Children-Basel最新文献

Obesity hypoventilation syndrome (OHS) is a severe and underrecognized respiratory disorder characterized by the coexistence of obesity, daytime hypercapnia, and sleep-disordered breathing. Although well described in adults, pediatric OHS remains poorly defined despite the rising prevalence of childhood obesity. Its pathophysiology is multifactorial, involving obesity-related mechanical constraints, impaired ventilatory control, altered chemosensitivity, and frequent overlap with obstructive sleep apnea. Clinical manifestations in children are often subtle and nonspecific, including snoring, sleep fragmentation, daytime sleepiness, and neurocognitive impairment, frequently leading to delayed diagnosis and, in some cases, acute cardiopulmonary decompensation. Management of pediatric OHS is challenging and largely extrapolated from adult data. Positive airway pressure therapy remains the cornerstone of treatment, while weight reduction is essential but difficult to achieve in pediatric populations. Pharmacological approaches such as medroxyprogesterone or acetazolamide remain experimental, with limited pediatric evidence. This review synthesizes current knowledge on pediatric OHS, focusing on epidemiology, pathophysiology, clinical presentation, diagnostic challenges, and therapeutic strategies. Increased awareness and earlier recognition are essential to prevent progression to chronic respiratory failure and long-term cardiovascular complications.

Background/Objectives: Many elementary school-aged children (i.e., 5 to 12 years old) experience sleep difficulties that negatively impact their daytime functioning. Despite this high prevalence, sleep education is rarely included in school curricula and evidence-based interventions are limited. To better understand this gap, a needs assessment was conducted to inform the development of a sleep education program. Method: Semi-structured virtual interviews were conducted with 14 elementary school teachers in Nova Scotia, Canada. Participants were asked 20 questions about their students' sleep and its impact, teachers' needs and practices in sleep education, what a sleep education program would look like, and how it could be delivered. During the interview, participants watched the online ABCs of SLEEPING storybook as a potential foundation for developing a sleep education program, and interview themes were analyzed using deductive thematic analysis. Results: All teachers identified poor sleep as an issue impacting students' behavior and learning, and reported that they had a lack of resources to teach sleep education. Teachers believed the storybook could be used with their students and integrated into the curriculum. Recommended modifications include making the storybook available for families, adding interactive activities and student discussions, providing teacher resources, and tailoring the content to be suitable for both lower and upper elementary school-aged students. Most teachers indicated that the storybook could be adapted for upper elementary students with more age-appropriate vocabulary and visuals. Conclusions: The findings from this needs assessment will inform the development of an elementary school sleep education program using the ABCs of SLEEPING storybook as the foundation of the program, while noting limitations such as sample diversity.

Background: Children of mothers exposed to adverse childhood experiences (ACEs) may be at increased risk of sleep disruptions, such as night waking, due to potential suboptimal caregiving or living conditions. Mothers' ACEs are also associated with maternal depressive symptoms, which in turn are associated with children's screen time and sleep disruptions, revealing relevant, but unexplored, mediation pathways. This Canadian study investigated if mothers' ACEs were associated with their 5-year-old children's sleep disruptions (1) directly and (2) indirectly through independent or serial mediation via maternal depressive symptoms and/or children's screen time.

Methods: Data (n = 622; maternal mean age 32.3 years, 88.4% white) came from the longitudinal APrON Study. ACEs were measured 1 year postpartum. Mother's depressive symptoms were measured across prenatal and postnatal timepoints. Children's evening screen time (i.e., number of days in a week children engaged in one hour of screen time before bedtime) and sleep disruptions (number of days in a week their child wakes up multiple times) were measured at 5 years postpartum using adapted scales (52.9% male). PROCESS was used to assess for mediation.

Results: Mothers' ACEs had an indirect effect on their children's sleep disruptions through mothers' mean depressive symptoms (effect = 0.018, 95% CI [0.006, 0.034]), but not through children's screen time. No other effects (i.e., direct, total) were observed.

Conclusions: Although replication studies are warranted, this novel study reveals that the effects of maternal ACEs on children's sleep disruptions may operate indirectly with effects potentiated through maternal depressive symptoms, thus serving as a target for intervention.

Background/Objectives: Effective airway management during pediatric cardiopulmonary resuscitation (CPR) is crucial but technically challenging, especially during continuous chest compressions. While direct laryngoscopy with Macintosh (MAC) or Miller (MIL) blades remains the standard, optical devices such as the VieScope (VSL) may enhance performance under dynamic resuscitation conditions. This study compared first-pass success and intubation time, as well as procedural difficulty and glottic visualization, of MAC, MIL, and VSL during simulated pediatric cardiopulmonary resuscitation. Methods: This prospective, randomized crossover simulation study involved 53 medical students. Participants performed endotracheal intubation on a high-fidelity manikin simulating a 5-year-old pediatric patient using MAC, MIL, and the Bebé VieScope laryngoscope. Each technique was evaluated in two scenarios: with and without continuous chest compressions. Results: Without chest compressions, first-pass success (FPS) and intubation time varied significantly between techniques. VSL achieved the highest FPS (100%; p = 0.032) and the shortest intubation time (27.9 ± 9.2 s; p = 0.040), performing faster than MIL and achieving higher FPS than MAC. Visualization quality, ease of intubation, and optimization maneuvers were similar across techniques. During continuous chest compressions, all outcomes differed significantly. FPS increased from MAC to MIL and VSL (p = 0.001), with MAC showing the lowest success rate. VSL showed the shortest intubation time (35.9 ± 13.0 s; p < 0.001), better glottic visualization, easier intubation, and fewer optimization maneuvers, followed by MIL. Conclusions: In this simulated pediatric cardiac arrest model, the VieScope laryngoscope demonstrated superior overall performance, especially during uninterrupted chest compressions. Optical tubular laryngoscopy may therefore provide clinically relevant benefits in pediatric resuscitation where maintaining high-quality chest compressions is crucial. Given the manikin-based design of this study, confirmation of these findings in clinical pediatric cardiac arrest settings will require further prospective clinical investigation.

Background: Hospitalisation for paediatric oncohaematological diseases entails significant physical and psychological stress, often compromising children's emotional regulation and daily functioning. In this context, complementary interventions can provide additional support to the clinical work conducted with children and adolescents undergoing treatment, fostering emotional awareness and well-being. This study evaluates the feasibility and perceived benefits of an animal-assisted psychoeducational intervention to enhance emotional coping during hospitalisation. Methods: A single-centre observational study was conducted at Regina Margherita Children's Hospital in Italy in collaboration with the ZOOM Foundation (Turin, Italy), between September 2023 and May 2025. Sixty patients aged 6-15 years participated in an intervention combining observation of an in-ward aquarium, virtual animal encounters, and completion of a psychoeducational booklet promoting emotional reflection through symbolic identification with animal behaviours. Results: The intervention showed high feasibility and acceptability: 90% of participants (54/60) reported positive emotions and enjoyment, 80% (48/60) found the booklet engaging, and all participants (100%) perceived care and attention from facilitators. The activities fostered engagement, curiosity, and well-being, though their impact on deeper emotional processing appeared limited. Conclusions: Animal-assisted psychoeducational interventions are feasible and well-received in paediatric oncohaematology, offering complementary support to clinical care by promoting emotional resilience and enriching the hospital experience.

Background: Adolescence is a sensitive period for psychological, academic, and social development, and sports participation has been described as a potential protective factor for academic performance and psychological well-being. However, limited research has examined the combined influence of sports involvement, sport type, and family background on adolescents' academic and psychological outcomes. This study aimed to investigate the associations between organized sport participation, sport type (football vs. judo), psychological well-being, psychosomatic symptoms, academic performance, and family socioeconomic background among adolescent boys.

Methods: The sample consisted of 52 boys aged 11-14 years from a rural school, divided into football players (n = 13), judo athletes (n = 13), non-athletes (n = 13), and a contextual subgroup of students with special educational needs (SEN; n = 13), with the latter included for exploratory purposes only. Data included school-record-based academic performance and validated self-report measures of life satisfaction, depressive symptoms, psychosomatic complaints, perceived physical fitness, and socioeconomic background.

Results: Athletes demonstrated significantly higher academic achievement than non-athletes in overall grade point average (p < 0.001), mathematics (p < 0.001), Romanian (p < 0.001), English (p = 0.03), and Hungarian (p < 0.001). They also reported higher life satisfaction (p < 0.001) but simultaneously showed slightly elevated depressive symptom scores (p < 0.001), indicating a paradoxical pattern of concurrent psychosocial benefits and psychological strain. Parental education (p < 0.001), parental occupational status (p = 0.01), and fathers' occupational position (p = 0.02) were significantly higher among athletes' families. Perceived physical fitness was also rated higher by athletes (p < 0.001). No significant differences were found in body mass index, family structure, or most psychosomatic symptoms.

Conclusions: Sport participation was associated with more favorable academic and psychological indicators, yet also with elevated depressive symptoms, highlighting the dual nature of organized sport during adolescence. Future research should apply longitudinal designs, include female participants, and incorporate objective indicators of training load.

Background: Adolescent violence occurs both within and beyond the school setting. Furthermore, risk factors for aggression, such as Moral Disengagement (MD), do not operate uniformly and may be triggered in one context but not another. This highlights the need for instruments that assess aggression's manifestation across contexts to enable a more comprehensive understanding of the phenomenon. Objective: To assess the psychometric properties of the Bullying at School and Bullying during Leisure subscales from the Questionnaire for Assessing Peer Violence in School and Leisure Settings (CEVEO) in Chilean adolescents, and to examine differences in MD among perpetrator profiles based on both frequency and context of aggression. Method: Instrumental, multivariate, cross-sectional, quantitative, and correlational design. The sample comprised 864 Chilean students (M age = 15.4; SD age = 1.3). Girls represented 58% of the sample. Results: A 13-item unifactorial model was supported for both subscales, with good internal consistency. Scores correlated positively with MD, and boys scored higher than girls on both subscales. Three profiles were identified: (1) no high aggression; (2) high aggression in one context; and (3) high aggression in two contexts. MD increased with the number of contexts, regardless of aggression frequency. Conclusions: Findings provide validity evidence for the CEVEO bullying subscales in Chilean adolescents, based on their internal structure, associations with external variables, and reliability. The instrument is useful for detecting violence across settings and identifying profiles based on the contextual extent of aggression.

Background: A sedentary lifestyle contributes to chronic disease risk in adults and may predict unfavourable body composition in adolescents. Declining physical activity and rising sedentary behaviour are linked to increasing global obesity rates. Given the scarcity of longitudinal studies examining how participation in organized sports and screen device use relate to body composition in early adolescence, this study aims to address this gap by analyzing temporal trends in both sexes.

Methods: A sample of 158 Italian students, 38% of whom were female, was followed longitudinally from ages 11 to 13. Annual anthropometric assessments were conducted, and self-reported data on screen time and organised sports participation were collected. Fat mass (FM), fat-free mass (FFM), fat mass index (FMI), fat-free mass index (FFMI), body mass index (BMI), and waist-to-height ratio (WHtR) were subsequently calculated, along with annual increments. Repeated-measures ANOVA assessed age and sex effects, while multiple regression models evaluated associations between behavioural variables or sex and body composition indices.

Results: Significant differences in %F, FM, FFM and its increment, WHtR and its increment, FMI, and FFMI (all p < 0.01) were observed by age and sex interaction. At age 13, weekly sports participation was negatively associated with annual increments in %F (β = -0.204, p = 0.04) and FMI (β = -0.227, p = 0.03). Female sex was associated with greater increments in %F (β = 0.188, p < 0.05) and WHtR (β = 0.323, p < 0.01), and with smaller increments in FFM (β = -0.421, p < 0.01). No significant associations were found for screen time (p > 0.05).

Conclusions: Sporting during early adolescence seems to have positive effects on body composition changes, while sex-specific patterns warrant further attention. A deeper understanding of how early adolescent lifestyle factors, such as physical activity and sedentary behaviour, shape body composition is essential for promoting long-term health.

Background/Objectives: To analyze the parent-perceived quality of life (QoL) in children with cerebral palsy (CP) and to study the relationship between sociodemographic and clinical factors and this perception, under the perspective of the International Classification of Functioning, Disability and Health (ICF). Methods: A cross-sectional study was conducted with 95 participants (ages 5-19 years) with CP. Participants' parents were asked about sociodemographic and clinical characteristics and compiled Cerebral Palsy Quality of Life (CP-QoL) and Pediatric Disability Inventory-Computer Adaptive Test (PEDI-CAT). Participants were assessed and classified into the following functional domains: gross motor function (GMFM-88, GMFCS), manual ability (MACS), eating and drinking abilities (EDACS), and communication function (CFCS). Correlations between CP-QoL domains and variables were investigated using Spearman's correlation coefficient and multivariate predictive models were used to investigate the variables predicting CP-QoL scores for each domain. Results: A total of 95 children with a mean age of 12.4 ± 3.5 years (range 5-19 years) were included. Participants demonstrated moderate-high GMFM-88 level (228.8 ± 44.7) and high functional performance across PEDI-CAT domains: Activity (57.2 ± 5.1), Mobility (63.1 ± 5.6), and Social/Cognitive (70.2 ± 4.3). Parent-perceived QoL was significantly higher when children did not require AFOs, botulinum toxin, or recent hospitalizations, and lower among children who attended physical therapy >2 h/week. Moderate correlations were consistently found between the 'Feelings about Functioning' domain and functional variables, being positive for GMFM-88 and all PEDI-CAT domains, and negative for GMFCS, MACS, EDACS and CFCS. That domain of CP-QoL was best explained by the regression model (R² = 0.619, p < 0.001), with the combination of three variables: GMFM-88, PEDI-CAT Activity and PEDI-CAT Social/Cognitive. Among them, PEDI-CAT Activity was the strongest predictor (β = 0.1436). Conclusions: In children with CP, to enhance family well-being, interventions should prioritize social participation and carefully balance the intensity and frequency of therapy against family burden and daily life demands, as QoL is primarily driven by manual ability and functional performance.

Background: Mini-puberty is a transient but critical postnatal activation of the hypothalamic-pituitary-gonadal axis, essential for male gonadal maturation, penile and testicular growth, and future reproductive potential: this physiological hormonal surge is absent or blunted in congenital hypogonadotropic hypogonadism (CHH), often manifesting as micropenis, cryptorchidism, and impaired Sertoli cell proliferation. Objective: The aim of this review is to summarize current evidence on the impact of early gonadotropin therapy in male infants with CHH. Methods: We conducted a comprehensive literature review using PubMed, including studies reporting on male infants with confirmed or suspected CHH receiving gonadotropin therapy. Keywords included "mini-puberty and hypogonadism", "gonadotropins and infancy," and "gonadotropin therapy in CHH." Eligible studies reported biochemical outcomes (luteinizing hormone, follicle-stimulating hormone, testosterone, inhibin B, anti-Müllerian hormone) and clinical measures (penile length, testicular volume, testicular descent). Data extraction focused on endocrine responses, genital growth, and safety. Results: Twelve studies including 95 infants were analyzed. Early gonadotropin therapy effectively restored postnatal hormonal levels, with consistent increases in testosterone, inhibin B, and anti-Müllerian hormone. Clinically, treatment induced significant penile growth, increased testicular volume and partial or complete testicular descent in the majority of cases. Both continuous infusion and intermittent injection regimens were effective, though hormone kinetics and growth responses varied. No serious adverse events were reported, and therapy was generally well tolerated. Conclusions: Early gonadotropin therapy during mini-puberty represents a safe and effective intervention to replicate the physiological postnatal hormonal surge in male infants with CHH. Prospective longitudinal studies are warranted to evaluate sustained effects on puberty, fertility, and adult reproductive function.