Objective To formulate spirometry reference equations that can be implemented on preschool-aged children in Jordan, while accounting for their age, sex and height. Methods This two-phase Jordanian study derived sex-specific spirometry reference equations for healthy children aged 3–6 years and evaluated their temporal performance in an independent previously published Jordanian preschool cohort. In the 2025 model-development cohort, generalized additive models for location, scale and shape (GAMLSS) were fitted separately for boys and girls for forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, comparing Box-Cox Cole and Green distribution (BCCG), Box-Cox Power Exponential distributions (BCPE), and Normal families and selecting models using GAIC with diagnostic assessment by quantile residuals and worm plots. In the validation cohort described by Al-Qerem and Jarab, calibration and external performance were evaluated and compared against Global lung initiative equations (GLI-2012 Caucasian and GLI-2022 race-neutral equations). Results The study included 1676 children: derivation cohort, n = 911, 461 boys; validation cohort, n = 765, 400 boys. BCPE models provided the best fit for FEV₁ and FVC in both sexes, whereas FEV₁/FVC was adequately captured by simpler models (boys: BCCG; girls: Normal). The validation phase indicated minimal systematic bias (intercepts near zero; slopes close to one), although FEV₁/FVC results were less precise. Jordanian and GLI-2012 yielded mean volume z-scores near zero, whereas GLI-2022 shifted volume estimates upward and reduced lower limit of normal yields, particularly for girls’ FEV₁. Conclusion These first Jordanian preschool spirometry equations demonstrate good performance and support population-specific interpretation in clinical practice.
OBJECTIVE:Although the effects of lactation on bone mass are frequently discussed, it is unknown whether these effects are intensified in breastfeeding mothers (BFM) who become donors (BFM-donors). Thus, the objective was to evaluate alterations in bone densitometry and bone metabolism in BFM-donors during six months of follow-up, compared with BFM-controls who did not donate maternal milk, to determine whether these changes would be intensified by the volume donated. METHODS:Data were obtained from two groups: 39 BFM-donors (six and twelve months postpartum) and 38 BFM-controls (up to 15 days [baseline] and six months postpartum). Donated milk volume, body mass index, and bone mineral density (BMD) of the lumbar spine, proximal femur, and total body were assessed by densitometry. Calcium, phosphorus, parathyroid hormone, 25(OH)D, estradiol, osteocalcin, bone alkaline phosphatase, and carboxy-terminal telopeptide were measured. Comparisons were performed using Student's t-test, followed by repeated-measures models and ANCOVA adjusted for confounders when appropriate. Effect size and statistical power were also calculated. RESULTS:BFM-donors showed bone mass mobilization similar to BFM-controls at six months, without influence of donated volume (9.0 ± 8.2 L). From six to 12 months postpartum, lumbar spine and femur BMD values increased (5% and 1.5%). CONCLUSIONS:Comparing BFM-donors at 12 months, versus BMF-controls at 15 days, even with continued complementary breastfeeding, densitometric results tended to return to the means seen 15 days postpartum. There were no correlations between BMD, bone markers, and total volume of donated milk.
Objective To systematically review and quantify the variation in quadriceps femoris muscle thickness in children admitted to pediatric intensive care units (PICUs) and to identify factors associated with this loss. Methods Searches were performed in Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases for studies published without date restrictions. Observational studies assessing quadriceps thickness via ultrasonography at a minimum of two time points during PICU stay were included. The study protocol was registered in PROSPERO (CRD42024628869). Following PRISMA guidelines, data were extracted regarding study characteristics, muscle thickness variations, and associated clinical/demographic factors. Quantitative synthesis utilized random-effects models for percentage change and meta-analysis of proportions for prevalence. Results Nine studies (n = 536 patients) were included. The mean reduction in muscle thickness at 7 days was −7.89% (95% CI, −11.36% to −4.41%; p < 0.001). The maximum observed loss during admission was −10.77% (95% CI, −12.87% to −8.67%; p < 0.001). The pooled prevalence of clinically significant atrophy (> 10%) was 49.4% (95% CI, 44.0% to 54.7%). Key factors associated with greater loss included the use of neuromuscular blocking agents, older age (older children vs. infants), and cumulative protein and caloric deficits. Conclusions Muscle atrophy in critically ill children is an early, severe, and multifactorial phenomenon, affecting nearly half of the patients. Bedside ultrasonography monitoring is essential to guide early interventions and mitigate long-term functional impairment.
OBJECTIVE:Multimodal Brain Function Monitoring (MBFM) enables simultaneous assessment of cerebral blood flow, intracranial pressure (ICP), and brain tissue oxygenation, providing dynamic evaluation for pediatric neurocritical care. This study evaluated MBFM-derived parameters, including perturbation factor (PF), edema factor (EF), ICP, and regional cerebral oxygen saturation (rSO₂), for disease severity stratification and prognostic prediction. METHODS:We prospectively enrolled 120 pediatric patients (6 months-12 years) in the PICU of the Children's Hospital, the Weifang People's Hospital (January 2022- November 2025). Continuous MBFM monitoring was performed for 72 h. Patients were stratified into mild, moderate, and severe groups using K-means and hierarchical clustering. Key predictive thresholds were identified via CART decision tree. Predictive performance for adverse outcomes, including Glasgow Outcome Scale scores, complications, and survival, was assessed by ROC analysis, logistic regression, Kaplan-Meier survival analysis, and decision curve analysis. RESULTS:PF, ICP, EF, and rSO₂ significantly differed among severity groups. PF predicted adverse outcomes with an AUC 0.86 (cutoff 0.34), while the combined model (PF + EF + ICP + rSO₂) improved the AUC to 0.91. Patients with PF > 0.34 and severe disease showed reduced 6-month survival (Log-rank χ² = 7.76, P = 0.005). CONCLUSIONS:MBFM provides a quantitative framework for grading pediatric neurocritical illness. PF is a core predictor, and integrating multimodal metrics enhances prognostic accuracy, guiding PICU interventions and outcome prediction.
Objective Acute kidney injury (AKI) is a life-threatening condition in children. Serum lactate is a critical indicator of oxygen metabolism and tissue hypoperfusion. This study investigated the association between early dynamic lactate trajectories during pediatric intensive care unit (PICU) and 30-day mortality in pediatric patients with AKI. Methods This single-center retrospective study included 1056 critically ill children with AKI admitted to the PICU. Multivariable Cox regression and restricted cubic spline (RCS) models were used to evaluate the association between admission lactate levels and 30-day mortality. Latent growth mixture model (LGMM) was used to identify distinct lactate trajectories based on daily measurements during the first four days of admission. Multivariable Cox regression and Kaplan-Meier analysis were then conducted to assess the association between trajectory classes and 30-day mortality. Results Admission lactate was independently associated with 30-day mortality (HR 1.13, 95% CI 1.08–1.18, p < 0.01), with a monotonic dose-response relationship (p for non-linearity = 0.46). Three distinct lactate trajectories were identified: Class 1 (high decreasing group, 5.11%), Class 2 (low stable group, 92.05%), and Class 3 (persistent high group, 2.84%). Compared with Class 2, both Class 1 (HR 3.37, 95% CI 1.83–6.24, p < 0.01) and Class 3 (HR 6.24, 95% CI 2.95–13.17, p < 0.01) were associated with significantly increased mortality. Kaplan-Meier curves confirmed the poorest survival in Class 3. Conclusion Both admission lactate level and early dynamic lactate trajectory provide valuable prognostic information in pediatric AKI patients. Identifying lactate patterns facilitates early risk stratification and guides individualized management.
Objective To evaluate the prevalence and risk factors for recurrent respiratory tract infections in preschool children. Methods Studies on RRTIs in preschool children were retrieved from PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, Wanfang, and VIP databases up to October 2025. Data was analyzed using Stata 15.0. Results Ten studies involving 15,271 preschoolers were included. Meta-analysis showed that the overall prevalence was 24.14% [95% CI (0.23,0.33)].A total of 11 risk factors for RRTIs in preschool children were identified, including: asthma (I² = 93.8%) [OR = 3.84, 95% CI (1.97, 7.47), P < 0.001], allergy(I² = 0) [OR = 2.27, 95% CI (2.06, 2.51), P < 0.001], dietary bias (I² = 65%) [OR = 2.10, 95% CI (1.37, 3.24), P = 0.001], smoking co-resident(I² = 42.7%) [OR = 1.83, 95% CI (1.44, 2.32), P < 0.001], low parental education level(I² = 0) [OR = 3.17, 95% CI (1.76, 5.69), P < 0.001], initial use of antibiotics < 6 months(I² = 0) [OR = 1.70, 95% CI (1.50, 1.93), P < 0.001], maternal BMI per 3 kg/m² increment(I² = 0) [OR = 1.18, 95% CI (1.08, 1.28), P < 0.001], and breastfeeding duration < 6 months(I² = 0) [OR = 1.26, 95% CI (1.12, 1.42), P < 0.001]. Conclusion The high prevalence (24.14%) of RRTIs in preschool children and the risk factors identified provide evidence for targeted prevention and intervention strategies.
OBJECTIVES:Urinary creatinine concentration is widely used to normalize urinary analytes. However, its reliability in preterm neonates remains uncertain. This study aimed to evaluate urinary creatinine concentrations in very low gestational age (VLGA) neonates and assess its impact on the interpretation of urinary creatinine normalized urinary amino acids. METHODS:Spot urine samples were collected from VLGA neonates (22-31 weeks gestational age, n = 32) and full-term neonates (≥ 37 weeks, n = 22) during the first days of life. Urinary creatinine was measured serially, and biological variation (within- and between-subject) was assessed. Urinary amino acids were measured on the 4th day in full-term neonates and in VLGA neonates at term-equivalent age using LC-MS/MS and expressed both as absolute concentrations (µmol/l) and normalized to creatinine (mmol/mol creatinine). RESULTS:Urinary creatinine concentrations were significantly lower in VLGA neonates compared to full-term neonates during the first days of life (p ≤ 0.004). A positive correlation between birth weight and urinary creatinine was observed (r = 0.46, p = 0.002). Within-subject biological variation was lower in VLGA neonates, while between-subject variation was comparable between groups. Urinary amino acid concentrations expressed in μmol/l did not differ significantly between groups, however, when expressed relative to creatinine, multiple significant differences emerged. CONCLUSIONS:Gestational age should be considered when interpreting creatinine normalized urinary amino acids concentrations in neonates.
Objective a) To verify the applicability of anthropometric indices (body mass index (BMI), tri- weight index (TWI), body surface area (BSA)) for evaluating velocity and agility tests in children and adolescents, and to propose reference values. Methods A descriptive cross-sectional (correlational) study was designed in 1573 schoolchildren aged 6 to 17 years. Weight and height were assessed. BMI, TWI, and BSA were calculated. The 20-meter sprint and agility (5 meters x 10 repititions) test was evaluated. Results In the individual analysis, the explanatory power for velocity and agility for BMI was almost nil. In the case of the TWI (r² = 0.123 and 0.110) and BSA (r² = 0.157 and 0.211), they showed significant explanatory power. When age was incorporated, the predictive power significantly increased. For BMI+age (r² = 0.342 and 0.435); TWI+age (r² = 0.382 and 0.467), and BSA+age (r² = 0.292 and 0.394). When sex was added, the results showed a further improvement. For BMI+age+sex (r² = 0.409 and 0.498); TWI+age+sex (speed test (r² = 0.435 and 0.517) and BSA+age+ sex (r² = 0.373 and 0.470). Conclusion The TWI better explained motor performance than the BMI and BSA in Chilean schoolchildren. Models that included TWI along with age and sex indicated that the TWI could be an alternative for assessing velocity and agility. Furthermore, percentiles were developed for the 20-meter sprint and the 5-meter agility test (10 repetitions), which are useful for monitoring and interpreting changes in the physical performance of schoolchildren.
OBJECTIVE:To characterize clinical outcomes of gene replacement therapy administered after symptom onset in a small group of children with 5q spinal muscular atrophy (SMA) and to describe its impact on motor function and supportive care needs in real-world practice. METHODS:Observational cohort study with retrospective and prospective data collection at a single pediatric center. Children with molecularly confirmed type 1 or type 2 5q SMA who received onasemnogene abeparvovec and remained in multidisciplinary follow-up were consecutively included. Due to the small sample (n = 7) and patient heterogeneity, analysis was exclusively descriptive. RESULTS:Seven symptomatic children were evaluated (six type 1, one type 2). After treatment, motor milestones showed localized improvements; all type 1 patients achieved head control and sitting with support, and 83.3% achieved independent sitting. The type 2 patient achieved independent ambulation. Adverse events occurred in 85.7% of patients and were mostly mild to moderate, though one case of thrombotic microangiopathy required dialysis with favorable recovery. Despite motor gains, prior and simultaneous use of other therapies (nusinersen, risdiplam) acted as confounding factors, and most children remained dependent on noninvasive ventilation and gastrostomy. CONCLUSIONS:In this small and heterogeneous cohort, gene therapy after symptom onset was primarily associated with clinical stabilization and limited motor milestone acquisition, while established respiratory and nutritional impairments persisted. These results emphasize the need for realistic treatment counseling and reinforce the importance of early diagnosis.
Objective To review the etiological factors that cause isolated rectal bleeding in otherwise asymptomatic neonates. Data source A scoping review was conducted following PRISMA-adapted guidelines. The databases consulted included PubMed, PubMed Central, BVS, Scopus, Embase, Web of Science, Cochrane, PROQUEST, and EBSCOHOST, with no language or publication period restrictions. The authors reviewed studies of any methodological design, including neonates up to 28 days of life with visible blood in the stool, with no symptoms of disease. Summary of the findings A total of 1,287 articles were identified, and 749 duplicates were removed. After screening the title and abstract, 139 studies were selected for full-text review, of which 56 were included. The data included 1,154 neonates. The diagnoses, in decreasing frequency order, were isolated rectal bleeding (IRB), cow’s milk protein allergy (CMPA), swallowing maternal blood, hemorrhagic colitis, intestinal infections, and nodular lymphoid hyperplasia. Around 22% of patients diagnosed with CMPA underwent oral food challenge to confirm the diagnosis. Conclusions Most of the reviewed articles presented case reports or observational case series. The main cause of rectal bleeding in otherwise asymptomatic neonates was the descriptive diagnosis of isolated rectal bleeding, which evolved benignly and spontaneously. The second most frequent cause was CMPA, though most cases were not confirmed by an oral food challenge. IRB in neonates has been managed without standardized protocols for investigation or treatment.
Objective: Intraoperative hypotension is associated with adverse postoperative outcomes, yet evidence in the neonatal population is limited. This study aimed to investigate the incidence, risk factors, and prognostic significance of intraoperative hypotension in this population. Methods: This single-center retrospective study included 1712 neonates undergoing non-cardiac surgery from 2020 to 2025 at a tertiary children’s hospital in China. Intraoperative hypotension was defined as a reduction in mean arterial pressure of more than 20% from the preoperative baseline and lasting for more than 5 min. Multivariate logistic regression identified independent risk factors. Results: The incidence of intraoperative hypotension was 59.8% (1024/1712). Independent risk factors included American Society of Anesthesiologists Physical Status Classification > Ⅲ (OR = 1.357, 95% CI: 1.079–1.706, P = 0.009), emergency surgery (OR = 1.323, 95% CI: 1.054–1.660, P = 0.016), surgery duration > 60 min (OR = 1.457, 95% CI: 1.162–1.826, P = 0.001), thoracic surgery (OR = 1.727, 95% CI: 1.053–2.831, P = 0.030), preoperative congenital heart disease (OR = 1.379, 95% CI: 1.117–1.702, P = 0.003), and preoperative acidosis (OR = 1.349, 95% CI: 1.036–1.757, P = 0.026). Higher gestational age (OR = 0.936, 95% CI: 0.891–0.983, P = 0.008) and neurosurgery (OR = 0.566, 95% CI: 0.385–0.832, P = 0.004) were protective factors. Intraoperative hypotension was associated with prolonged postoperative recovery and increased acute kidney injury and intraventricular hemorrhage (all P < 0.05). Conclusions: Intraoperative hypotension is highly prevalent in neonatal non-cardiac surgery and was associated with short-term outcomes. Identified risk and protective factors may guide perioperative hemodynamic optimization in this vulnerable population.
Objective The aim of this systematic review (SR) is to evaluate the relationship between congenital infections (Toxoplasmosis, Cytomegalovirus, Rubella, Herpes simplex type 1 and 2, HIV, Zika, and Syphilis) and the development of Autism Spectrum Disorder (ASD). Data source The authors seek to identify loopholes in the current knowledge about this content and to understand the role of congenital infections in children’s neurodevelopment. After the systematic search, 32 articles were included. Quality of articles was evaluated by the e Newcastle-Ottawa Scale (NOS). Findings The data obtained were heterogeneous; the NOS varied from 4 to 9. In 19 studies, an association between congenital infection and the development of ASD and/or features of this spectrum was not observed. Furthermore, the present findings indicate that the link between congenital infections and ASD varies depending on the pathogen and there is no common causal factor among the diseases, as their mechanisms are not yet fully understood. Conclusion This review highlights that there is a possible correlation between some congenital infections and the development of ASD, as is the case with CMV, Zika, Rubella and Toxoplasmosis infection. As the mechanisms are not yet fully understood, there is a need for further studies and research on this topic to bridge the existing knowledge gap regarding its mechanisms.
Objective To evaluate the factors linked to Food Insecurity (FI) in children and adolescents with Type 1 Diabetes Mellitus (DM1). Methods A cross-sectional study was conducted with children and adolescents at the Diabetes Outpatient Clinic of the IPPMG/UFRJ. Procedures included assessing FI levels using the Brazilian Food Insecurity Scale (EBIA). Sociodemographic data collected included age, gender, number of family members, caregiver's education, social benefits, and income. A 5% significance level was used, with 95% confidence intervals. Results The sample included 130 children and adolescents, mostly female (60.8%, n = 79), and most did not receive social benefits (63.8%, n = 81). In most cases, the mother was the primary caregiver (77.7%, n = 101), and the caregivers had at least completed high school (80%, n = 104). Most participants were eutrophic based on BMI/age and sex (58.4%, n = 76) and had appropriate height for their age (96.9%, n = 126). The prevalence of FI was 67.4% (n = 87), with 50.4% (n = 65) experiencing mild FI, 11.6% (n = 15) moderate FI, and 5.4% (n = 7) severe FI. Conclusion A significant association was found between FI and income, caregiver's education, and receipt of benefits. The study highlights income as a key factor in food acquisition. These findings stress the need for intersectoral actions to develop public policies and programs aimed at reducing poverty, promoting food security, and ensuring adequate, healthy nutrition, especially within this population.
OBJECTIVE:To evaluate the incidence and epidemiological, clinical, and laboratory characteristics of Central Precocious Puberty (CPP) before, during, and after the COVID-19 pandemic in Goiás, Brazil. METHOD:This retrospective, longitudinal, observational study with a quantitative approach was conducted in Goiás using administrative records of high-cost medication dispensing. All patients registered in the state dispensing center who initiated treatment between 2018 and 2023 were included. Data were analyzed using the Statistical Package for Social Sciences (IBM Corporation, Armonk, USA), version 26.0. Statistical significance was set at 5% (p < 0.05). RESULTS:A total of 910 CPP treatment requests were evaluated, including 153 before the pandemic, 390 during 2020-2021, and 367 during 2022-2023. This corresponded to increases of 154% and 140% during the pandemic and post-pandemic periods, respectively (p < 0.001). From 2020 onward, patients started gonadotropin-releasing hormone analog therapy at younger ages (104.84 ± 12.52 vs. 107.17 ± 13.42 months; p = 0.027), but showed more advanced pubertal development, with higher Tanner stages (B/G stage 4: 15.9% and 21.4% vs. 8.6%; p = 0.035) and higher stimulated LH levels (22.39 ± 16.81 and 24.64 ± 22.13 vs. 19.87 ± 18.08 mIU/mL; p = 0.046). CONCLUSIONS:CPP incidence increased significantly in Goiás during and after the COVID-19 pandemic. Patients also presented more advanced clinical and laboratory features than those diagnosed before the pandemic.
OBJECTIVE:To evaluate the Pediatric Respiratory Assessment Measure (PRAM) score for hospital admission and prolonged stay risk stratification in the emergency department (ED) at different time points. METHOD:Retrospective cohort study using prospectively collected protocol data (August 2023-March 2025) at a tertiary pediatric ED. Patients aged 2-17 years with acute asthma exacerbations were included; those with systemic comorbidities, other chronic lung diseases, or confounding acute conditions were excluded. PRAM was assessed hourly (PRAM 0 to 4). Outcomes were hospital admission and prolonged ED stay (> 3 h). RESULTS:A total of 428 visits were analyzed (35.0% hospital admission rate). PRAM demonstrated satisfactory discriminatory capacity for admission at triage (AUC: 0.791; 95% CI: 0.745-0.836; p < 0.001), with optimized accuracy during serial assessments, performing best at the second hour (PRAM 2; AUC: 0.829; 95% CI: 0.773-0.885; p < 0.001). For predicting prolonged ED stay, the score showed moderate accuracy at the second hour (AUC: 0.677; p < 0.001), with no significant correlation between sequential scores and time to admission decision (p > 0.05). CONCLUSIONS:PRAM is a valuable, dynamic risk-stratification tool for pediatric asthma exacerbations. Serial assessments provide superior prognostic accuracy compared to a single static measurement at admission by actively reflecting therapeutic response. Although its ability to predict operational outcomes is restricted by non-clinical factors, the score demonstrates consistent utility for standardizing clinical assessment and supporting medical disposition in the ED.
OBJECTIVE:To evaluate parental and caregiver practices in the management of childhood fever and to identify factors independently associated with appropriate fever management according to Brazilian Pediatric Society recommendations. METHODS:A cross-sectional study was conducted in 2024 using a structured questionnaire administered both online and in person at primary health care units. A total of 847 parents or caregivers of children and adolescents participated in the study. Fever management was considered appropriate only when all predefined diagnostic and therapeutic criteria were met simultaneously. Associations were assessed using chi-square tests and multivariable logistic regression. RESULTS:60.7% (n = 514) of responses were collected online and 39.3% (n = 333) in person. Only 42% of caregivers fulfilled all predefined criteria for appropriate fever management. In bivariate analyses, appropriate management was associated with both educational level and time elapsed before seeking medical care. However, after multivariable adjustment, educational level was no longer significantly associated with the outcome, whereas only time to medical consultation remained independently associated. Compared with immediate consultation, caregivers who waited 6-12 h (OR = 1.91; 95% CI: 1.16-3.16), 12-24 h (OR = 1.96; 95% CI: 1.20-3.20), or 24-36 h (OR = 1.67; 95% CI: 1.02-2.75) were more likely to manage fever appropriately. CONCLUSIONS:Less than half of caregivers managed childhood fever appropriately. A short period of observation before seeking medical care was independently associated with better adherence to recommended practices. These findings highlight persistent gaps in home-based fever management and suggest that caregiver decision-making regarding healthcare-seeking may be a relevant target for future educational interventions.
Objective The study described early sexual initiation, forced sexual initiation, and associated factors in young participants of a Brazilian birth cohort. Methods Participants who, at the 18-year-of-age follow-up, answered yes to the question “Have you ever had sexual intercourse (had sex)?” were included. They were asked about age at first intercourse (< 14 or ≥ 14) and whether it was consensual (“because I wanted to” or “because I was forced”). Factors associated with these outcomes were analyzed by Poisson regression with robust variance according to a hierarchical model. Results The sample consisted of 3255 participants, with a prevalence of sexual intercourse before 14 years of age of 13.3% and of forced first sexual intercourse of 1.6%. First intercourse before 14 years of age was more likely to occur in boys, those who identified as asexual or in the category “other” when asked about their sexual orientation, who currently used drugs daily/almost daily, whose first sexual intercourse was forced, and who had more lifetime sexual partners. First forced sexual intercourse was more likely to occur in girls, those who identified as pansexual, who had sexual intercourse before 14 years of age, and who had more lifetime sexual partners. Conclusions Better guidance is recommended for adolescents regarding sexual abuse and violence and methods of self-preservation and reporting.
