Children

14 pages, 267 KiB

Open AccessArticle

Inflammatory Markers in the Blood of Spastic Cerebral Palsy Children: A Case–Control Study

by Özlem Tezol, Sıddika Songül Yalçın, Gözde Girgin, Anıl Yirün, Sonia Sanajou, Aylin Balcı Özyurt, Belgin Bayram, Oytun Portakal, Terken Baydar, Çetin Okuyaz and Pınar Erkekoğlu

Children 2025, 12(3), 343; https://doi.org/10.3390/children12030343 (registering DOI) - 9 Mar 2025

Abstract

Objectives: The aim was to simultaneously investigate inflammatory biomarkers, neopterin, the kynurenine/tryptophan (Kyn/Trp) pathway, vitamin D (VitD), vitamin D binding protein (VDBP), and erythrocyte folate, in cerebral palsy (CP). Methods: A case–control study was conducted at Mersin University Hospital. Three- to ten-year-old patients [...] Read more.

Objectives: The aim was to simultaneously investigate inflammatory biomarkers, neopterin, the kynurenine/tryptophan (Kyn/Trp) pathway, vitamin D (VitD), vitamin D binding protein (VDBP), and erythrocyte folate, in cerebral palsy (CP). Methods: A case–control study was conducted at Mersin University Hospital. Three- to ten-year-old patients with spastic CP (n = 50) and age- and gender-matched healthy controls (n = 55) were included. Serum levels of neopterin, Trp, Kyn and 25OHD, plasma VDBP, and erythrocyte folate concentrations were measured. Indoleamine-2,3-dioxygenase 1 (IDO-1) enzyme activity was evaluated according to the Kyn/Trp ratio. Comparison and correlation analyses were performed. Results: The levels of neopterin, Trp, and Kyn were lower in children with CP than in healthy controls (p = 0.037, p < 0.001, and p = 0.003, respectively). IDO1 was not significantly different between the CP and control groups (p = 0.214). The levels of VitD and VDBP were higher in children with CP (p < 0.001 and p = 0.001, respectively). The level of erythrocyte folate was also higher in children with CP (p < 0.001). No significant correlation was found between age and inflammatory biomarkers in the CP group. Neopterin was correlated with the level of Gross Motor Function Classification System (GMFCS) level (r = 0.292, p = 0.044), while there was no significant correlation between the other biomarkers and the level of GMFCS in the CP group. Conclusions: Inflammatory biomarkers of neopterin and Kyn are lower, inflammatory biomarkers of VDBP and erythrocyte folate are higher, and anti-inflammatory VitD is higher in children with spastic CP compared to healthy children. More knowledge is needed to demonstrate inflammatory and anti-inflammatory status in children with CP. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

19 pages, 294 KiB

Open AccessArticle

Pre-K–12 Teachers’ Views on ASD+ADHD: Prevalence Estimates and Teaching Preparedness

by Sidni A. Justus, Emily M. Pogue and Victoria Simanovich

Children 2025, 12(3), 342; https://doi.org/10.3390/children12030342 (registering DOI) - 9 Mar 2025

Abstract

Background/Objectives: Teachers play a significant role in the identification and intervention of neurodevelopmental disorders such as ASD and ADHD. However, their perceptions of ASD+ADHD comorbidity remain underexplored. This study investigates teachers’ estimates of ASD+ADHD prevalence and their perceived preparedness to teach students with [...] Read more.

Background/Objectives: Teachers play a significant role in the identification and intervention of neurodevelopmental disorders such as ASD and ADHD. However, their perceptions of ASD+ADHD comorbidity remain underexplored. This study investigates teachers’ estimates of ASD+ADHD prevalence and their perceived preparedness to teach students with co-occurring diagnoses, exploring key predictors of both outcomes. Methods: Pre-K-12 teachers (N = 199) completed demographic questions and four additional questionnaires assessing ASD- and ADHD-specific knowledge, neurodiversity attitudes and overall teaching self-efficacy. Participants estimated the prevalence of ASD+ADHD comorbidity and rated their preparedness to instruct students with ASD+ADHD, ASD-only, and ADHD-only. Regression analyses examined factors predicting prevalence estimates and preparedness. Results: Teachers underestimated the lifetime prevalence of ASD+ADHD, though current prevalence estimates were more aligned with meta-analytic findings. Personal experience and current teaching of comorbid students predicted higher prevalence estimates, whereas greater ASD knowledge was associated with lower estimates. Preparedness to teach ASD+ADHD was rated lower than for ASD-only or ADHD-only students. Self-efficacy, neurodiversity attitudes, and professional training were predictors of preparedness. Current teaching of comorbid students, disorder-specific knowledge, and total years of teaching experience showed inconsistent associations across conditions. Conclusions: Findings suggest that while direct experience and training enhance both awareness and preparedness, disorder-specific knowledge alone does not consistently translate to confidence in supporting students with co-occurring diagnoses. Implications for teacher training and the need for comorbidity-focused professional development are discussed. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Advances in Social-Cognitive and Educational Processes)

11 pages, 272 KiB

Open AccessArticle

Efficacy of Laser Pulpotomy vs. Conventional Vital Pulpotomy in Primary Teeth: A Comparative Clinical Analysis

by Jasna Simonoska, Roko Bjelica, Aleksandar Dimkov, Jasmina Simjanovska, Dragana Gabrić and Elizabeta Gjorgievska

Children 2025, 12(3), 341; https://doi.org/10.3390/children12030341 (registering DOI) - 8 Mar 2025

Abstract

Background/Objectives: Vital pulpotomy involves the partial removal of the coronal pulp tissue in cases of vital pulp exposure, aiming to maintain the health and function of the remaining radicular pulp. The first aim of this study was to compare the effects of [...] Read more.

Background/Objectives: Vital pulpotomy involves the partial removal of the coronal pulp tissue in cases of vital pulp exposure, aiming to maintain the health and function of the remaining radicular pulp. The first aim of this study was to compare the effects of two different methodological approaches towards vital pulpotomy of the primary teeth—conventional and laser pulpotomy; thereafter, the aim was to perform a comparison of the effects of the application of calcium hydroxide (Ca(OH)₂) versus mineral trioxide aggregate (MTA); then, we analyzed and compared clinical and radiographic changes in pulpotomized teeth over a defined time period; finally, we determined the degree of efficiency of different methods of vital pulpotomy of the primary teeth. Methods: This study analyzed 40 primary molars, 20 teeth treated with conventional pulpotomy and 20 teeth submitted to laser pulpotomy. Additionally, two pulpotomy agents—Ca(OH)₂ and MTA—were used. The following clinical parameters were examined: pain, percussion sensitivity, swelling, sinus tract presence and pathological mobility. Absence of apical radiolucency, external and internal root resorption, and periodontal ligament widening were key radiographic parameters of the success of the endodontic therapy. Results: The results showed that there was no statistically significant difference between the two pulpotomy agents—Ca(OH)₂ and MTA—and therefore both can be used as alternative pulpotomy agents in the primary teeth. Conclusions: The success rate of pulpotomy with Ca(OH)₂ is similar to that of pulpotomy with MTA. The combination of laser pulpotomy and the use of MTA gave the best results according to all clinical and radiographic criteria examined and in all analyzed periods. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

15 pages, 259 KiB

Open AccessArticle

The Psychometric Properties of the ACE-IQ Questionnaire’s Binary and Frequency Scoring Methods in a Chilean Community Sample

by Maria-Pia Santelices, Maria-Carolina Velasco-Hodgson, Catterina Ferreccio, Catalina Undurraga and Karla Carvajal-Araneda

Children 2025, 12(3), 340; https://doi.org/10.3390/children12030340 (registering DOI) - 8 Mar 2025

Abstract

Background/Objectives: Adverse childhood experiences (ACEs) impact social, emotional, psychological, and physical development, often leading to health risk behaviors in adulthood. Instruments like the Adverse Childhood Experiences International Questionnaire (ACE-IQ) are essential for assessing ACEs globally and confirming their association with health outcomes in [...] Read more.

Background/Objectives: Adverse childhood experiences (ACEs) impact social, emotional, psychological, and physical development, often leading to health risk behaviors in adulthood. Instruments like the Adverse Childhood Experiences International Questionnaire (ACE-IQ) are essential for assessing ACEs globally and confirming their association with health outcomes in adulthood. Methods: This study evaluates the ACE-IQ’s validity in a Chilean cohort by analyzing the prevalence of ACEs and the instrument’s psychometric properties. Structural validity, internal consistency, and concurrent validity were assessed using the Marshall Scale as a comparative measure. Additionally, binary and frequency scoring methods were compared. Results: Structural validity analyses showed the best fit for three- and four-dimensional models using frequency scoring. The overall internal consistency of the scale was adequate (α > 0.7), although dimensions such as childhood neglect and violence outside the home demonstrated lower internal consistency. Concurrent validity showed significant positive correlations between ACE-IQ scores (both binary and frequency methods) and the Marshall Scale. Conclusions: The ACE-IQ demonstrates adequate reliability for the full scale, with strong evidence of construct validity using the frequency scoring method and concurrent validity for both scoring methods. These findings support the ACE-IQ’s use for measuring childhood adversities in Chile and assessing their association with adult health outcomes. Full article

(This article belongs to the Section Pediatric Mental Health)

14 pages, 468 KiB

Open AccessReview

Neonatal Kidney Function, Injury and Drug Dosing: A Contemporary Review

by Eveline Staub, Srinivas Bolisetty, Karel Allegaert and Anke Raaijmakers

Children 2025, 12(3), 339; https://doi.org/10.3390/children12030339 - 7 Mar 2025

Abstract

In neonates, estimation of the glomerular filtration rate is problematic, and assessment of renal impairment is challenging. Serum creatinine is a widely used marker, and urine output is an important vital parameter monitored in intensive care settings, particularly in unwell neonates. However, the [...] Read more.

In neonates, estimation of the glomerular filtration rate is problematic, and assessment of renal impairment is challenging. Serum creatinine is a widely used marker, and urine output is an important vital parameter monitored in intensive care settings, particularly in unwell neonates. However, the rapid changes after birth with adaptation to the extrauterine environment is a unique situation in which absolute serum creatinine is not a reliable indicator of renal function. A rise in serum creatinine from the previous value during the neonatal period can be a result of worsening renal function in neonates but is dependent on many other factors. In addition, urine output can be difficult to measure in sick neonates during their intensive care stay. Despite a high prevalence of acute kidney injury (AKI) in preterm and/or unwell infants, the current definitions are not straightforward and do not take postnatal adaptation processes into account. The management of AKI is challenging in very young and small patients because the assessment of fluid status as well as balancing nutritional needs with fluid restriction can be problematic. The Australian Neonatal Medicines Formulary provides advice on drug dosing in the face of reduced renal function in neonates. Predictors (or long-term outcome, or recovery) after AKI diagnosis are still poorly described. Therefore, the diagnosis of neonatal AKI needs to be documented and transferred to the paediatrician responsible for the follow-up of the child. This educational review aims to give a perspective on neonatal kidney function and AKI, the relation of fluid balance and creatinine, the management of neonatal AKI and the consequences for drug dosing and long-term outcomes. Full article

(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)

29 pages, 977 KiB

Open AccessReview

The Role of Physical Activity in ADHD Management: Diagnostic, Digital and Non-Digital Interventions, and Lifespan Considerations

by Alexandra Martín-Rodríguez, Silvia Herrero-Roldán and Vicente Javier Clemente-Suárez

Children 2025, 12(3), 338; https://doi.org/10.3390/children12030338 - 7 Mar 2025

Abstract

Background: Attention Deficit Hyperactivity Disorder (ADHD) has been described as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity affecting cognitive, emotional, and social functioning. While pharmacological and behavioral treatments remain primary, physical activity (PA) (digital and non-digital versions) has emerged as a [...] Read more.

Background: Attention Deficit Hyperactivity Disorder (ADHD) has been described as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity affecting cognitive, emotional, and social functioning. While pharmacological and behavioral treatments remain primary, physical activity (PA) (digital and non-digital versions) has emerged as a great complementary intervention due to its potential impact on executive functions, emotional regulation, and neurobiological markers. Objectives: This study aimed to assess the effects of PA on ADHD symptoms, executive function, and emotional regulation, exploring its potential impact and new practical applications in digital and non-digital treatment. Methods: This narrative review assessed 132 studies published between 1 January 2010 and January 2025, ensuring the inclusion of the most recent and relevant findings. The review was conducted in Scopus, PubMed, and Web of Science, using a predefined combination of terms related to ADHD, physical activity, executive function, neuroplasticity, and emotional regulation. Results: Regular PA improves executive functions, attention, inhibitory control, and cognitive flexibility in ADHD. Aerobic exercise enhances sustained attention, high-intensity training improves impulse control, and coordinative activities boost cognitive flexibility. Non-digital and digital innovations, such as exergaming and wearable fitness trackers, offer promising solutions to improve adherence to PA regimens, reinforcing their role as a key intervention in ADHD management. Conclusions: PA could be a valuable complementary intervention for ADHD through a hybrid approach that may improve cognitive and emotional functioning while addressing comorbidities. Full article

(This article belongs to the Special Issue Attention Deficit/Hyperactivity Disorder in Children and Adolescents)

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10 pages, 1306 KiB

Open AccessArticle

Sodium Patterns and Their Variables in a Cohort of ELBW Infants in the First 10 Days of Life

by Stijn van Sas, Myrna Pace, Thomas Salaets, Annouschka Laenen, Anke Raaijmakers and Karel Allegaert

Children 2025, 12(3), 337; https://doi.org/10.3390/children12030337 - 7 Mar 2025

Abstract

Background: Sodium regulation is critical in extremely low-birth-weight (ELBW, <1000 g) infants. In a recent systematic review, a sodium pattern over postnatal age and its variables (care factors, fluid regimens, and maturational factors) has been summarized. However, this systematic review also illustrated [...] Read more.

Background: Sodium regulation is critical in extremely low-birth-weight (ELBW, <1000 g) infants. In a recent systematic review, a sodium pattern over postnatal age and its variables (care factors, fluid regimens, and maturational factors) has been summarized. However, this systematic review also illustrated the shortages and limitations of reported cohorts, and the need to report on additional datasets. This study therefore aims to describe the postnatal sodium patterns and their variables in a cohort of ELBW neonates in the first 10 days of postnatal life. Methods: Data on 1704 serum sodium observations in the first 10 days of life from 211 ELBW infants hospitalized in a single neonatal intensive care unit were available to explore associations between serum sodium and perinatal variables. Multivariate linear models with sodium as a response variable and postnatal day as a factor were hereby applied. Baseline and treatment characteristics were included as variables, applying an unstructured covariance matrix to account for the longitudinal data. Results: Gestational age, birth weight, and length showed variable correlations with serum sodium concentrations over postnatal age. Interestingly, the analysis of sodium patterns in this ELBW cohort also revealed significant associations between prenatal betamethasone use, delivery mode, ibuprofen, or the use of inotropes and the postnatal serum sodium concentrations patterns. Multivariate analyses confirmed that gestational age and birth weight independently impacted sodium concentration patterns, and that ibuprofen use remained a significant variable after adjusting for these variables. Conclusions: Gestational age and birth weight complexities emphasize the need for nuanced understanding and standardized methodologies. Sodium patterns in the current ELBW cohort provide support for previously published sodium reference patterns in this population. New variables associated with sodium levels include ibuprofen administration and the use of inotropic agents. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 845 KiB

Open AccessArticle

The Effect of GnRH Analogs on Body Mass Index in Girls with Central Precocious Puberty: A Single-Center Retrospective Study with a Literature Review

by Ignazio Cammisa, Elena Malavolta, Federica Arzilli, Giulia Rotunno, Donato Rigante and Clelia Cipolla

Children 2025, 12(3), 336; https://doi.org/10.3390/children12030336 - 7 Mar 2025

Abstract

Background/Objectives: Central precocious puberty (CPP) is defined by the premature onset of secondary sexual characteristics prior to the age of 8 and 9 years in girls and boys, respectively. The administration of GnRH analogs (GnRH-a) has become a cornerstone in the management of [...] Read more.

Background/Objectives: Central precocious puberty (CPP) is defined by the premature onset of secondary sexual characteristics prior to the age of 8 and 9 years in girls and boys, respectively. The administration of GnRH analogs (GnRH-a) has become a cornerstone in the management of CPP, but effects on metabolic processes, particularly body mass index (BMI), remain a subject of ongoing investigation. This study aimed to investigate the relationship between GnRH-a treatment and BMI changes in a cohort of Italian children with CPP. Methods: We conducted a retrospective cohort study of 34 girls with idiopathic CPP, all treated with GnRH-a. Anthropometric parameters including BMI were collected at three time points: baseline, one year after treatment, and one year after treatment cessation. A comprehensive review of the medical literature concerning GnRH-a and BMI was performed. Results: Statistical analysis using the Wilcoxon and McNemar tests revealed a significant increase in BMI-for-age z-scores after one year of GnRH-a, with a slight increase also observed one year post-treatment of CPP. These findings suggest that GnRH-a treatment contributes to an increase in BMI, particularly in CPP children with a normal weight at baseline, although the overall impact on the progression of obesity remains minimal. A review of the existing literature supports the notion that changes in BMI during GnRH-a treatment are influenced by various factors, including baseline BMI, gender, and metabolic processes. Conclusions: Despite our findings suggesting the potential impact of GnRH-a on BMI, further longitudinal studies are necessary to fully understand the long-term metabolic consequences of GnRH-a therapy in children with CPP. Full article

(This article belongs to the Special Issue Metabolic Syndrome in Childhood Obesity)

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17 pages, 908 KiB

Open AccessArticle

Motor-Sensory Learning in Children with Disabilities: Does Piano Practice Help?

by Simon Strübbe, Susmita Roy, Irina Sidorenko and Renée Lampe

Children 2025, 12(3), 335; https://doi.org/10.3390/children12030335 - 7 Mar 2025

Abstract

Background/Objectives: Patients with physical disabilities, like cerebral palsy, the most common movement disorder in childhood, can benefit from instrumental therapy using piano. Playing the piano promotes the interaction between different brain regions and integrates motor skills, sensory skills, musical hearing, and emotions. A [...] Read more.

Background/Objectives: Patients with physical disabilities, like cerebral palsy, the most common movement disorder in childhood, can benefit from instrumental therapy using piano. Playing the piano promotes the interaction between different brain regions and integrates motor skills, sensory skills, musical hearing, and emotions. A pilot music study examined the effects of six months of piano lessons on hand motor skills and musical hearing in groups of children with motor disabilities. Methods: The allocation to the group was not randomized. Various tests, including the standardized Box and Block Test (BBT) and piano tests, assessed hand motor skills. Musical hearing was evaluated, and a questionnaire was used to determine the participants’ enjoyment and experience with the piano lessons. The regularity, tempo of keystrokes, and synchronization between the two hands were assessed and compared to evaluate the effects of six months of piano training. Results: After six months of piano training, statistically significant improvements were observed in the BBT, as well as in the regularity and tempo of the non-dominant hand. The children showed significant improvement in hand-motor control, moving 27.3% more cubes in the BBT. Regularity and tempo in piano playing, especially in the non-dominant hand, also improved. Moreover, 55% of the children better recognized the correct pitches of notes. Conclusions: Thus, this study supports the concept that piano lessons are an effective form of physical therapy for the development of hand motor skills and musical hearing. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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20 pages, 3076 KiB

Open AccessArticle

Music Therapy with Preterm Infants During Kangaroo Care: A Mixed-Methods Feasibility Study on Physiological and Electroencephalographic Parameters and Parental Perspectives

by Anna Carina Kriechbaum, Bernhard Csillag, Claudia Wenzel and Friederike Barbara Haslbeck

Children 2025, 12(3), 334; https://doi.org/10.3390/children12030334 - 7 Mar 2025

Abstract

Background: Music therapy in neonatal care is a rising interdisciplinary interest in clinical practice and research. Studies showed that music therapy benefits preterm infants and their parents. We aimed to explore the possible influence of music therapy on physiological parameters in premature infants [...] Read more.

Background: Music therapy in neonatal care is a rising interdisciplinary interest in clinical practice and research. Studies showed that music therapy benefits preterm infants and their parents. We aimed to explore the possible influence of music therapy on physiological parameters in premature infants during skin-to-skin care and to assess the parents’ perspectives on music therapy and participation in the research project. Methods: The feasibility project was conducted in an Austrian neonatal intensive care unit with a mixed-methods design. The subjects were six preterm infants and their parents. We collected quantitative data on heart rate, oxygen saturation, and brain activity (EEG) and analyzed them descriptively. Qualitative interviews were conducted to explore the parents’ perspectives on music therapy and study participation and analyzed by using grounded theory coding. Results: The results of the quantitative data indicated a stabilizing effect on the vital parameters in the included premature infants. EEGs showed interburst intervals were longer during music therapy than before its application. Parents reported a great interest in the research project, an experience of deep relaxation through music therapy, and an intensification of their relationship with their infants. Discussion/Conclusions: Our feasibility sample indicates positive changes in the vital parameters and brain activity tendencies. The parents reported positive experiences and observations in their infants related to music therapy, and they enjoyed participating in the research project. However, the small number of subjects means that our descriptions should be interpreted cautiously, and more extensive investigations into EEG measurements in preterm infants are needed. Full article

(This article belongs to the Section Pediatric Neonatology)

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15 pages, 278 KiB

Open AccessReview

Diagnosis and Treatment of Pediatric Feeding Disorders: A Narrative Literature Review

by Hugo Pergeline, Léo Gonnet, Arnaud Fernandez, Federico Solla, François Poinso and Jokthan Guivarch

Children 2025, 12(3), 333; https://doi.org/10.3390/children12030333 - 6 Mar 2025

Abstract

Background/Objectives: The definitions of feeding disorders of infants and young children were historically based on a dichotomic organic/non-organic vision. Since 2019, a new definition of pediatric feeding disorders (PFDs) has reshaped the understanding of these disorders with a global vision. The aim of [...] Read more.

Background/Objectives: The definitions of feeding disorders of infants and young children were historically based on a dichotomic organic/non-organic vision. Since 2019, a new definition of pediatric feeding disorders (PFDs) has reshaped the understanding of these disorders with a global vision. The aim of this study is to obtain a better understanding of the diagnostic criteria for general practice, both by exploring the evolution of classifications and by clearing the actual definition of PFDs and their possible treatments. Methods: We conducted a narrative review of the literature, including 36 articles about PFDs, excluding adolescents, anorexia nervosa, bulimia, pica, rumination, and specific neurodevelopmental or chronic pediatric disorders. We summarized these studies in three parts: the specific classifications for children before puberty, the current definition, and the clinical guidelines. Results: Concerning the history of the classifications, we summarized the studies of Chatoor and nzner and the older pediatric vision of failure to thrive. For the definition of pediatric feeding disorders, we presented this new category involving at least one out of four domains: medical, nutritional, feeding skills, or psychosocial. For the main clinical guidelines, we presented recommendations for both severe and common PFDs in each altered domain for use in daily practice. Conclusions: The new definition promotes a transdisciplinary vision of childhood feeding disorders, which considers each of the intricate domains of PFDs. Using common terminology for PFDs could help all healthcare providers, families, and researchers to better understand and address PFDs. Full article

(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)

10 pages, 205 KiB

Open AccessArticle

Factors Associated with Hospital Length of Stay and Intensive Care Utilization Among Pediatric COVID-19 Patients in Southern Nevada: A Multivariate Analysis

by Erika Marquez, Amanda Haboush-Deloye, Jihye Kim, Erick B López, Anil T. Mangla, Binita Adhikari and Jay J. Shen

Children 2025, 12(3), 332; https://doi.org/10.3390/children12030332 - 6 Mar 2025

Abstract

The COVID-19 pandemic has revealed significant disparities in health outcomes across various populations, with children being no exception. Objective: This study aimed to identify factors associated with hospital length of stay and intensive care unit (ICU) utilization among children hospitalized with COVID-19. Methods: [...] Read more.

The COVID-19 pandemic has revealed significant disparities in health outcomes across various populations, with children being no exception. Objective: This study aimed to identify factors associated with hospital length of stay and intensive care unit (ICU) utilization among children hospitalized with COVID-19. Methods: The project evaluated inpatient COVID-19 hospitalization data of children aged 0 to 17 years between 2020 and 2021 with a positive PCR COVID-19 test 14 days prior to or during hospitalization. Using a multivariate linear regression model, hospital length of stay and ICU utilization were evaluated by sociodemographic factors, including age, gender, race/ethnicity, primary payer status, comorbidities, CDC Social Vulnerability Index (SVI), and clinical factors. Results: Among 376 hospitalized pediatric patients, 62.2% were non-White minorities, 4.3% had at least one comorbidity, and 58.5% were covered by public insurance. Additionally, 67.6% scored high on the SVI. The average hospital stay was 3.89 days (standard deviation (SD) = 4.8), and 25% of children utilized the ICU during their hospitalization (SD = 0.43). After adjusting for sociodemographic and clinical characteristics, minority patients were more likely to have a longer length of stay by 1.09 days compared to White patients. Minority patients were also 72% more likely to use the ICU than White patients. Conclusions: These findings demonstrate that non-White children experience more severe outcomes related to COVID-19, supporting the need for culturally specific mitigation and intervention strategies for children and families during a pandemic. Full article

(This article belongs to the Section Global Pediatric Health)

11 pages, 749 KiB

Open AccessArticle

Remdesivir Use in Pediatric Patients with Acute SARS-CoV-2 Infection Is Safe and Well Tolerated

by Delma J. Nieves, M. Tuan Tran, Jasjit Singh, Negar Ashouri, Tricia Morphew, Jennifer G. Lusk, Felice C. Adler-Shohet, Rachel Marano, Stephanie Osborne, Jennifer Strickland and Antonio C. Arrieta

Children 2025, 12(3), 331; https://doi.org/10.3390/children12030331 - 6 Mar 2025

Abstract

Background/Objective: Millions of children were infected with SARS-CoV-2, and a small proportion progressed to severe disease, especially those with underlying risk factors. Adult COVID-19 studies showed mortality benefits with Remdesivir. Data on Remdesivir use in pediatrics are limited. We report on the safety [...] Read more.

Background/Objective: Millions of children were infected with SARS-CoV-2, and a small proportion progressed to severe disease, especially those with underlying risk factors. Adult COVID-19 studies showed mortality benefits with Remdesivir. Data on Remdesivir use in pediatrics are limited. We report on the safety and tolerability of Remdesivir in pediatric patients seen at our institution. Methods: This was a retrospective cohort study of patients <19 years old with acute SARS-CoV-2 infection who received at least one dose of Remdesivir. Patients followed strict institutional guidelines for safety monitoring including standard clinical and laboratory daily observations. Demographics and underlying conditions were reported as averages; for laboratory values, linear regression was applied within a generalized linear mixed-effects model framework to evaluate the significance of changes in average levels over time. Results: We enrolled 318 patients with acute SARS-CoV2 infection from May 2020 to December 2022. In total, 53% were male, and the age range was distributed broadly. In total, 61% were school-aged children (28% 5–11 and 33% 12–18 years of age). In total, 62% of cases were Hispanic. The most common reasons for Remdesivir treatment included respiratory distress (201; 63%) and having high-risk underlying conditions (109; 34%). Therapy was completed as planned in 91% and discontinued early in 9%. Mean baseline, peak, and end of treatment values for AST were 57 (95% CI 53, 61), 79 (95% CI 73, 84) (p < 0.001), and 55 (51, 59) (p = 0.479); for ALT, they were 42 (38, 47), 59 (95% CI 52, 66) (p < 0.001), and 46 (95% CI 41, 52) (p = 0.054); and for bilirubin, they were 0.56 (95% CI 0.50, 0.62), 0.67 (95% CI 0.61, 0.74) (p < 0.001), and 0.44 (95% CI 0.40, 0.48) (p < 0.001), respectively. During Remdesivir treatment, we did not observe marrow suppression or renal toxicity. Conclusions: No clinically significant hematological or renal toxicity was noted. Mean liver enzymes increased modestly and returned to baseline without interrupting treatment. Remdesivir was well tolerated in patients <19 years old. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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14 pages, 610 KiB

Open AccessSystematic Review

Navigating Barriers to Dental Care for Patients with Down Syndrome: A Scoping Review of Challenges and Strategies

by Man Hung, Aaron Graves, Johanna Lu, Connor Schwartz and Martin S. Lipsky

Children 2025, 12(3), 330; https://doi.org/10.3390/children12030330 - 5 Mar 2025

Abstract

Objective: Access to dental care is critical for overall health, yet individuals with Down Syndrome (DS) face numerous barriers, including communication difficulties, insufficiently trained professionals, and financial constraints leading to poor oral health outcomes. These obstacles are compounded by a shortage of specialized [...] Read more.

Objective: Access to dental care is critical for overall health, yet individuals with Down Syndrome (DS) face numerous barriers, including communication difficulties, insufficiently trained professionals, and financial constraints leading to poor oral health outcomes. These obstacles are compounded by a shortage of specialized services and geographic disparities that limit access to appropriate care. This scoping review aimed to explore the existing literature about these barriers and to identify strategies to enhance dental care for this vulnerable population. Methods: This scoping review followed the Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. A comprehensive search was conducted across PubMed, Scopus, and Web of Science focusing on peer-reviewed studies published in English within the last 10 years that examined barriers and strategies related to patients with DS. To ensure methodological rigor, eligible studies were independently screened and reviewed by two reviewers. Any disagreements were resolved through discussion, and if consensus could not be reached, a third reviewer made the final decision. Data were extracted using a standardized form. The extracted data were analyzed and synthesized to identify and categorize barriers and strategies across different studies. Results: The initial search yielded 58 articles, with 42 remaining after duplicates were removed. Following titles and abstracts screening, 13 studies were considered for full-text review, and 6 studies met the inclusion criteria. These studies, published between 2015 and 2023, primarily employed cross-sectional designs and identified key barriers, including challenges in maintaining oral hygiene, limited access to specialized dental services, and behavioral and sensory difficulties affecting dental care for children with DS. Strategies to overcome these barriers included enhancing dental professional training, developing tailored care approaches, and integrating preventive dental programs into broader health initiatives. Conclusions: This review highlights significant, persistent barriers to dental care for children with DS. By emphasizing the need for enhanced dental professional training, personalized care approaches, and integrated preventive programs, this review provides a framework for improving dental care accessibility for this population. Addressing these barriers can lead to better oral health outcomes and improved overall well-being for children with DS. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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11 pages, 452 KiB

Open AccessArticle

Optimising Psychological Well-Being in Chinese-Australian Adolescents: A 24-Hour Movement Guidelines Approach

by Wei-Cheng Chao, Asaduzzaman Khan, Jui-Chi Shih, Wen Li, Ching-Lin Wu, Kuan-Chung Chen and Bill Cheng

Children 2025, 12(3), 329; https://doi.org/10.3390/children12030329 - 5 Mar 2025

Abstract

Background: Chinese-Australian adolescents face unique academic and cultural challenges that may impact their lifestyle and psychological well-being. Physical activity, screen time, and sleep are known to influence well-being. However, research on the adherence to the 24-Hour Movement Guidelines among Chinese-Australian adolescents remains limited [...] Read more.

Background: Chinese-Australian adolescents face unique academic and cultural challenges that may impact their lifestyle and psychological well-being. Physical activity, screen time, and sleep are known to influence well-being. However, research on the adherence to the 24-Hour Movement Guidelines among Chinese-Australian adolescents remains limited and awaits further investigation. Objective: This study hypothesized a significant positive association between adherence to the 24-Hour Movement Guidelines for physical activity, screen time, and sleep, and the psychological well-being of Chinese-Australian adolescents. Methods: A self-reported questionnaire was distributed to two language schools in Brisbane, Australia, targeting high school students from grades 7 to 12 with Chinese-Australian backgrounds. This study used multiple linear regression modelling to examine the associations between meeting or not meeting recommendations. Meeting the 24-Hour Movement Guidelines was defined as ≥60 min/day of moderate to vigorous physical activity (MVPA), ≤2 h/day of recreational screen time, and 9–11 h/night of sleep. Results: Out of 251 participants (average age: 13.31 years; 58% female), only 20.3% met two or three recommendations, while 43.3% met one, and 36.2% met none. The most common compliance was meeting only the screen time guideline alone (48%), while 9.6% met either MVPA + screen time or screen time + sleep. The regression analysis showed that meeting at least MVPA (β = 1.41, 95% CI: 0.07 to 2.74) or at least sleep (β = 1.40, 95% CI: 0.19 to 2.60) was associated with better psychological well-being. Notably, meeting MVPA and sleep guidelines was significantly associated with higher well-being (β = 3.83, 95% CI: 1.06–6.60). From the results, adherence to additional 24-Hour Movement Guidelines was associated with improved psychosocial well-being. However, a small proportion of adolescents met all the guidelines. Conclusions: Greater adherence to physical activity and sleep guidelines is linked to better psychological well-being among Chinese-Australian adolescents. These results highlight the importance of promoting healthy behaviours and implementing public health strategies to enhance education on exercise and sleep, particularly at the school and family levels, to support adolescents’ psychological well-being. Full article

(This article belongs to the Section Pediatric Mental Health)

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9 pages, 2757 KiB

Open AccessArticle

The Efficacy of a Novel Hybrid Brace in the Treatment of Adolescent Idiopathic Scoliosis: A Prospective Case-Series Study

by Hyoungmin Kim, Sam Yeol Chang, Bong Soon Chang, Jun Yeop Lee, Seonpyo Jang and Sung Taeck Kim

Children 2025, 12(3), 328; https://doi.org/10.3390/children12030328 - 5 Mar 2025

Abstract

Background/Objectives: Bracing is an effective treatment for preventing curve progression in skeletally immature adolescent idiopathic scoliosis (AIS) patients. A novel hybrid brace has been developed to overcome the limitations of conventional rigid and soft braces. This study aimed to evaluate the clinical [...] Read more.

Background/Objectives: Bracing is an effective treatment for preventing curve progression in skeletally immature adolescent idiopathic scoliosis (AIS) patients. A novel hybrid brace has been developed to overcome the limitations of conventional rigid and soft braces. This study aimed to evaluate the clinical efficacy of the novel hybrid brace. Methods: We enrolled AIS patients who were candidates for brace treatment: aged 10–18 years, with a coronal Cobb angle of 20–45° and a Risser stage of 0–2. The primary outcome was the rate of successful brace treatment, defined as meeting all three criteria: (1) less than 5° of progression in the Cobb angle during follow-up, (2) less than 45° of Cobb angle at the final follow-up, and (3) avoidance of surgical treatment. Results: A total of 24 patients (1 male, 23 female) with a mean age of 12.2 ± 1.2 years were included in this study. At the initiation of bracing, the major curve had a mean Cobb angle of 34.5 ± 6.3° and an in-brace correction (IBC) rate of 41.5 ± 16.0%. The hybrid brace demonstrated a success rate of 91.7% (22/24) during a mean follow-up period of 22.1 ± 6.4 months. After brace treatment, seven (29.2%) patients showed an improvement of more than 5° in their Cobb angle. When compared to a matched control from a retrospective cohort, the hybrid brace demonstrated a greater success rate (91.7% vs. 83.3%) and a higher proportion of patients with an improved curve (29.2% vs. 12.5%), although statistically insignificant. Conclusions: A novel hybrid brace was effective in preventing curve progression in skeletally immature patients with AIS. Full article

(This article belongs to the Special Issue Advancements in Pediatric Orthopedics: Integrating Emerging Technologies for Enhanced Care)

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8 pages, 180 KiB

Open AccessArticle

Evaluation of Complete Blood Count Parameters to Predict Abnormal Uterine Bleeding

by Defne Ay Tuncel and Can Acıpayam

Children 2025, 12(3), 327; https://doi.org/10.3390/children12030327 - 5 Mar 2025

Abstract

Background/Objectives: To investigate the diagnostic value of hematological parameters in adolescents with abnormal uterine bleeding (AUB), to make early diagnoses, and to prevent life-threatening bleeding. Methods: A total of 141 children, 70 patients, and 71 controls were included in the study. The [...] Read more.

Background/Objectives: To investigate the diagnostic value of hematological parameters in adolescents with abnormal uterine bleeding (AUB), to make early diagnoses, and to prevent life-threatening bleeding. Methods: A total of 141 children, 70 patients, and 71 controls were included in the study. The laboratory findings of the patient and control groups were obtained from medical records. Cut-off values were estimated using constructing receiver operating characteristic (ROC) curves of complete blood count parameters to differentiate patients with AUB from control patients. Results: WBC, neutrophil, eosinophil, neutrophil/lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), CRP/albumin ratio, CRP, albumin, PDW, RDW, MPV, and APTT were higher in the AUB group compared to the control group (p = 0.010, p = 0.002, p = 0.017, p = 0.017, p = 0.005, p = 0.003, and p < 0.001, respectively). Erythrocytes, hemoglobin, hematocrit, MCV, MCH, MCHC, fibrinogen, and INR were lower in the AUB group than in the control group (p < 0.001 for all). According to ROC analysis, RDW showed the highest diagnostic performance, with an AUC of 0.999 (p < 0.001). PDW and MPV also demonstrated high diagnostic values (AUC = 0.995 and AUC = 0.928, respectively) (p < 0.001). The NLR, SIRI, and CRP/albumin ratio had moderate diagnostic efficacy, with AUC values of 0.612, 0.640, and 0.642 (p = 0.022, p = 0.004, and p = 0.004, respectively). Conclusions: The high diagnostic performance of parameters such as RDW, PDW, and MPV in diagnosing AUB indicates that these parameters should be considered in clinical applications. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

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14 pages, 2084 KiB

Open AccessArticle

Sharing Milk and Knowledge in the Neonatal Intensive Care Unit Improves Care for Neonates in a Low- and Middle-Income Population—A North–South Collaboration

by Kirsti Haaland, Srishti Goel, Gunjana Kumar, Ingvild Andresen Hurv, Isha Thapar, Jitesh Jalthuria and Sushma Nangia

Children 2025, 12(3), 326; https://doi.org/10.3390/children12030326 - 4 Mar 2025

Abstract

Background: Basic healthcare may significantly decrease neonatal morbidity and mortality. Attention to this, particularly in populations where rates of potentially preventable illness and death within the first weeks of life are extremely high, will have a positive impact on global health. Objective: This [...] Read more.

Background: Basic healthcare may significantly decrease neonatal morbidity and mortality. Attention to this, particularly in populations where rates of potentially preventable illness and death within the first weeks of life are extremely high, will have a positive impact on global health. Objective: This manuscript presents the development and impact of a quality improvement programme to reduce the evidence–practice gap in care for neonates admitted to the NICU in a public hospital in India. The programme was locally customised for optimal and sustainable results. Method: The backbone of the project was educational exchange of neonatal nurses and physicians between Norway and India. Areas of potential improvement in the care for the neonates were mainly identified by the clinicians and focus areas were subject to dynamic changes over time. In addition, a service centre for lactation counselling and milk banking was established. Progress over the timeframe 2017–2019 was compared with baseline data. Results: The project has shown that after a collaborative effort, there is a significant reduction in mortality from 11% in the year 2016 to 5.5% in the year 2019. The morbidity was reduced, as illustrated by the decrease in the proportion of neonates with culture-proven sepsis. Nutrition improved with consumption of human milk by the NICU-admitted neonates remarkably increasing from one third to more than three forth of their total intake, and weight gain in a subgroup was shown to increase. With the introduction of family participatory care, hours of skin-to-skin contact for the neonates significantly increased. Additional indicators of improved care were also observed. Conclusions: It is feasible to reduce neonatal mortality and morbidity in a low- and middle-income hospitalised population by improving basic care including nutrition relatively inexpensively when utilising human resources. Full article

(This article belongs to the Special Issue Impacts of Newborn Breast Milk Feeding)

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13 pages, 745 KiB

Open AccessReview

Efficacy and Safety of Growth Hormone (GH) Therapy in Patients with SHOX Gene Variants

by Giorgio Sodero, Federica Arzilli, Elena Malavolta, Marilea Lezzi, Fabio Comes, Antonietta Villirillo, Donato Rigante and Clelia Cipolla

Children 2025, 12(3), 325; https://doi.org/10.3390/children12030325 - 4 Mar 2025

Abstract

Background: Among the potential indications for growth hormone (GH) therapy is the presence of mutations in the SHOX (short stature homeobox-containing) gene, located in the telomeric pseudotautosomal region (PAR1) on the short arm of both sex chromosomes. Despite general recommendations supporting GH therapy [...] Read more.

Background: Among the potential indications for growth hormone (GH) therapy is the presence of mutations in the SHOX (short stature homeobox-containing) gene, located in the telomeric pseudotautosomal region (PAR1) on the short arm of both sex chromosomes. Despite general recommendations supporting GH therapy in these cases, there is a lack of comprehensive evidence specifically evaluating its efficacy and safety in this subgroup of pediatric patients. Aim: The objective of this scoping review was to evaluate the efficacy and safety of growth hormone therapy in patients with SHOX gene variants, providing a narrative synthesis of the included studies. Materials and Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We summarized information extracted from 22 articles identified by our search strategy. Currently, only one randomized clinical trial has analyzed the efficacy profile of GH in patients with SHOX mutations. Results: Growth hormone is a valuable therapeutic aid for these patients. However, its prescription in children with SHOX gene mutations should consider the specific characteristics of each patient, similar to the approach taken for patients with idiopathic growth hormone deficiency (GHD). Conclusion: Growth hormone therapy in patients with SHOX gene alterations appears to be both safe and effective. However, longitudinal prospective studies and targeted clinical trials are necessary to confirm these findings. Despite this, GH remains one of the preferred hormonal therapies for patients with short stature and confirmed SHOX gene mutations. Full article

(This article belongs to the Special Issue Pediatric Growth and Skeletal Disorders)

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