116 - 3 Nov 2025

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a life-threatening condition resulting from failure of postnatal circulatory adaptation. Inhaled nitric oxide (iNO) is the standard first-line therapy; however, limited access or inadequate response highlight the need for alternative treatments. Milrinone, a selective [...] Read more.

Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a life-threatening condition resulting from failure of postnatal circulatory adaptation. Inhaled nitric oxide (iNO) is the standard first-line therapy; however, limited access or inadequate response highlight the need for alternative treatments. Milrinone, a selective phosphodiesterase-3 inhibitor with nitric oxide-independent vasodilatory and inotropic properties, has been proposed as one such option. Methods: In this study we present a case series of three neonates with PPHN—term (41 weeks), late preterm (35 weeks), and extremely preterm (23 weeks)—treated with intravenous milrinone in a neonatal unit without immediate access to iNO. A narrative literature review was also conducted, focusing on clinical outcomes, safety, and therapeutic applicability. Results: Milrinone was initiated within the first 24 h of life. In the term and late-preterm infants, oxygenation and echocardiographic parameters improved within 48 h, with normalization of shunt direction and successful extubation by days 4–10. Transient systemic hypotension occurred in both cases and required dose adjustment or vasoactive support. In the extremely preterm neonate, only temporary hemodynamic improvement was achieved, followed by severe intraventricular hemorrhage and coagulopathy, possibly exacerbated by vasodilatory and antiplatelet effects of milrinone. Conclusions: Milrinone may serve as a feasible adjunct or bridging therapy for PPHN when iNO is unavailable. However, its use requires careful hemodynamic and neurological monitoring, particularly in very preterm infants. Further studies are needed to confirm safety and define optimal dosing across gestational ages. Full article

► Show Figures

Graphical abstract

11 pages, 432 KB

Open AccessArticle

Accuracy of Death Certificates for Children: A Population-Based Retrospective Analysis

by Masahito Yamamoto, Masahito Hitosugi, Eisuke Ito, Kohei Takashima, Mami Nakamura, Seiro Narumiya and Yoshihiro Maruo

Pediatr. Rep. 2025, 17(6), 115; https://doi.org/10.3390/pediatric17060115 - 3 Nov 2025

Abstract

Background/Objective: Accurate determination and documentation of causes of death in children are essential for generating reliable mortality statistics and guiding public health strategies. Previous studies have reported frequent inaccuracies in pediatric death certificates (DCs), including the use of vague terms, omissions of [...] Read more.

Background/Objective: Accurate determination and documentation of causes of death in children are essential for generating reliable mortality statistics and guiding public health strategies. Previous studies have reported frequent inaccuracies in pediatric death certificates (DCs), including the use of vague terms, omissions of relevant conditions, and variability across physician specialties. This study evaluated the accuracy of pediatric DCs in Shiga Prefecture, Japan; identified common errors in these DCs; and examined changes in the underlying causes of pediatric death before and after the COVID-19 pandemic. Methods: We performed a population-based retrospective review of 391 DCs for individuals under 18 years issued between 2015 and 2023. Two pediatricians and two forensic pathologists independently reviewed each DC, assessed accuracy, and classified errors using predefined criteria. Error rates were compared by physician specialty. Underlying causes of death were reassessed into ten categories, and their distributions were compared between 2015–2019 and 2020–2023. Results: Overall, 30.9% of DCs contained errors. The error rates differed by physician specialty: obstetricians had the highest error rate (92.9%), whereas forensic physicians had the lowest (8.4%). The most common error type was the use of non-specific mechanisms such as “cardiac arrest” or “respiratory failure”, rather than the actual causes of death. Congenital anomalies were often listed under other significant conditions contributing to death and not as an underlying cause of death. After the onset of the COVID-19 pandemic, deaths from acute diseases declined from 16.8% to 4.0%, while deaths from congenital disorders increased from 12.6% to 24.3%. Conclusions: Pediatric DCs often contain errors, particularly those completed by obstetricians. Misclassifying mechanisms as causes of death and underreporting congenital anomalies remain the main challenges. Strengthening physician education and introducing systematic review processes are essential to improve accuracy, clarify regional mortality trends, and guide effective public health interventions. Full article

► Show Figures

Figure 1

13 pages, 272 KB

Open AccessArticle

Pregnancy and Pregnancy Outcomes in Women with Eating Disorders: A Four-Year Longitudinal Study with Case Series

by Bárbara César Machado, Sónia Gonçalves, Sofia Duarte, Isabel Brandão, António Roma-Torres and Filipa Soares

Pediatr. Rep. 2025, 17(6), 114; https://doi.org/10.3390/pediatric17060114 - 3 Nov 2025

Abstract

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to [...] Read more.

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood. Full article

5 pages, 430 KB

Open AccessCase Report

Is Beta Ketothiolase Deficiency an Uncommon Disease or an Unsuspected Diagnosis? The Role of Genetic Biochemistry Approaches in Metabolic Acidosis

by Luis D. Campos-Acevedo, Joel Arenas-Estala, Marisol Ibarra-Ramírez, Graciela A. López-Uriarte, María C. Ruíz-Herrera, Marcelo Rodríguez-Rivera and Laura E. Martínez-de-Villarreal

Pediatr. Rep. 2025, 17(6), 113; https://doi.org/10.3390/pediatric17060113 - 3 Nov 2025

Abstract

Beta ketothiolase deficiency is a hereditary metabolic disorder caused by the pathogenic variants of the ACAT gene, which encodes for the mitochondrial enzyme acetoacetyl-CoA thiolase. Patients with a deficiency of the enzyme experience recurrent episodes of metabolic ketoacidosis. Knowledge of the clinical course [...] Read more.

Beta ketothiolase deficiency is a hereditary metabolic disorder caused by the pathogenic variants of the ACAT gene, which encodes for the mitochondrial enzyme acetoacetyl-CoA thiolase. Patients with a deficiency of the enzyme experience recurrent episodes of metabolic ketoacidosis. Knowledge of the clinical course of this entity, together with the available diagnostic tests, allows for its early diagnosis and prompt intervention to avoid complications or death of the infant. In this study, we present a case of a 9-month-old girl that attended the emergency room and diagnosis was made at the first episode of metabolic ketoacidosis. Full article

► Show Figures

Figure 1

Journal Description

Pediatric Reports

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI