Hypertension in childhood has been recognized as an early marker of future cardiovascular risk, and blood pressure trajectories are known to track from early life into adulthood. Environmental exposures during early childhood, particularly indoor air pollutants such as particulate matter (PM) and volatile organic compounds (VOCs), may influence blood pressure regulation; however, evidence in very young children remains limited. Identifying early-life environmental factors associated with blood pressure may help improve risk assessment and prevention strategies later in life. This study used secondary data from children who participated in a national birth cohort study in Japan, the Japan Environment and Children's Study. We measured the indoor concentrations of PM and VOCs at the ages of 1.5 and three years, and blood pressure (BP) at the ages of two and four years. To investigate the correlation between PM and VOCs and BP, scatter plots were created to visually assess the presence of a correlation, and the correlation coefficients were calculated. We investigated the correlation between PM and VOCs at 1.5 years of age and BP at two years of age. Similarly, we examined the correlation between PM and VOCs at three years of age and BP at four years of age. The total number of participants in this study was 4,854. There were no clear correlations between any of the PM, VOCs, and BP across all sexes and years. The absolute values of the correlation coefficients were all less than 0.2, indicating no significant correlation between any of the variables. Multiple regression analyses also showed that m,p-xylene at 1.5 years was associated with higher BP at age two, whereas PM2.5 was associated with lower BP. P-dichlorobenzene and toluene were associated with lower BP, respectively, and benzene at age three was associated with lower BP at age four; however, all effect sizes were small. Exposure to PM and VOCs at levels sufficient to affect BP in early childhood is unlikely to occur during normal household life. However, this does not eliminate the long-term risks of hypertension or the potential for other diseases.
Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting millions worldwide, yet epidemiological data and awareness research remain scarce in Sudan. Parental knowledge is crucial for early recognition and timely intervention. This study aimed to assess knowledge, perceptions, and predictors of ASD awareness among parents in Sudan. A cross-sectional survey using convenience sampling was conducted across four geographic regions of Sudan (North, East, South, and Central) from January to February 2026. Using face-to-face interviews with a structured questionnaire. The questionnaire was culturally adapted for the Sudanese context and demonstrated acceptable internal consistency (Cronbach’s α = 0.72), 947 parents were recruited. Knowledge was assessed using 31 items; scores ≥ 60
Mendelian Susceptibility to Mycobacterial Disease (MSMD) arises from defects in the interferon-gamma (IFN- γ ) immunity, and most commonly due to IL12 receptor 1 (IL12R β 1) deficiency. Patients have reduced IFN- γ production, impaired immunity to intracellular pathogens, and a higher risk of infections with weakly virulent mycobacteria, including Bacillus Calmette–Guérin (BCG), non-tuberculous mycobacteria (NTM), and Salmonella. We report a 10-year-old female born to consanguineous parents who presented with recurrent lymphadenitis, extensive abscess formation and multifocal osteomyelitis due to BCG. The patient harbored a homozygous deleterious variant in IL12R β 1 (c.517 C > T, p.Arg173Trp), confirming MSMD diagnosis. IL12R β 1 deficiency should be considered in children with unusual or disseminated mycobacterial infections, particularly in the setting of consanguinity. Molecular confirmation enables accurate diagnosis, treatment, prognosis, and genetic counseling.
Dental fear is common among preschool children and may adversely affect their ability to cope with dental treatment. This study aimed to identify factors associated with dental fear, focusing on the dentist’s appearance, characteristics of the dental environment, and previous dental experiences. An observational cross-sectional stratified questionnaire-based survey was conducted in 15 randomly selected preschool facilities and included 897 children aged 2–7 years (mean age 4.8 years; 442 girls and 455 boys). Children were stratified according to age, sex, and geographic location. The comprised 18-questions questionnaire assessed dental fear, perceptions of the dental environment and the dentist, and previous dental experiences. It was administered directly to children by trained dentists using standardized verbal and pictorial instructions. Statistical analyses included two-sample t-tests, and multivariate ANOVA with post-hoc Duncan’s test. Associations were assessed using Pearson’s chi-square test, with odds ratios (OR) and 95
The Baby Monitor scoring system, developed in U.S. neonatal networks, evaluates care quality through internationally accepted indicators, but its applicability in Chinese NICUs has not been assessed. This study provides the first regional benchmark using this system within the Shenzhen Neonatal Data Network (SNDN) for infants born before 32 weeks’ gestation. A retrospective analysis was conducted on data from preterm infants admitted between January 1, 2022, and December 31, 2023. The Baby Monitor scoring system assessed NICU performance using eight key indicators: survival rate, antenatal steroid administration, admission hypothermia, pneumothorax, hospital-acquired infections, chronic lung disease (CLD), growth velocity, and any breastfeeding at discharge. Risk-adjusted z-scores were calculated for each indicator to compare NICU performance. A total of 1,267 preterm infants were included, with a median gestational age of 30.0 weeks and a median birth weight of 1,280 g. Significant variability was observed in individual quality indicators. Risk-adjusted composite scores did not differ significantly, largely due to overlapping confidence intervals reflecting limited unit-level sample sizes and offsetting performance across individual indicators. The overall unadjusted survival rate was 93.8
Effective paediatric obesity treatment requires high intensity, scalable interventions. A digi-physical tool for paediatric obesity treatment has shown positive results in Stockholm, Sweden. This study evaluates whether the same treatment method is effective in a different cultural setting. This non-inferiority intervention study, using an external historical comparator, included 60 consecutively recruited children aged 6–15.9 years with obesity who initiated treatment at Sheikh Shakhbout Medical City in Abu Dhabi between June and December 2023. Patients were treated with Evira, a digi-physical tool and working method enabling high intensity individualized care, real-time monitoring, and interactive patient-clinician communication. The primary outcome was BMI z-score change at 26 weeks. Non-inferiority was assessed using a predefined margin of 0.10 BMI z-score, with outcomes compared to a prior published trial in Stockholm (n = 107). A total of 112 children were included in the analysis (Abu Dhabi cohort, n = 35; Stockholm cohort, n = 77). The adjusted mean change in BMI z-score was − 0.20 (95
Complete transposition of the great arteries (TGA) is a critical cyanotic congenital heart disease (CHD) requiring early surgical correction. Central venous catheterization is an important risk factor for venous thrombosis and superior vena cava obstruction syndrome (SVCS). SVCS following an arterial switch operation (ASO) in a premature infant is rarely reported. We describe one of the few reported cases of postoperative SVCS in a premature infant and discuss its clinical course and individualized management. A male premature infant born at 33 + 4 weeks of gestation with a prenatally and postnatally diagnosed TGA with an intact ventricular septum (TGA-IVS) underwent an ASO on postnatal day 8. His postoperative course was complicated by generalized edema, chylothorax, pericardial effusion, hydrocephalus, severe infection, and feeding intolerance. Bedside ultrasound revealed catheter-associated SVC thrombosis, and contrast-enhanced computed tomography (CT) confirmed complete proximal SVC occlusion with collateral vein formation. The central venous catheter (CVC) was removed, and the patient received unfractionated heparin (UFH) followed by low-molecular-weight heparin (LMWH), together with comprehensive supportive treatment. His edema, respiratory symptoms, and pleural effusion gradually improved. However, follow-up imaging showed persistent SVC occlusion without anatomical recanalization. Anticoagulation was discontinued after multidisciplinary review because the obstruction was considered organized and the patient remained clinically stable with adequate collateral venous drainage. At 11 months of age, telephone follow-up confirmed satisfactory feeding, growth, and development. SVCS should be considered in infants with CVCs who develop upper-body edema, chylothorax, or other signs of impaired systemic venous return after congenital heart surgery. Early imaging assessment and timely catheter removal are critical Carefully monitored anticoagulation may be considered in selected patients when catheter-based or surgical intervention is technically unsuitable. However, clinical improvement does not necessarily indicate thrombus resolution or restoration of SVC patency. In this patient, clinical stability was achieved despite persistent SVC occlusion in the presence of extensive collateral venous drainage. Management should therefore be individualized through multidisciplinary evaluation.
Post-intensive care syndrome in children has been conceptualized as the physical, psychological, cognitive, and social deficits that persist in patients for an extended period of time from the onset of critical illness until discharge from the pediatric intensive care unit. However, there is still no clear consensus on prevention strategies for the syndrome, despite the fact that nursing plays a fundamental role in its preventive approach. To analyze the concept of “prevention of post-intensive care syndrome in children.” The concept analysis methodology proposed by Walker and Avant was used, based on a comprehensive review of the PubMed, Web of Science, Ovid, and ScienceDirect databases. Prevention of post-intensive care syndrome in children was identified as an emerging and multidimensional concept. Among the most relevant antecedents were increased survival following pediatric critical illness, growing evidence of persistent physical, cognitive, psychological, and social sequelae, and the subsequent recognition of PICS-p as a clinical construct. Potential consequences associated with the implementation of preventive approaches include better functional recovery, fewer long-term impairments, and greater support for children and their families. Pediatric adaptations of the ABCDEF bundle and family-centered care were identified as relevant conceptual and clinical frameworks, although evidence regarding their direct effectiveness in preventing PICS-p remains limited. Prevention of post-intensive care syndrome in children is defined as a multidimensional and comprehensive process that includes the early implementation of physical, cognitive, psychological, and social strategies during and after hospitalization in the PICU, with the aim of anticipating, reducing, or avoiding the appearance of persistent sequelae in the child and their family environment. This prevention involves humane care, focused on development, active family participation, and continuous interdisciplinary work from admission to the transition home.
Children with cerebral palsy (CP) and other central nervous system (CNS) impairments often have limitations in walking capacity and gross motor function. Robot-assisted gait training (RAGT) is increasingly used in pediatric rehabilitation, but existing evidence remains inconsistent. To evaluate the effects of RAGT versus conventional therapy for improving walking capacity and broader motor and functional outcomes in children with CP and other CNS impairments. PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, and ClinicalTrials.gov were searched from inception to April 1, 2026. Randomized controlled trials of children aged 2–18 years with CP or other CNS impairments were included. Risk of bias and methodological quality were assessed using the Cochrane Risk of Bias 2 tool and PEDro scale. Random-effects meta-analyses used mean differences (MDs) or standardized mean differences (SMDs), and certainty of evidence was assessed using GRADE. A total of 22 studies (n = 718) were included, of which 20 focused on CP and two on spinal cord injury (SCI); no studies involving acquired brain injury (ABI) were identified. Compared with conventional therapy, RAGT was associated with greater improvements in walking speed (SMD = 0.58, 95
This study systematically evaluated the measurement properties of ADHD-relevant subscales (i.e., subscales measuring inattention and/or hyperactivity-impulsivity) embedded within broad-band behavior rating scales for children with ADHD, using the COSMIN methodology. The aim was to provide evidence-based support for clinical screening, co-occurring assessment, and treatment monitoring. Following PRISMA 2020 guidelines, we conducted a systematic literature search across PubMed, Web of Science, Scopus, and ProQuest. Risk of bias and measurement properties were assessed with the COSMIN Risk of Bias Checklist and Updated Criteria for Good Measurement Properties, respectively. Evidence synthesis was performed through an adapted GRADE approach. Thirty-six studies, covering 12 broad-band instruments, were included. The CBCL Attention Problems subscale was rated as "not recommended" due to insufficient cross-cultural validity (high quality evidence). The SDQ Hyperactivity-Inattention subscale demonstrated the most favorable evidence profile, with moderate quality evidence for structural validity and internal consistency, and high quality evidence for cross-cultural validity, reliability, and convergent/discriminant validity. The CADBI Inattention and Hyperactivity/Impulsivity subscales showed high quality evidence for structural and cross-cultural validity, and moderate quality evidence for internal consistency. The FTF Attention and Hyperactive/Impulsive subscales had moderate quality evidence for structural validity and internal consistency. The CABI Attention Deficit and Hyperactivity subscale had high quality evidence for reliability, but low quality evidence for structural validity and internal consistency. The remaining instruments (ANSER-PQ, CBAI, ECI-4, YI-4, DSMD, ABC, CSI-4) had limited or unsatisfactory evidence for their ADHD-related subscales. Among the included broad-band instruments, given the evidence of insufficient cross-cultural validity, applying the COSMIN criteria to the CBCL Attention Problems subscale would lead to a recommendation against its use; users outside North America should be cautious. The SDQ Hyperactivity-Inattention subscale demonstrates comparatively favorable measurement properties, though this does not establish its overall superiority for ADHD assessment. Future studies should evaluate content validity, measurement error, and responsiveness following COSMIN guidelines. PROSPERO (CRD420250655032).
Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate lung-protective ventilation in children with pediatric acute respiratory distress syndrome (PARDS), but pediatric experience remains limited. We aimed to descriptively characterize the clinical use, physiological changes, technical implementation, and observed complications of ECCO₂R integrated into continuous renal replacement therapy (CRRT) in pediatric patients with PARDS and acute kidney injury (AKI). We conducted a retrospective, uncontrolled, single-center case series of pediatric patients with PARDS and AKI who received ECCO₂R integrated into an already indicated CRRT circuit between November 2023 and November 2025. To avoid non-independence of repeated observations, the first treatment episode per patient was included in the principal analysis (n = 7). Predefined physiological outcomes were assessed longitudinally at predefined time points. Longitudinal changes were analyzed using Friedman tests. Safety-related laboratory parameters were analyzed using Wilcoxon matched-pairs signed-rank tests. Median age was 12 years (interquartile range [IQR] 6–14 years). ECCO₂R was delivered at a median blood flow of 270 mL/min (IQR 100–300), corresponding to 9 https://drks.de/search/en/trial/DRKS00038799/details . ECCO₂R integrated into an already indicated CRRT circuit was technically feasible in carefully selected pediatric patients with PARDS and AKI. Integrated ECCO₂R-CRRT was associated with rapid reductions in PaCO₂ and ventilatory pressures. No predefined major bleeding, clinically apparent hemolysis, thromboembolic complications, or device-related infections attributable to ECCO₂R-CRRT were identified; circuit clotting requiring circuit exchange was the main observed complication. This retrospective case series provides hypothesis-generating data to inform future prospective studies on patient selection, anticoagulation, and implementation of integrated ECCO₂R-CRRT.
Early identification of neonates at risk of necrotizing enterocolitis (NEC) is challenging due to nonspecific early gastrointestinal manifestations. This study aimed to develop and internally validate a nomogram for identifying neonates at increased risk of NEC using early postnatal clinical and laboratory information. This single-center retrospective study included neonates admitted to the neonatal intensive care unit of Southwest Hospital between January 2018 and January 2024 who developed suspected NEC or feeding intolerance–related gastrointestinal manifestations. NEC was defined as Modified Bell stage II or III disease. Controls were neonates with Modified Bell stage I disease or other gastrointestinal manifestations, such as vomiting, regurgitation, or abdominal distension, without progression to NEC. Candidate predictors included perinatal characteristics, feeding-related variables, pre-symptom clinical-course variables, and routine laboratory indicators measured within 48 h after birth. Multivariable logistic regression was used to construct the nomogram, and model performance was assessed using discrimination, calibration, decision curve analysis, and bootstrap internal validation. A total of 248 neonates were included, including 77 with NEC and 171 controls. Of the included neonates, 14.1
To summarize the multidisciplinary rescue and evidence-based nursing experience for a former 32-week preterm infant with severe hypoxemia (SpO₂ min 29
Pathogenic variants in the FRRS1L gene are associated with developmental and epileptic encephalopathy 37 (DEE37, OMIM: 616981). Patients carrying FRRS1L variants typically exhibit global developmental delay, epileptic encephalopathy, hyperkinetic movement disorder with choreoathetosis, spasticity, and rigidity. However, rare variants have been reported. Here, we report a girl presenting with epilepsy, global developmental delay, choreiform movement disorder, and unique thyroid dysfunction and elevated levels of blood ammonia and lactic acid. Although therapeutic intervention with adrenocorticotropic hormone (ACTH), valproic acid, and oral prednisone successfully achieved seizure control and electroencephalographic (EEG) improvement, the patient passed away from an unclear cause. Whole exome sequencing (WES) revealed a novel homozygous FRRS1L variant (NM_014334.4: exon5: c.725 A > G(p.His242Arg), OMIM: 604574). Sanger sequencing confirmed that the variant was inherited from her parents. Furthermore, we summarized previously reported variants and compared the phenotypes among affected patients. To our knowledge, this is the first reported Chinese case carrying FRRS1L variants. Our study expands the genetic and phenotypic spectrums of DEE37, provides novel evidence supporting the correlation between FRRS1L variants and DEE37, and underscores the necessity for dynamic EEG monitoring and proactive management in high-risk patients with refractory seizures.
Inherited metabolic diseases (IMDs) constitute a heterogeneous group of disorders that represent significant causes of morbidity and mortality in the neonatal period and throughout childhood. This study aimed to evaluate the knowledge level, attitudes, and clinical experiences of pediatricians regarding IMDs. This descriptive cross-sectional study was conducted among pediatricians working in different geographical regions of Türkiye. Data were collected through a 27-item online questionnaire designed to assess sociodemographic and professional characteristics as well as knowledge, attitudes, and clinical experience/practice related to IMDs. The final analysis included 169 participants who completed the questionnaire in full. The median age of the participants was 33 years, and 60.9
Movement is crucial for health, but it has declined due to increased sedentary behavior, which is associated with physical and mental health problems in children and adolescents. School-based interventions have shown positive effects on behavior, academic performance, and cognitive development. However, further research is needed, particularly in middle- and low-income countries such as Brazil, which presents contextual characteristics different from those in countries where most studies have been conducted. Understanding these processes and comparing them with other existing projects is essential to inform potential public policies. The present study aims to methodologically describe a five-year cluster-randomized clinical trial of physically active classroom interventions designed to promote improvements in cognitive and academic outcomes. This is a cluster randomized clinical trial, called the ERGUER/Aracaju Project, conducted in public schools in Aracaju/SE with 1st-grade elementary school students followed over five years (2022–2026). The interventions are carried out by classroom teachers twice a week. Physically active lessons (PAL) are carried out through school content with methodologies that involve movement, while physically active breaks (PAB) have no school content and consist of exercises lasting an average of five minutes to interrupt sedentary behavior and promote moderate to vigorous movement. A total of six schools is participating in the project: two in PAL condition, two in PAB condition, and two in control condition. The primary outcome is cognitive development assessed through computerized tests that check executive functions and academic performance assessed by teachers’ grades and national and state exams. Secondary outcomes, such as anthropometry, physical activity level and sedentary behavior, eating habits, sleepiness, quality of life, and perception of school are also measured. We expect to provide information that expands the current knowledge in the field by offering a perspective on the potential long-term effects of classroom-based physical activity strategies, particularly in the context of outside high-income countries. Brazilian Clinical Trials Registry (REBEC trial: RBR-10zxwdrh, retrospectively registered on 2025-01-09, https://ensaiosclinicos.gov.br/rg/RBR-10zxwdrh).
Opioid-related morbidity and mortality among adolescents continue to rise, yet buprenorphine remains underused in pediatric settings despite strong evidence of effectiveness and professional society endorsement. Identifying modifiable barriers to prescribing, such as legal and regulatory uncertainty, parental consent, and restrictive beliefs about MOUD, is essential to expanding adolescent access to medications for opioid use disorder (MOUD). We conducted a cross-sectional, anonymous online survey of US pediatric prescribers using snowball sampling. Eligible participants were MD/DO physicians, nurse practitioners, and physician assistants authorized to prescribe opioids or MOUD and actively providing pediatric care. Survey domains assessed legal awareness, clinical knowledge, prescribing confidence, parental consent concerns, and beliefs about MOUD. Responses were compared by self-reported history of ever prescribing buprenorphine for adolescent opioid use disorder. Group differences were assessed using chi-square tests with Monte Carlo estimation, and adjusted associations were estimated using multivariable logistic regression reported as odds ratios (ORs) with 95
The definition of the double burden of malnutrition is inconsistent, and longitudinal evidence from mid-to-late childhood, when adiposity typically increases, remains limited. Little is also known about how these patterns differ according to socio-economic status (SES). We longitudinally investigated the population-level double burden of malnutrition by SES, using multiple proxy measures of malnutrition in South African boys and girls. This study used data (2010–2016) from the North-West Child-Health-Integrated with Learning and Development longitudinal study, South Africa. The same children (N = 333) were followed across Grades 1 (6–7 years), 4 (9–10 years), and 7 (12–13 years). Prevalences and odds of malnutrition were determined in boys and girls of low (n = 186) versus high (n = 147) SES. At risk of undernutrition (≤ − 1 SD) was defined by height-for-age (HAZ), weight-for-age (WAZ), and body mass index-for-age (BAZ); overnutrition by BAZ (≥ + 1 SD), waist-to-height ratio (WHtR; ≥ 0.5), and body fat percentage (BF
Predicting short-term mortality in pediatric septic shock is difficult due to the variability of the condition and the restricted practicality of current severity scoring frameworks. This study was conducted to determine predictors of 28-day mortality in children with septic shock. The study developed the Septic Shock Clinical Score System (SCSS) and performed internal validation of the score. This single-center retrospective observational study included pediatric patients (0–16 years) with septic shock admitted to the pediatric intensive care unit of Shanxi Children’s Hospital between January 2020 and December 2024. Clinical variables, including mechanical ventilation and vasoactive medication use, and laboratory parameters obtained within the first 24 h after PICU admission were collected. Univariable logistic regression and least absolute shrinkage and selection operator (LASSO) regression were used for predictor selection. A multivariable logistic regression model was constructed, and a point-based Septic Shock Clinical Score System (SCSS) was derived. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots with bootstrap resampling, and decision curve analysis. The primary outcome was 28-day mortality. A total of 123 children with septic shock were included, of whom 83 (67.5
To evaluate the association of patent ductus arteriosus (PDA) with the occurrence of neonatal pulmonary hemorrhage (NPH) and post-hemorrhage mortality in very preterm infants (< 32 weeks gestation). This retrospective cohort study included 482 very preterm infants (gestational age < 32 weeks) admitted between January 2019 and October 2025. The Patent Ductus Arteriosus Severity Score (PDAsc) was calculated for those diagnosed with PDA. Univariate and multivariate logistic regression analyses were performed to identify factors associated with NPH and post-hemorrhage mortality. Nomograms for risk assessment were constructed and internally validated using the bootstrap method. SHAP analysis was conducted to enhance model interpretability by visualizing the impact of individual predictors on outcomes. Of the 482 infants, 93 (19.3
