Background and Objectives: To analyze the complications and associated risk factors after neonatal necrotizing enterocolitis (NEC) treated with ileostomy, and to determine the importance of clinical care and treatment. Methods: A retrospective study was performed on 95 infants who underwent ileostomy for NEC in our hospital from January to December 2020. Follow-up data were collected to analyze gestational age, prematurity, stoma duration, weight gain, and postoperative complications. Univariate and logistic regression analyses were used to identify risk factors for complications. Results: Among 95 infants, 3 preterm infants died due to pneumoperitoneum with multiple organ failure, 1 discontinued treatment due to multiple malformations and social factors, and 3 were lost to follow-up. Of the 88 infants followed, 67 (76.14%) had complications, including 35 (39.77%) with >= 3 complications. The most common complications were electrolyte disorders (59.1%), peristomal dermatitis (55.7%), liver function abnormalities (40.9%), malnutrition (39.8%), parastomal hernia (18.2%), intestinal failure (18.2%), stoma retraction (11.4%), and stoma prolapse (5.7%). All 88 infants underwent stoma closure with 100% survival. Univariate analysis showed that stoma duration, parenteral nutrition duration, and weight gain were associated with complications (P < 0.05), but not sex, prematurity, or surgical weight (P > 0.05). Logistic regression confirmed these as independent risk factors. Conclusions: Neonatal ileostomy for necrotizing enterocolitis is characterized by a notably high incidence of postoperative complications, with a substantial proportion of infants experiencing three or more concurrent issues - a pattern distinct from that observed in adult stoma patients. The predominant complications include electrolyte disturbances, peristomal dermatitis, hepatic dysfunction, and malnutrition. These findings warrant considerable clinical attention, and the implementation of targeted interventions is essential to mitigate their occurrence.

ObjectiveInvestigate the current status of family management styles among families of children aged 1–7 years with bronchial asthma and analyze influencing factors to provide a basis for developing intervention strategies.MethodsA cross-sectional questionnaire survey was administered between February and December 2024 to 257 pediatric patients with physician-diagnosed asthma and their primary caregivers at a tertiary care children's hospital in Zhejiang, China. The family management styles of children with asthma and their influencing factors were assessed using a general information questionnaire, the Childhood Asthma Control Test (C-ACT, for children aged five and above), the Test for Respiratory and Asthma Control in Kids (TRACK, for children under five), and the Family Management Scale for Children with Asthma.ResultsThe Family Management Scale for Children with Asthma scores were (239.30 ± 20.38) points, above average. Univariate analysis revealed that the child's nutritional status and the caregiver's educational level significantly influence asthma management styles (P < 0.05). Multiple linear regression analysis found child's wasting was associated with higher FMSCA scores (Beta = 0.16, P < 0.05), indicating better management styles. However, child's obesity was associated with lower scores (Beta = −0.13, P < 0.05), indicating worse management styles. Regarding educational level, caregivers with junior high school education or below were associated with lower scores (Beta = −0.19, P < 0.05) compared to those with junior college qualifications, indicating worse management styles.ConclusionThe family management style for pediatric asthma patients (children aged 1–7 years) was adaptive and primarily influenced by the child's nutritional status and the caregiver's level of education. Specifically, child's obesity and a caregiver education level of junior high school or below were associated with worse family management styles, whereas child's wasting was linked to better family management styles.

Background: A dedicated pediatric intravenous therapy team may improve the quality, safety, and efficiency of vascular access care by centralizing specialized nursing expertise, standardizing technical procedures, and enhancing complication management. Objectives: This study aimed to describe the establishment and management of a dedicated pediatric intravenous therapy team at a single children's hospital and to report observed changes in service quality and efficiency over a 5-year period using a retrospective before-and-after observational design. Methods: The team was established in 2019. Management strategies included role definition, eligibility criteria, workflow standardization, and performance-based incentives. Indicators of service volume, puncture success rate, complication rate, and regional influence were compared descriptively between the preimplementation and postimplementation periods from 2019 to 2024. Results: After the team was established, the compound annual growth rate of outpatient maintenance procedures reached 44.5%, and the success rate of ultrasound-guided puncture exceeded 98%. The catheter-related infection rate declined to < 1‰. The mean satisfaction rate among pediatric patients and their parents was 99.3%. Although the total number of complications during in-hospital consultations decreased, exudation/bleeding at the PICC puncture site emerged as a new management priority, accounting for 35.3% of complications in 2024. Out-of-hospital consultations rebounded by 80.0% in 2024, and the team provided systematic training to 18 visiting nurses. Conclusions: In this single-center before-and-after observational study, the implementation of a dedicated pediatric intravenous therapy team was associated with improvements in observed nursing quality and efficiency. This model provides a practice-based reference for specialized pediatric nursing management; however, its causal effectiveness requires validation through more rigorous study designs.

BACKGROUND:Physical activity participation among children with asthma is highly variable and cannot be explained by disease severity alone. Understanding distinct patterns of activity engagement and their underlying mechanisms may help inform more tailored support strategies. OBJECTIVE:To identify distinct physical activity profiles in children with asthma and to explore the lived experiences and family processes underlying these profiles using a mixed-methods design. METHODS:An explanatory sequential mixed-methods study was conducted in two phases. In the quantitative phase, 243 children with asthma aged 6-17 years were consecutively recruited between March 2024 and February 2025 from respiratory outpatient clinics of two tertiary hospitals in Zhejiang Province, China. Measures assessed physical activity, asthma control, breathlessness-related fear, perceived physical competence, and parental activity support. Person-centered profile modeling was used to identify distinct profiles. In the qualitative phase, 16 child-parent dyads (4 per profile) were purposively selected for semi-structured interviews between June and September 2025. Joint display analysis was used to integrate quantitative patterns with lived experiences. RESULTS:Four distinct profiles were identified. Profile 1, Fearful Avoiders (14.4%), showed the lowest activity, poorest asthma control, highest symptom fear, and lowest physical competence; qualitative findings suggested a self-reinforcing cycle of fear, avoidance, and reduced confidence. Profile 2, Unsupported Potentials (15.6%), showed predominantly moderate activity, the lowest parental support, and predominantly partial asthma control; interviews suggested that symptom stability was often interpreted as "good enough," leading families to disengage from active lifestyle support. Profile 3, Struggling Strivers (21.4%), maintained moderate activity despite elevated symptom fear and intermediate psychosocial outcomes; qualitative data suggested that activity was often sustained under peer and family pressure rather than through genuine confidence. Profile 4, Supported Thrivers (48.6%), demonstrated the most favorable pattern, with higher activity, better asthma control, lower fear, stronger perceived competence, and greater parental support. External validation supported the clinical relevance of the profiles, with significant between-profile differences in depression, anxiety, quality of life, and exercise adherence (all p < .001). CONCLUSION:Physical activity participation in children with asthma appears to be shaped by interacting physiological, psychological, and family processes rather than by disease severity alone. Similar activity levels may reflect very different underlying mechanisms, including disengagement, fear-driven persistence, or adaptive self-management. These findings suggest that support for physical activity in pediatric asthma may need to be tailored to profile-specific behavioral and family mechanisms.

Objective:To investigate the present state of adherence to subcutaneous specific immunotherapy (SCIT) in children sensitized to dust mites, explore the factors contributing to the cessation of SCIT in this demographic, and provide scientific evidence aimed at improving compliance and efficacy of SCIT in pediatric patients. Methods:A retrospective analysis was conducted on clinical data of pediatric patients who received treatment at our desensitization center between January 2017 and December 2023. These children exhibited sensitivity to dust mites and were diagnosed with allergic asthma, allergic rhinitis, or other allergic diseases, subsequently undergoing SCIT therapy. The fulfillment of the SCIT regimen was evaluated, and the factors contributing to treatment cessation were analyzed. Results:A total of 680 children were included in the study. Of these, 424 children (62.35%) successfully completed the entire treatment regimen (total course ≥3 years), whereas 256 children (37.65%) chose to discontinue the treatment prematurely (total course <3 years). The reasons for the cessation of SCIT, ranked from most to least common, included efficacy issues (54.69%), drug intolerance (18.75%), family-related factors (10.94%), the repercussions of the COVID-19 pandemic (6.64%), influence from other diseases (6.25%) and various other reasons. The primary reason for discontinuation within the first month was family factors (46.15%), while within six months, it was drug intolerance (40.82%), and after 6 months, efficacy issues (68.04%) became the leading cause. Conclusion:The uncertain efficacy and intolerance to the medication predominantly hinder compliance with SCIT in children, while family factors serve as the main reason for discontinuation within the first month. By enhancing parental comprehension and awareness of SCIT, standardizing operational protocols, and promptly addressing any adverse reactions, compliance with SCIT could be significantly improved.

The expanding use of Artificial Intelligence(AI) in healthcare raises ethical concerns that necessitate assessing nurses' awareness with valid instruments. The Nurses' AI Ethical Awareness Scale (NAIEA) was specifically developed to address this requirement. This study examines the reliability and validity of the Chinese version (NAIEA-C) to establish it as a practical instrument. To examine the reliability and validity of the Chinese version (NAIEA-C) to establish it as a practical instrument. The NAIEA was translated and adapted following an enhanced version of the Brislin model. A convenience sample of 423 nurses was recruited from five Chinese provinces (Zhejiang, Guangdong, Sichuan, Jiangsu, and Yunnan) between March and July 2026. Participants completed a general questionnaire and the NAIEA-C. The total sample was randomly split into two: Sample 1 (n = 211) for an Exploratory Factor Analysis (EFA) and Sample 2 (n = 212) for a Confirmatory Factor Analysis (CFA). Descriptive statistics, internal consistency, reliability, and regression of the NAIEA-C scores were conducted using the total sample. The reliability of the instrument was verified using Cronbach’ s α. The final NAIEA-C comprised 21 items and had a three-factor structure. Internal consistency was high (Cronbach’ s α = 0.959). The EFA accounted for 76.839% of the variance, and the CFA confirmed a good model fit with factor loadings ranged from 0.83 to 0.93. The I-CVI for each item was 1.00. The Chinese version of the NAIEA-C demonstrates good reliability and validity and is suitable for assessing nurses’ AI ethical awareness. This study was conducted in accordance with the Declaration of Helsinki. The research protocol was reviewed and approved by the Institutional Review Board of the Children's Hospital of Zhejiang University School of Medicine (Approval No. 2026-IRB-0171-P-01).

Background: Childhood cancers, though relatively rare, are a leading cause of disease-related death in children. Chemotherapy, which requires central venous access devices [peripherally inserted central catheters (PICCs)or implantable venous access ports (PORTs)], is fundamental. However, the child’s perspective is often overlooked in device selection. Objectives: This study aims to understand the current status and influencing factors of shared decision-making (SDM) regarding venous access selection from the perspectives of children with cancer and their parents and to explore the facilitators and barriers to children’s participation in SDM, so as to provide evidence for promoting pediatric involvement in clinical decision-making. Methods: A qualitative interview study was conducted using purposive sampling. Twelve children hospitalized in hematology and oncology departments and 14 parents were recruited between May and July 2025. Semi-structured interviews were performed, and the data were analyzed using a grounded theory (GT) approach for coding, category development, and theme extraction. Results: Children’s participation in SDM was influenced by multiple interacting factors. Insufficient information; limited communication with parents or physicians; concerns about decision outcomes; and fear of pain or discomfort led children to adopt passive acceptance or indifference. Conversely, desires for more information, respect, and being heard motivated active engagement. Children’s preferred decision-making approaches varied, including parent-led, physician-led, and shared models. Parental perceptions of their child’s age, maturity, and decision-making capacity directly determined whether they supported the child’s involvement. These perceptions shaped parents’ attitudes, ranging from protective to autonomy-supporting, which in turn influenced their chosen decision-making approach and ultimately determined whether children were genuinely included in the process. Conclusions: This study reveals that SDM regarding venous access in children with cancer is a complex process shaped by the interplay of child, parent, and clinical factors. Although children express a desire to participate, their preferred level of involvement varies and is often limited by information gaps, communication barriers, and psychological concerns. Parental attitudes critically influence whether children are genuinely included. By capturing the perspectives of both children and parents, this study identifies key barriers and facilitators, offering a foundation for developing inclusive, age-appropriate SDM models and communication strategies in pediatric oncology practice and future research.

OBJECTIVE:This cross-sectional study examined asthma control levels in children aged 1-7 years with asthma, while evaluating the potential associations between family management and caregiver social support with asthma control outcomes in this pediatric population. DESIGN:A cross-sectional study. METHOD:A cross-sectional questionnaire survey was administered between February and December 2024 to 257 children (aged 1-7 years) with physician-diagnosed asthma and their primary caregivers at a tertiary care children's hospital in Zhejiang, China. General information questionnaires, along with the Childhood Asthma Control Test (for children aged five and above) and the Test for Respiratory and Asthma Control in Kids (for children under five), the Family Management Scale for Children with Asthma, and the Social Support Rating Scale, were employed to examine the impacts of family management and social support on pediatric asthma control. RESULTS:The asthma control rate was 39.69%. Four dimensions showed significant correlations with asthma control: children identity, view of condition, and future expectation in the Family Management Scale for Children with Asthma scale; along with subjective support in the Social Support Rating Scale scores. CONCLUSION:This study demonstrated that asthma control was suboptimal among asthmatic children aged 1-7 years in China. Further analysis revealed that asthma control correlated with multiple caregiver-related factors, including their disease-specific attention, beliefs regarding etiology, perceived severity and disease course, and perceptions of the disease's impact on the child's future and family well-being. Additionally, the external emotional support received by caregivers emerged as a significant determinant of asthma nursing outcomes. IMPACT:This study elucidates the role of family management and social support in asthma control among young children, revealing that sub-optimal asthma control is significantly associated with caregivers' proficiency in family management and access to social support. These findings underscore the need for healthcare providers to design tailored nursing interventions informed by these insights.

OBJECTIVE:Food addiction (FA) is implicated in obesity, yet the potential moderating role of mindful eating and the underlying neural mechanisms in youth remain unclear. METHODS:This study integrated a multicenter cross-sectional survey, a longitudinal study with 6- and 12-month follow-ups, and an independent magnetic resonance imaging (MRI) sample. FA, eating motives, mindful eating, BMI z-score, fat content, and visceral fat level were assessed. Analyses utilized structural equation modeling, latent growth modeling, and voxel-based morphometry. RESULTS:Among 2071 screened, 1601 youth (55.5% boys; mean age = 12.69 ± 3.04 years) completed the baseline survey, with 880 and 564 completing the 6- and 12-month follow-ups, respectively. FA mediated the relationship between eating motives and weight status, and mindful eating moderated this pathway (p < 0.05). Longitudinally, baseline FA predicted accelerated accumulation of fat content and visceral fat level, but not BMI z-score (p > 0.05). The independent 75-MRI sample revealed that left insula gray-matter volume was negatively associated with FA but positively associated with mindful eating. CONCLUSIONS:FA may link eating motives to fat accumulation in youth, particularly abdominal fat; mindful eating may be protective, with left insula structure and left insula-striatum connectivity as possible neural correlates.

BackgroundTo evaluate the effect and safety of modified ultrafiltration warming technology during pediatric congenital heart disease (CHD) surgery.MethodsA retrospective analysis included 68 children (<1 year) who underwent CHD correction surgery with cardiopulmonary bypass (CPB) and modified ultrafiltration (MUF). Patients were divided into a warmed MUF group (W-MUF, n = 38) and a conventional MUF group (n = 30). The W-MUF group used a dual-channel infusion warmer during MUF. Preoperative and postoperative parameters, including Nasopharyngeal temperature (NPT),rectal temperature (RT), hemoglobin (Hb), hematocrit (HCT),prothrombin time (PT), Prothrombin Time Ratio (PTR) ,pericardial drainage volume, the intensive care unit (ICU) stay, extubation time,and transfusion requirements were compared.ResultsNo significant differences were found between groups preoperatively. The PT and prothrombin ratio in the MUF group were significantly prolonged compared to pre-MUF values and the W-MUF group (p < .05). After MUF, the W-MUF group had higher nasopharyngeal and rectal temperatures and shorter ICU stay, faster extubation time,and lower pericardial drainage volume compared to the MUF group (p < .05). The W-MUF group also required less fresh frozen plasma, cryoprecipitate,and platelets postoperatively (p < .05),while there was no significant difference in red blood cell (RBC) transfusion requirements between the two groups.ConclusionModified ultrafiltration warming technology is safe and effective. It is beneficial for temperature regulation in CHD surgery and is worthy of promotion.

Bronchial asthma is a common chronic respiratory disease in children. For many years, concerns about exercise-induced bronchoconstriction have limited physical activity in this population, with negative consequences for both physical and mental health. Recent evidence indicates that exercise should be incorporated into the daily routine of children with asthma, with appropriately prescribed programs shown to improve disease control, lung function, and quality of life. This study aims to systematically describe the safety, benefits and key factors of exercise for children with asthma. Initiated by the National Clinical Research Center for Child Health, this set of recommendations was developed by a multidisciplinary team of 17 experts. A comprehensive Literature search was conducted across PubMed, Embase, Cochrane and other databases, yielding 64 studies that met inclusion criteria up to May 2025. The Oxford Centre for Evidence-Based Medicine 2011 levels of evidence were used to evaluate evidence quality. Two rounds of expert voting were conducted using Delphi methodology to formulate final recommendations on key clinical topics. Recommendations were formulated across nine core domains: exercise safety, exercise-related benefits, pre-exercise screening, exercise prescription design, plan adjustment and progression, pre-exercise preparation, exercise monitoring, outcome assessment and the management of exercise-induced bronchoconstriction. Specific guidance is offered on individualized exercise planning based on asthma control status, physical fitness, exercise habits and environmental factors. Recommendations also address appropriate modalities of aerobic, resistance and flexibility training, strategies for monitoring intensity and progression and both pharmacologic and non-pharmacologic approaches to exercise-induced bronchoconstriction prevention and management. These recommendations provide scientific and practical guidance for the development and implementation of individualized exercise prescriptions in children with asthma. Moreover, they highlight the importance of multidisciplinary collaboration and reinforce exercise as an integral component of asthma management. Further high-quality clinical research is needed to optimize exercise protocols and evaluate long-term outcomes.

BACKGROUND:Adolescents living with both asthma and obesity face distinctive challenges to physical activity. Evidence that integrates the perspectives of adolescents, families, schools, and healthcare providers remains limited. OBJECTIVE:This study aimed to explore the barriers to physical activity faced by adolescents with concurrent obesity and asthma, and to understand the perceptions of patients, families, PE teachers, and healthcare providers regarding these challenges. METHODS:A qualitative study was conducted with semi-structured interviews of 15 adolescents (12 to 18 years) and focus group discussions with 36 stakeholders (12 parents, 8 physical education teachers, and 16 healthcare providers). Data were analyzed inductively using thematic analysis in NVivo. RESULTS:Four themes were identified: (1) psychological and social barriers to physical activity (self-efficacy and identity struggles; social acceptance barriers); (2) family and school barriers to physical activity (family support dilemmas; school policy limitations); (3) community and tech adaptation gaps (barriers to community resource access; digital tool personalization gaps); and (4) collaborative support solutions (personalized activity plans; stakeholder collaboration needs). CONCLUSIONS:Barriers operate at intrapersonal, interpersonal, institutional, and community or technology levels. Co-designed and individualized activity plans and coordinated communication among families, schools, and healthcare may enhance participation. Existing digital tools require health-sensitive personalization and safety features to support adolescents with asthma and obesity.

Abstract The timely detection and management of hemorrhagic shock hold paramount importance in clinical practice. This study was designed to establish a nomogram that may facilitate early identification of hemorrhagic shock in pediatric patients with multiple-trauma. A retrospective study was conducted utilizing a cohort comprising 325 pediatric patients diagnosed with multiple-trauma, who received treatment at the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China. For external validation, an additional cohort of 144 patients from a children's hospital in Taizhou was included. The model's predictor selection was optimized through the application of the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Subsequently, a prediction nomogram was constructed using multivariable logistic regression analysis. The performance and clinical utility of the developed model were comprehensively assessed utilizing various statistical metrics, including Harrell's Concordance Index (C-index), receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA). Multivariate logistic regression analysis identified systolic blood pressure (ΔSBP), platelet count, activated partial thromboplastin time (APTT), and injury severity score (ISS) as independent predictors for hemorrhagic shock. The nomogram constructed using these predictors demonstrated robust predictive capabilities, as evidenced by an impressive area under the curve (AUC) value of 0.963. The model's goodness-of-fit was assessed using the Hosmer–Lemeshow test (χ2 = 10.023, P = 0.209). Furthermore, decision curve analysis revealed significantly improved net benefits with the model. External validation further confirmed the reliability of the proposed predictive nomogram. This study successfully developed a nomogram for predicting the occurrence of hemorrhagic shock in pediatric patients with multiple trauma. This nomogram may serve as an accurate and effective tool for timely and efficient management of children with multiple trauma.

ObjectivesTo create a nomogram for early delirium detection in pediatric patients following cardiopulmonary bypass.Research Methodology/DesignThis prospective, observational study was conducted in the Cardiac Intensive Care Unit at a Children's Hospital, enrolling 501 pediatric patients from February 2022 to January 2023. Perioperative data were systematically collected through the hospital information system. Postoperative delirium was assessed using the Cornell Assessment of Pediatric Delirium (CAPD). For model development, Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to identify the most relevant predictors. These selected predictors were then incorporated into a multivariable logistic regression model to construct the predictive nomogram. The performance of the model was evaluated by Harrell's concordance index, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. External validity of the model was confirmed through the C-index and calibration plots.ResultsFive independent predictors were identified: age, SpO2 levels, lymphocyte count, diuretic use, and midazolam administration, integrated into a predictive nomogram. This nomogram demonstrated strong predictive capacity (AUC 0.816, concordance index 0.815) with good model fit (Hosmer-Lemeshow test p = 0.826) and high accuracy. Decision curve analysis showed a significant net benefit, and external validation confirmed the nomogram's reliability.ConclusionsThe study successfully developed a precise and effective nomogram for identifying pediatric patients at high risk of post-cardiopulmonary bypass delirium, incorporating age, SpO2 levels, lymphocyte counts, diuretic use, and midazolam medication.Implications for Clinical PracticeThis nomogram aids early delirium detection and prevention in critically ill children, improving clinical decisions and treatment optimization. It enables precise monitoring and tailored medication strategies, significantly contributes to reducing the incidence of delirium, thereby enhancing the overall quality of patient care.

AIM:To understand preoperative experiences and information needs of Chinese school-aged children undergoing elective surgery to design standardized preoperative education programs to alleviate preoperative anxiety. METHODS:Semi-structured interviews combined with drawing, writing, and telling techniques were conducted in 12 children. The paintings were interpreted alongside children's verbal expressions. All data were analyzed using thematic analysis. RESULTS:Three themes emerged: Origins of Surgical Knowledge: Proximity-based knowledge, media exposure, past personal medical experiences, ward-mate interactions, healthcare staff education; Pre-Surgery Experiences: Anticipation of pain, post-op sensations and impact on life, fantasizing about the operation, being aware of risks, demonstrating psychological resilience, being curious about anesthesia experience, enjoying a break; Preoperative Informational Needs: 55 identified. CONCLUSIONS:Lack of standardized preoperative education creates a gap between children's knowledge and actual surgical experiences. Developing preoperative education tailored to individualized informational needs and developmental level helps fill their gaps, alleviate preoperative anxiety and improve health outcomes.

Abstract Background Postoperative delirium (POD) represents a prevalent and noteworthy complication in the context of pediatric surgical interventions. In recent times, a hypothesis has emerged positing that cerebral ischemia and regional cerebral oxygen desaturation might serve as potential catalysts in the pathogenesis of POD. The primary aim of this study was to methodically examine the potential relationship between POD and regional cerebral oxygen saturation (rSO2) and to assess the predictive and evaluative utility of rSO2 in the context of POD. Methods This prospective observational study was conducted at the Children’s Hospital, Zhejiang University School of Medicine, Zhejiang, China, spanning the period from November 2020 to March 2021. The research cohort comprised children undergoing surgical procedures within this clinical setting. To measure rSO2 dynamics, cerebral near-infrared spectroscopy (NIRS) was used to monitor rSO2 levels both before and after surgery. In addition, POD was assessed in the paediatric patients according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. The analysis of the association between the rSO2 index and the incidence of POD was carried out through the application of either the independent samples t-test or the nonparametric rank-sum test. To ascertain the threshold value of the adjusted rSO2 index for predictive and evaluative purposes regarding POD in the pediatric population, the Receiver Operating Characteristics (ROC) curve was employed. Results A total of 211 cases were included in this study, of which 61 (28.9%) developed POD. Participants suffering delirium had lower preoperative rSO2mean, lower preoperative rSO2min, and lower postoperative rSO2min, higher ∆rSO2mean, higher amount of ∆rSO2mean, lower ∆rSO2min (P < 0.05). Preoperative rSO2mean (AUC = 0.716, 95%CI 0.642–0.790), ∆rSO2mean (AUC = 0.694, 95%CI 0.614–0.774), amount of ∆rSO2mean (AUC = 0.649, 95%CI 0.564–0.734), preoperative rSO2min (AUC = 0.702, 96%CI 0.628–0.777), postoperative rSO2min (AUC = 0.717, 95%CI 0.647–0.787), and ∆rSO2min (AUC = 0.714, 95%CI 0.638–0.790) performed well in sensitivity and specificity, and the best threshold were 62.05%, 1.27%, 2.41%, 55.68%, 57.36%, 1.29%. Conclusions There is a close relationship between pediatric POD and rSO2. rSO2 could be used as an effective predictor of pediatric POD. It might be helpful to measure rSO2 with NIRS for early recognizing POD and making it possible for early intervention.

Background:Allergic conditions, identified as a significant global health challenge, are profoundly influenced by indoor allergens, especially house dust mites (HDM). Yet the relationship between mite sensitized components and respiratory allergies and asthma control remains poorly understood. Methods:A cohort of 96 children, either with allergic rhinitis (AR) or rhinitis with asthma syndrome (ARAS), was assessed. Protein microarray technology was deployed to quantify sIgE responses to the allergenic components of Der p and Der f. Results:The study cohort comprised 18 AR and 78 ARAS patients; with 43 mild and 53 moderate-to-severe AR; with 28 uncontrolled, 21 partially controlled, and 29 well-controlled asthma. Sensitization prevalence for HDM components was highest with Der p (97.9%), Der f 2 (97.9%), Der p 2 (94.8%), Der f 1(94.8%), Der p 1 (93.8%), Der p 23 (57.3%). Notably, sIgE concentrations for Der f and Der f 2 were significantly greater in the ARAS compared to AR (P < 0.05). While sIgE levels varied between mild and moderate-to-severe AR, the differences were not statistically significant (P > 0.05). However, Der p 23 sIgE levels demonstrated a significant fluctuation across the asthma control strata (P < 0.05), with the well-controlled group exhibiting the lowest readings. Conclusion:The sIgE levels to HDM allergens were higher in ARAS group compared to AR group, especially Der f and Der f 2, indicating an association between sIgE reactivity and the diagnosis of asthma. Reduced Der p 23 sIgE levels were indicative of enhanced asthma control.

AIM: Acute appendicitis is one of the most common causes of acute abdomen in pediatric surgery. The purpose of this study was to observe the effects of integrated rapid rehabilitation nursing in children with laparoscopic appendectomy (LA) during the perioperative period. METHODS: A total of 200 children with appendicitis who underwent LA in our hospital from January 2022 to January 2023 were retrospectively selected as the study subjects. According to the nursing mode, they were divided into a control group (n = 100) and an observation group (n = 100). The control group was treated with routine nursing intervention, and the observation group was treated with an integrated rapid rehabilitation nursing intervention. Perioperative indices (operation time, first postoperative exhaust time, length of hospital stay) were recorded and compared between the two groups. The visual analog scale (VAS) was used to score the two groups at 6 h, 12 h, 24 h, and 48 h after surgery, and the pain degree of the children was quantitatively evaluated. The levels of serum stress response indices (cortisol (Cor), norepinephrine (NE), and adrenocorticotropic hormone (ACTH)) in the two groups were measured. The incidence of postoperative complications, improvement of postoperative quality of life, and nursing satisfaction were compared between the two groups. RESULTS: The operation time, first postoperative exhaust time, and hospitalization time in the observation group were significantly shorter than those in the control group (p < 0.05), and the VAS scores of the patients in the observation group were lower than those in the control group at each time point of 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.05). One hour after surgery, the serum Cor, NE, and ACTH levels of the two groups of patients were significantly higher than those before surgery, and the levels for the observation group were significantly lower than those of the control group (p < 0.05). After treatment, the quality of life scores of patients in both groups was significantly higher than before treatment, and the quality of life scores of patients in the observation group was significantly higher than that of the control group (p < 0.05). The postoperative complication rate of the observation group was 3.00% (3/100), which was significantly lower than that of the control group (13.00% (13/100)) (χ2 = 6.793, p = 0.009). The nursing satisfaction of the observation group was 95.00% (95/100), which was significantly higher than that of the control group (79.00% (79/100)) (χ2 = 11.317, p = 0.001). CONCLUSIONS: The integrated rapid rehabilitation nursing management mode is an intervention that can effectively alleviate the effects of LA on stress reactions and pain in children with appendicitis. It can effectively reduce the incidence of postoperative complications and improve the patient's nursing satisfaction, allowing children with appendicitis to recover as soon as possible after surgery, and can improve patients' quality of life. It helps to improve the overall clinical efficacy, and the treatment process is simple to operate, relatively safe and reliable, has high use value, and is worthy of further promotion in clinical treatment.

Backgrounds Moral distress significantly affects pediatric ICU nurses, leading to nurse burnout, increased turnover and reducing patient care quality. Despite its importance, there’s a notable gap in knowledge on how to manage it effectively. Aims This review aimed to systematically identify and analyze coping strategies and interventions targeting moral distress among pediatric nurses in ICU, uncovering research gap and future studies directions. Methods A scoping review was conducted followed framework by Levac, Colquhoun, and O'Brien and Arksey and O'Malley. Searches were performed in 11 electrical databases, like PubMed and China Biology Medicine disc, within a timeframe of the database construction to November 2023, and performed literature screening and data extraction. Results Sixteen articles were ultimately included. Coping strategies adopted by pediatric ICUs nurses can be categorized into adaptive and maladaptive strategies, with the latter including passive acceptance, taking leave, and drinking, while the former involve pursuing interests outside of work, reflection and philosophizing, and communication. Nine articles described and evaluated the effectiveness of interventions for moral distress, categorizing them into individual and institutional levels. Individual-level interventions include Interprofessional Perspective-Taking, the PICU Resiliency Bundle, Ethics Education/Skills, and the Center for Caring. Institutional-level interventions encompasses Comprehensive Care Round, Goals of Care Conversations, Pediatric Ethics and Communication Excellence Rounds, Nursing Ethics Council, and Medical Ethical Decision-Making, though not all were effective in alleviating moral distress. Conclusions Nurses often use self-adjustment strategies for moral distress, institutional ethical support focusing on enhancing nurses’ moral resilience, promoting reflective thinking and improving communication remains crucial. Various interventions for moral distress are currently available, but nurse engagement is low and their effectiveness remained to be verified. Future studies should explore what aids or hinders these interventions. There’s also a need for large, multicenter trials and ongoing evaluations to create effective support systems for pediatric ICU nurses.

Objective This study aimed to explore the impact of high-fidelity simulator (HFS) training on the bronchoscopy operation skills, confidence, stress, and learning satisfaction of trainees who further their training at endoscopy center in our hospital. The study also investigated the practical application effects of HFS training and provided a reference for the development of clinical teaching and training programs in hospitals. Methods The 18 trainees who furthered their training at the endoscopy center were evaluated for their bronchoscopy operation skills, confidence, and stress levels before and after HFS training. A survey on learning satisfaction was conducted after the completion of HFS training. The scores of all evaluations were collected for comparison of differences before and after HFS training. Results HFS training improved the clinical operation skill levels and confidence of trainees who further their training at the endoscopy center, reduced their stress, and achieved 100% satisfaction from this training. Education level and department had no significant impact on trainees' operational skills and confidence improvement, and stress reduction (p > 0.05). The results of this study supported the influence of the history of endoscopy operations on the improvement of trainees' improved operational skills after HFS training, but it had no relation to the improvement of confidence and stress reduction. Trainees with a history of endoscopy operations had higher operation skill scores before and after HFS training (n = 5, 94.80 +/- 2.95 and 97.60 +/- 1.82, respectively) than those without a history of endoscopy operations (n = 13, 80.62 +/- 2.53 and 86.38 +/- 2.82, respectively), and the difference was significant (p < 0.05). Conclusion HFS training is an effective clinical teaching method that can significantly improve trainees' bronchoscopy operation skills and confidence, reduce stress, and achieve high levels of satisfaction.