Children-Basel最新文献

Background: Novel approaches such as video games represent a promising tool in increasing visual acuity (VA) in children with amblyopia. The aim was to determine the effectiveness of video game-based interventions (VGBIs) in increasing VA in children with amblyopia. Secondarily, to estimate safety, satisfaction, and compliance with VGBIs.

Methods: According to the PRISMA guidelines, a systematic review with meta-analysis (SRMA) was conducted, including studies retrieved from PubMed Medline, SCOPUS, WOS, CINAHL, and PEDro without publication date and language restrictions. We included randomized controlled trials (RCTs) and pilot RCTs, comprising children with amblyopia, that compared the effectiveness of VBGI vs. others in improving VA. Pooled effect was estimated with the Cohen's standardized mean difference (SMD) and its 95% confidence interval (95%CI).

Results: Twenty-one RCTs, providing data from 1515 children, were included. VGBIs are effective (SMD = 0.38; 95%CI 0.08 to 0.68; p = 0.013) in increasing VA. Subgroup analyses suggested that non-immersive video games are the most appropriate for improving VA (SMD = 0.35; 95%CI 0.02 to 0.68; p = 0.039) and that VGBI is more effective than patching therapy, especially in combination with patching therapy (SMD = 0.63; 95%CI 0.29 to 0.97; p < 0.001).

Conclusion: This SRMA, including a large number of RCTs to date, demonstrates that VGBI is effective in improving VA in children with amblyopia.

Background: The aim of this study was to identify patient clusters based on acute symptom profiles and individual characteristics most likely to develop pediatric post-acute sequelae of SARS-CoV-2 infection (PASC), as well as clusters among patients with PASC based on post-acute sequelae and associated characteristics. Methods: This multicenter cohort study in 12 Italian pediatric units enrolled patients aged 0-17 years within three months of a laboratory-confirmed SARS-CoV-2 infection. Participants who completed at least two surveys developed by the ISARIC over one year were analyzed. PASC was defined per WHO criteria. Multiple Correspondence Analysis and Hierarchical Clustering were performed. Results: Of 1137 children enrolled, 850 (76%) completed at least two surveys. The most prevalent age group was older children (6-11 years) (46%); adolescents (12-17) and young children (0-5) were numerically similar. Males were more represented (51.9%), except for the adolescent group (45.1%). PASC occurred in 32.8% of participants, with the distribution of sequelae types varying by age. Clustering in COVID-19 cases identified three clusters: young children mainly presented with respiratory symptoms and with a higher risk of hospitalization, while older children were spared in both acute and post-acute phases. Adolescents, particularly females, reported more pronounced acute symptoms and developed PASC more frequently. Clustering analysis of cases with PASC identified three clusters, confirming these age-related patterns. Young children still exhibited respiratory sequelae, and older children confirmed good recovery with minimal complications, while adolescents, especially females, remained the most affected subgroup, reporting persistent neuropsychological sequelae such as fatigue and insomnia. Conclusions: Findings support age-tailored follow-up, emphasizing respiratory monitoring for young children and targeted neuropsychological care for adolescents, particularly girls.

Background: Very Low Birth Weight preterm infants are at elevated risk for disrupted brain growth and later neurodevelopmental impairment. Bedside-accessible tools for monitoring cerebral development remain limited.

Methods: In this retrospective pilot cohort study, 153 Very Low Birth Weight infants (<32 weeks gestational age and/or <1500 g) from two Level III Neonatal Intensive Care Units underwent serial cranial ultrasound assessments. Total brain volume was estimated using an ellipsoid formula derived from standardized imaging planes. Growth trajectories were analysed via linear mixed-effects modelling. Associations with clinical predictors-including invasive ventilation, sepsis, and somatic growth-were evaluated.

Results: A total of 976 brain volume measurements were collected. Median cerebral volume increased from 164 cm³ to 275 cm³ across the hospital stay, corresponding to a median growth rate of 2.3 cm³/day (95% CI: 1.5-3.1). Duration of invasive mechanical ventilation was associated with reduced cerebral growth (p < 0.01, R² = 0.26). Cerebral volume growth showed a weak but statistically significant correlation with head circumference percentile progression (p < 0.05, ρ = 0.16).

Conclusions: Sonographic brain volumetry is a feasible and non-invasive method for tracking cerebral development in Very Low Birth Weight infants. These findings confirm significant associations between cerebral growth and head growth and identify prolonged invasive ventilation as a risk factor for impaired cerebral development.

Background: The aim of this study was to develop an artificial intelligence (AI)-based decision support model for evaluating the extraction indication of permanent first molars in pediatric patients using panoramic radiographs, and to investigate the potential contribution of this model to the clinical decision-making process. Methods: This retrospective observational study analyzed 1000 panoramic radiographs obtained from children aged 8-10 years who attended the Clinics of Batman University Faculty of Dentistry for routine dental examination. Among the radiographs meeting the inclusion criteria, a total of 176 panoramic images were selected based on dental maturation assessment using the Demirjian tooth development staging system. Cases in which the permanent second molar was classified as Demirjian stages E-F were labeled as "extraction indication present", while the remaining stages were labeled as "extraction indication absent". A balanced dataset was created, consisting of 88 cases in each group. Image features were extracted using Gabor filters and Histogram of Oriented Gradients (HOG). The selected features were analyzed using a Support Vector Machine (SVM) classifier with a radial basis function (RBF) kernel. Model performance was evaluated using accuracy, sensitivity, specificity, F1-score, and area under the receiver operating characteristic curve (ROC-AUC). Results: The proposed Gabor-HOG-SVM-based AI model achieved an overall classification accuracy of 77.78% with an AUC value of 0.77 in distinguishing between "extraction indication present" and "extraction indication absent" cases. For the extraction-indicated group, the sensitivity was 0.81 and the F1-score was 0.79, whereas for the non-indicated group, the sensitivity and F1-score were 0.74 and 0.77, respectively. No statistically significant differences were observed between the groups in terms of age or sex distribution (p > 0.05). Conclusions: This study demonstrates that artificial intelligence-based analysis of panoramic radiographic images can provide an objective and reproducible decision support approach for evaluating extraction indications of permanent first molars in pediatric patients. The proposed model should be considered as an adjunctive tool to reduce observer-dependent variability rather than a replacement for clinical judgment, and its clinical applicability should be further validated through multicenter and multi-parametric studies.

Background/Objectives: Assessing psychosocial burden in families can help identify those at risk and prevent negative effects on children's well-being. This study (1) describes the longitudinal stability of psychosocial risk patterns; (2) examines group differences in the home learning environment as protective factors and in child behavior problems as an outcome; and (3) tests the moderating role of home learning activities on child behavior problems. We further explore associations with the use of institutional childcare. Methods: Data from 1459 children aged 0-6 years from the representative longitudinal study AID:A 2019 were analyzed across two time points (T1: 2019, T2: 2023). We tested differences in children's behavioral problems according to risk patterns, home learning environment, and control variables, including institutional care and support service use. Results: The shares of families categorized as low-burdened, economically burdened, parenting-stress-and-conflict-burdened and multiple-burdened remained stable over time, even though individual stability was only moderate. Children in families with parenting stress and conflict as well as those from multiple-burdened families more frequently displayed behavioral problems at T2 than other groups. Educational activity was a protective factor for behavioral problems for most groups, but was a risk factor in conflict-and-stress-burdened families. Similar results were found for the use of universal social/educational prevention services. Conclusions: For most families, a better home learning environment appears to act as a buffer against the effect of risk group membership on children's emotional well-being. However, in families marked by stress and conflict, the frequency of time together might not be beneficial-possibly because the quality of interactions matters more than the quantity. Universal social and educational services might be a place to address these families and develop targeted support.

Aims: To assess the impact of systemic afterload reduction on cardiorespiratory health in infants with a severe bronchopulmonary dysplasia (BPD)-systemic hypertension-left heart dysfunction (LHD) phenotype.

Methods: Ten-year data were prospectively collected and analysed. The cohort included extremely preterm infants with severe BPD-systemic hypertension-LHD pathophysiology, treated with systemic afterload reduction with captopril. Main outcome measures included improvement in oxygenation and echocardiographic measures of LHD.

Results: Twenty-six infants with gestation of 26.5 ± 2 weeks and median (interquartile range) birthweight of 900 (582, 1083) g were administered captopril at the corrected gestation median (range) of 40 weeks (37-67). On reassessment after five weeks, oxygen requirements (43 ± 16% to 26 ± 7%, p = 0.0001) and paired pCO₂ decreased (64 ± 9 to 53 ± 9 mm Hg, p = 0.0001). Significant improvements were seen in cardiac indices (diastolic: trans-mitral E/A ratio [1 ± 0.07 to 0.94 ± 0.07, p = 0.0004] and iso-volumic relaxation time [ms] [65 ± 3 to 56 ± 4, p < 0.0001], and systolic: mean velocity of circumferential fibre shortening [circ/s] [1.6 ± 0.2 to 1.9 ± 0.2, p < 0.0001] and left ventricular output [mL/kg/min] [177 ± 34 to 230 ± 54, p = 0.0002]). This coincided with improved aortic pulsatility (40 ± 13 to 50 ± 11 µm, p = 0.005).

Conclusions: Systemic hypertension-LHD pathology amongst infants with severe BPD may be under-recognised. Systemic afterload reduction is physiologically suited in a subset of infants with severe BPD.

(1) Background: Eating disorder risk factors in children are early maturation, body dissatisfaction, dieting, stress and physical inactivity. The COVID-19 pandemic has further exacerbated these factors due to isolation, online classes and reduced physical activity, all of which have increased children's risk of developing eating disorders. The aim of the research was to examine the frequency of eating disorders among school-aged children in the Republic of Serbia during the COVID-19 pandemic, as well as the association of these disorders with socio-demographic characteristics, lifestyle habits, and levels of depression, anxiety and stress. (2) Methods: The research was conducted as a descriptive cross-sectional study on a sample of students from the fifth grade of elementary school to the fourth year of secondary school. The research was conducted from May to August in 2023. using the EAT-26 questionnaire. Before the research, the approval of the ethics committee of the Jagodina Health Center (No. 1238/28.04.2023.) was obtained, where the research was conducted. (3) Results: The results show that 5.8% of students exhibited eating disorder symptoms during the COVID-19 pandemic (EAT-26 ≥ 20). Statistically significant differences were observed in girls with an eating disorder, who had a significantly lower body weight compared to the others (p < 0.05). Students with symptoms of depression, anxiety and stress showed eating disorders significantly more often. Also, elementary school students and boys with an eating disorder visited a nutritionist and played sports more often. (4) Conclusions: Research has shown that during the COVID-19 pandemic, a smaller percentage of students showed symptoms of eating disorders, with girls being more sensitive. Disorders were significantly associated with the presence of depression, anxiety and stress. The obtained results indicate the importance of monitoring children's psychological and nutritional health, as well as the need for preventive and intervention measures in crisis conditions.

Background: Low birth weight (LBW) is one of the most significant health issues worldwide, especially in countries with fewer resources. No systematic reviews or meta-analyses on LBW have been conducted in Sudan, the third largest African country.

Methods: A systematic review and a meta-analysis were conducted to assess the pooled prevalence of LBW in Sudan and the associated factors. PubMed, Google Scholar, and ScienceDirect were searched for studies on LBW in Sudan. The meta-analysis was performed by calculating the pooled prevalence of LBW. The meta package in R was used for statistical analysis.

Results: The final sample comprised 10 studies, with 10,043 neonates enrolled. The overall pooled prevalence of LBW was 13.0% (95% CI [13.0, 14.0]; I² = 47.0%, p = 0.05), without significant heterogeneity. Primiparity (adjusted odds ratio [AOR] = 1.4, 95% CI [1.1, 2.1]), a short interpregnancy interval, lack of iron-folic acid supplementation (AOR = 3.33, CI [1.47, 5.88]), a low level of antenatal/perinatal care (AOR = 2.10, 95% CI [1.30, 3.57]), maternal undernutrition (AOR = 1.66, 95% CI [1.09, 2.53]), and decreasing gestational age of pregnancy (AOR = 0.80, 95% CI [0.66, 0.96]) were associated with LBW in different studies. In three studies, anemia was associated with LBW.

Conclusions: This review reveals a high prevalence of LBW in Sudan. The factors identified in this review may help health planners and policymakers design and implement preventive interventions for LBW.

Bronchopulmonary dysplasia (BPD) remains a major long-term morbidity among preterm infants. As lung-protective strategies advance and survival of extremely premature neonates improves, BPD has evolved from a ventilator-induced inflammatory and fibrotic process to a disease marked by arrested pulmonary vascular and alveolar development-pulmonary vascular disease. Within this evolving phenotype, pulmonary hypertension (PH) has emerged as a critical yet underrecognized complication. BPD-associated pulmonary hypertension (BPD-PH) is increasingly linked to higher mortality and worse clinical outcomes, but its pathophysiology, screening strategies to detect early changes, and optimal management remain incompletely understood. This review delineates the pathophysiology of BPD-PH, linking impaired pulmonary vascular development with subsequent maladaptation influenced by genetic, prenatal, and postnatal factors. The phenotypic and hemodynamic spectrum of BPD-PH is further subclassified using echocardiographic markers to support a physiology-based approach to diagnosis and management. We also propose a pragmatic algorithm for screening, evaluation, and longitudinal follow-up. Collectively, this review highlights the need for physiology-driven strategies and clinical studies to improve outcomes in these neonates.

Background/objectives: Gastroschisis remains one of the most debated congenital abdominal wall defects with respect to its embryologic and developmental origins. Despite decades of investigation, no consensus exists regarding a single causative mechanism, and competing hypotheses variably explain laterality, bowel injury, and closing variants. This scoping review aims to synthesize historical and contemporary embryologic theories of gastroschisis and integrate them into a coherent developmental framework with direct relevance to prenatal assessment and clinical interpretation.

Methods: A structured literature search was conducted in PubMed, Web of Science, and Scopus from inception through December 2025. Studies proposing original embryologic mechanisms or providing primary experimental, placental, or developmental evidence were included. Eligible publications were qualitatively synthesized and classified according to evidence strength as historical descriptive, experimental, placental pathology, or integrative synthesis. Embryologic theories were organized into mechanistic categories based on affected structures, developmental timing, and proposed pathophysiology.

Results: Twenty-six publications met inclusion criteria, yielding fourteen distinct embryologic theories. These were categorized into four mechanistic categories: mesodermal and ventral body wall folding abnormalities, vascular disruption models, umbilical ring and extraembryonic attachment defects, and integrated multifactorial developmental concepts. No single mechanistic category alone consistently accounted for right-sided predominance, variability in bowel injury, and the occurrence of closing variants.

Conclusions: Gastroschisis is best understood as a spectrum of periumbilical developmental disturbances arising from interacting mesodermal, vascular, and biomechanical factors. An integrated embryologic framework improves interpretation of dynamic prenatal imaging findings, supports refined risk stratification and counseling, and provides a biologic foundation for future translational research.