Search Results (8,022)

Pulmonary hypertension (PH) is a progressive disorder characterized by obstructive changes in the pulmonary vasculature, leading to increased pulmonary vascular resistance (PVR), right ventricular (RV) strain, and eventual RV failure (RVF). Despite advancements in medical therapy, PH remains associated with significant morbidity and mortality, particularly in children. RVF is a clinical syndrome resulting from complex structural and functional remodeling of the right heart, leading to inadequate pulmonary circulation, reduced cardiac output, and elevated venous pressure. Management paradigms for pediatric PH diverge significantly from those in adults, particularly due to the predominance of congenital heart disease (CHD) and the dynamic nature of pediatric cardiovascular and pulmonary development. CHD remains a principal driver of PH in children, and its associated pathophysiology demands a nuanced approach. In patients with unrepaired left-to-right shunts, elevated pulmonary blood flow can lead to progressive pulmonary vascular remodeling and increased PVR. The postoperative persistence or progression of PH may occur if irreversible vascular changes have already developed. Current PH treatments primarily focus on reducing PVR, yet distinguishing between therapeutic approaches that target the pulmonary vasculature and those aimed at improving RV function remain challenging. In pediatric patients with progressive PH despite optimal therapy, additional targeted interventions may be necessary to mitigate RV dysfunction and disease progression. This review provides a comprehensive analysis of the mechanisms underlying RVF in PH, incorporating insights from clinical studies in adults and experimental models, while highlighting the unique considerations in children. Furthermore, it explores current pharmacological and interventional treatment strategies, emphasizing the need for novel therapeutic approaches aimed at directly reversing RV remodeling. Given the complexities of RV adaptation in pediatric PH, further research into disease-modifying treatments and innovative interventions is crucial to improving long-term outcomes in affected children. Full article

Objectives: The current study aims to investigate the factors associated with the severity of conditions for pediatric cases with postural orthostatic tachycardia syndrome (POTS). Methods: Patients hospitalized and first diagnosed with POTS were retrospectively included and reviewed. The severity of symptoms was evaluated by symptom scores (SSs). Multiple Spearman correlation analyses and multiple linear regression analyses were used to determine factors independently associated with SS. Patients were divided into the mild (SS ≤ P25) and severe (SS ≥ P75) groups to test the distinguishing efficiency of the candidate factors. The efficiency of each independently correlated factor in indicating the condition of children with POTS was assessed by the receiver operating characteristic (ROC) curve. Results: A series of 296 pediatric patients aged 5–17 years suffering from POTS were included. Multiple Spearman correlation analyses and multiple linear regression analyses showed that corrected QT interval dispersion (QTcd) was independently correlated with SS (p < 0.05). QTcd can be used to suggest the severity of POTS symptoms, and the area under the curve (AUC) was 0.986 (95% CI 0.976–0.997). At a threshold of QTcd = 45 ms, the sensitivity and specificity were, respectively, 94.0% and 91.8% for symptom severity indication. Conclusions: In pediatric cases with POTS, QTcd was positively correlated with their symptom severity and exhibited a strong indicative value. A QTcd of 45 ms was a valid cut-off value for indicating symptom severity. Full article

Background/Objectives: Dental plaque is a significant contributor to various prevalent oral health conditions, including caries, gingivitis, and periodontitis. Consequently, its detection and management are of paramount importance for maintaining oral health. Manual plaque assessment is time-consuming, error-prone, and particularly challenging in uncooperative pediatric patients. These limitations have encouraged researchers to seek faster, more reliable methods. Accordingly, this study aims to develop a deep learning model for detecting and segmenting plaque in young permanent teeth and to evaluate its diagnostic precision. Methods: The dataset comprises 506 dental images from 31 patients aged between 8 and 13 years. Six state-of-the-art models were trained and evaluated using this dataset. The U-Net Transformer model, which yielded the best performance, was further compared against three experienced pediatric dentists for clinical feasibility using 35 randomly selected images from the test set. The clinical trial was registered on under the ID NCT06603233 (1 June 2023). Results: The Intersection over Union (IoU) score of the U-Net Transformer on the test set was measured as 0.7845, and the p-values obtained from the three t-tests conducted for comparison with dentists were found to be below 0.05. Compared with three experienced pediatric dentists, the deep learning model exhibited clinically superior performance in the detection and segmentation of dental plaque in young permanent teeth. Conclusions: This finding highlights the potential of AI-driven technologies in enhancing the accuracy and reliability of dental plaque detection and segmentation in pediatric dentistry. Full article

Background: Acute diarrheal disease remains a leading cause of childhood morbidity and mortality, particularly among children under five. Despite being preventable and treatable, cultural, socioeconomic, and familial factors influence home management. This study examined how these factors shape childhood diarrhea care in Ecuador. Objective: To analyze maternal, child, and household characteristics associated with diarrhea management in children under five years of age using data from the 2018 Ecuadorian National Health and Nutrition Survey (ENSANUT). Methods: This cross-sectional study applied logistic regression models to assess the influence of various factors on diarrhea management practices. Results: Maternal education, ethnicity, child’s age, household size, and urban or rural residence significantly influenced diarrhea management. Households with 4–6 persons (OR = 1.584, p < 0.05) and 7–9 persons (OR = 2.006, p < 0.05) had higher odds of receiving medical care. However, the child’s sex, birth order, maternal marital status, and socioeconomic status were not significant predictors. Conclusions: Although most children received some form of healthcare, disparities persisted, particularly in education level, ethnicity, and rural residence. These findings highlight the need for targeted maternal health literacy programs, culturally tailored interventions, and improved water-security initiatives to enhance diarrhea management and reduce inequities in care. Full article

Background: The aim of this study was to investigate the effects of multimodal rheumatologic complex treatment (MRCT) in childhood and adolescence. MRCT means a high-frequency treatment program of at least 11 h per week. Methods: MRCTs in children, carried out between May 2009 and May 2022 at the Department of Pediatrics of the University Hospital in Halle (Saale), were included in this study. The effects of the MRCT were evaluated based on inflammatory activity, functionality (using the Childhood Health Assessment Questionnaire (CHAQ)), subjective statements regarding pain intensity, state of health, and coping with the illness, as well as the objective determination of joint mobility. Data were analyzed retrospectively using t-tests to compare different groups and values before and after treatment. Results: During the study period, N = 133 MRCTs were conducted in n = 95 children. The most common diagnosis was juvenile idiopathic arthritis (83.2%). The c-reactive protein (CRP) fell from an average of 25.3 mg/L to 7.3 mg/L, and the erythrocyte sedimentation rate (ESR) fell from 29.5 mm in the first hour to 17.9 mm. Pain intensity was reduced from 5.4 to 4.0. The state of health and coping with the illness also improved. The disability index showed a moderate reduction from 0.92 to 0.81. Furthermore, an improvement in joint mobility was observed. Positive effects were also shown in patients with somatoform disorders. Conclusions: Due to the positive effects of MRCT on subjective well-being and physical health, the treatment program can be recommended for affected children, including patients with an additional diagnosed somatoform disorder. Full article

Introduction: Handgrip strength, measured by dynamometry (HGD), is a key measure in assessing physical condition and nutritional status. Its correlation with anthropometric measures and body composition makes it an accessible method for the evaluation of cardiovascular health. This study aimed to develop a new reference for right-hand dynamometry in the Spanish population and compare it with previous references. Material and Methods: A total of 3281 subjects aged 3 to 16 years (1608 females) from the PESCA, PASOS, and ASOMAD projects were included. Handgrip strength was measured using the same methodology in all cases. Data on age, weight, height, and BMI were collected, and the handgrip strength per kilogram of body weight was calculated. Sexual dimorphism in the temporal development of strength was analyzed, and multiple correlations were established between dynamometry and anthropometric variables. Results: Percentile curves and tables for dynamometry are presented for each sex, including data from as early as 3 years old, for the first time. Conclusions: Sexual dimorphism in strength development is confirmed, becoming more pronounced with puberty. In absolute terms, our study shows a decrease in handgrip strength among adolescents, occurring earlier and more markedly in females. When compared to the previous literature, the 16-year-old male adolescents in our study exhibited lower strength than those from 40 and 16 years ago. Full article

Objectives: Non-invasive ventilation (NIV) is a widely used treatment for neonatal respiratory distress syndrome (RDS). Data on diaphragm contractility and thickness during NIV is scarce. We aimed to describe changes in diaphragm thickness/contractility during NIV and to explore associations with NIV discontinuation failure. Methods: This is a single-center prospective study. Diaphragmatic ultrasound was performed weekly during NIV, then within 7 days from NIV discontinuation. Diaphragm thickness was measured at end-inspiration (DTI) and end-expiration (DTE). Diaphragm thickening fraction (DTF) was calculated as (DTI-DTE/DTE). The clinical characteristics of patients and NIV discontinuation failure were recorded. Univariate analysis, logistic regression and linear regression were performed to describe diaphragm features during NIV and associations with NIV discontinuation failure. Results: We studied 17 NIV cycles (median duration 21 days). Median DTE increased from 0.12 cm (SD 0.05) at the start of NIV to 0.15 cm (SD 0.04) at NIV discontinuation. The mean DTF decreased from 32.8 (SD 16.8) at the start of NIV to 25.6 (SD 8.9) at NIV discontinuation. NIV discontinuation failure occurred in 23.5% of infants and was associated with higher DTI and DTE at the start of NIV and with a more pronounced decrease in DTI and DTE over the NIV cycle, compared to infants with NIV discontinuation success. There were no differences in neonatal outcomes between the infants with NIV discontinuation failure vs. success. We did not find any significant predictors of NIV failure. Conclusions: Diaphragm thickness increased, whereas DTF decreased over time on NIV in preterm infants with RDS. NIV duration was not associated with changes in diaphragm trophism. NIV discontinuation failure was associated with thicker diaphragm at the start of NIV, as well as with a reduction in diaphragm trophism over the NIV cycle. Full article

Background/Objectives: Parent training programs (PTPs) have long been recognized as effective interventions for early onset of child behavior problems, with evidence showing significant improvements in parenting practices and child outcomes. However, little is known about potential differences in treatment outcomes between mothers and fathers. This study examined changes in parenting practices and self-efficacy between mothers and fathers (n = 31 couples). Methods: Couples participated in a 10-week digital parent training program for child behavior problems. Both parents completed measures of parenting practices (Parenting Scale, Alabama Parenting Questionnaire) and self-efficacy (Parenting Tasks Checklist, Me as a Parent Scale) at baseline and post-intervention. Results: Significant, large-effect-size improvements in most parenting variables were found for both mothers and fathers (p_s ≤ 0.03, η_p² ≥ 0.15). No significant interaction effects were found between the parent (mother, father) and intervention time (pre, post-intervention) in parenting variables (p ≥ 0.18), indicating similar patterns of improvement. Mothers reported higher levels of positive parenting practices compared to fathers regardless of intervention time (p = 0.01, η_p² = 0.19). The initial severity of child behavior problems moderated differences between parents in improvements in sense of competence (U = 171.50, p = 0.03), with smaller mother–father gaps observed for families beginning with higher levels of child behavior problems. No other demographic variables moderated parent differences. Conclusions: Digital delivery format may help promote more equitable benefits for both parents. Further research with larger samples and longer follow-up time is needed to validate these preliminary findings. Full article

Background: Neurodevelopmental disorders (NDDs) and mental health disorders (MH) present significant challenges to Canadian Children. While there is increased awareness, the NDD/MH service needs and barriers to service for immigrant children in Canada are unclear. Therefore, the present study explores NDD and MH problems and management among Canadian children compared to immigrant children. Method: An online survey was administered to eligible participants using AskingCanadians. A total of 682 parents (Mean age = 31.8, SD = 7.4), 41.3% of whom were immigrants, completed the survey. Participants were asked to complete questionnaires related to mental health in general, child MH and NDD service needs, social support and use and barriers to accessing services. Results: Results showed that immigrant participants reported significant underuse of child mental health services (1.5 times less use) despite a higher reported child need. Similarly, a higher frequency of children born to Canadian parents reported accessing NDD/MH assessment referrals compared to immigrant families. Parents of children referred for NDD/MH assessment also reported a higher prevalence of mood disorders and anxiety disorders. Furthermore, parents of children presenting with NDD/MH concerns overall reported a significantly higher impact of barriers to their child’s education compared to parents whose children did not present with NDD/MH concerns. This effect was driven by Canadian parents of children with NDD/MH reporting increased barriers. Conclusions: These findings highlight the importance of considering cultural background in clinical approaches to MDD/MH services. There is a need to increase awareness and reduce stigma regarding service access. Furthermore, the findings reiterate the ongoing challenges families of children with NDD/MH challenges face in accessing support. Full article

Background: Invasive fungal disease is a significant cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. Posaconazole, a broad-spectrum triazole, is widely used as prophylaxis. Methods: We conducted a monocentric, retrospective study to present real-world data on posaconazole trough levels in paediatric alloHSCT patients. The main objective was to determine the required daily dose of posaconazole in paediatric patients. We analysed factors influencing posaconazole levels, and the association between posaconazole levels and breakthrough fungal infection. Results: Among 102 allogeneic HSCT recipients, we measured posaconazole plasma concentrations in 548 blood samples. The required daily doses to reach a target range of 0.7–2.0 mg/L were 15.22 (suspension), 7.52 (tablet), and 7.84 mg/kg (intravenous). Patients aged < 13 years needed higher doses to achieve the target range. The presence of enteral symptoms during prophylaxis was associated with lower plasma concentrations (p < 0.001), while co-administration of proton pump inhibitors did not (p = 0.09). Eight breakthrough infections occurred; low levels of posaconazole (<0.7 mg/L) were observed in five out of eight cases. The Cox regression model showed that higher mean plasma concentrations decreased the hazard of breakthrough infections. Conclusions: The tablet and intravenous formulations of posaconazole outperformed the suspension in terms of predictability. Our analyses on breakthrough infections and posaconazole plasma levels suggest an exposure–response relationship. Full article

Background/Objectives: Vitiligo is an autoimmune condition causing melanocyte destruction and skin depigmentation. First-line treatments for vitiligo include topical medications and phototherapy; however, access and utilization of these treatments vary, particularly in pediatric patients. This study evaluates nbUVB use in pediatric versus adult vitiligo patients to better understand utilization in the pediatric population. Methods: A retrospective chart review study was conducted, collecting demographics and treatment characteristics for 102 adults and 19 children with vitiligo treated with nbUVB phototherapy at one institution. Statistical analysis included comparisons for categorical variables made using Chi-squared test or Fisher’s exact test, as appropriate, and using a non-parametric Mann–Whitney U test for continuous variables. Results: On average, adults underwent nbUVB for 23.8 months (range 0.5–418, median 9), while children had an average duration of 14.8 months (range 2–60, median 8). The average number of nbUVB sessions for adults was 83.8, whereas children had an average of 33.5 sessions. Overall, 59.6% of adults and 60.0% of children experienced repigmentation with nbUVB. Conclusions: Retrospective analysis indicated that the duration and frequency of nbUVB sessions varied widely among both adults and children. While the average duration of treatment was comparable between the groups, children underwent fewer sessions on average. This may reflect differences in physician recommendation, scheduling constraints, or treatment adherence. Despite this variability, most pediatric patients exhibited repigmentation, supporting nbUVB efficacy. Our results suggest nbUVB is underutilized in pediatric vitiligo. Addressing obstacles to access is crucial for improving treatment outcomes and quality of life. Full article

Parental empathy and sensitivity play a crucial role in the development of child attachment and socioemotional growth, influencing emotional regulation, social skills, and psychological well-being. However, no comprehensive systematic review integrates emotional, genetic, and neurobiological perspectives. Objectives: this systematic review aims to synthesize existing evidence on the relationship between parental empathy and sensitivity with child attachment and socioemotional development, integrating classical theories with contemporary findings and considering contextual factors such as adversity and intergenerational dynamics. Method: searches were conducted for studies published between 1993 and 2024. Empirical studies examining empathy (affective, cognitive, and multidimensional), parental sensitivity, child attachment (secure, avoidant, ambivalent, disorganized, or DMM), and socioemotional development were included. A total of 16 studies met the inclusion criteria, encompassing longitudinal, cross-sectional, genetic, neurobiological, and experimental designs. Results: key findings include the following: positive socialization predicted greater empathy, and self-regulation maternal anxiety reduced sensitivity and indirectly affected attachment; emotional empathy positively influenced sensitivity; genetic predispositions affected sensitivity through crying; neurobiological studies revealed altered PCC–amygdala connectivity in postpartum depression. Conclusions: the findings demonstrate that parental empathy and sensitivity significantly influence child attachment security and socioemotional development through emotional regulation, genetic predispositions, and neurobiological mechanisms. This review provides a comprehensive framework for understanding the parent–child bond and highlights implications for evidence-based parenting interventions. Full article

Background: Expanded Newborn Screening (ENS) allows the early identification of many inherited metabolic diseases (IMDs) for which timely treatment can modify the natural history. For most IMDs, diagnosis by ENS is pre-clinical. However, clinical symptoms may emerge for certain conditions before screening results become available. Methods: We describe six cases of patients with early-onset IMDs born between 2013 and 2023, who were admitted or transferred to Sant’Orsola University Hospital in Bologna (Italy). Results: Over the study period, 379,013 newborns underwent ENS in the Italian region of Emilia-Romagna. Excluding cases of congenital hypothyroidism, pre-clinical diagnoses from ENS were 410. In addition, six cases of IMD presented with early-onset clinical symptomatology, an antecedent to the outcome of newborn screening (incidence over 11 years of 1.58 cases per 100,000 infants). Among these patients, three were diagnosed with Urea Cycle Disorders (UCDs)—two with Citrullinemia type I (CIT1) and one with Argininosuccinic Acidemia (ASA); two were diagnosed with Methylmalonic Acidemia (MMA); and one was found to have Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD). Conclusions: Our 11-year experience with ENS has shown that clinical onset can occur between the second and fourth day of life, though rare. Even if dried blood spot (DBS) collection was performed 24–48 h after birth, the time required for sample transportation and processing would still delay result availability, making early intervention unlikely. Therefore, our experience supports performing ENS at 48–72 h, as currently implemented in Italy, while also highlighting the advantages and limitations of earlier screening. Full article

Background/Objectives: This study sought to identify key barriers to treatment adherence in children and adolescents with type 1 diabetes (T1D) using the Adherence Starts with Knowledge-12 (ASK-12) questionnaire and to evaluate its impact on metabolic control, providing insights for optimizing T1D management. Methods: A total of 160 children and adolescents with T1D aged 5–18 years who sought treatment from a pediatric endocrinology outpatient clinic between June and August in 2022 were prospectively examined. The patients’ low treatment adherence (LTA) or high treatment adherence (HTA) was determined based on their ASK-12 questionnaire scores. Two pediatric endocrinologists reviewed the participants’ medical records and then classified them into two groups: tight metabolic control and poor metabolic control. Results: LTA, which was determined based on the participants’ ASK-12 scores, was significantly associated with puberty, presence of diabetic ketoacidosis, and daily self-management (p < 0.001, p < 0.001, and p < 0.001, respectively). Those whose ASK-12 scores indicated LTA were older and had a longer duration of T1D, higher hemoglobin A1c levels, and lower BMI-SDS values than those with HTA) (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). A total of 94 (59%) participants were indicated to have HTA, but 24 (25.5%) of them were found by the clinicians to have poor metabolic control. Conclusions: The ASK-12 questionnaire scores can identify pediatric patients with T1D who exhibit LTA and thus may be beneficial for early recognition of low adherence. Approximately 25% of the patients with ASK-12 scores indicating HTA were at risk of poor metabolic control. Puberty, duration of T1D, BMI-SDS, HbA1C, and parental involvement alongside ASK-12 score may be considered to improve treatment compliance. Integrating these variables into adherence assessments may enhance treatment compliance and improve long-term outcomes in pediatric T1D management. Full article

Introduction: Lipomas are among the most encountered neoplasms in clinical practice, occurring mainly in adults between the fourth and sixth decades of life. Deep-seated lipomas in children are found in the thorax, chest wall, mediastinum, pleura, pelvis, retroperitoneum, and paratesticular area. Herein, we present a case of a three-year-old child with a giant mesenteric lipoma, along with a review of the literature on mesenteric lipomas in childhood. Case presentation: A three-year-old male toddler was referred to our hospital for severe, intermittent abdominal pain. Imaging studies at admission revealed a fat lesion occupying most of the peritoneal cavity and dislocating adjacent structures. An urgent laparotomy was performed. A giant lipoma arising from the mesentery and leading to the torsion of the mesenteric radix was confirmed and completely excised alongside an adherent small tract of jejunum. The child recovered uneventfully and is still being followed-up with no signs of recurrence. Discussion: Lipomas of the mesentery in children are very rare, and they are reported to be more common among children younger than three years of age. Mesenteric lipomas appeared to be more frequent in males than females. Even though they might be asymptomatic, voluminous lipomas can also create a lead point for intermittent torsion of the mass causing ischemia and infarction. Abdominal pain was the most frequent symptom, and the ileum was the tract of bowel more frequently involved by the tumor. Laparotomy was reported to be the preferable approach to safely remove this abdominal mass, especially in case of huge dimensions. Full article