The journal retracts the article titled “Universal Design for Learning for Children with ADHD” [...]
BACKGROUND:Adolescent mental health is a global concern, with lifestyle factors such as diet and physical activity (PA) playing a crucial role. While the Mediterranean Diet adherence (MDA) is known for its neuroprotective benefits on mental health, the mechanisms by which they are related remain unclear. Therefore, the aim of this study was twofold: (1) to examine the associations between MDA, PA, and screen time (ST) with anxiety symptoms, depression, stress, and total psychological distress in Chilean adolescents; and (2) to determine whether PA mediates the relationship between MDA and anxiety symptoms. METHODS:A cross-sectional study was conducted with 322 Chilean school-aged adolescents 158 males and 164 females (14.98 ± 1.96 years). Mental health outcomes (depression, anxiety, and stress) and lifestyle behaviors, including MDA, PA, and ST, were comprehensively assessed using validated self-reported questionnaires. RESULTS:After adjusting for age and sex, multiple linear regression models showed that higher MDA was significantly and inversely associated with anxiety (b = -0.23, p = 0.044), stress (b = -0.25, p = 0.022), and total psychological distress (b = -0.72, p = 0.022). Conversely, ST was identified as a consistent risk factor, positively predicting higher levels of anxiety (b = 0.45, p = 0.008), stress (b = 0.42, p = 0.008), and total distress (b = 1.11, p = 0.014). Furthermore, PA was inversely linked to anxiety (b = -0.35, p = 0.013) and successfully mediated the relationship between MDA and anxiety symptoms (Indirect Effect = -0.047, 95% CI: -0.10 to -0.01). No significant mediation effects were observed for depression or stress. CONCLUSIONS:The present study identifies robust inverse associations between MDA and symptoms of anxiety, depression, and stress in Chilean adolescents. A key finding is the specific pattern of relationships observed: while higher MDA is directly linked to lower levels of depression and stress, its association with anxiety is shared with levels of PA. Despite these findings, the cross-sectional nature of the study limits the establishment of causal relationships, and further longitudinal research is needed to confirm these directional pathways.
Sickle cell disease is the most common monogenetic disease worldwide and affects millions of children and adults. While supportive care practices have improved life expectancy, particularly in high income countries, sickle cell disease typically has adverse impact on quality of life and reduced life expectancy. As a result, patients and providers are increasingly seeking information regarding curative and transformative therapies and advocating for improved global access. This review will describe allogeneic hematopoietic cell transplantation eligibility, approaches to transplant, short and long-term outcomes and key supportive care considerations for providers who care for patients with sickle cell disease.
BACKGROUND/OBJECTIVES:Pediatric obesity poses significant public health challenges and is associated with an increased risk of adult obesity. Healthcare professionals play an important role in providing patient-centered care; however, barriers to effective pediatric obesity management remain insufficiently explored in South Korea. METHODS:Eleven healthcare professionals managing pediatric obesity participated in focus group interviews. Audio-recorded interviews were transcribed verbatim and analyzed using thematic content analysis. Four main themes emerged: (1) the current status of pediatric obesity management, (2) clinical experiences and outcomes, (3) awareness of governmental policies, and (4) areas needing improvement. RESULTS:Participants described multiple barriers to pediatric obesity management, including limited clinical resources, time constraints, low awareness among patients and families, and perceived inadequacies in reimbursement policies. Participants also reported low treatment adherence and frequent dropout during follow-up care. Many participants reported limited awareness of governmental initiatives related to pediatric obesity management but expressed willingness to utilize such programs if they became more accessible and better integrated into clinical practice. CONCLUSION:The findings suggest that pediatric obesity management in South Korea may be influenced by structural, financial, and sociocultural barriers. Participants emphasized the need for improved multidisciplinary collaboration, greater institutional support, and increased accessibility of obesity-related programs and resources. Further comparative and context-specific studies may help inform tailored approaches to pediatric obesity management.
Background/objectives: Obesity is a multifactorial condition influenced by interactions between genetic susceptibility and environmental factors. The fat mass and obesity-associated (FTO) gene has been widely linked to obesity risk, particularly the rs9939609 polymorphism, which is associated with higher body mass index (BMI) and adiposity. However, evidence in adolescents remains inconsistent, and lifestyle factors such as physical activity and diet may modify genetic risk. The objectives of this study were: (i) to examine the influence of environmental, genetic, physical activity, and dietary factors on the BMI and overweight-related variables of adolescents, and (ii) to assess the impact of the rs9939609 polymorphism in the FTO gene on these variables. Methods: A cross-sectional study was conducted involving 206 adolescents aged 12 to 16 years. Body mass index (BMI), physical fitness, physical activity levels, adherence to the Mediterranean diet, mobile phone usage, and FTO rs9939609 genotyping from buccal swabs were collected. Results: No significant associations were found between the FTO genotype and BMI, or with physical activity, mobile phone usage and dietary habits. Boys showed higher physical fitness and physical activity levels than girls (p < 0.05). The only factor significantly associated with BMI was regular breakfast consumption: adolescents who habitually ate breakfast had a lower prevalence of overweight (χ2 = 7.98, p = 0.005). Conclusions: The rs9939609 polymorphism in the FTO gene was not associated with overweight in this adolescent cohort. The findings underscore the relevance of healthy behaviours, particularly regular breakfast consumption and physical activity, especially among boys, as factors potentially associated with lower prevalence of overweight during adolescence.
Background: Joint attention is a fundamental skill supporting early social communication and cognitive development. However, its development in children with severe visual impairment and its relationship with early play behaviors remain insufficiently understood. This study aimed to compare joint attention skills and play behaviors in toddlers with severe visual impairment and sighted peers, and to examine the relationship between these two developmental domains. Methods: The sample included 17 toddlers with severe visual impairment (no light perception) and 20 sighted toddlers aged 16-36 months. Groups were matched based on language developmental age scores. Joint attention skills were assessed using structured observational categories adapted to visual status, while play behaviors were evaluated with the Developmental Play Assessment. Data were collected through semi-structured play and interaction sessions in familiar environments to support natural behavior. Analyses were conducted using non-parametric tests, including the Mann-Whitney U test and Spearman correlation analysis. Results: Toddlers with severe visual impairment scored significantly lower than sighted peers across all joint attention categories. In play development, these children showed higher levels of indiscriminate actions, whereas sighted peers demonstrated more advanced play behaviors, including combinational and symbolic play. Significant associations were found between joint attention and play skills in both groups; however, these relationships were stronger in sighted children, particularly for higher-level play forms. Conclusions: These findings suggest distinct developmental trajectories and underline the importance of early intervention targeting these foundational skills in early childhood development and highlight important implications for early intervention practices.
Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely.
Background/Objectives: Children's mental health and positive development are shaped by family, environmental, and individual factors. Although neurodevelopmental disabilities (NDDs) are well-established correlates of poorer mental health outcomes, few national-scale studies have simultaneously modeled positive (flourishing) and negative (anxiety, depression) outcomes within a unified ecological framework. This study examined how parent mental health, peer victimization, neighborhood and school context, and four NDD diagnoses (autism spectrum disorder [ASD], attention-deficit/hyperactivity disorder [ADHD], developmental delay, and learning disability) are associated with flourishing, current anxiety, and current depression in a national sample of U.S. children aged 6-17 years. Methods: Cross-sectional data from the 2023-2024 National Survey of Children's Health (NSCH; N = 71,172) restricted to ages 6-17 with complete data (unweighted n = 64,263; weighted population estimate ≈ 44.6 million children) were analyzed using Complex Sample logistic regression (SPSS 30), accounting for stratified design (state × stratum), household clustering, and sampling weights. Three hierarchical models were estimated for each outcome. NDD-stratified subgroup analyses (n = 13,971; weighted ≈ 8.6 million) triangulated moderation findings. Multiple imputation (m = 5) sensitivity analyses confirmed robustness. Results: Weighted prevalence was 60.7% for flourishing, 13.2% for current anxiety, and 5.1% for current depression. In Block 2 models, poorer parent mental health and more frequent bullying victimization were robustly associated with all outcomes (flourishing OR = 0.62 and 0.65; anxiety OR = 1.64 and 1.63; depression OR = 1.95 and 1.75; all p < 0.001). Supportive neighborhood (flourishing OR = 1.40, depression OR = 0.80) and safe school (flourishing OR = 1.20, anxiety OR = 0.87) were protective. ADHD was the strongest disability-specific correlate (flourishing OR = 0.29; anxiety OR = 4.69; depression OR = 4.27). Three of the twelve interaction terms were significant, all involving ADHD. Relative to children without any NDD, subgroup analyses suggested attenuated associations of parent mental health and bullying with anxiety and depression among children with any NDD (e.g., bullying on anxiety: no-NDD aOR = 1.73 vs. Any-NDD 1.52); however, formal interaction tests identified ADHD as the only significant moderator of these associations. On the absolute-risk scale, however, the increase in internalizing problems with more frequent bullying was larger in children with ADHD. Conclusions: Family mental health support and bullying prevention are universally relevant levers for improving children's mental health and flourishing. Although attenuation of the odds-ratio associations was observed primarily in ADHD-related analyses, specifically for the internalizing outcomes (anxiety and depression), universal anti-bullying and parent mental health interventions remain relevant for children with NDDs, supporting integration into pediatric clinical and public-health programs alongside disability-specific support pathways.
The landscape of child and adolescent mental health has become increasingly complex, moving away from solely child-focused approaches to more holistic, systemic models that consider youth development within the context of the family environment [...].
Background and Objectives: Child dental neglect is a clinically significant form of maltreatment that frequently reflects broader challenges related to caregiving within the family environment. Although oral manifestations have been described in prior research, the socio-behavioral profile of responsible caregivers remains insufficiently characterized, particularly in Central and Eastern European contexts. This study aimed to identify caregiver-level socio-behavioral characteristics associated with child dental neglect and to examine their relationships with clinical outcomes. Materials and Methods: A retrospective cross-sectional analytical study was conducted on 333 children (aged 4-17 years) diagnosed with dental neglect, presenting at a municipal hospital and a private dental practice in Oradea, Romania (2020-2024). Caregiver-level variables included age, educational attainment, socioeconomic status, health condition, substance use, and family structure. Associations were analyzed using Fisher's Exact Test, Pearson Chi-Square, and Mann-Whitney U test, with Bonferroni correction applied where appropriate. Results: Most caregivers were young adults (93.1%), with low educational attainment (40.2% had no formal schooling) and high rates of alcohol use (47.1%). Low family income was present in 89.2% of cases and was significantly associated with non-adherence to the dental treatment plan (p = 0.039). Caregivers without formal education were associated with neglect in rural areas (43.4% vs. 26.2%; p < 0.001). Children of drug-using caregivers were significantly older at presentation (median: 12 vs. 8 years; p = 0.014), and caregiver drug use was more prevalent in urban settings (18.0% vs. 1.8%; p < 0.001). Over half of the children (52.9%) came from disrupted family environments. Conclusions: Dental neglect was consistently associated with young, poorly educated, and financially disadvantaged caregivers exhibiting high rates of substance use and unstable family structures. These factors may interact in complex ways, highlighting the multifactorial nature of dental neglect. Dental professionals are well positioned for early identification and have a professional and ethical responsibility to integrate child safeguarding into routine clinical practice.
Background/Objectives: Parenting interventions are an effective way to support child development, and brief screening tools can support equitable implementation of parenting interventions by reducing program costs, increasing accessibility, and engaging populations who have traditionally been underserved. However, brief assessments are frequently overlooked and underutilized. The Family Check-Up (FCU) Online is a digital parenting intervention that integrates a brief FCU Online Assessment, feedback, and parenting skills via an app along with optional provider support. To date, no prior work has validated the FCU Online Assessment. Method: The current study combined two samples of parents participating in FCU Online studies and assessed: (1) reliability, (2) construct validity, (3) convergent validity by comparing FCU Online Assessment subscales to similar parenting and child behavior measures, and (4) predictive validity by using FCU Online Assessment at pretest to predict posttest scores as well as parenting and child behaviors at time 2 and time 3. Results: Strong reliability was found among all five subscales, including Low Conflict (7 items, α = .81), Positive Parenting Practices (11 items, α = .80), Positive School Behaviors (5 items, α = .83), Consistent Rules and Routines (11 items, α = .81), and Child Mental Health (5 items, α = .80). The FCU Online Assessment demonstrated construct and convergent validity, as well as predictive validity in that the FCU Online Assessment at pretest predicted posttest scores. Conclusions: The FCU Online Assessment is a brief, reliable, and valid measure of parenting and child wellbeing. It can be used by parents and providers alike to evaluate parenting skills and child mental health, develop targeted goals and intervention approaches, and assess family wellbeing over time.
Introduction: Medical care for transgender minors is understudied, largely because these forms of care are relatively recent. The primary objective of this work was to describe the cohort of transgender adolescents who initiated follow-up at the Strasbourg University Hospital before the age of 18, whether or not they began hormone therapy prior to reaching adulthood. Method: This was an observational, retrospective, single-center, descriptive study conducted among adolescents who had attended at least one consultation in our center before the age of 18 between January 2017 and March 2024. Results: Our population consisted of 115 patients predominantly made up of transmasculine (AFAB) adolescents (68%). Compared with the general population, we observed significantly higher rates of psychiatric co-occurrences, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Only 46.1% initiated gender-affirming hormone therapy (GAHT) in our cohort, and just 34.8% before age 18. A total of 6% of adolescents received puberty blockers as monotherapy. The mean age at GAHT initiation was 16.99 years. Transition pathways appear to differ according to the adolescent's type of schooling. The rate of retransition/treatment interruption in our sample ranged from 0% to 6.1%, depending on the criteria applied. We did not identify any adolescent who retransitioned to their sex assigned at birth after starting GAHT by the end of the data collection. Discussion: The high prevalence of psychiatric co-occurrences raises important questions regarding how to improve care for these adolescents. The predominance of AFAB adolescents similarly prompts reflection on the barriers that transfeminine adolescents may face when seeking to transition before adulthood. In addition, the substantial number of adolescents presenting with ASD or ADHD underscores the need for particular vigilance regarding their specific needs and overall well-being. Finally, the variability in retransition rates depending on the criteria applied highlights the absence of a consensual definition, which limits the comparability and validity of existing studies. Conclusions: Long-term prospective studies are needed to objectively demonstrate the effectiveness of current transition pathways. Academic research in this field should be strengthened, along with the development of larger prospective datasets, to improve the overall health of this population.
Background: Bisphenol A (BPA) release from resin-based dental materials is a growing concern due to its potential endocrine-disrupting effects, particularly in pediatric patients. This in vitro study evaluated cumulative BPA release and elution kinetics from commonly used pediatric resin-based materials, due to the limited evidence available. Methods: Three restorative materials (Clearfil Majesty ES-2, Estelite Sigma Quick, and Stela Automix) and one orthodontic material (Transbond XT) were investigated. Eighteen disk-shaped specimens (5.5 mm in diameter and 2 mm in thickness) were prepared for each material and immersed in artificial saliva (pH 6.8) at 37 °C for 1, 7, and 28 days. BPA concentrations were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). BPA release kinetics were evaluated during the early (1-7 days) and late (7-28 days) release phases. Results: All investigated materials released measurable BPA concentrations, with cumulative BPA release progressively increasing up to 28 days. Clearfil Majesty ES-2 and Estelite Sigma Quick exhibited the highest cumulative BPA concentrations, whereas Stela Automix showed markedly lower values. Transbond XT also demonstrated measurable BPA release. For all materials, BPA release kinetics were significantly higher during the early phase than during the late phase (p < 0.001), indicating a non-linear release behavior over time. Conclusions: BPA release from pediatric restorative and orthodontic resin-based materials is material-dependent and characterized by progressive cumulative accumulation associated with significantly higher early-phase release rates. These findings highlight the importance of assessing the safety of resin-based materials used in pediatric dentistry.
OBJECTIVES:The aim of this study was to analyze current trends in screen exposure and to provide a deeper understanding of the relationships between temperament, screen exposure, and psychological adjustment in preschoolers. METHODS:The study was conducted in kindergartens and one health center in the city of Zagreb, using a convenience sample of 115 mothers who assessed their preschool children's screen exposure, temperament, and psychological adjustment. RESULTS:Descriptive data analysis indicated that children's screen time generally fell within the American Academy of Child and Adolescent Psychiatry's recommended guidelines. Correlation analysis indicated that externalizing problems were significantly positively correlated with impulsivity, activity, emotionality, and weekend screen time. Conversely, prosocial behavior was negatively correlated with impulsivity and weekend screen exposure. Moderation analyses revealed that weekend screen time significantly altered the associations between temperament and externalizing problems. Specifically, longer weekend screen exposure weakened the relationships between Impulsivity and externalizing problem and between Activity and externalizing problems, suggesting that screen time may buffer the impact of high-risk temperament profiles on behavioral difficulties. Weekend screen time did not moderate the relationship between Emotionality and externalizing problems. Similarly, longer screen exposure weakened the negative association between Impulsivity and prosocial behavior, indicating that screen time may reduce the extent to which impulsive temperament undermines prosocial functioning in preschool children. CONCLUSIONS:These findings provide deeper insight into the role of temperament and screen time exposure in predicting both maladaptive and prosocial behaviors among preschool-aged children.
BACKGROUND/OBJECTIVES:Rural-urban disparities are well documented in pediatric healthcare, influencing access, service organization, and outcomes. However, whether these differences extend to the domain of nursing care remains unclear. This study examined the association between degree of urbanization and nursing complexity among children admitted to a single tertiary-care pediatric hospital, comparing clinical, organizational, and nursing characteristics across geographic groups. METHODS:Routinely collected electronic nursing documentation and hospital administrative records were retrospectively examined in a tertiary-care pediatric hospital in Rome, Italy. Children aged 2 to <18 years were consecutively included. Degree of urbanization was defined using the ISTAT-derived DEGURBA classification. The study outcome for nursing complexity corresponded to the number of nursing diagnoses documented at hospital admission. Descriptive analyses and a multivariable negative binomial regression model assessed the association between urbanization and nursing complexity, adjusting for age, sex, DRG weight, number of medical diagnoses, and chronic conditions. RESULTS:Among 1652 pediatric hospitalizations, those from rural areas showed a higher clinical burden, with significantly higher DRG weight and more chronic conditions, but nursing complexity did not differ significantly across geographic groups. In the multivariable model, degree of urbanization was not independently associated with nursing complexity for admissions from towns and suburbs (IRR = 0.93, 95% CI 0.82-1.04, p = 0.211) or rural areas (IRR = 1.00, 95% CI 0.84-1.20, p = 0.966), compared with those from cities. Higher DRG weight (IRR = 1.11, 95% CI 1.05-1.17) and a greater number of medical diagnoses (IRR = 1.17, 95% CI 1.11-1.25) were positively associated with nursing complexity, whereas the number of chronic conditions showed an inverse association (IRR = 0.90, 95% CI 0.84-0.96). CONCLUSIONS:In this single-center sample, rural-urban differences in clinical burden are not accompanied by statistically detectable differences in nursing complexity at hospital admission. Despite a higher clinical burden among children admitted from less urbanized areas, nursing complexity does not appear to differ significantly across geographic groups. Standardized nursing data enhance the ability to compare admission-level care needs across geographic contexts, enabling more precise and stratified population and public health analyses.
Background/Objectives: This study examined the association between parental physical activity and preschool children’s physical activity and social behavior. Methods: Participants were 151 preschool children (70 girls, 81 boys; Mage = 52.51 months, SD = 3.38) attending public and private kindergartens in Thessaloniki (Greece) and Nicosia (Cyprus). Children’s psychosocial development was assessed by kindergarten teachers using the Strengths and Difficulties Questionnaire, while parents reported their own and their children’s physical activity through the Preschool-age Children’s Physical Activity Questionnaire (home version). Descriptive statistics and Pearson correlations were computed, and the main hypotheses were tested using multiple linear regression analyses. Results: Results indicated a consistent positive association between parental physical activity and children’s physical activity across intensity levels. Parental physical activity frequency and duration during both weekdays and weekends was significantly associated with children’s low-, moderate-, and vigorous-intensity physical activity, while parental beliefs about physical activity were negatively associated with children’s sedentary behavior. In contrast, parental physical activity showed no significant association with all indicators of social behavior at school, including emotional symptoms, conduct problems, hyperactivity/inattention, and prosocial behavior. Conclusions: Overall, the findings support the role of parental physical activity as an important correlate of preschool children’s physical activity behavior, while its direct association with broader psychosocial development appears small. These results highlight the importance of parental role modeling and attitudes toward physical activity, particularly in shaping children’s movement behaviors.
Pediatric new daily persistent headache (NDPH) is a clinically defined headache subtype that remains controversial due to a lack of unique and objective mechanistic features. For many headache subtypes, different, and sometimes unique, patterns of structural and functional changes can be observed in the brain, supporting a unique role for neuroimaging in identifying the presence and type of headache experienced. To date, there has been little research into pediatric NDPH and how it may have a unique mechanism relative to other headache subtypes. We review published research that addressed structural and functional neuroimaging in persons with NDPH. We found that research to date supports differences in both brain structure and function in persons with NDPH relative to healthy controls. Such differences reflect both cortical and sub-cortical regions of the brain. No studies to date have evaluated brain data between persons with NDPH and other headache subtypes. We discuss application of machine learning and artificial intelligence to validate NDPH as a unique headache diagnosis. We believe that future work pursuing both neuroimaging alongside machine learning can help inform the classification and differential diagnosis of pediatric patients with NDPH from other chronic headache conditions.
Background: Iron deficiency is common in very-low-birth-weight (VLBW) infants because of limited iron stores, rapid postnatal growth and repeated phlebotomy. Early detection is essential to prevent anaemia and neurodevelopmental impairment. This study investigated the prevalence of, and factors associated with, iron deficiency at hospital discharge using serum ferritin and the reticulocyte haemoglobin equivalent (RET-He). Methods: In this prospective cohort study, iron status was evaluated in 68 VLBW infants admitted between April 2022 and March 2024 at 36 weeks post-menstrual age (PMA) or at discharge. Iron deficiency was defined as serum ferritin below 75 ng/mL or RET-He below 28 pg. Univariable and multivariable logistic regression analyses were performed to explore clinical factors associated with iron deficiency. Iron status and anaemia were reassessed at 6-12 months of age. Results: At 36 weeks PMA or discharge, 39.7% of the infants were iron deficient, whereas only 1.5% were anaemic. Higher gestational age (aOR 1.81, 95% CI 1.07-3.06) and lower haemoglobin at birth (aOR 0.63, 95% CI 0.42-0.96) were independently associated with iron deficiency. Bronchopulmonary dysplasia showed a possible association (aOR 14.02, 95% CI 1.23-160.34), though this estimate should be interpreted cautiously. At 6-12 months, 18.8% of the patients had anaemia and 50% had iron deficiency, with no significant associated factors identified, likely reflecting the limited sample availability. Conclusions: Iron deficiency is common in VLBW infants and often precedes anaemia. Assessment of iron status beyond haemoglobin before discharge may be clinically justified to guide early supplementation, though further prospective multicentre studies are needed to confirm whether routine dual-biomarker screening is warranted.
Objectives: The diagnosis of pediatric acute appendicitis remains challenging due to clinical findings that overlap with nonspecific abdominal pain (NSAP). In this study, the value of fibrinogen in the diagnosis of pediatric acute appendicitis and in the classification of disease severity was investigated. Methods: In a single-center, retrospective cohort study, 145 patients aged 1 month to 18 years who underwent contrast-enhanced abdominal computed tomography were divided into three groups: NSAP (n = 62), uncomplicated appendicitis (n = 44), and complicated appendicitis (n = 39). Hemogram parameters, CRP, procalcitonin, albumin, and fibrinogen levels were compared. Diagnostic performance was assessed using ROC analysis, and independent predictors were evaluated via multivariate logistic regression. Results: Fibrinogen levels showed a gradual and statistically significant increase from NSAP to uncomplicated appendicitis and then to complicated appendicitis (p < 0.001 for all pairwise comparisons). In distinguishing appendicitis from NSAP, fibrinogen achieved the highest diagnostic accuracy among the biomarkers examined (AUC = 0.95); CRP, WBC, ANC, and NLR demonstrated lower discriminatory performance. In multivariate logistic regression analysis, fibrinogen was validated as an independent predictor of appendicitis (p < 0.001). Conclusions: Fibrinogen demonstrates high discriminatory performance in the diagnosis of pediatric acute appendicitis and shows a graded relationship with disease severity. These findings suggest that fibrinogen may be a promising biomarker for the evaluation of pediatric acute appendicitis. However, larger prospective multicenter studies are required before its routine integration into diagnostic algorithms can be recommended.
Background/Objectives: Dyslipidemia is increasingly linked to retinal microvascular changes, yet its impact in pediatric populations remains unclear. Given the retina's role as a microvascular model, this review evaluates the association between dyslipidemia and retinal vascular alterations in children and adolescents. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to evaluate the association between lipid profiles, body composition, and retinal vascular parameters in individuals younger than 19 years. Four eligible studies were found. Results: Triglyceride (TG) levels, total cholesterol (TC) levels, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (apoB) levels were associated with smaller retinal arteriole diameters (CRAE), whereas there was no consistent association between venular diameter (CRVE) and lipid levels. In addition, families with familial hypercholesterolemia (FH) had lower capillary densities and larger foveal avascular zone areas detected by optical coherence tomography angiography (OCT-A) compared to control subjects. The presence of both obesity and dyslipidemia resulted in greater degrees of arteriolar narrowing. Conclusions: These findings suggest that adverse metabolic profiles in childhood may be linked to early microvascular alterations. However, the limited number of heterogeneous studies highlights the need for larger longitudinal investigations.
