Background:Pulmonary aspiration and foreign bodies (PAFB) represent one of the most common pediatric emergencies. The condition shows a marked age-related distribution, with children under five years of age being particularly vulnerable. As the region with the largest pediatric population worldwide, Asia may bear a substantial burden of PAFB; however, large-scale, population-based studies remain scarce. This study aimed to assess the epidemiological burden of pediatric PAFB in Asia from 1990 to 2021 and to provide evidence-based insights for public health policymaking. Methods:Data were obtained from the Global Burden of Disease (GBD) 2021 database, covering incidence, mortality, and disability-adjusted life years (DALYs) related to PAFB among children aged 0-14 years across Asian countries. Descriptive statistical analyses were conducted to examine trends over time. Correlation analyses were performed to explore associations between the sociodemographic index (SDI) and disease burden. The Bayesian Age-Period-Cohort (BAPC) model was used to project future trends in countries including China, India, Japan, and South Korea. Results:In 2021, an estimated 353,768 new PAFB cases occurred among Asian children aged 0-14 years, with an incidence rate of 32.457 per 100,000. A total of 11,159 deaths were reported, corresponding to a mortality rate of 1.024 per 100,000. The burden in terms of DALYs reached 992,887, with a DALY rate of 91.094 per 100,000. Between 1990 and 2021, the estimated annual percentage change (EAPC) was -2.59% for incidence, -3.43% for mortality, and -3.44% for DALYs. Central Asia experienced the highest disease burden, while Southeast Asia had the lowest. A significant negative correlation was observed between the SDI and disease burden. Projections indicate a continued decline in PAFB burden in China, India, Japan, and South Korea through 2035. Conclusions:Over the past three decades, the burden of pediatric PAFB in Asia has significantly declined, though regional disparities persist, with Central Asia remaining the most affected. The strong inverse relationship between the SDI and PAFB burden underscores the importance of socioeconomic development, public health education, and emergency response systems. Projections based on the BAPC model suggest continued improvements in disease burden across the Asia-Pacific region in the coming years.
Background and Objective:Pediatric sepsis is a high-stakes, time-sensitive emergency, yet early recognition in the emergency department (ED) remains inconsistent because presenting features are heterogeneous, early signs are nonspecific, and implementation capacity varies across hospitals. At the same time, evidence for bundle-based care has expanded, but important clinical questions remain regarding which recognition approaches are most reliable in frontline ED settings, which bundle elements are best supported, and why pathway uptake remains uneven. This narrative review was undertaken to address these questions and to clarify current evidence gaps relevant to pediatric emergency practice. Methods:This structured narrative review searched PubMed on March 15, 2026 for studies published from January 1, 2010 through March 15, 2026 using terms related to pediatric sepsis, emergency care, screening, early recognition, sepsis bundles, biomarkers, quality improvement, and digital decision support. We focused on ED-relevant studies addressing recognition strategies, bundle implementation, nursing or workflow processes, and emerging technologies. Titles and abstracts were screened against predefined inclusion and exclusion criteria, and the final literature set was synthesized thematically into recognition, management, implementation, and future-direction domains. No language filter was planned at search design, but the review was limited to studies with accessible English full-text data for analysis. Key Content and Findings:Current evidence supports a layered ED recognition model that combines clinical assessment with structured screening, targeted biomarkers, and workflow-integrated digital support rather than reliance on any single tool. Evidence is strongest for bundle pathways improving process outcomes such as time to antibiotics, pathway activation, and compliance with first-hour care targets. By contrast, evidence for direct mortality benefit, stand-alone biomarker superiority, and routine use of artificial intelligence (AI)-enabled systems remains promising but inconsistent because studies are heterogeneous in definitions, populations, and implementation context. The literature also shows that success in general ED practice depends heavily on pediatric readiness, nursing-led escalation, local workflow design, and multidisciplinary coordination. Conclusions:Pediatric sepsis care in the ED should be organized around rapid recognition plus measurable, context-adapted bundle delivery. The clearest evidence gaps involve external validation of recognition tools in general EDs, more explicit evaluation of individual bundle components, harmonized operational definitions and bundle metrics, and implementation studies that test how digital support and nursing workflows can improve frontline performance.
Background and Objective:Alveolar cleft is a congenital craniofacial anomaly of common occurrence and is frequently seen in cleft lip and palate patients. This condition affects the patient's chewing, speech, and psychological and social life. This review aims to offer a broad overview of the role of artificial intelligence (AI) throughout the entire management of an alveolar cleft from diagnosis to treatment and to life after surgery, in terms of quality of life. Methods:This is a narrative review, and the information was obtained from the literature and clinical guidelines. From the previous publications, we reviewed the advancements in the use of AI for the diagnosis, treatment, and management of alveolar clefts and other fields. Key Content and Findings:In the field of alveolar ridge defects, the applications of AI have been mainly used in combination with cone-beam computed tomography (CBCT). It accurately identifies the extent of the bone defect and calculates the volume of the bone defect from imaging. Moreover, AI can support personalized surgical planning and predict bone resorption and maxillofacial growth patterns. AI and CBCT are shifting the subjective, "experience-driven" qualitative assessment of alveolar clefts to an objective, "data-driven" evaluation that is multidimensional. Conclusions:AI holds significant potential for applications in 3D image analysis, quantitative evaluation, and surgical planning of alveolar clefts, but it is currently hindered by several challenges, such as limited generalizability of models, lack of interpretability, and privacy concerns. Solutions to these problems include advancing towards multicenter standardized databases, federated learning, and model efficiency. The future of alveolar cleft management is expected to be improved with the use of generative AI and digital twins throughout their lifespan, in a personalized way.
Background:Very low birth weight infants often require peripherally inserted central catheter (PICC) for long-term venous access. Conventional securement methods are associated with high rates of catheter dislodgement and skin injury, but the clinical effectiveness and cost-effectiveness of modified combination securement methods remain insufficiently validated. This study aimed to investigate the effects of a novel combination securement method on catheter dislodgement and skin injury in very low birth weight infants (VLBWIs) undergoing PICC placement, and to perform a cost-effectiveness analysis to inform evidence-based selection of the optimal securement strategy. Methods:This retrospective, single-center analysis comprised 181 VLBWIs who underwent PICC placement in the neonatal intensive care unit (NICU) between January 2018 and December 2025. Infants were assigned to either a conventional securement group (conventional group) or a modified combination fixation group (modified group), the latter consisting of four steps: pressure relief protection, tension-free fixation, buffer reinforcement, and sealing coverage (termed 'protection-pressure reduction-fixation-sealing'). A 1:1 nearest-neighbor propensity score matching (PSM) approach was used to balance baseline confounders. After matching, clinical outcomes and direct medical costs were compared between groups, and correlations between cost metrics and clinical outcomes were analyzed. Results:Following matching, baseline characteristics were well balanced between groups, with no significant differences (all P>0.05). The modified group showed significantly lower rates of unplanned PICC removal and skin injury than the conventional group (P=0.02 and P<0.001, respectively). Logistic regression identified the modified securement method as an independent protective factor against unplanned PICC removal in VLBWIs [odds ratio (OR) =0.275, P=0.005]. Moreover, total direct medical cost per PICC placement was significantly lower in the modified group (P<0.001). Conclusions:The modified combination securement method significantly improves clinical outcomes associated with PICC placement in VLBWIs, reduces complication rates, and achieves overall cost savings. Offering both clinical and economic benefits, this approach warrants widespread adoption in the NICU.
Background:Airway hyperresponsiveness (AHR) is a frequent sequela after acute Mycoplasma pneumoniae pneumonia (MPP) in children. This study assessed the association between bronchoalveolar lavage fluid (BALF) leukotriene C4 (LTC4) and MPP, evaluated its predictive value for AHR, and developed an early-identification machine-learning model. Methods:We retrospectively studied 158 children with MPP admitted between January 2023 and December 2024; 20 children undergoing bronchoscopy for airway foreign bodies served as controls. BALF LTC4 was measured by enzyme-linked immunosorbent assay (ELISA). AHR was assessed in 87 patients at a 2-week follow-up (positivity 39.1%) using a composite of clinical and spirometric criteria rather than bronchial provocation testing. Features were selected by least absolute shrinkage and selection operator (LASSO) regression and recursive feature elimination (RFE). Nine machine-learning models, including a support vector classifier (SVC), were compared, and predictions were interpreted with SHapley Additive exPlanations (SHAP). Results:In the matched cohort, BALF LTC4 was higher in MPP than in age- and sex-matched controls (46.14 vs. 10.46 pg/mL, P<0.001). Baseline LTC4 was higher in AHR-positive than AHR-negative patients (80.91 vs. 39.92 pg/mL, P<0.001). LTC4 correlated negatively with follow-up lung function [forced expiratory volume in 1 second (FEV1) percent predicted, FEV1/forced vital capacity (FVC); Spearman's rho =-0.44 to -0.48], whereas C-reactive protein (CRP) and interleukin-6 (IL-6) did not. An SVC using LTC4 and lactate dehydrogenase (LDH) performed best, with a leave-one-out cross-validation area under the curve (AUC) of 0.876 [95% confidence interval (CI): 0.791-0.943], accuracy 81.6%, sensitivity 73.5%, and specificity 86.8%. SHAP analysis indicated LTC4 was the stronger predictor, with a contribution approximately 1.92 times that of LDH. Conclusions:In this retrospective single-center cohort, BALF LTC4 was associated with post-MPP AHR in children and showed greater predictive value than systemic inflammatory markers. A parsimonious SVC based on BALF LTC4 and serum LDH showed encouraging performance, suggesting potential utility for early risk stratification. However, the 55% follow-up rate and selection toward clinically complex patients may have overestimated performance; prospective multicenter validation with more complete follow-up is warranted before clinical implementation.
Background and Objective:Postoperative pain is a prevalent and clinically important issue in pediatric surgery. Poor pain control can hinder recovery, increase distress, and lead to negative short- and long-term outcomes. Due to developmental, physiological and behavioral differences between children and adults, pediatric pain management needs tailored strategies. This review aims to summarize recent evidence on multimodal pediatric postoperative pain management. Methods:A narrative review was conducted to synthesize updated evidence on multimodal analgesic approaches for children undergoing surgery. Literature from 2010 to 2025 was retrieved from PubMed using keywords: pediatric postoperative pain, multimodal analgesia, opioid-sparing care, non-pharmacologic intervention, family-centered care, evidence-based practice and digital health. The review was prepared in accordance with the Narrative Review reporting checklist. Key Content and Findings:Evidence supports non-opioid basic analgesics, regional techniques and standardized perioperative pathways for better pain control and less opioid use. Non-pharmacological and theory-guided interventions [distraction, virtual reality (VR), family engagement, caring nursing] further enhance pain relief and recovery. Future trends focus on implementable models integrating standardized assessment, individualized multimodal therapy, family participation and digital follow-up. Conclusions:Effective pediatric postoperative pain management relies on multidisciplinary cooperation throughout the perioperative period. Family‑centered multimodal strategies with ongoing pain monitoring are essential to reduce opioid‑related side‑effects and facilitate children's holistic recovery.
Background:Heterotaxy syndrome (HS) is a rare and complex congenital disorder characterized by abnormal development of the left-right axis and heterogeneous cardiovascular malformations. HS is associated with substantial morbidity and mortality, posing significant clinical challenges. Despite surgical advances, global research trends in HS remain poorly characterized. This study aimed to systematically analyze the global research landscape of HS from 2006 to 2025 using bibliometric methods, identify emerging themes, and highlight areas of clinical relevance. Methods:Publications on HS published from 2006 to 2025 were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using CiteSpace and VOSviewer to assess publication trends, collaboration networks, journal distributions, and research hotspots. Results:A total of 493 publications involving 2,548 authors from 184 journals were included. Overall, publication output increased over time, peaking in 2022. The United States was the leading contributor to research productivity. Harvard Medical School and Boston Children's Hospital were the leading institutions. Anderson RH was identified as the most prolific author, whereas Cardiology in the Young was the most productive journal in this field. Keyword and co-citation analyses revealed a transition from anatomical classification and staged surgical palliation toward genetic mechanisms, prognostic assessment, and long-term outcome evaluation. Conclusions:HS research remains in an evolving stage of development. This study outlines emerging research directions and thematic trends as the first bibliometric analysis in this field. These findings provide clinicians and researchers with a clearer understanding of the current research landscape and may serve as a reference for future investigations aimed at improving the management and outcomes of patients with HS.
Background:Chlamydia pneumoniae pneumonia (CPP) is a common respiratory disease in children after the coronavirus disease 2019 (COVID-19) pandemic. Some may develop severe complications and augment the health burden on children. This study aims to analyze the epidemiological and clinical characteristics of children with CPP and explored the associated factors for severe Chlamydia pneumoniae pneumonia (SCPP). Methods:Based on the diagnostic criteria of severe community-acquired pneumonia (CAP) defined by the 2024 revised Guidelines for the management of CAP in children, we consecutively enrolled hospitalized children with CPP from January 2022 to December 2025. We retrospectively collected the clinical data of 121 children diagnosed with CPP and divided them into severe and non-severe groups. Univariate analysis was performed to explore the potentially relevant indicators associated with SCPP occurrence. Subsequently, meaningful indicators were subjected to multivariate logistic regression analysis to screen for independent clinical correlates for SCPP. Results:A total of 6,137 hospitalized children were enrolled in this study, among whom 121 cases were diagnosed with CPP, with a total positive rate of 1.97%. The proportion of CPP among the total hospitalized showed a significant annual increasing trend (rising from 1.53% to 6.81%). The significant difference was observed among different seasons (χ2=3.516, P=0.06). Comparisons between different genders showed no statistical difference. The mean age of CPP children was 9.67±3.32 years, with the highest incidence observed in 12-14 years (positive rate:14.23%). The main clinical manifestations were paroxysmal cough and fever. Besides, pulmonary and extrapulmonary complications occurred in 32 cases (26.45%) and 13 cases (10.74%) respectively; and 79 samples were found positive detection of other pathogens. Multivariate analysis indicated that neutrophil percentage (N%) [odds ratio (OR) =1.066, P=0.02], complement 4 (C4) (OR =1,251.898, P=0.03), immunoglobulin E (IgE) (OR =1.001, P=0.03), and the imaging findings predominantly characterized by consolidation (OR =31.106, P=0.03) are the independent clinical correlates for SCPP in children. Conclusions:Following the COVID-19 pandemic, the overall incidence of CPP among children in Shanghai remained at a relatively low level, but it exhibited a clear annual increasing trend with the highest prevalence occurred in spring and school-aged children that aged 12-14 years were particularly susceptible. The majority of symptoms were fever and cough. CPP is also prone to concurrent infections with other pathogens, and a higher proportion of severe cases were observed. In children with CPP, N% >57.45%, C4 >0.28 g/L, IgE >102.40 IU/mL, and the imaging changes predominantly manifested as pulmonary consolidation may be the critical condition alerts of SCPP.
Background:Hepatoblastoma and retinoblastoma, two common extracranial embryonal tumors, are the most prevalent primary cancer of liver and eye in childhood, respectively. Despite high survival in high-income regions, outcomes remain extremely poor in low-income regions, underscoring global health inequities and the need for evidence-based resource allocation. To address this gap, we explored the global, regional, and national burden of the two diseases from 1990 to 2021 and projected trends until 2050. Methods:We extracted data on incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) of hepatoblastoma and retinoblastoma by age, sex, region, and country from the Global Burden of Disease (GBD) 2021 database. Age-standardised rates (ASRs) with 95% uncertainty intervals (UIs) and estimated annual percentage changes (EAPCs) were calculated to measure disease burden and trends. Spearman correlation analysis was applied to evaluate the association between the socio-demographic index (SDI) and disease burden. The Bayesian age-period-cohort (BAPC) model was utilized for projections. Results:From 1990 to 2021, ASRs of incidence, prevalence, deaths, and DALYs of hepatoblastoma decreased significantly (EAPCs: -2.03, -1.84, -2.54, -2.53, respectively). For retinoblastoma, the ASRs of incidence and prevalence first increased until 2019 and then decreased, yet exhibited overall upward trends (EAPCs: 1.35 for incidence, 1.36 for prevalence). However, the deaths and DALYs of retinoblastoma went downward. The combined burden of both cancers also declined from 1990 to 2021. Disease burden peaked at age 0-6 days for hepatoblastoma, and at 0-6 days and 2-4 years for retinoblastoma. In low SDI regions, ASRs of deaths and DALYs of retinoblastoma were higher than those of hepatoblastoma. V-shaped associations were seen between SDI and both ASRs of incidence and prevalence of hepatoblastoma (incidence: r=-0.241, prevalence: r=-0.159) and retinoblastoma (incidence: r=0.221, prevalence: r=0.224) from 1990 to 2021. The deaths and DALYs of both cancers declined with increasing SDI. Positive correlation was found between SDI and EAPCs of ASRs of hepatoblastoma and retinoblastoma from 1990 to 2021 (all r>0), except for those of retinoblastoma deaths and DALYs which were negatively correlated with SDI (deaths: r=-0.282, DALYs: r=-0.192). Projections suggested hepatoblastoma burden would decline globally but rise in America, while retinoblastoma incidence and prevalence would increase globally. Conclusions:Despite decreased global burden of hepatoblastoma, retinoblastoma incidence and prevalence increased. Besides, substantial age-related, regional and socioeconomic disparities existed. Predictions showed decreasing hepatoblastoma burden, but rising retinoblastoma cases. Targeted strategies are needed, especially in low SDI regions, including antenatal examination, early screening, genetic counseling, environmental and nutritional improvements, and international collaboration to strengthen healthcare training, referral networks, and multidisciplinary consultation to reduce disparities and promote children health.
Background:The relationship between advanced bone age (BA), obesity, and vitamin D status remains understudied in preschool Asian children, particularly in economically developing regions. This study examined the associations of overweight/obesity and vitamin D deficiency with advanced BA among children in northwest China. Methods:A cross-sectional study was conducted involving 1,462 children aged 3-12 years who underwent physical examinations at Gansu Provincial Maternity and Child-Care Hospital (February 2019-October 2023). BA was assessed via left wrist X-ray using the Tanner-Whitehouse 3 (TW3) RUS (radius, ulna, and short bones) method, with inter-rater reliability verified by an intraclass correlation coefficient (ICC) of 0.92 (discrepancies resolved by a third senior pediatrician). Serum 25-hydroxyvitamin D [25(OH)D] was measured using electrochemical luminescence immunoassay [Cobas e601, Roche Diagnostics; detection range: 3-100 ng/mL; intra-batch coefficient of variation (CV) <3%; inter-batch CV <5%]. Advanced BA was defined as the difference between BA and chronological age (CA) (BA-CA; BA minus CA) >1 year. The definition of advanced BA as BA-CA >1 year is widely adopted in clinical pediatric practice in China. Results:The prevalence of advanced BA was 7.9%, with significantly higher rates in girls (11.9% vs. 3.4% in boys, P<0.001), children aged 9-12 years (19.4%), and those with overweight (17.1%) or obesity (16.9%) compared to normal weight children (5.8%, P<0.001). Body mass index (BMI) was positively correlated with advanced BA (Spearman ρ=0.361, P<0.001) and exhibited moderate predictive value for advanced BA [area under the curve (AUC) =0.735; 95% confidence interval (CI): 0.684-0.786]. Overweight and obesity were associated with increased odds of advanced BA after adjustment for age and sex [overweight: odds ratio (OR) =2.49, 95% CI: 1.435-4.314, P<0.05; obesity: OR =2.33, 95% CI: 1.463-3.71, P<0.001], whereas serum 25(OH)D levels showed no significant association. Conclusions:Overweight and obesity were significantly associated with advanced BA in this cross-sectional cohort of children from northwest China, whereas no significant association was detected between serum 25(OH)D and advanced BA. These findings highlight the importance of nutritional monitoring for healthy skeletal development in economically transitioning regions.
Background:N6-methyladenosine (m6A), 5-methylcytosine (m5C) and N1-methyl-adenosine (m1A) are among predominate forms of RNA methylations implicated in the progression of cancer. The study aims to dissect the associations of m6A/m1A/m5C genes with survival, tumor microenvironment (TME) and predicted immunotherapy response in pediatric patients with acute myeloid leukemia (AML). Methods:RNA sequencing (RNA-seq) data were downloaded from Xena database. Differentially expressed m6A/m1A/m5C genes were filtered between dead and alive samples. Least absolute shrinkage and selection operator (LASSO) cox regression analysis was used to identify optimal prognostic genes and construct a risk-score model. TME characteristics and immunotherapy response were analyzed across different risk subgroups. Results:Twenty-five differentially expressed m6A/m1A/m5C genes were identified. Eight optimal prognostic genes were selected via LASSO and an 8-gene-based prognostic model was built. It effectively distinguished high- from low-risk patients [survival difference: P value =6.328e-07, area under the curve (AUC) value =0.861 (0.820, 0.778)], with valid verification in a validation dataset [survival difference: P value =2.677e-02, AUC value =0.774 (0.625, 0.833)]. The risk score was an independent prognostic factor and a composite nomogram could more accurately predict survival probability. Low-risk patients had significantly higher levels of monocytes and lower tumor purity compared to high-risk patients. A trend toward differential risk scores was observed between predicted immunotherapy responders and non-responders. ZC3H13, NSUN2, METTL16, TRMT10C and DNMT3B, and TRMT6 possessed stronger correlations with tumor purity. Conclusions:We propose an 8-gene prognostic signature related to m6A/m5C/m1A and a risk-score model for assessing prognosis in pediatric AML. These genes may serve as promising preliminary prognostic biomarkers and warrant further exploration as potential immunotherapy targets for pediatric AML, pending validation in larger-scale prospective cohorts.
Background:Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity, and macrophages are increasingly recognized as important drivers of lung injury and repair. We therefore performed a bibliometric analysis to map research trends, key contributors, and evolving hotspots in macrophage-related BPD research. Methods:We searched the Web of Science Core Collection (WoSCC) on December 5, 2025, using topic terms for BPD/ventilator-induced lung injury and macrophage-related keywords, and included English-language original research articles published from January 1990 to December 2025. VOSviewer, CiteSpace, and the R package bibliometrix were used to analyze publication trends, collaboration networks, keyword co-occurrence clusters, and burst keywords. Results:A total of 587 original research articles from 1990 to 2025 were included. Annual publications rose from fewer than 5 before 1995 to a peak of 30 in 2020, showing steady linear growth. The USA led in output (217 articles, 37.0%), followed by China (123, 21.0%) and Germany (45, 7.7%). The University of Toronto (104 articles) and Harvard University (78 articles) were the most productive institutions. The top journal was American Journal of Physiology-Lung Cellular and Molecular Physiology (70 articles, h-index =37). Leading authors included Li Li-Fu (11 articles) and Jankov Robert P. (10 articles). Keyword network and temporal analyses revealed a thematic shift from early emphasis on ventilator-associated injury and classical inflammatory mediators toward developmental biology, gene regulation, cellular heterogeneity, and pulmonary vascular disease, with recent bursts highlighting NF-κB signaling, pulmonary hypertension, inflammation, and BPD. Conclusions:Macrophage-related BPD research has shifted from early work on general inflammation and injury to more recent studies emphasizing gene regulation, signaling pathways, and pulmonary vascular complications. Key needs include stronger integration of human data with animal models, improved data standardization, and broader collaboration. Future studies should combine multi-omics with clinical outcomes to support immune-targeted and precision approaches for neonatal lung disease.
Background:There is still a lack of a noninvasive, individualized tool to pre-screen children with obesity for the risk of non-alcoholic fatty liver disease (NAFLD) and to prioritize referral for confirmatory abdominal ultrasonography. In this study, we aimed to develop and interpret a machine learning (ML)-based model for predicting ultrasound-defined NAFLD risk among children with obesity using routine clinical and biochemical indicators. Methods:This single-center retrospective study included 439 obese children treated at Siyang Hospital between February 2021 and December 2025. Demographic, anthropometric, and routine laboratory indicators were collected, and ultrasound-defined NAFLD was used as the study outcome. Least absolute shrinkage and selection operator (LASSO) regression and the Boruta algorithm were applied to identify robust predictive features, and six ML models-logistic regression, decision tree, random forest, extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and support vector machine (SVM)-were developed and compared to determine the optimal model. Model performance was evaluated in the test set, and Shapley Additive exPlanations (SHAP) was used to interpret the final model. Results:A total of 439 obese children were included in the analysis, of whom 206 (46.9%) had ultrasound-defined NAFLD. Seven variables were selected to develop six ML models. Among these, the LightGBM model showed the best overall performance across multiple metrics, with comparable discrimination among the top models in the test set, with an area under the curve (AUC) of 0.870, accuracy of 0.823, precision of 0.828, sensitivity of 0.787, specificity of 0.855, and F1 score of 0.807. SHAP analysis further demonstrated that waist-to-height ratio contributed most to the model output, followed by body mass index (BMI), triglyceride-glucose index × waist circumference (TyG-WC), serum uric acid, and triglyceride-glucose index × body mass index (TyG-BMI). Conclusions:This study developed an interpretable ML-based model for predicting ultrasound-defined NAFLD risk in obese children using routine clinical and biochemical indicators. LightGBM showed the best overall predictive performance, with good calibration and potential clinical utility. It may serve as a noninvasive auxiliary tool to pre-screen children with obesity and prioritize referral for confirmatory abdominal ultrasonography, supporting early identification and risk assessment of ultrasound-defined NAFLD, although further multicenter prospective studies and external validation are still needed before broader clinical application.
Background:Sudden infant death syndrome (SIDS) remains a leading cause of infant mortality. The neonatal period, as a distinct stage within infancy, has been a focus due to its associated mortality burden. We evaluated the global mortality burden and temporal trends of neonatal SIDS attributable to each risk factor from 1990 to 2021, assessed socioeconomic inequalities across these risk factors, and projected these trends through 2035. Methods:Data on neonatal SIDS deaths and the proportions attributable to risk factors were obtained from the Global Burden of Disease (GBD) 2021 study. Temporal trends in mortality rates were assessed using the average annual percent change (AAPC), socioeconomic inequalities were evaluated using the slope index of inequality (SII) and the concentration index, and future mortality burden through 2035 was projected using autoregressive integrated moving average (ARIMA) models. Results:Behavioral risks, child and maternal malnutrition, and low birth weight and short gestation were the leading contributors to neonatal SIDS mortality, with the burden concentrated in lower sociodemographic index (SDI) regions. Between 1990 and 2021, mortality attributable to these risk factors declined globally but remained unevenly distributed across socioeconomic groups. Inequality analyses indicated a persistent concentration of deaths in disadvantaged settings. Projections to 2035 suggest continued declines for most risk factors, although environmental risks may decrease more slowly. Conclusions:SIDS in the neonatal period remains a major global health challenge, particularly in low-SDI regions. Interventions targeting behavioral risks, child and maternal malnutrition, and low birth weight and short gestation are urgently needed.
Background:Gonadotropin releasing hormone analogs (GnRHa) are recommended for both central precocious puberty (CPP) and early and fast puberty, but their benefit on final adult height in later onset cases remains controversial. Boennuokang® leuprorelin acetate microspheres, the first domestic generic formulation, have been approved for CPP, but evidence in early and fast puberty girls is still limited. Considering the complexity of clinical management in early and fast puberty, more real-world studies are needed. Therefore, this study aimed to explore the effect of Boennuokang® leuprorelin acetate microspheres on hypothalamic-pituitary-gonadal (HPG) axis and predicted adult height (PAH) in early and fast puberty girls. Methods:This real-world, single-arm, retrospective cohort study consecutively enrolled 198 early and fast puberty girls treated with Boennuokang® leuprorelin acetate microspheres at The First Bethune Hospital of Jilin University between January 2022 and November 2023. Early and fast puberty was defined as pubertal onset after the diagnostic age cutoff for CPP, accompanied by progression to the next Tanner stage within 6 months and bone age (BA) advancement exceeding chronological age (CA) progression. Baseline variables were collected from the electronic medical record. Tanner stage was assessed by pediatric endocrinologists, sex hormones were measured using standardized biochemical assays, uterine length was evaluated by pelvic ultrasonography, BA was assessed using the Greulich Pyle method, and PAH was calculated using the Bayley-Pinneau method. Follow-up assessments were performed at baseline (T0) and at 3 (T1), 6 (T2), 12 (T3), and 18 (T4) months. Longitudinal changes were analyzed using repeated measures analysis of variance (ANOVA) or Friedman tests. Results:The mean CA and BA of girls were 9.73±0.99 and 12.08±0.82 years, respectively. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol decreased after 18 months of treatment (all P<0.001). Specifically, the median [quartile 1 (Q1)-quartile 3 (Q3)] LH decreased from 2.7 (2.23-3.51) mIU/mL at T0 to 0.66 (0.48-1.22) mIU/mL at T4; the median (Q1-Q3) FSH decreased from 5.27 (4.82-6.10) mIU/mL at T0 to 2.00 (1.56-2.42) mIU/mL at T4; the median estradiol decreased from 163.50 (129.00-195.00) pmol/L at T0 to 36.70 (36.70-36.70) pmol/L at T4. Of note, the proportions of girls in the Tanner stage B5 exhibited a decreasing trend over time. The length of uterus decreased after 18 months of treatment (P<0.001). BA/CA ratio (P<0.001) and growth velocity (P=0.002) decreased over time. PAH increased, and loss in growth potential [genetic target height (GTH) minus PAH] decreased over time (both P<0.001). Body mass index initially increased after 3 months of treatment, then showed a reducing trend until month 18 (P=0.005). Conclusions:Boennuokang® leuprorelin acetate microspheres are associated with suppression of the HPG axis and increased PAH in early and fast puberty girls.
Background:Postoperative delirium (POD) is a common complication after pediatric general anesthesia, impairing recovery. While vitamin D deficiency (VDD) is linked to POD in adults, its role in children remains unclear. This study investigates the association between preoperative 25-hydroxyvitamin D3 [25(OH)D3] levels and POD in children undergoing laparoscopic surgery under general anesthesia. Methods:This single-center retrospective study enrolled 320 pediatric patients. Demographic, surgical, anesthetic, and laboratory data were collected. Preoperative serum 25(OH)D3 was measured, and POD was assessed using the Cornell Assessment of Pediatric Delirium (CAPD) scale on postoperative days 1, 3, and 7. Meanwhile, patients were categorized into VDD (<30 ng/mL) and non-VDD (≥30 ng/mL) groups. Multivariable logistic regression identified independent risk factors for POD. Results:The incidence of POD was 80.3% (257/320) based on the CAPD score ≥9. POD patients had significantly lower serum 25(OH)D3 levels (P<0.05). In multivariable analysis, preoperative VDD was independently associated with a significantly higher risk of POD [adjusted odds ratio (OR) =14.25; 95% confidence interval (CI): 3.33-61.0; P<0.001]. A sensitivity analysis incorporating postoperative sleep quality [Children's Sleep Habits Questionnaire (CSHQ) score] confirmed the robustness of this association (OR =8.15; 95% CI: 1.88-35.3; P=0.005). The area under the receiver operating characteristic (ROC) curve for 25(OH)D3 in identifying POD was 0.613. Conclusions:Preoperative VDD is independently associated with a substantially increased risk of POD in pediatric patients undergoing general anesthesia for laparoscopic surgery. Preoperative screening for VDD may help identify at-risk children, and randomized controlled trials are warranted to evaluate whether preoperative vitamin D supplementation reduces POD incidence.
Background:Pertussis is a globally prevalent infectious disease caused by Bordetella pertussis. Although extensive research has examined pertussis in children, studies specifically focusing on infants aged less than 3 months remain limited. The aim of this study was to analyze the clinical characteristics of pertussis and the risk factors associated with severe pertussis in infants aged less than 3 months. Methods:Clinical data from infants aged less than 3 months who were hospitalized with pertussis were retrospectively analyzed. Multivariate logistic regression analysis was conducted to determine risk factors for severe pertussis. Results:This study included 205 infants aged <3 months with pertussis who were hospitalized at a provincial‑level tertiary referral center for pediatric infectious diseases in Anhui, China, between July 2021 and August 2025. The median age at disease onset was 59.0 [interquartile range (IQR), 40.5-73.0] days. Among 205 infants, the incidence of severe disease was 13.2% (27 cases). Compared with the non-severe group, the severe group demonstrated statistically significant differences in the presence of cyanotic episodes, whooping cough, fever, maximum white blood cell (WBC) count >30×109/L, and concurrent pulmonary consolidation (χ2=20.523, 5.52, 8.376, 35.194, and 21.446; all P<0.05). Multivariate logistic regression analysis indicated that fever [odds ratio (OR) =6.874, 95% confidence interval (CI): 2.155-21.931], whooping cough (OR =0.155, 95% CI: 0.032-0.764), cyanotic episodes (OR =18.82, 95% CI: 4.013-88.252), maximum WBC count >30×109/L (OR =15.755, 95% CI: 1.650-150.437), and pulmonary consolidation (OR =7.772, 95% CI: 1.376-43.908) were independently associated with severe pertussis. Conclusions:In infants aged less than 3 months with pertussis, the incidence of severe disease is 13.2% in this cohort. Fever, cyanotic episodes, a maximum WBC count >30×109/L, and pulmonary consolidation are independently associated with an increased risk of severe pertussis, whereas whooping cough is associated with a lower risk of severe disease.
