Children-Basel最新文献

Background: Respiratory tract infections (RTIs) represent one of the most prevalent reasons for visits to Pediatric Emergency Departments (PEDs). Because viral and bacterial presentations frequently overlap, a substantial proportion of antibiotic prescriptions in pediatric acute care are potentially unnecessary, contributing to antimicrobial resistance. Rapid Diagnostic Tests (RDTs) for respiratory viruses have been suggested as tools to enhance diagnostic precision and support antimicrobial stewardship. However, evidence regarding their real-world impact in pediatric emergency settings is limited. Objectives: This study aimed to assess the association between point-of-care RDT results and antibiotic management in a tertiary PED, focusing on both the discontinuation of antibiotics in children already receiving treatment and the avoidance of new antibiotic prescriptions in untreated children. The secondary objective was to evaluate the short-term safety through 72-h return visits. Methods: A retrospective cohort study was conducted at a tertiary PED during two epidemic seasons (December-February 2023-2024 and 2024-2025). Children aged <18 years who underwent RDTs for febrile respiratory illnesses were included. Patients were stratified based on whether they were already receiving antibiotic therapy at presentation. The primary outcomes were antibiotic discontinuation among treated patients and initiation among untreated patients. Unplanned return visits to the PED within 72-h post-discharge were used as a pragmatic short-term safety outcome to capture early clinical deterioration. RDTs (SD Biosensor Standard F Antigen) were performed at the bedside with a turnaround time of 10-15 min. Results: A total of 1238 children were included, of whom 330 (26.6%) tested positive for influenza and/or adenovirus. Among the 234 children already receiving antibiotics, discontinuation was significantly more frequent in the RDT-positive group (p < 0.001; OR 0.044). Among the 1004 untreated children, antibiotic prescription was significantly lower in the positive group than in the negative group (p < 0.001; OR 0.097). Return visits within 72-h did not differ between the groups in either cohort. No invalid tests occurred. Conclusions: Influenza/adenovirus RDT positivity was associated with lower antibiotic initiation among untreated children and higher discontinuation among those already receiving antibiotics, with no differences in 72-h return visits. These findings suggest a potential role for bedside viral testing as a decision-support tool for antibiotic management in the PED.

Background/objectives: Artificial intelligence (AI) has gained substantial prominence in pediatric dentistry, offering new opportunities to enhance diagnostic precision and clinical decision-making. AI-based systems are increasingly applied in caries detection, early childhood caries (ECC) risk prediction, tooth development assessment, mesiodens identification, and other key diagnostic tasks. This systematic review and meta-analysis aimed to synthesize evidence on the diagnostic performance of AI models developed specifically for pediatric dental applications.

Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase following PRISMA-DTA guidelines. Studies evaluating AI-based diagnostic or predictive models in pediatric populations (≤18 years) were included. Reference screening, data extraction, and quality assessment were performed independently by two reviewers. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated using random-effects models. Sources of heterogeneity related to imaging modality, annotation strategy, and dataset characteristics were examined.

Results: Thirty-two studies met the inclusion criteria for qualitative synthesis, and fifteen were eligible for quantitative analysis. For radiographic caries detection, pooled sensitivity, specificity, and AUC were 0.91, 0.97, and 0.98, respectively. Prediction models demonstrated good diagnostic performance, with pooled sensitivity of 0.86, specificity of 0.82, and AUC of 0.89. Deep learning architectures, particularly convolutional neural networks, consistently outperformed traditional machine learning approaches. Considerable heterogeneity was identified across studies, primarily driven by differences in imaging protocols, dataset balance, and annotation procedures. Beyond quantitative accuracy estimates, this review critically evaluates whether current evidence supports meaningful clinical translation and identifies pediatric domains that remain underrepresented in AI-driven diagnostic innovation.

Conclusions: AI technologies exhibit strong potential to improve diagnostic accuracy in pediatric dentistry. However, limited external validation, methodological variability, and the scarcity of prospective real-world studies restrict immediate clinical implementation. Future research should prioritize the development of multicenter pediatric datasets, harmonized annotation workflows, and transparent, explainable AI (XAI) models to support safe and effective clinical translation.

Background and objectives: Suicide attempts and self-harm are critical issues in adolescence, often leading to serious and irreversible consequences. These behaviours frequently co-occur and share common biopsychosocial risk factors. Identifying these factors enables a more comprehensive assessment of suicide and self-harm risk, helping specialists recognize high-risk individuals and implement effective preventive measures. This study aimed to examine the association between suicide attempts, self-harm and psychosocial factors among hospitalized adolescents. Materials and methods: A retrospective data analysis was performed using the database of the University Department of Children and Adolescents of the Republican Vilnius Psychiatric Hospital. The study covered patients' records from December 2022 to February 2025. Information on gender, age, suicide attempts, self-harm, adverse events (bullying, psychological abuse, physical violence within the family, and sexual abuse) and unhealthy habits (smoking, harmful alcohol consumption, and psychoactive substance use), was selected and analyzed in this study. A Chi-square test was used to assess the difference between groups. Results were considered statistically significant when p < 0.05. Results: The study included 599 hospitalized adolescents (26.9% boys; mean age 15.1 ± 1.4 years), of whom 70.8% reported at least one episode of self-harm and 37.8% at least one suicide attempt. Rates of self-harm and suicide attempts were significantly higher in girls than in boys (self-harm: 81.3% vs. 42.2%, ϕ=0.381, p<0.001; suicide attempts: 45.5% vs. 16.5%, ϕ=0.304, p<0.001), and adolescents with self-harm had a significantly higher prevalence of suicide attempts than those without self-harm (46.7% vs. 15.8%, ϕ=0.308, p<0.001). Adverse childhood experiences and unhealthy behaviours were significantly more frequent in adolescents with self-harm and suicide attempts, although effect sizes were small to moderate (ϕ range 0.086-0.230, all p<0.05). In multivariable models, female gender (β=0.355, p<0.001) and smoking (β=0.330, p<0.001) were the strongest predictors of self-harm, whereas alcohol use (β=0.337, p<0.001) and self-harm (β=0.232, p<0.001). Conclusions: Exposure to adverse childhood experiences and engagement in unhealthy habits were associated with higher rates of both self-harm and suicide attempts. A comprehensive assessment and early detection of self-harm behaviours and adverse psychosocial circumstances are crucial elements of effective suicide prevention strategies and prompt intervention among high-risk adolescents.

Background: Adolescents in residential care frequently face functional challenges, yet few interventions integrate functional-cognitive models with motivational theories to support their daily function. Methods: This mixed-methods feasibility study is an innovative conceptual integration that links motivational and metacognitive approaches with growth-mindset principles to address both beliefs about the ability to change and functional performance. Quantitative data were collected from staff (n = 44), alumnae (n = 5), and current residents (n = 3), assessing mindset and functional-skill confidence among three focus groups (n = 16). The qualitative insights highlighted the motivational processes, strategy use, and barriers each group faced. Results: The findings informed the development of structured intervention psychoeducation protocol to facilitate goal-setting and reflective questioning. The feasibility and acceptability were tested by a pilot study among five staff members. Before implementation, staff demonstrated lower confidence in promoting daily autonomy and providing strategy-focused feedback. Alumnae and residents reported high emotional support, yet persistent gaps in functional independence. Conclusions: The pilot findings may inform the development of structured staff practices for delivering functional guidance, pending further evaluation. This study offers a novel conceptual contribution by positioning growth mindset as an active mechanism that supports functional-cognitive processes to enhance autonomy among adolescents in residential care settings.

Background: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study aimed to identify epidemiological, clinical, and laboratory predictors of OFC outcomes and reaction severity in children with suspected immediate-type food allergies. Methods: We conducted a retrospective review of 148 children who underwent hospital-based, open OFCs due to suspected immediate-type food reactions. Data on demographics, comorbidities, characteristics of the initial reaction, sensitisation profiles (specific IgE [sIgE], skin prick test [SPT]), and OFC outcomes were analysed. Reactions were graded using the Ring and Messmer scale. Results: OFC was positive in 44 of 148 children (29.7%). However, no clinical or laboratory parameters-including prior reaction severity and the magnitude of allergy test results-were associated with the severity of reactions during OFC. Comorbidities-specifically asthma, atopic dermatitis, and allergic rhinitis-were significantly associated with a positive OFC (p < 0.01), as were elevated sIgE levels and larger SPT wheal diameters (p < 0.01 for both). The optimal thresholds for predicting a positive OFC were 0.73 IU/mL for sIgE and 3.5 mm for SPT. Conclusions: Oral food challenge (OFC) remains essential for confirming food allergies in children. Given that the severity of reactions during OFCs cannot be reliably predicted and that low cut-off values of allergy tests were identified for predicting a positive OFC outcome, OFCs should be performed in a controlled and fully equipped medical setting, particularly in children with atopic comorbidities.

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54-11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17-0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies.

Background: Children with ADHD and children with intellectual disability (ID) often have problems with daily time management (DTM). It is, however, less well-known how the underlying time-processing ability (TPA) may impact children's DTM and autonomy. The purpose of this study was to investigate DTM, TPA, and self-rated autonomy in the activities of everyday life among children aged 9-15 years with and without disabilities.

Methods: The participants were matched samples of children with ADHD (n = 47), with ID (n = 47), and typically developing (TD) children (n = 47). A descriptive, comparative, and cross-sectional design was used. Group comparisons with one-way analysis of variance (ANOVA), Tukey post-hoc tests, bootstrapping, and a cluster analysis were used to analyze the data.

Results: Children with ADHD and children with ID had significantly lower TPA and DTM than TD children. Children with ADHD had even lower DTM than those with ID. Children with ADHD and ID have the same overall pattern of TPA, but it may be delayed, affecting their DTM and autonomy. However, there was considerable heterogeneity among the children with ADHD and ID, ranging from skilled to having significant problems in TPA. For all children, the levels of self-rated autonomy seemed to follow the level of TPA.

Conclusions: Children with ADHD and children with ID have an increased risk of delayed TPA, affecting their DTM and autonomy, which may also influence their participation in daily activities. The results indicate a need to measure TPA and DTM to tailor interventions for each child.

Background and Clinical Significance: Malaria remains a significant public health issue in Latin America, where Plasmodium vivax predominates but P. falciparum continues to circulate. Mixed-species infections are uncommon and can pose diagnostic challenges, particularly when parasite densities differ markedly, increasing the risk of underdetecting P. falciparum with conventional methods. Case report: We report a 9-year-old boy from an endemic area with a six-day febrile syndrome. Thick smear and peripheral blood film microscopy, complemented by rapid diagnostic tests for pan-Plasmodium and HRP2 antigens, confirmed a mixed infection with P. vivax (5500 parasites/µL) and P. falciparum (562 parasites/µL). The patient was hemodynamically stable, without severe malaria criteria, and laboratory values were within normal limits. Following confirmation of normal glucose-6-phosphate dehydrogenase activity, treatment with artemether-lumefantrine was initiated, followed by primaquine for hypnozoite eradication. Clinical evolution was favorable, with progressive defervescence, treatment tolerance, and documented parasite clearance. Conclusions: This case illustrates the risk of underestimating P. falciparum in mixed infections with disparate parasitemias and highlights the value of integrated diagnostic approaches in resource-limited endemic settings. It also underscores surveillance limitations that can misclassify mixed infections, potentially affecting epidemiological estimates and treatment strategies. Timely recognition and comprehensive diagnostic evaluation are essential to ensure appropriate antimalarial therapy, prevent complications, and inform public health interventions in regions where both species coexist.

Background: Mastocytosis is a rare hematologic disorder, classified into cutaneous mastocytosis (CM) and systemic mastocytosis (SM). Understanding age-related differences in presentation and management is essential for individualized care. Methods: Data from patients recruited from the Montreal Children's and Montreal General Hospitals between 2015 and 2024 were analyzed. Descriptive statistics were employed to present patient demographics, clinical characteristics, and medication usage. Statistical analyses included Fisher's exact test for categorical variables and t-tests or non-parametric equivalents for continuous variables. Results: A total of 63 patients were included, comprising 39 children and 24 adults. Children had a median age of 1.9 years, while adults had a median age of 49.3 years. CM was exclusively prevalent in children (100.0%), while SM was more common in adults (45.8%). Adults with SM had a significantly higher median age than CM (49.4 versus 44.7 years, respectively, p = 0.03). Epinephrine use was more frequent in adult SM patients (36.4% versus 0%, respectively, p = 0.03). No pediatric patients required epinephrine for symptom control. Conclusions: This study highlights important clinical differences between pediatric and adult mastocytosis. CM was more common in children while SM predominated in adults and was associated with greater flare severity and higher tryptase levels.

Background/Objectives: Neonates with hypoxic-ischemic encephalopathy (HIE) are born in delivery facilities with different levels of neonatal care. The objective of this study was to investigate differences in the incidence of HIE and postnatal management between different levels of neonatal care in delivery facilities. Methods: This is a retrospective, multi-center cohort study of neonates with moderate-to-severe HIE receiving therapeutic hypothermia (TH) in the Canton of Zurich, Switzerland, registered in the Swiss National Asphyxia and Cooling Register between 2015 and 2023. Incidences of HIE receiving TH were calculated for all delivery facilities according to the national levels of neonatal care on site (Level I-basic; Level IIB-intermediate (no Level IIA facility in the Canton of Zurich); Level III-intensive neonatal care). Perinatal characteristics and variables on transport and outcomes were compared between neonates born in Level I and Level IIB facilities (the majority of the HIE population) and reported for neonates born in all other facilities (for completeness). Results: A total of 173 neonates (79 (45.7%) born in Level I; 80 (46.2%) in Level IIB; 9 (5.2%) in Level III; 5 (2.9%) in birthing centers) were admitted to a neonatal cooling center to receive TH. The average number of annual cases of HIE receiving TH per facility was 0.67 (0.11-1.50) in Level I and 2.22 (0.22-3.11) in Level IIB facilities (p = 0.088), respectively. There was no difference in Apgar score, worst pH (within 60 min after birth) and the severity of encephalopathy between neonates born in Level I and Level IIB facilities. Neonatal transport team requests were initiated earlier in Level I facilities (median 12 vs. 34 min of life, p < 0.001). There was no difference in age at initiation of TH (median 3 vs. 3 h, p = 0.431) and the time when target temperature was reached (median 4 vs. 4 h, p = 0.431) between neonates born in Level I and Level IIB facilities. Conclusions: The level of neonatal care available in delivery facilities influenced the management of neonates with HIE receiving TH.