Background: Early diagnosis of obesity in adolescents is crucial for the prevention of severe health consequences. Different criteria for the diagnosis of obesity may lead to variations in prevalence. We aimed to compare the three most widely used international definitions (by WHO, IOTF and CDC) for overweight/obesity in adolescents in Northwestern Greece. Methods: A total of 403 adolescents aged 10-17 years were included. Agreement metrics and assessment of marginal heterogeneity and asymmetry were used for the comparison of the definitions. Results: In the total population, high agreement was observed among all definitions (Krippendorff's alpha: 0.931, 95% CI 0.913-0.949). However, there was significant marginal heterogeneity (p < 0.001) and asymmetry (p < 0.001) for each pairwise comparison. WHO definition consistently yielded higher prevalence of obesity (WHO: 23.1%, IOTF: 15.4%, CDC: 21.6%). There were no significant differences in agreement (p = 0.247 for the comparison) between males and females, with more prominent marginal heterogeneity and asymmetry in males. Agreement among definitions was numerically lower in young adolescents aged < 14 years versus older ones (alpha: 0.919 vs. 0.953, p = 0.082), and systematic bias (p < 0.001) and asymmetry (p < 0.001) were present only in young adolescents without any significant difference in older ones. Conclusions: Although agreement was very high among definitions, they are not interchangeable, yielding different prevalence rates, particularly in young adolescents. IOTF criteria resulted in a reduced diagnosis of obesity and could lead to undertreatment; in contrast, WHO and CDC criteria may lead to overdiagnosis in our population. Caution is required when interpreting international criteria for overweight/obesity in various populations.

Multifocal splenic lesions are rare in the pediatric population, usually arising from infectious or inflammatory conditions. They have been described as an extraintestinal manifestation of inflammatory bowel disease, particularly Crohn Disease (CD), in patients with long-standing illness, but are rarely reported as an initial manifestation, especially in children. We present a case of a previously healthy 13-year-old boy admitted with a 25-day history of intermittent left upper quadrant pain. An abdominal ultrasonography performed 2 days before admission revealed splenomegaly with multiple hypoechoic nodules, findings confirmed by abdominal magnetic resonance imaging. Despite broad-spectrum antimicrobial therapy, there was no clinical improvement. Extensive diagnostic workup yielded negative results, and an initial lower gastrointestinal endoscopy showed no specific findings. However, 6 months later, a repeat colonoscopy confirmed CD. This case highlights the importance of considering inflammatory bowel diseases, particularly CD, when evaluating unexplained splenic nodules. Early recognition and conservative management are crucial to avoid unnecessary splenectomy, particularly in pediatric patients.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) comprise a broad spectrum of malformations and constitute the leading cause of end-stage kidney disease (ESKD) in childhood. Despite extensive research, a monogenic cause is identified in only ~10% of cases, while variable penetrance and expressivity suggest a more complex disease mechanism. Epigenetic and environmental factors have also been implicated, further complicating efforts to elucidate the etiology of these anomalies. Methods: Whole exome sequencing (WES) was performed in 47 individuals with isolated, non-syndromic congenital renal parenchymal anomalies. Results: Variants in four genes (BBS1, PKHD1, XPNPEP3, and KCTD1) were identified, each of which has an established role in nephrogenesis and is implicated in syndromic disorders in which CAKUT can occur as part of the clinical spectrum. In addition, a variant in GREB1L was detected, a gene previously associated with CAKUT. The WES analysis identified candidate variants in 10.6% of patients, consistent with diagnostic yields reported in comparable CAKUT studies. The genes harboring variants are involved in key biological processes, including signaling pathways, ciliary function, and mitochondrial biology, supporting their relevance for further investigation. Conclusions: Our findings support WES as a valuable tool for identifying clinically relevant variants and expanding the genetic landscape of CAKUT.

Background/objectivesOverweight and obesity in children and adolescents is a global health issue with increasing prevalence. The Mediterranean diet (Med diet) is an extensively studied dietary pattern with benefits on various health conditions such as cardiovascular disease, diabetes mellitus and obesity in adult populations but the evidence on children and adolescents remains limited. The aim of this systematic review and meta-analysis is to collect, assess, and synthesize evidence from randomized controlled trials (RCTs) on the efficacy of Med diet on anthropometric and cardiometabolic parameters in children and adolescents with excess body weight.MethodsThree electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Scopus) and references in relevant studies and systematic reviews were searched. Random-effects meta-analysis models were used to synthesize study effect estimates. Heterogeneity was assessed using the I2. The quality of evidence was evaluated using the Cochrane Risk of Bias tool v2.0.ResultsFive RCTs involving 330 children and adolescents affected by overweight or obesity were included. Mean study duration was 12 weeks (range: 8–16 weeks). Compared with the control group, Med diet was significantly associated with lower body mass index (BMI) (Standardized mean difference [SMD] = −0.26, 95% confidence intervals [CI] = −0.49 to −0.03, I2 = 0%) and lower systolic blood pressure (SMD = −0.48, 95% CI = −0.87 to −0.09, I2 = 45.9%). No statistically significant associations were observed for any other anthropometric or cardiometabolic parameter studied. Regarding risk of bias, all RCTs were judged to have some concerns for each outcome assessed.ConclusionThis systematic review suggests that Med diet could have a potentially beneficial effect on the reduction of BMI among youths with excess body weight. Nevertheless, further research, with greater methodological rigor, higher participation rates and longer follow-up is needed.Systematic Review RegistrationThis systematic review and meta-analysis is registered with PROSPERO (CRD420251143115).

Background: Adolescent obesity is an escalating public health concern globally and in Greece, associated with significant physical and psychological consequences. Pediatricians serve as frontline clinicians in the early identification, counseling, and management of adolescents with excess weight; however, their practices, perceived competence, and the barriers they face remain insufficiently explored in certain Greek regions. Methods: A cross-sectional observational study was conducted using a structured, anonymous questionnaire distributed to all pediatricians working in Western Macedonia (n = 60). Fifty-one pediatricians participated (response rate 85%). The questionnaire assessed demographic characteristics, training, knowledge, clinical practices, attitudes, self-assessed competence, and perceived barriers. Results: Most participants (88.2%) reported no specialized training in adolescent obesity. Nearly half of respondents were unfamiliar with current diagnostic criteria for adolescent obesity. Although pediatricians expressed confidence in providing nutritional and lifestyle counseling, they reported limited competence in pharmacotherapy and bariatric surgery discussions. The most prominent barriers included insufficient family cooperation, lack of referral pathways, and difficulty engaging adolescents. Older and more experienced pediatricians reported higher levels of perceived competence and stronger interdisciplinary collaboration. Conclusions: Significant gaps in training and clinical support hinder the effective management of adolescent obesity in Western Macedonia. Strengthening continuous professional education, establishing multidisciplinary obesity care networks, and improving family engagement strategies appear crucial to enhancing clinical practice and improving health outcomes for adolescents.

Obesity is a major global health crisis with rising prevalence in both pediatric and adult populations, leading to an increased risk of cardiovascular, metabolic, and other chronic complications affecting all organ systems. A clear understanding of the genetic contributors to polygenic, syndromic, and monogenic obesity is essential for early diagnosis and targeted management. Advances in genome-wide association studies (GWAS) and sequencing technologies have greatly expanded our understanding of the genetic alterations underlying this multifaceted disease and have helped in delivering personalized treatment. The pathogenesis of common, polygenic obesity is related to a complex interplay between genetic susceptibility and environmental factors. Syndromic obesity, a less common form, is characterized by early-onset accompanied by additional features such as developmental delay, dysmorphic traits, and various organ system involvement. The rarest form, monogenic obesity, is characterized by severe early-onset non-syndromic obesity caused by mutations in single genes regulating appetite within the hypothalamus. These monogenic obesity cases, though infrequent, have been instrumental in elucidating key pathways involved in hunger and satiety. This review provides a comprehensive summary of the most recent findings on the genetic basis of obesity across all age groups, highlighting clinical implications and emerging therapeutic opportunities.

Invasive Candida infections in the neonatal intensive care unit (NICU) are associated with significant morbidity and mortality, particularly among extremely preterm neonates. Early treatment with antifungals is critical to improve survival rates and avoid long-term adverse outcomes. Prevention with antifungal prophylaxis in high-risk neonates has been shown to reduce the prevalence of invasive Candida infections effectively. However, the irrational and/or inappropriate use of antifungals has been documented. This narrative review aims to provide an overview of the rationales for the inappropriate use of antifungals in the NICU, the consequences that ensue, and the promising strategy of antifungal stewardship programs to optimize antifungal use. The nonspecific clinical presentation of systemic Candida infections and the lack of rapid, accurate diagnostic techniques for Candida identification and specification in most settings lead to a high rate of empirical treatment in neonates without a proven infection. Moreover, evidence on the optimal dosing of antifungal agents and the treatment duration in the neonatal population is lacking, which may result in excessive or subtherapeutic drug exposure. Antifungal misuse is associated with microbiological consequences, including the emergence of antifungal-resistant Candida strains, and clinical consequences, such as drug toxicities and alterations in the intestinal mycobiome. It is therefore imperative to optimize antifungal use in the NICU. The implementation of antifungal stewardship programs, which, through a multidisciplinary approach, aim to improve diagnosis and guide clinicians on antifungal selection, dosing, and duration for both prevention and treatment according to the local epidemiology, represents a promising strategy for antifungal optimization in the NICU.

Congenital hyperinsulinism (HI) is the most prevalent cause of persistent hypoglycemia in infancy and childhood and comprises a heterogeneous group of genetic disorders affecting insulin secretion. The most common etiology involves inactivating mutations in the ABCC8 and KCNJ11 genes, which encode the SUR1 and Kir6.2 subunits of the pancreatic β-cell ATP-sensitive potassium (KATP) channel. Variants in these genes are associated with a broad phenotypic spectrum, ranging from asymptomatic macrosomia and mild diazoxide-responsive disease to severe, persistent hyperinsulinemic hypoglycemia unresponsive to medical therapy. In some individuals, the clinical course may evolve over time, with progression from early hyperinsulinism to impaired glucose regulation and eventual diabetes mellitus. We describe a 13-year-old girl with diazoxide-unresponsive congenital hyperinsulinism caused by a heterozygous de novo ABCC8 variant (c.2147G>A, p.Gly716Asp) who later developed insulin-deficient diabetes mellitus. She was treated with octreotide from 2 months until 7 years of age, when therapy was discontinued after gradual remission of hypoglycemia. At 11 years, evaluation revealed impaired fasting glucose and impaired glucose tolerance, and glibenclamide was initiated. After being lost to follow-up, she presented at 13 years with hyperglycemia and was diagnosed with antibody-negative, insulin-deficient diabetes mellitus. Basal insulin therapy led to progressive normalization of glycemic levels. To our knowledge, this is the first report linking the ABCC8 p.Gly716Asp variant to transition from congenital hyperinsulinism to adolescent-onset diabetes, underscoring the phenotypic continuum of ABCC8-related disorders and the necessity for lifelong metabolic surveillance.

Background: Small for gestational age neonates represent a population at risk of growth failure or deviant growth patterns and long-term metabolic complications. Breastfeeding has been identified as a critical factor in promoting healthier growth and long-term metabolic health in both full-term and preterm appropriate for gestational age infants, but similar studies in small for gestational age infants are limited. The aim of this narrative review is to assess the impact of breastfeeding on growth and body composition in small for gestational age neonates. Methods: The PubMed and Google Scholar databases were screened for the relevant literature. The following terms, were used: “low birth weight”, “in utero growth restriction”, “small for gestational age”, “human milk”, and “growth”. The initial screening identified 57 relevant studies. Thirteen of them fulfilled the eligibility criteria and were included in this narrative review. Results: In preterm small for gestational age neonates, human milk nutrition was associated with healthier catch-up growth without excessive fat accumulation. Fortification strategies were associated with enhanced growth outcomes without increased incidence of neonatal morbidities. In the context of full-term, small for gestational age neonates, exclusive breastfeeding has been demonstrated to be associated with healthy catch-up growth. Furthermore, human milk nutrition has been shown to mitigate the predisposition of these children to obesity and cardiometabolic complications. Conclusions: According to the limited extant literature, human milk feeding has been identified as a potentially protective factor for small for gestational age neonates, promoting healthier growth patterns and long-term cardiometabolic health. However, larger prospective studies are needed to evaluate human milk feeding and human milk fortification in association with growth and long-term outcomes in small for gestational age infants.

Background/Objectives: To evaluate the effect of triptorelin on final height of girls with precocious or early puberty, compared to the untreated group, and to investigate factors that contribute to its maximum effectiveness in terms of final height. Methods: We collected for the last two decades the data of patients evaluated in our Pediatric Endocrinology Clinic for precocious (PP) (thelarche before 8 years of age) or early puberty (EP) (thelarche before 9 years of age) during the last two decades. Our final set included 178 girls (85 with precocious and 93 with early puberty, of whom 85 received triptorelin). Final heights, measured and documented by health professionals, and the exact date of menarche were collected after telephone communication. Logistic regression analysis assessed the effect of various parameters on the response to treatment. Results: Τhe difference in mean standard deviation (ΔSDS) of final and midparental height did not show significant difference between treated and untreated girls (ΔHeight SDS (Final − Midparental): −0.20 ± 0.89 vs. −0.28 ± 0.83, p = 0.243). The results were similar when we compared the EP (−0.22 ± 0.71 vs. −0.17 ± 0.83, p = 0.778) and PP (−0.19 ± 1.04 vs. −0.39 ± 0.83, p = 0.315) subgroups. Menarche occurred earlier in the PP group compared to the EP group (10.68 ± 1.22 vs. 11.12 ± 0.90 years, p = 0.005) and in the untreated compared to the treated group (10.31 ± 0.91 vs. 11.57 ± 0.06 years, p < 0.001 for EP, 11.53 ± 0.90 vs. 9.86 ± 0.86 years, p < 0.001 for PP). Predictors of final height were height at diagnosis (positively correlated), midparental height, and bone age at diagnosis (negatively correlated). Conclusions: There was no significant difference in final height between treated and untreated girls. Triptorelin was effective in delaying the onset of menarche. Factors contributing to a better final height in treated girls were higher height at baseline, lower midparental height, and younger bone age.

BACKGROUND:The aim of this study was to evaluate possible predictive factors for acute pyelonephritis (APN) and renal scarring in children ≤2 years of age hospitalized with a first febrile urinary tract infection (UTI). METHODS:Sixty patients and 63 age-matched controls were prospectively included in the study. On admission, work-up including cystatin C, vitamin 25OHD, and urine angiotensinogen (U-AGT) was conducted. Children with UTI had an acute DMSA scan (technetium 99m-dimercaptosuccinic acid scan) and were grouped in those with a normal DMSA and those with APN findings on DMSA scanning. The patients with APN had a follow-up DMSA scan after 6 months to evaluate for renal scarring. RESULTS:The children with APN (53 %) had significantly higher CRP and ESR and lower 25OHD levels compared with normal DMSA group. The correlation between 25OHD level and APN remained significant after adjusting for age, fever duration and CRP/ESR level. Cystatin C and U-AGT levels did not differ significantly between patients and controls. Renal scaring was found in 33 % of children with APN. CRP levels >100 mg/L during APN and vesicoureteral reflux (VUR) grade ≥3 were found more frequently in children with renal scarring, comparing to those without scarring (p < 0.01). CONCLUSION:Vitamin D levels could be an independent predictor of acute renal damage in children with febrile UTI. Cystatin C and U-AGT were not found to be predictive factors for renal damage. CRP levels >100 mg/L during APN and VUR grade ≥3 were associated with renal scarring.

Background/Objectives: In recent years, strategies for improving outcomes in preterm neonates have been implemented in various aspects of neonatal care. This study aims to determine the prevalence, microbiology, and outcomes of late-onset sepsis (LOS) and the incidence of other morbidities in very preterm neonates following the implementation of specific infection control, enteral feeding, and ventilation strategies. Methods: This study retrospectively compared the morbidity and mortality of preterm neonates with a 23-32 weeks gestational age over two periods, period A (2010-2014),and period B (2018-2022). A series of changes were introduced between these periods, including restrictive use of antibiotics, aggressive enteral feeding, and wider use of non-invasive ventilation modalities. Results: A total of 310 neonates were included: 163 in period A and 147 in period B. The mean duration of antibiotic treatment was reduced from 4 +/- 2 to 2 +/- 1 days and from 5 +/- 2 to 3 +/- 1 days for suspected early-onset sepsis and LOS, respectively, and from 11.2 +/- 4 to 16 +/- 4 days for confirmed LOS between the two study periods. The incidence of LOS was 24% and 18%, while, for multiple LOS episodes, it was 26% and 11% in periods A and B, respectively. Total parenteral nutrition (TPN) duration and gestational age were independent predictors of LOS in both periods. The rate of Candida infections declined from 9.2% to 0.7%. The full enteral nutrition in period B was achieved after a median of 7.5 days compared with 10 days (p = 0.001), resulting in fewer days of TPN (p = 0.008). Episodes of feeding intolerance and necrotizing enterocolitis I (NEC I) were significantly reduced (p < 0.001). Incidence of intraventricular hemorrhage were significantly decreased. Conclusions: After changing antibiotic, ventilation, and nutrition protocols, Candida infections were almost completely eliminated. The incidence of LOS and multiple LOS episodes decreased. Early full enteral nutrition was achieved without adverse effects, and fewer episodes of food intolerance were observed. Candida elimination appears feasible when antibiotic stewardship is implemented in conjunction with other interventions in an NICU.

Neonatal sepsis is a major cause of morbidity and mortality in neonates. A particular concern is the increasing prevalence of antibiotic-resistant strains among neonatal intensive care units (NICUs). Two novel beta-lactam/beta-lactamase inhibitors have recently been approved for use in neonates with multidrug-resistant infections: ceftazidime/avibactam and ceftolozane/tazobactam. These agents demonstrate efficacy against a range of multidrug-resistant gram-negative pathogens, including extended-spectrum beta-lactamases (ESBL)-producing and carbapenem-resistant Enterobacterales, as well as multidrug-resistant Pseudomonas aeruginosa. This narrative review aims to summarize the current knowledge concerning the utilization of ceftazidime/avibactam and ceftolozane/tazobactam in the NICU. According to the existing literature, both agents have been shown to be highly effective with a favorable safety profile in the neonatal population.

Anaphylaxis, the most severe end of the spectrum of allergic reactions, has shown increasing incidence globally over recent years. This hypersensitivity reaction can occur at any age, including infancy. Recent data, although scarce, show that anaphylaxis is increasingly reported in infancy, with food identified as the leading cause of anaphylaxis cases in this age group. Infants constitute a unique subgroup with specific challenges regarding diagnosis of anaphylaxis due to a variety of factors, such as lack of age-specific diagnostic criteria, inability of infants to describe their symptoms, and the broad spectrum of clinical manifestations that may be mistaken as normal findings. Additionally, there are special issues in reference to the treatment of anaphylaxis during infancy, such as the limited availability of weight-appropriate epinephrine autoinjectors for infants weighing <15 kg. In this study, we review the current literature regarding specific characteristics of anaphylaxis in infants as well as unique challenges in terms of diagnosis, acute treatment, and long-term management of this medical emergency in this vulnerable age group.

Congenital hypothyroidism (CH) is one of the most common endocrine disorders of childhood. The primary form of CH is attributable to thyroid dysgenesis (agenesis, hypoplasia, or ectopy) in 65-85% of cases, with the remaining cases being attributed to dyshormogenesis. Thyroid dysgenesis was considered a sporadic disease. However, the recent advantages of molecular techniques have significantly contributed to the understanding of the pathogenesis of the disease. The higher prevalence of congenital malformations and syndromes in patients with CH compared to the general population supports the genetic basis. This narrative review aims to provide an overview of the identified and potential genetic causes of thyroid dysgenesis. Mutations in ten genes involved in thyroid gland development during embryogenesis, TSHR, PAX8, NKX2-1, NKX2-5, FOXE1, JAG1, NTN1, GLIS3, CDC8A, and TUBB1, have been identified in cohorts of patients with thyroid dysgenesis. However, most cases remain unexplained. Novel candidate genes have been proposed. The extant evidence suggests that the pathogenesis of thyroid dysgenesis involves a spectrum of genetic etiologies, ranging from monogenic to multigenic, and that epigenetic or environmental factors may also contribute. As molecular techniques are continuously refined, future studies are expected to elucidate the complex genetic background of thyroid dysgenesis.

PURPOSE:To identify clinical predictors of permanent congenital hypothyroidism (PCH) and transient congenital hypothyroidism (TCH). METHODS:This retrospective cohort study enrolled neonates with risk factors for congenital hypothyroidism as diagnosed by neonatal screening test or blood testing. Levothyroxine (LT4) dose and serum thyroid stimulating hormone (TSH) concentrations were recorded from birth to 3 years of age. RESULTS:We enrolled 88 neonates, 35 with PCH and 53 with TCH. An LT4 dose > 3.8 μg/kg/day at 6 months (sensitivity 62%, specificity 96%), 3.0 μg/kg/day at 12 months (64%, 97%, respectively), 2.6 μg/kg/day at 2 years (80%, 98%), and 2.5 μg/kg/day at 3 years (89%, 98%) of age could predict PCH. Daily total LT4 doses > 50 µg at any time during the follow-up period were found solely in the PCH group (28% vs 0%, P<0.001). Independent discriminative predictors of PCH and TCH were TSH concentrations at diagnosis (beta=-4.3, P<0.001); daily LT4 dose at 6 (beta=-2.9, P=0.004), 12 (beta=-3.4, P=0.001), and 24 months of age (beta=-3.2, P=0.001); TSH > 5 μIU/mL at any time after treatment initiation (beta=-3.6, P<0.001); and increase in LT4 dose by more than twice (beta=-3.2, P<0.001). CONCLUSION:Discrimination between PCH and TCH was achieved based on serum TSH concentrations at diagnosis, TSH > 5 μIU/mL during treatment, LT4 dose, LT4 > 50 µg during treatment, and increasing LT4 dose during treatment.

Obesity and asthma are increasingly prevalent chronic conditions that often coexist in the pediatric population and may influence each other through shared pathophysiological mechanisms. Obesity can affect asthma expression and severity via mechanical effects on the lungs, systemic inflammation, altered adipokine levels, and metabolic dysregulation. These mechanisms contribute to a distinct asthma phenotype in children with obesity that is often less responsive to standard therapy. Nutrition plays a critical role in this context by influencing immune function, inflammation, and respiratory outcomes. Specific dietary patterns, such as the Mediterranean diet, along with nutrients including vitamin D, antioxidants, and polyunsaturated fatty acids, have been associated with the modulation of airway inflammation and asthma risk. Additionally, early-life nutritional exposures and gut microbiota composition may influence immune development and the propensity for allergic diseases. This narrative review aims to synthesize current evidence on the interplay between obesity, asthma, and nutrition in the pediatric population, highlighting potential dietary interventions and targets for improved asthma management in children with obesity.

Congenital hypothyroidism (CH) is one of the most common endocrine disorders of childhood. The primary form of CH is attributable to thyroid dysgenesis (agenesis, hypoplasia, or ectopy) in 65–85% of cases, with the remaining cases being attributed to dyshormogenesis. Thyroid dysgenesis was considered a sporadic disease. However, the recent advantages of molecular techniques have significantly contributed to the understanding of the pathogenesis of the disease. The higher prevalence of congenital malformations and syndromes in patients with CH compared to the general population supports the genetic basis. This narrative review aims to provide an overview of the identified and potential genetic causes of thyroid dysgenesis. Mutations in ten genes involved in thyroid gland development during embryogenesis, TSHR, PAX8, NKX2-1, NKX2-5, FOXE1, JAG1, NTN1, GLIS3, CDC8A, and TUBB1, have been identified in cohorts of patients with thyroid dysgenesis. However, most cases remain unexplained. Novel candidate genes have been proposed. The extant evidence suggests that the pathogenesis of thyroid dysgenesis involves a spectrum of genetic etiologies, ranging from monogenic to multigenic, and that epigenetic or environmental factors may also contribute. As molecular techniques are continuously refined, future studies are expected to elucidate the complex genetic background of thyroid dysgenesis.

Background: The etiology of type 1 diabetes (T1D) remains an area of active research, with genetic and environmental factors being investigated. This meta-analysis aimed to determine if rotavirus vaccination influences the onset of T1D in children. Methods: Following PRISMA 2020 guidelines, two researchers independently searched multiple databases, including PubMed and Google Scholar, for studies published in English from 2006 to September 2024. They used the search terms “rotavirus vaccination” and “type 1 diabetes”, and assessed study quality using the ROBINS-E tool. The analysis pooled hazard ratios (HRs) from selected studies using a fixed-effects model, with statistical significance set at p < 0.05 and heterogeneity evaluated using the I2 statistic. Results: A systematic search identified 90 records, of which 5 studies met the inclusion criteria. These studies, encompassing a total population of 4,427,291 children from developed countries, suggest a protective effect of rotavirus vaccination against T1D. The pooled HR was 0.87 (95% CI: 0.78–0.98), indicating a 13% lower risk of T1D in vaccinated children compared to unvaccinated ones (p = 0.03). Moderate heterogeneity was noted (χ2 = 10.02, df = 4, p = 0.04, I2 = 60%). Conclusions: This analysis suggests that rotavirus vaccination may reduce the risk of T1D in children from high-income Western countries. While these findings are promising, they may not be generalizable to settings outside similar advanced healthcare systems. Further research is needed to confirm the protective effects of rotavirus vaccination against T1D across diverse populations.