Background: Physical activity and breakfast consumption are commonly clustered adolescent health behaviors, but Saudi evidence on their association is limited to a single city, and whether this relationship varies by sex or age remains untested. Objective: We aimed to examine the association between physical activity frequency and breakfast skipping among Saudi adolescents and determine whether it differs by sex and age. Methods: This cross-sectional study used 2019 Global School-based Student Health Survey (GSHS) data from adolescents in five Saudi cities (Riyadh, Jeddah, Dammam, Khamis Mushait, Tabuk; N = 5900). Cases with missing data on any analysis variable were excluded listwise (final N = 5431). Physical activity frequency and breakfast skipping were both assessed using self-reported GSHS questionnaire items. Logistic regression via generalized estimating equations (clustered on school) estimated adjusted odds ratios, adjusting for sex, age (years), grade, nationality, and city; moderation by sex and age was tested with interaction terms and a joint Wald test, and robustness was assessed with three sensitivity analyses. Results: The final analytic sample (N = 5431) had a mean age of 13.71 years (standard deviation (SD) 1.13) and was 54.6% female. Breakfast-skipping prevalence was 18.7%. Each additional physically active day was associated with 10% lower odds of breakfast skipping (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] 0.86–0.93, p < 0.001), a finding robust across all sensitivity analyses, including multiple imputation (OR = 0.89, 95% CI 0.87–0.92). Female sex, non-Saudi nationality, older age, and city of residence (higher odds in Jeddah and Dammam relative to Riyadh) were independently associated with greater odds of skipping. Neither sex nor age moderated the physical activity–breakfast association (joint Wald χ2(2) = 2.70, p = 0.259). Conclusions: Physical activity frequency was independently and robustly associated with lower breakfast skipping among Saudi adolescents, irrespective of sex or age, extending single-city evidence to a larger and more diverse population. School-based strategies that jointly promote physical activity and breakfast consumption may not require tailoring by sex or age, although this study did not evaluate intervention effectiveness, and this inference should be confirmed prospectively; city-level variation suggests monitoring and resource allocation may benefit from geographic disaggregation.
Background: Rare diseases collectively affect millions of children worldwide and are a major cause of pediatric morbidity, mortality, and lifelong disability. Although most have a genetic basis, obtaining a timely molecular diagnosis remains challenging because of substantial clinical and genetic heterogeneity. Advances in genomic medicine are transforming rare disease diagnosis and establishing genomics as the center of precision medicine. Methods: This review summarizes current evidence on genomic approaches for pediatric rare diseases, including established and emerging sequencing technologies, their clinical applications, implementation challenges, and future directions. Results: Whole-genome sequencing is increasingly being adopted as a first-line genomic test for suspected rare genetic disorders, particularly when the phenotype is heterogeneous or does not point to a specific diagnosis. Conventional cytogenetic and targeted molecular techniques remain important complementary approaches for selected phenotypes, variant classes, and orthogonal confirmation. Gene panels are effective for well-defined phenotypes, whereas whole-exome sequencing remains a high-yield approach for genetically heterogeneous disorders, particularly when whole-genome sequencing is not available or is not clinically indicated. Long-read whole-genome sequencing expands diagnostic capacity by detecting structural variants, repeat expansions, complex rearrangements, and non-coding pathogenic variants that frequently escape short-read technologies. Emerging multi-omics approaches further improve variant interpretation and help resolve previously unsolved cases. Beyond diagnosis, molecular findings guide personalized clinical management, genetic counselling, reproductive planning, and access to targeted therapies and genotype-driven clinical trials. However, broad implementation is constrained by challenges in variant interpretation, ethical and legal considerations, data governance, workforce capacity, cost, and inequitable access to genomic services. Artificial intelligence, international data-sharing initiatives, and coordinated healthcare networks are helping overcome these barriers and improve diagnostic equity. Conclusions: Whole-genome sequencing is increasingly emerging as a first-line genomic strategy for pediatric rare diseases, while complementary technologies, expert phenotyping, and iterative data interpretation remain essential for comprehensive and accurate diagnosis and equitable access to genomic medicine.
Background/Objectives: Indigenous children in Canada face higher rates of overweight and obesity compared to non-Indigenous children. Parents’ perceptions of their child’s body weight are shaped by broader systemic influences, including historical trauma and limited access to healthy food. This study aimed to evaluate the association between children’s actual body weight (measured by BMI) and parental perceptions among First Nations children. Methods: Participants were children from two Saskatchewan First Nations communities involved in the First Nations Lung Health Project (2013 and 2017). Self-administered questionnaires were distributed through schools to parents of children in Grades 1–12. The questionnaire collected data on health, environment, physical activity, and diet. Parents assessed their child’s weight as underweight, about the right weight, or overweight. BMI was calculated using clinically measured height and weight. Logistic regression was used to identify predictors of BMI misclassification. Results: Among 472 children with both survey and clinical data, 42.6% were boys. Clinically measured overweight prevalence was 52.3%, compared to 15.9% based on parental perception. Overall, 58% of parents accurately perceived their child’s weight status. Misclassification was more likely among children who engaged in at least 60 min of daily physical activity on more days per week. Conclusions: Parents underestimated their children’s overweight status compared to clinical measures. Questionnaire-based assessments significantly underestimated true weight status among school-aged First Nations children. These findings highlight the need to consider systemic and environmental factors when addressing childhood obesity in First Nations communities.
Background/Objectives: Exercise-induced bronchoconstriction (EIB) may persist despite apparently adequate asthma control and may remain unrecognized in children without prominent exercise-related symptoms. This study aimed to determine the prevalence of objectively confirmed EIB in children with controlled asthma who did not report prominent exercise-related respiratory symptoms and to identify factors associated with EIB. Methods: This cross-sectional study included 67 children with controlled asthma who underwent standardized exercise challenge testing with serial spirometry. Demographic, environmental, allergic, laboratory, aeroallergen sensitization, and baseline pulmonary function characteristics were evaluated. Children were classified as EIB-positive or EIB-negative according to their post-exercise FEV1 response. Factors associated with EIB were assessed using univariate analyses and multivariable logistic regression. Results: EIB was identified in 24 of 67 children (35.8%). Baseline pulmonary function was generally preserved and did not differ significantly between EIB-positive and EIB-negative children. A history of atopic eczema was more frequent in the EIB-positive group (37.5% vs. 14.0%; p = 0.035). Allergic rhinitis, food allergy, total IgE, eosinophil percentage, and aeroallergen sensitization were not significantly associated with EIB. In multivariable logistic regression, a history of atopic eczema remained associated with EIB (adjusted odds ratio, 3.95; 95% CI, 1.08–14.41; p = 0.038), although the wide confidence interval indicates substantial uncertainty in the effect estimate. Conclusions: EIB was objectively detected in more than one-third of children with controlled asthma without prominent exercise-related symptoms despite preserved baseline pulmonary function. A history of atopic eczema may help identify children with persistent susceptibility to exercise-induced airway narrowing who might otherwise remain unrecognized.
Parents play an important role in adolescent substance use prevention, yet the competencies underlying their protective role remain inconsistently conceptualized and measured. This scoping review aimed to map parental competencies as modifiable family-level protective factors for adolescent substance use prevention. Following Joanna Briggs Institute methodology and PRISMA-ScR guidance, nine electronic databases were searched from inception to 20 July 2026. Peer-reviewed original studies addressing parental competencies relevant to substance use prevention among adolescents aged 9–19 years were included. Competencies were mapped according to their conceptual domains and evidence roles. Thirty-two publications were included, identifying 11 parental competency domains. Relational bonding and family involvement (90.6%), prevention communication (87.5%), monitoring and supervision (62.5%), and rules, boundaries, and expectations (53.1%) were most frequently represented. Competencies were more often targeted in interventions than directly measured or examined in relation to adolescent substance-use outcomes, and measurement approaches varied considerably across studies. Parental competencies relevant to adolescent substance use prevention encompass multiple relational, communicative, supervisory, and behavioral capacities. The findings highlight important gaps between intervention content, competency measurement, and outcome-related evidence and provide a foundation for developing competency-based prevention interventions and measurement tools.
Helicobacter pylori infection is a major cause of gastric cancer, and eradication before advanced precancerous gastric changes develop provides a biologically plausible opportunity for primary prevention. Adolescence represents a strategically favorable, although not universally established, window for intervention in Japan because persistent childhood-acquired infection can be identified before extensive mucosal damage while school-based programs provide organized access to defined birth cohorts. This narrative review evaluates the evidence supporting population-based adolescent H. pylori screening, its potential harms and uncertainties, and the lessons derived from Japanese implementation. Representative programs demonstrate that organized screening is feasible but show substantial heterogeneity in participation, diagnostic pathways, antimicrobial resistance, eradication outcomes, and retention across the care cascade. Direct evidence that adolescent screening reduces future gastric cancer incidence or mortality is not yet available. As H. pylori prevalence declines, the balance among screening yield, diagnostic performance, antimicrobial exposure, cost, and equity will continue to change. International experience further indicates that prevention strategies should be matched to local epidemiology and healthcare systems. Adolescent screening should therefore be viewed as an adaptive prevention strategy whose target population, diagnostic pathway, and treatment approach require periodic reassessment.
Purpose: Hypernatremia is a common electrolyte disorder in pediatric intensive care units (PICU) and is associated with considerable morbidity and mortality. We aimed to evaluate underlying etiologies, clinical characteristics, and factors associated with outcomes in critically ill children with hypernatremia, while accounting for illness severity. Methods: We retrospectively analyzed pediatric patients with at least one serum sodium measurement > 145 mEq/L during their stay in a tertiary Level 3 PICU. Demographic, clinical, laboratory, Glasgow Coma Scale (GCS), and Pediatric Risk of Mortality (PRISM) data were collected. Factors associated with in-hospital mortality were evaluated using univariate and multivariable analyses. Results: A total of 113 children were included (mean age 4.8 ± 5.3 years; 57.5% male). Neurological disorders were the most common underlying disease category, while free water deficit was the most frequently identified etiology of hypernatremia. Overall in-hospital mortality was 15.9%. Mortality rates were 21.5% among patients with PICU-associated hypernatremia and 8.3% among those with hypernatremia within the first 24 h of admission; the difference was not statistically significant (p = 0.058). PRISM score remained independently associated with mortality (OR 1.124, 95% CI 1.059–1.193; p < 0.001), whereas serum sodium concentration was not significantly different between survivors and non-survivors. Conclusions: Among critically ill children with hypernatremia, mortality was higher than the overall PICU mortality rate but was primarily associated with overall illness severity rather than with the degree of hypernatremia itself. PRISM score, rather than serum sodium concentration, was independently associated with mortality, suggesting that hypernatremia may represent a marker of severe underlying illness rather than an independent determinant of outcome.
Background: Endotracheal intubation is a painful and stressful procedure for neonates, and premedication is recommended for non-emergent settings. However, there is no consensus on the optimal pharmacological regimen. In recent years, several drugs have emerged as treatment options to improve comfort and safety of neonates undergoing endotracheal intubation. Worldwide, a range of agents are used. Remifentanil is a short-acting opioid with rapid onset and recovery characteristics that may be useful for neonatal intubation. Methods: A structured search of PubMed/MEDLINE, Embase, and Cochrane Library databases (1990–December 2024) identified publications evaluating remifentanil for neonatal intubation. Clinical studies, pharmacokinetic investigations, reviews and guidelines were qualitatively synthesized with an emphasis on dosing, efficacy, safety, dosing, administration technique, and clinical context. Results: The literature search retrieved 45 publications, but only a small subset were randomized clinical studies. Findings generally support feasibility and short-term efficacy, while results vary across studies, particularly for intubation conditions and respiratory adverse events. Chest wall rigidity, apnea, and desaturation appear to be influenced by dose, administration rate, patient characteristics, and co-medication, although the available studies are too small and heterogeneous to define an optimal regimen. Conclusions: Remifentanil can be considered for selected non-emergent neonatal intubation and INSURE procedures when administered by experienced teams under appropriate monitoring conditions. Particular caution is warranted in clinically unstable infants, during LISA procedures where preservation of spontaneous breathing is desirable, and in settings where immediate airway rescue capabilities are unavailable. The study did not demonstrate clear superiority of remifentanil. Current evidence is limited and heterogeneous, and larger comparative studies with standardized dosing, administration, and outcome definitions are needed.
Background/Objectives: Neonates with hypoxic–ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH) frequently develop coagulation abnormalities and bleeding complications, yet data on transfusion burden and its clinical correlates in this population remain limited. Materials and Methods: We performed a secondary analysis of a retrospective single-center cohort of neonates with HIE treated with TH between 2014 and 2022. Transfusion burden was defined as receipt of at least one blood component and coagulation/plasma products during hospitalization and the total number of transfusion episodes. Demographic, perinatal, biochemical, and clinical severity variables were collected. Univariable and multivariable logistic regression analyses were used to identify factors independently associated with transfusion exposure. Brain magnetic resonance imaging (MRI) findings were compared between transfused and non-transfused infants. Results: Among 142 included neonates, 74 (52.1%) received at least one blood product. The median number of transfusion episodes among transfused infants was 2 (IQR 1–3). Fresh frozen plasma and prothrombin complex concentrate were the most frequently administered products. Transfused infants showed higher markers of illness severity. In multivariable analysis, clinically visible bleeding (adjusted odds ratio [aOR] 12.95, 95% CI 1.34–124.97) and need for respiratory support (aOR 2.98, 95% CI 1.19–7.45) remained independently associated with transfusion exposure. Pathological brain MRI findings, including intracranial bleeding and hypoxic–ischemic injury, were more frequent among transfused infants. Conclusions: blood components and coagulation/plasma-derived products transfusions are common in neonates with HIE undergoing TH and appear to primarily reflect underlying disease severity. These findings highlight the need for optimized, evidence-based transfusion strategies in this vulnerable population.
Background/Objectives: While screening, brief intervention, and referral to treatment (SBIRT) is a widely recommended evidence-based approach for early detection and intervention for alcohol and other drug (AOD) use, limited guidance exists for implementing SBIRT among hospitalized adolescents with chronic medical conditions (A-CMCs). This exploratory qualitative study examined A-CMC and caregiver perspectives on factors that may shape the acceptability, feasibility, and equitable implementation of a proposed inpatient SBIRT approach for A-CMCs. Methods: Two separate focus groups were conducted in an urban pediatric hospital in 2023 with A-CMCs aged 13–18 (n = 7), who had a history of hospitalization for their medical condition, and their caregivers (n = 6). Data were coded using thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation Framework (HEIF), which captured implementation and equity-relevant determinants, respectively. Results: Although A-CMCs and caregivers recognized the importance of SBIRT within hospital settings, its acceptability hinged on the conditions of its delivery. The timing, relevance to current health needs, and modality of screening shaped an A-CMC’s willingness to disclose AOD use. Clinician communication style, including the use of a nonjudgmental tone and clear parameters for confidentiality, were also indicated as crucial for SBIRT delivery. Broadly, participants noted the significant impact that the sociopolitical context (e.g., stigma) and structural factors (e.g., financial burden) had on a family’s ability to benefit from SBIRT. Conclusions: In this exploratory qualitative study, participants identified confidentiality-forward, patient-centered workflows, and accessible follow-up supports as potentially important considerations for inpatient SBIRT among A-CMCs. These findings generate hypotheses for future co-design and implementation research across diverse pediatric inpatient settings.
Background/Objectives: We examined discharge-level associations between an administrative NQI03 numerator-code-positive bloodstream infection construct and hospital outcomes in very low birth weight (VLBW) discharges and whether the NQI03 short-stay criterion altered mortality estimates. Methods: Using the 2022 HCUP Kids’ Inpatient Database, we constructed an independent 500–1499 g cohort from ICD-10-CM birth-weight codes. Mortality, procedure-defined mechanical ventilation, and prolonged hospitalization (≥108 days, cohort P90) were modeled with adjustment for birth weight, completed gestational age, patient/discharge characteristics, and hospital characteristics. Missing baseline covariates were addressed with 50 multiple imputations; survey-design, transfer/inborn, short-stay, and model-specification sensitivities were examined. Results: Among 39,630 discharges from 1750 hospitals, 1655 (4.18%) were NQI03 numerator-code-positive. Multiple-imputation aORs were 1.20 (95% CI 1.005–1.432) for mortality, 2.50 (2.14–2.93) for mechanical ventilation, and 2.02 (1.75–2.33) for prolonged hospitalization; corresponding adjusted risk ratios were 1.17, 1.29, and 1.60. Secondary complete-case record-level standardized probabilities were 7.5% versus 6.5%, 58.6% versus 42.6%, and 15.4% versus 9.5%, respectively; uncertainty for these estimates is reported using hospital-cluster bootstrap confidence intervals. Of 3041 deaths, 1528 (50.25%) occurred during stays <3 days; imposing LOS ≥ 3 days increased the mortality aOR to 1.96. Conclusions: NQI03 numerator-code-positive bloodstream infection showed a modest, imprecise association with mortality and more pronounced associations with mechanical ventilation and prolonged hospitalization. Mortality estimates were sensitive to short-stay eligibility. Because infection timing is unavailable, findings are non-causal discharge-level associations.
Objectives: Mental health problems and post-traumatic stress symptoms are prevalent among adolescent refugees, yet little is known about the role of resilience in relation to these difficulties among Syrian adolescents. This study examined the unique contribution of resilience to mental health problems and post-traumatic stress symptoms after controlling for age and gender. Methods: Participants were 501 Syrian refugee adolescents residing in Ankara, Türkiye (63.67% male; aged 12–18 years, M = 15.72, SD = 1.61), recruited through multistage cluster sampling in 15 schools. They completed the Brief Resilience Scale, the Children’s Revised Impact of Event Scale (CRIES), the Depression, Anxiety, and Stress Scale, and a socio-demographic questionnaire. Five hierarchical multiple regressions were conducted, entering age and gender at Step 1 and resilience at Step 2. Results: After controlling for age and gender, resilience was significantly and negatively associated with depression (β = −0.11, p < 0.05), anxiety (β = −0.19, p < 0.01), stress (β = −0.15, p < 0.01), intrusion (β = −0.14, p < 0.01), and avoidance (β = −0.15, p < 0.01), explaining a modest but consistent proportion of unique variance (1–3%). Conclusions: These findings suggest that resilience is a modest but consistent correlate of mental health and post-traumatic stress symptoms among Syrian refugee adolescents in Türkiye. Longitudinal studies incorporating trauma exposure and multi-level resilience resources are needed before causal or intervention-related conclusions can be drawn.
Background/Objectives: School closures and social restrictions during the COVID-19 pandemic substantially disrupted adolescents’ everyday lives. However, much of the existing evidence relies on standardized measures or retrospective accounts, providing less insight into how adolescents themselves described the psychosocial meaning of this disruption while it was still unfolding. This study aimed to explore Hungarian secondary school students’ real-time written reflections on their experiences during COVID-19-related school closures, online education, and social restrictions, with a focus on adolescent mental health, peer connectedness, school belonging, and developmental disruption. Methods: A retrospective qualitative study was conducted using 111 anonymized open-ended student reflections written in 2021 during the active period of online education and social restrictions. The texts were originally produced in a pedagogical-reflective context, not as research interviews or questionnaire responses. The material was analysed using structured qualitative content analysis. Two researchers independently coded the texts; disagreements were resolved through discussion, and a third researcher was involved when consensus was required. Descriptive frequency summaries were used to contextualize the qualitative findings. Results: In the descriptive frequency summaries, negative appraisals were most common in relation to the general pandemic situation, online schooling, and peer relationships. Thematic analysis identified recurring patterns of confinement, loss of normality, reduced peer contact, weakened school routines, academic overload, uncertainty about graduation and the future, and the loss of age-specific adolescent experiences and transition rituals. Family appeared as both a stabilizing resource and, in some cases, a source of conflict or additional burden. A central interpretive theme was that adolescents experienced the pandemic not merely as educational disruption but as an interruption of adolescence itself. Conclusions: The findings highlight that adolescent mental health support during large-scale crises should extend beyond maintaining educational continuity. Early prevention and intervention strategies should preserve peer connectedness, school belonging, daily structure, emotional validation, and developmentally sensitive support during future pandemics or comparable periods of prolonged social restriction.
Background/Objectives: Protein–energy malnutrition is common in children with congenital heart disease (CHD) due to increased metabolic demand and limited oral intake capacity. Achieving adequate protein intake in this population through oral feeding remains a critical yet underexplored challenge. This review aims to synthesize the currently available evidence on protein requirements, barriers to oral intake, and strategies for optimization of protein delivery in children with CHD. Methods: A narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Relevant observational studies, randomized trials, guidelines, and recent reviews addressing nutritional management and oral feeding in pediatric CHD were included. Evidence was synthesized across metabolic, clinical, and practical domains. Results: Children with CHD exhibit increased protein requirements driven by hypermetabolism, inflammation, and perioperative stress, often reaching a requirement of 3–4 g/kg/day in high-risk settings. However, feeding limitations—including fatigue, gastrointestinal dysfunction, and oral motor impairment—restrict intake capacity and contribute to protein inadequacy in this population. Evidence supports the use of nutrient-dense feeding, optimized feeding frequency, food fortification, oral nutritional supplementation, and multidisciplinary care to improve protein delivery efficiency and nutritional status. Conclusions: Achieving adequate protein delivery through oral feeding requires a shift toward targeted, protein-focused strategies that address intake limitations. Early attention to protein adequacy may support nutritional recovery and growth, although its independent effects on postoperative and long-term outcomes remain uncertain. Further research is needed to establish standardized, evidence-based protocols tailored to this population.
Background/Objectives: 18F-FDG PET/CT is increasingly used in pediatric Burkitt lymphoma (BL) for staging and treatment response assessment, but data on quantitative prognostic markers remain limited. Methods: We retrospectively evaluated 33 children with pathologically confirmed BL who underwent baseline and end-of-treatment (EOT) 18F-FDG PET/CT between 2009 and 2024. SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured at baseline and EOT, and the Deauville score (DS) was assigned visually. Progression-free survival (PFS) and overall survival (OS) were estimated with the Kaplan–Meier method; receiver operating characteristic (ROC) analysis identified predictive thresholds. Results: Three-year and 5-year OS was 89.6%, and PFS was 90.1%. The percentage reduction in SUVmax from baseline to EOT (%ΔSUVmax) was the strongest predictor of survival (AUC = 0.94; optimal cutoff ≥ 73.6% reduction; sensitivity 100%, specificity 93%). Patients with an unfavorable EOT DS (4–5) had significantly lower OS than those with a favorable DS (1–3) (60.0% vs. 96.4%; log-rank p = 0.009). Baseline SUVmax, MTV, and TLG did not differ significantly by stage or splenic involvement. Given the small number of survival events (n = 3), the corresponding hazard ratios and confidence intervals should be regarded as exploratory and hypothesis-generating rather than definitive effect sizes. Conclusions: Dynamic metabolic response such as %ΔSUVmax and the EOT Deauville score are promising prognostic markers in pediatric BL. Given the small number of events, these findings warrant validation in larger, prospective cohorts.
Pain in children remains frequently underrecognized and undertreated despite significant advances in pediatric analgesia. The pharmacologic management of pediatric pain is challenging due to developmental differences in pharmacokinetics and pharmacodynamics, variability in drug metabolism, age-dependent responses, and the limited availability of high-quality pediatric clinical trials. This narrative review summarizes current evidence regarding the pharmacologic management of nociceptive, neuropathic, and nociplastic pain in children, integrating developmental pharmacology, efficacy data, safety considerations, and limitations of available evidence. A mechanism-based classification of pain provides a useful framework for therapeutic decision-making; however, clinical conditions often involve overlapping mechanisms requiring individualized and multidisciplinary approaches. Evidence supporting pharmacological interventions varies considerably according to pain type. Acetaminophen and NSAIDs remain the most commonly used agents for nociceptive pain, while opioids retain a role in selected cases of moderate-to-severe pain under careful monitoring. Management of neuropathic and nociplastic pain remains particularly challenging due to limited pediatric trials, frequent off-label prescribing, and reliance on extrapolation from adult populations. Future research should focus on age-specific randomized controlled trials, pharmacokinetic and pharmacogenomic variability, long-term safety outcomes, and integration of pharmacologic treatments within multimodal pain management strategies.
Objective: To evaluate the response of various oxygenation indices to the oxygen challenge test (OCT), prior to decannulation, in neonates supported with VA ECMO for respiratory indications, and to compare these responses between survivors and non-survivors. Design: Single-center retrospective observational study. Setting: Single, tertiary care, 40-bed Pediatric Intensive Care Unit in Miami, Florida. Patients: Neonates cannulated to VA ECMO for respiratory failure from 2012 to 2022 who had an OCT. Patients with congenital heart disease were excluded. Measurements and Main Results: A total of 63 neonates were included, of whom 13 patients died (20.6%). Oxygenation indices compared before and during OCT include PaO2, Delta PaO2, P/F ratios, Alveolar-arterial gradient, arterial/alveolar ratios, and shunt fraction. The Wilcoxon signed-rank test demonstrated increases in all oxygenation indices during OCT compared to pre-OCT, except for P/F ratios. There were no differences in oxygenation indices between survivors and non-survivors during OCT. However, after decannulation, all oxygenation indices were worse in non-survivors (p < 0.05). Linear regression analysis demonstrated that delta FiO2 on the ventilator, P/F before OCT, and ECMO flow during OCT significantly affected PaO2 response during OCT. Shunt fraction above 28.8% after decannulation demonstrated the highest discriminatory ability for mortality (AUC 0.853). Conclusions: The OCT response during ECMO is not a reliable predictor of survival in neonates on VA ECMO, and its value in assessing readiness for ECMO trial-off warrants further evaluation. Further studies investigating the role of oxygenation indices at the time of trial-off for predicting outcomes may be helpful.
Background/Objectives: Problematic internet use (PIU) is a growing behavioral health concern among school-aged children. Whether health literacy and health-promoting lifestyle beliefs are associated with PIU among gifted children—a developmentally distinct population—has, to the best of our knowledge, not been investigated. Methods: A cross-sectional correlational design was used with 118 gifted students (M = 13.80, SD = 2.06) attending a Science and Art Center (BİLSEM) in İzmir, Türkiye. Data were collected using the Problematic Internet Use Scale–Adolescent Form (PIUS-A; α = 0.92), the Health Literacy for School-Aged Children Scale (HLSAC; α = 0.87), and the Adolescent Health-Promoting Lifestyle Beliefs Scale (AHPLBS; α = 0.91) in a classroom setting under researcher supervision. A three-step hierarchical multiple linear regression was performed, with age, sex, daily sleep duration, daily screen time, and weekly physical activity entered as covariates in the first step. Results: Covariates explained 24.8% of the variance in PIU (p < 0.001), with daily screen time as the strongest predictor (β = 0.36). Health-promoting lifestyle beliefs added significant incremental variance (ΔR2 = 0.063, p = 0.023); health beliefs were the only statistically significant belief predictor (β = −0.24, p = 0.036), with lower health belief scores associated with higher PIU. Health literacy domains did not add statistically significant incremental variance (ΔR2 = 0.028, p = 0.495), and no individual domain was a statistically significant predictor. Conclusions: Within the constraints of a cross-sectional design, health beliefs appear to play a more prominent role than health literacy in the covariate-adjusted explanation of PIU among gifted school-aged children. School health nurses may prioritize interventions that strengthen internalized health beliefs alongside information-based education, contributing to more equitable, tailored school health services for this population.
Background: Executive functions (EFs) are cognitive and emotional abilities that underpin goal-directed behavior, decision-making, and problem-solving. EFs can be categorized into two broad types, Hot EFs and Cool EFs, distinguished by their relation to emotional processing. Cool EFs are associated with cognitive control, while Hot EFs involve emotional regulation and decision-making in emotionally charged contexts. EFs contribute to self-regulation, including the ability to adjust behavior in response to feedback. Methods: The aim of this study is to investigate the relationship between Hot (decision-making under uncertainty) and Cool (cognitive flexibility) EFs in middle childhood. To assess these dimensions of EFs, we used two tasks, the Iowa Gambling Task (IGT) and the Wisconsin Card Sorting Test (WCST), completed by children (N = 90) aged 6–12 years. Results: Traditional WCST indices of cognitive flexibility were not associated with IGT performance. Using hierarchical linear regression models, the most significant overlap concerns the negative relationship between post-loss adjustment in the WCST (post-loss reaction time—plRT) and learning across the IGT (learning index—LI). Children who responded faster after negative feedback (plRT ↓) showed greater improvement in advantageous choice over the course of the task (LI ↑). Conclusions: The findings suggest that decision-making in the IGT is more closely linked to dynamic, process-based aspects of self-regulation than to static measures of cognitive flexibility. It can be concluded that the relationship between WCST and IGT during middle childhood is best described as weak, process-specific, and developmentally modulated, indicating that Cool and Hot EFs are partially distinct yet interconnected systems.
Legal definitions of human viability vary worldwide. Background/Objectives: The treatment of periviable newborns remains controversial and raises ethical concerns. However, currently, the World Health Organization (WHO) sets the lower limit of viability at 22 weeks of gestation or 500 g birth weight. The aim of our research was to determine the knowledge of healthcare practitioners in our country regarding this topic, as well as including a course after which we sought to evaluate whether their perceptions regarding the management of these cases changed. Methods: The recruitment of participants encompassed those who voluntarily took part in the survey, and 30 clinicians were included; they participated in a 30 h online course and completed a survey questionnaire before and after the course. Results: After Holm adjustment, we observed an improvement in participants’ perceptions regarding recommendations concerning a multidisciplinary approach, perinatal counseling (20.0% vs. 100.0%), ethical issues (16.7% vs. 93.3%), and awareness of national guidelines (36.7% vs. 100.0%). Moreover, they recognized the importance of including parental wishes in decision-making (Holm-adjusted p = 0.0469), but with clinicians having the final word in the decision. Other factors did not change, with practitioners having knowledge about the serious outcomes of newborns in such challenging situations. Conclusions: Ethically grounded strategies to guide the management of newborns at the limit of viability is of great importance, whereby gestational age is an insufficient parameter. A collaborative, multidisciplinary process is mandatory in order to ensure the best outcomes for the newborn. The value of continuing medical education should be acknowledged.
