Children-Basel最新文献

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental motor disorder characterised by marked difficulties in the acquisition and execution of motor skills, substantially affecting daily activities and quality of life. Martial arts (MAs), due to their multi-skilled nature, have been studied as possible intervention strategies to improve motor competence and functionality in children with DCD.

Objectives: The present systematic review aimed to explore the effects of MA practice in children and adolescents with DCD, identifying the benefits, methodological characteristics and practical implications of existing interventions.

Methods: The search was conducted in the PubMed, Web of Science, and EBSCO databases, following the PRISMA 2021 guidelines, using the keywords (developmental coordination disorder OR DCD OR dyspraxia) AND (karate OR judo OR taekwondo OR aikido OR martial art) AND (child OR preschool). Experimental and quasi-experimental studies that applied MA programmes to children and adolescents (≤18 years) with a confirmed diagnosis of DCD were included.

Results: Of the 1834 identified records, five studies met the inclusion criteria. The MA modalities examined were karate, tai chi, and taekwondo. Across studies (n per study = 16-145), MA-based programmes consistently yielded significant pre- to post-intervention improvements in overall motor competence (MC), balance, muscle strength, and coordination; one study reported maintenance of coordination gains at 3-month follow-up. Methodological quality assessed with the Downs and Black checklist ranged from fair to good (scores = 18-22). No adverse events were reported.

Conclusions: Based on the included studies, MA interventions demonstrate potential as an effective motor intervention approach for children and adolescents with DCD. Findings consistently indicated significant improvements in motor competence, balance, muscle strength, and coordination, with additional benefits observed in cognitive and psychosocial domains and no reported adverse effects.

Within the Developmental Origins of Health and Disease (DOHaD) framework, breast-feeding is a modifiable early postnatal exposure, but its long-term associations are difficult to separate from socioeconomic and family context. We conducted a structured literature search (PubMed/MEDLINE and Scopus; January 2015-December 2025) and prioritised large prospective/birth cohorts and genetic epidemiology studies reporting quantitative associations between breastfeeding in infancy (ever versus never, duration and, where available, exclusivity) and adult outcomes. Eighteen key primary studies were included in evidence tables across cardiometabolic, cancer, and neurocognitive domains. Overall, breastfeeding was associated with modestly lower all-cause and cardiovascular mortality, small reductions in cardiovascular disease and type 2 diabetes, and slightly more favour-able cardiometabolic profiles, including lower adiposity and higher HDL cholesterol. Where reported, effect sizes were generally small (e.g., hazard ratios typically close to 1.00), indicating limited clinical impact at the individual level but potential population relevance. Genetic analyses provide cautious support for a protective association with coronary outcomes, although lipid-mediated pathways appear to explain only a small proportion of the observed associations. Evidence for adult cancer outcomes remains mixed and largely inconclusive, while longer breastfeeding is associated with small ad-vantages in cognitive performance, educational attainment and selected psychological outcomes. Taken together, current evidence suggests that breastfeeding is associated with modestly more favourable adult cardiometabolic and neurobehavioural profiles, but its contribution to long-term health is small relative to the influence of later-life lifestyle and clinical risk factors and should therefore be interpreted cautiously.

Background/objectives: This study investigates the normative data and determinants of retinal and choroidal vessel density (VD) in Tibetan children using optical coherence tomography angiography (OCTA).

Methods: This study recruited students from primary schools in Lhasa who underwent OCTA encompassing VD in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) and choriocapillaris (CC) in the macular region, as well as refractive status, axial length, and systemic examinations.

Results: This study included a total of 645 children who met the criteria. The results showed that VD in the fovea was significantly higher in the SCP than in the DCP, while CC had the highest VD in the fovea. Correlation analysis revealed strong correlations in VD among all quadrants of the SCP, DCP, and CC, as well as significant correlations between corresponding regions of the SCP and DCP. VD showed no significant association with age, sex, axial length, or spherical equivalent. Foveal VD in both the SCP and DCP was positively correlated with oxygen saturation. No consistent correlation was found between choroidal or retinal thickness and VD in any layer.

Conclusions: The identified link between systemic oxygen saturation and foveal vascular density offers a novel perspective on human adaptation to chronic hypoxia, positioning the retinal microcirculation as a sensitive indicator of systemic oxygen homeostasis.

Introduction: Since its introduction in 1994, robot-assisted surgery has advanced significantly and has become a widely accepted tool in minimally invasive surgery. Over the past two decades, robotic technology has also been increasingly adopted in pediatric surgery. Currently, only two robotic systems are officially approved for pediatric use: the da Vinci surgical system and the Senhance system, both of which have certain limitations. To address these challenges, new robotic platforms such as the Versius system are being developed. Materials and Methods: Following approval from the institutional bioethics committee, a total of 14 pediatric patients underwent robotic-assisted surgery using the Versius robotic system between 10 June and 21 October 2024. Procedures included pyeloplasty, vascular hitch, and cholecystectomy. Results: Procedures with the Versius system were performed including children as young as six years of age and with body weight as low as 15 kg. All procedures were completed successfully without conversion to conventional laparoscopy or open surgery. No intraoperative complications were recorded. The overall postoperative complication rate was 21.4% (3/14 cases), including one anastomotic leak, one case of postoperative hematuria, and one case of postoperative ascites. Discussion: The Versius system represents a promising robotic platform for pediatric surgery, offering a different approach to robotic surgery through modularity, mobility, and compatibility with 5 mm instruments. However, several challenges remain, including prolonged setup and docking times, cable management issues, arm conflicts, and limited access to advanced instrumentation. Nevertheless, with ongoing technological development, robotic surgery is likely to play an increasingly important role in pediatric surgical care.

Background/Objectives: Adolescence is a critical developmental period in which individuals are required to orient themselves toward the future and construct a coherent life plan, including educational and career aspirations. Future orientation is closely linked to identity development and self-understanding, which allow adolescents to integrate past, present, and anticipated future selves. Among the personal resources supporting this process, problem-solving skills play a key role by enabling effective coping with challenges and informed, goal-directed decision-making. This study examined the association between problem-solving skills and adolescents' aspirations for an ideal occupation, and tested whether this relationship was mediated by identity acquisition and self-understanding, with attention to gender differences. Methods: A quantitative study design was adopted. Participants were 2443 Italian adolescents (aged 15-19 years) attending upper secondary schools. They completed self-report measures assessing perceived problem-solving skills, identity acquisition, self-understanding, and aspiration for an ideal occupation. Two multigroup mediation models were tested using structural equation modeling, examining identity acquisition and self-understanding as mediators and comparing pathways across genders. Results: Problem-solving skills were indirectly associated with stronger aspirations toward an ideal occupation through identity-related processes. Identity acquisition mediated this association only among females, whereas self-understanding emerged as a significant mediator for both females and males, with partial mediation among females and full mediation among males. Conclusions: Overall, although constrained by the cross-sectional design, the findings are consistent with the notion that problem-solving skills contribute to future-oriented career aspirations chiefly by promoting identity coherence and self-clarity. These findings highlight the importance of integrating problem-solving training with identity-focused interventions in educational and career guidance programs, while considering gender-specific developmental pathways.

Purpose: To synthesize all existing literature on the association between sodium disturbances during the first 10 days of life in Extremely-Low-Birth-Weight (ELBW) infants and the risk of developing severe intraventricular hemorrhage (IVH > grade 1) or long-term neurodevelopmental impairment.

Methods: Applying systematic review (ID CDR42024622933) principles, five major databases were explored. Any study was included if it reported on ELBW infants, on serum sodium values within the first 10 postnatal days, or was related these to neurocognitive or neurodevelopmental outcomes.

Results: Ten studies (13,276 infants) met inclusion criteria. Six studies evaluated the association between hypernatremia (>145 or >150 mmol/L) and severe IVH, and two reported a significant association. Among two studies studying hyponatremia (ranging <130 or <120 mmol/L), one found a significant association with severe IVH. Evidence regarding sodium fluctuations (difference between the maximum and minimum serum sodium values) identified fluctuations >13 mmol/L as a strong risk factor for severe IVH, while another study showed that glucose-corrected sodium fluctuations were independently associated with severe IVH. Long-term neurodevelopmental outcomes were reported in four studies; hyponatremia was significantly associated with hearing loss in one study (OR 5.6 (95% CI 1.1-27.8)), while another study reported that glucose-corrected sodium fluctuations were associated with neurodevelopmental impairment at 18-21 months, although significance disappeared after adjustment for confounding factors.

Conclusion: Considering the limitations related to heterogeneity in study design, threshold sodium values and cohort size, this systematic review suggests a possible association between early sodium disturbances and adverse neurodevelopmental outcomes in ELBW infants, emphasizing the need for further high-quality, prospective studies, especially since sodium management can be modulated.

Background: Congenital renal masses in neonates are most commonly congenital mesoblastic nephroma or, less frequently, or Wilms tumor. We describe a neonate with an apparent primary renal tumor that proved to be adrenal neuroblastoma infiltrating the kidney, highlighting diagnostic pitfalls in this subgroup of patients.

Methods: We retrospectively reviewed the diagnostic work-up, histopathology, genomic profiling, treatment, and outcome of a term neonate in whom a renal mass was detected incidentally on ultrasound.

Results: Ultrasound and MRI showed a 2 cm solid lesion centered in the upper pole of the left kidney, interpreted as nephroblastomatosis/early Wilms tumor. Left nephrectomy with adrenalectomy revealed stroma-poor, undifferentiated neuroblastoma with regional node involvement and multiple segmental chromosomal aberrations, including 1p and 3p loss, but no MYCN or ALK alterations. Initial management consisted of surgery alone with close surveillance. Within weeks, early disseminated relapse with bone and soft-tissue metastases occurred, necessitating escalation to high-risk, COJEC-based chemotherapy; resection of residual mass; and modified consolidation without high-dose chemotherapy or radiotherapy. The child remains in complete remission with preserved renal function.

Conclusions: Neuroblastoma should be considered in the differential diagnosis of congenital "renal" masses. Imaging-driven provisional diagnoses may be misleading, and genomic risk profiling may help lower the threshold for systemic therapy in selected cases.

Background/objectives: Work-family conflict (WFC) is a common stressor for working parents and has been associated with poorer child adjustment. However, the mechanisms linking WFC to young children's emotional and behavioral difficulties remain insufficiently understood. This study examined whether parental mental health mediates the association between WFC and children's emotional and behavioral difficulties in early childhood.

Methods: This quantitative cross-sectional study was conducted in Portugal with 313 parents of children aged 18-72 months. Parents completed validated self-report measures of WFC, parental stress, depressive symptoms, parental self-efficacy, and children's emotional and behavioral difficulties. Mediation and moderated mediation analyses were performed, testing children's age (toddlers vs. preschool-aged) as a moderator.

Results: Higher WFC was associated with greater emotional and behavioral difficulties in children (parents reported). This association was fully mediated by parental stress and depressive symptoms, whereas parental self-efficacy did not show a significant mediating effect. The indirect pathways were consistent across children's age groups.

Conclusions: The findings indicate that WFC may affect young children's adjustment, primarily through its impact on parental psychological distress. Supporting parental mental health and reducing WFC may be key targets for early prevention and intervention.

Background: Both home accidents and sleep problems are prevalent health issues among young children. This study aimed to investigate the association between the sleep characteristics of both preschool children and their mothers and the occurrence of home accidents among children.

Methods: In this analytical cross-sectional study, the home accident group consisted of 90 children who presented to the Mersin University Hospital Pediatric Emergency Department due to home accidents. The control group comprised 90 healthy children, matched for age and sex with the home accident group. Sleep patterns of both children aged 12-72 months and their mothers, as primary caregivers, were evaluated through face-to-face interviews with the mothers.

Results: Each one-hour increase in the child's total nocturnal sleep duration increased the risk of being in the home accident group by 1.63 times (95% CI: 1.19-2.21, p = 0.002). Conversely, each one-hour increase in the mother's total nocturnal sleep duration reduced the risk of child home accidents by a factor of 0.72 (95% CI: 0.58-0.91, p = 0.006). Maternal excessive daytime sleepiness increased the risk of home accidents in children by 11.35 times (95% CI: 2.38-54.26, p = 0.002).

Conclusions: Preschool children who have had home accidents and their mothers should be evaluated for sleep problems. To reduce the frequency and severity of injuries associated with home accidents, greater focus must be placed on improving the sleep hygiene of both children and their mothers.

Background: Parents of preterm infants face significant emotional, informational, and caregiving challenges during neonatal intensive care unit (NICU) hospitalisation. Educational interventions are increasingly used to support parental readiness; however, considerable variation exists in their content, structure, and delivery. A clearer understanding of these components is essential to inform the development of effective, contextually responsive programmes.

Aim: To identify and synthesise the core educational components, programme structures, and embedded parental support needs within NICU-based educational interventions for parents of preterm infants.

Methods: A systematic search of peer-reviewed literature (January 2010-September 2022) identified 33 studies of high methodological quality. Data were extracted and synthesised using thematic analysis.

Results: Three overarching domains were identified: (1) educational content, (2) programme structure and delivery, and (3) parental support needs integrated within educational delivery. The educational content encompassed the NICU environment, infant health and behaviour, caregiving practices, parental well-being, and discharge preparation. Programme structures varied widely in terms of intensity, duration, delivery modality, and facilitator roles, with limited justification for structural choices. Parental support-emotional, relational, and confidence-building-was inconsistently embedded despite evidence of its importance. Established interventions such as COPE, FICare, and FCC have clearer theoretical foundations and more holistic support than most locally developed programmes.

Conclusions: NICU educational interventions positively influence parental knowledge, confidence, and parent-infant interaction; however, substantial variation and limited conceptual grounding hinder their comparability and scalability. The evidence base remains dominated by high-income settings, which limits its global applicability. Future research must prioritise theory-informed design, transparent reporting, and context-sensitive adaptation, particularly in under-resourced health systems, to support equitable and effective parental education for families of preterm infants worldwide.