Children-Basel最新文献

Background: Oral malignancies in the paediatric population are rare, but if left untreated, the patient's prognosis may be altered. The current literature is varied in its findings regarding common sites and types of tumours found in the paediatric population. Our goal was to describe the distribution of paediatric head and neck cancers, test associations, quantify temporal trends and perform survival analyses. We then compared our results with the current literature.

Methods: Approval for the study was given by the Hadassah Medical Organization Helsinki Committee (HMO0792-20). We obtained data from the Israel National Cancer Registry, for the years 1970-2017, regarding head and neck malignancies, including oral malignancies, diagnosed in Israel in individuals under the age of 19. We performed a comprehensive statistical analysis, including annual incidence analysis, Kaplan-Meier survival curves to estimate 5-year survival, and a multivariable Cox proportional hazards model to evaluate the association between demographic and tumor-related variables and overall survival.

Results: Our study consisted of 393 cases. The most common cancer location was the nasopharynx, and the most common cancer histology was of epithelial origin. Regarding gender, there were significantly more males diagnosed with cancer. Over 40% of the diagnosed cases were in the 15-18 age group. There was no evidence of a notable change in the average incidence rate over time. The lowest survival rates were observed in cancers originating in the oropharynx and in hematologic malignancies when stratified by tumor location and histology, respectively.

Conclusions: The importance of this research is significant, as it adds to the current pool of information and touches on aspects that have not been commonly analysed.

Purpose: Respiratory syncytial virus-positive bronchiolitis continues to be the main diagnosis prompting transportation in children younger than one year of age. It represents approximately 15-20% of all services performed by a specialized pediatric transport team. In October 2023, an immunization program with nirsevimab, a monoclonal antibody against RSV, was started in Spain. The purpose of the present study is to describe how nirsevimab affects the rates of bronchiolitis managed by a pediatric team specialized in critical patient transport. Secondary objectives included describing and comparing the clinical aspects of the two cohorts-pre-nirsevimab (pre-n) and post-nirsevimab (post-n)-to quantify how immunization has modified the clinical phenotype of bronchiolitis. Methods: This is a descriptive and observational study. Patients with bronchiolitis transported by a specialized pediatric transport team between September 2021 and August 2025 were included. Demographic, clinical, and microbiological data were collected. The pre-n and post-n periods were compared. Results: From a total of 2347 interfacility transports conducted by the unit between 2021 and 2025, 463 (19.7%) involved bronchiolitis patients, all of whom were recruited: 307 in the pre-n period and 156 in the post-n. The median age was 2.5 months (IQR 1.3-5.7), and 55% were male. There was a significant decrease in bronchiolitis cases that required specialized transport between the two periods: 28.2% (307/1089) pre-n vs. 12.4% (156/1258) post-n (p < 0.001). RSV detection also declined (74.3% vs. 47.4%, p < 0.001), while other viruses increased significantly in the post-n period, including rhinovirus, metapneumovirus and bocavirus. Age at admission showed statistically significant differences across the two periods (2.2 vs. 3.4 months, p < 0.001). There were no differences in severity between the two periods in terms of respiratory and inotropic support and length of stay. No mortality was reported. Conclusions: Universal nirsevimab immunization was associated with a marked reduction in pediatric transports for bronchiolitis, particularly RSV-related cases, without modifying disease severity among those requiring transfer.

Background: Trisomy 18 (T18; Edwards syndrome) and Trisomy 13 (T13; Patau syndrome) are rare autosomal aneuploidies characterized by severe congenital anomalies, high neonatal mortality, and complex clinical trajectories.

Objective: This study aimed to describe the clinical features, management approaches, and outcomes of genetically confirmed patients aged 0-18 years diagnosed with T18 or T13 in a tertiary care center.

Methods: This retrospective study reviewed hospital records of genetically confirmed T18 and T13 cases identified through ICD-10 codes (Q91-Q92) between January 2015 and December 2024. Patients aged 0-18 years at diagnosis were included. Demographic, clinical, and interventional data were collected from electronic medical records. Survival analyses were conducted using the Kaplan-Meier method, with comparisons assessed using the log-rank test.

Results: Among 29 patients, 23 had T18 and 6 had T13. Cardiovascular involvement was the most frequent anomaly, and overall mortality was high despite intensive care. Median survival was 90 days for T18 and 120 days for T13, with more than 80% surviving the first month but showing a steep decline thereafter. Most deaths were attributed to cardiopulmonary complications or sepsis secondary to prolonged intensive care. Kaplan-Meier analysis revealed marked early mortality in both groups, with no significant survival difference (log-rank p ≈ 0.3). A small subset demonstrated longer-term survival with heterogeneous clinical courses.

Conclusions: T18 and T13 are associated with high early mortality driven by complex congenital heart disease, respiratory instability, and infection-related complications. Although the overall prognosis remains poor, a minority of patients achieve extended survival, highlighting variable trajectories. Early multidisciplinary care, individualized decision-making, and strict infection prevention remain essential to optimize outcomes and support families.

Background/objectives: Creativity has become an essential skill for children and adolescents to cope with the challenges of contemporary society. Beyond academic success, creativity is closely linked to well-being, social adjustment, and personal development. Schools, therefore, play a crucial role in creating conditions that allow students to explore ideas, express themselves, and develop socioemotional resources. This study aimed to examine how self-perceived creativity relates to educational, socioemotional, and well-being factors in Portuguese students, to identify different creativity profiles, and to explore the main variables that predict creativity.

Methods: This cross-sectional study was based on secondary analyses of national data from the project Psychological Health and Well-being|School Observatory. The sample included 3011 students aged between 9 and 20 years (M = 13.62; SD = 2.53), from grades 5 to 12. Data were collected using validated instruments: the OECD Socioemotional Skills Survey (SSES), the Positive Youth Development (PYD) scale, and the WHO-5 Well-Being Index. Analyses included group comparisons, cluster analysis to identify self-perceived creativity profiles, correlation analyses, and multiple regression models.

Results: Self-perceived creativity did not differ between boys and girls, but it decreased significantly with higher grade levels. Three profiles were identified: low, medium, and high self-perceived creativity. Students with higher self-perceived creativity reported better well-being, more positive relationships with teachers, a stronger sense of belonging at school, and higher parental educational levels. Self-perceived creativity was positively associated with socioemotional skills such as curiosity, sociability, and optimism, as well as with PYD dimensions and well-being. Negative associations were found with age and test anxiety. Socioemotional variables were the strongest predictors of creativity, explaining 39% of its variance.

Conclusions: These results show that creativity is closely connected to students' socioemotional development. Investing in emotional skills, supportive relationships, and positive school environments may be a powerful way to foster creativity and promote healthier, more balanced development. This has important implications for educational practice and policy.

Background: Pediatric inflammatory bowel disease (IBD) is characterized by a heterogeneous and often aggressive disease course, requiring complex multimodal assessment and long-term monitoring. Artificial intelligence (AI) has emerged as a promising tool to support clinical decision-making by enabling an objective analysis of large, multidimensional datasets. Objectives: This narrative review aims to critically synthesize current evidence on the application of AI across the diagnosis, monitoring, and treatment of pediatric IBD. Methods: A narrative literature review was conducted using the PubMed (MEDLINE) and Cochrane Library databases, including publications available up to December 2025. Pediatric-focused studies were prioritized. However, due to the limited availability of pediatric-specific AI research, a considerable proportion of the evidence reviewed derives from adult or mixed cohorts, which were included when methodological frameworks or clinically relevant endpoints were applicable to pediatric IBD. Eligible publications included narrative and systematic reviews, observational studies, and clinical trials focusing on AI applications in endoscopy, histology, imaging, disease monitoring, and therapeutic response prediction. Results: AI-based models, particularly those using machine learning and deep learning, demonstrated promising performance in the automated analysis of endoscopic, histological, and imaging data, reducing interobserver variability and improving workflow efficiency. Multimodal approaches integrating imaging, clinical, and biomarker data consistently outperformed unimodal models. Emerging applications in patient-centered monitoring, digital biomarkers, and telemedicine enabled continuous disease assessment and early detection of flares, with particular relevance in pediatric settings where repeated, non-invasive monitoring is essential. AI-driven models also showed promising accuracy in predicting therapeutic response, supporting treatment stratification and precision medicine strategies. Conclusions: AI shows promising potential to complement clinical expertise in pediatric IBD by supporting diagnostic assessment, disease monitoring, and therapeutic optimization. However, translation into routine clinical practice remains constrained by methodological heterogeneity, limited pediatric-specific validation, and unresolved ethical and regulatory challenges. Future research should prioritize prospective multicenter pediatric studies, the development of transparent and explainable models, and the integration of AI-based tools into clinically meaningful and patient-centered care pathways.

Background: England is a high-income country with a predominantly publicly funded health system organised around the National Health Service (NHS). Yet children's oral health outcomes continue to reflect a persistent access and prevention gap, with late presentation and hospital-based extractions remaining common. Objective: To present a policy-facing, evidence-informed critique of how structural constraints in NHS dentistry shape paediatric clinical pathways-often converting "advances" (biological caries management, silver diamine fluoride, and planned extraction pathways for compromised permanent molars) into compensations for service failure rather than patient-centred progress. Methods: Narrative commentary drawing on UK official statistics and major policy reports, alongside key clinical trials and evidence syntheses relevant to contemporary paediatric dentistry. Results: The dominant failure mode is not a lack of clinical tools but impaired delivery: restricted access to routine NHS dentistry, contract and workforce pressures, and unequal prevention coverage. These pressures correlate with crisis-led care (including extractions under general anaesthesia) and can distort how minimally invasive/biological interventions are used-functioning as endpoints rather than bridges to definitive care. In parallel, guidance for compromised first permanent molars (including those affected by MIH) risks being operationalised as an "efficiency pathway" when restorative capacity is constrained. Conclusions: In NHS England, paediatric dental "advances" cannot be judged solely by trial efficacy; they must be evaluated within a delivery system that currently selects for late-stage, irreversible outcomes. A credible "advances" agenda requires contract reform, workforce retention, prevention at scale, and explicit safeguards against the normalisation of extraction-only trajectories.

Background: In 2020, the World Health Organization declared a Public Health Emergency of International Concern due to the global outbreak of SARS-CoV-2. Recognized as a severe and highly contagious disease, it affected both the adult and pediatric population. However, due to the early timing of the pandemic, limited research was conducted in the perinatal field, leaving many questions regarding the true impact of maternal transmission to fetuses and its consequences during the neonatal period. Methods: In this case series, we reviewed data from ten newborns delivered in the Instituto Nacional de Perinatología (INPer) in Mexico City (tertiary referral institute), all from high-risk pregnancies, between November 2020 and January 2021, all of whom tested positive for SARS-CoV-2 at various points during their hospital stay. Results: Despite showing correct extrauterine adaptation after birth, several of them developed complications such as sepsis, superinfections, inadequate weight gain, and, in some cases, death. Conclusions: These results highlight the urgent need for targeted neonatal care protocols and further research to better understand the impact of persistent viral positivity and immune vulnerability in this population.

Background/objectives: This study aimed to investigate the internalizing characteristics, including anxiety and depressive symptoms, in adolescents presenting with non-cardiac chest pain (NCCP), and to explore the effects of sociodemographic variables and prior psychosocial experiences on psychological distress.

Methods: This cross-sectional study was conducted in Turkey and included 128 adolescents aged 10-18 years (57.0% female, 43.0% male) who presented to pediatric cardiology or general pediatric outpatient clinics. The Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAI-C), Screen for Child Anxiety Related Emotional Disorders (SCARED), Brief Symptom Inventory (BSI), and the Social Support Appraisals Scale for Children (SSAS-C). Sociodemographic variables and prior psychosocial symptom history were also recorded.

Results: Adolescents with non-cardiac chest pain exhibited elevated anxiety and psychological distress compared to controls. Female participants demonstrated higher levels of stress, anxiety, and overall psychological symptom burden than males. Higher maternal age was associated with lower perceived stress, while a prior history of psychosocial symptoms was linked to increased anxiety and global psychological distress. Participants with a history of psychosocial symptoms had higher anxiety (p = 0.027) and BSI (p = 0.004) scores. Significant positive correlations were found between anxiety, depression, obsessive-compulsive symptoms, and the BSI total score (r values ranging from 0.718 to 0.892).

Conclusions: Adolescents with NCCP exhibit significant internalizing symptoms, particularly anxiety and depression. Female gender and prior psychosocial stressors were associated with elevated symptom scores. Maternal age may have a buffering effect on adolescent stress levels. These findings underscore the importance of integrating psychological screening into the evaluation of chest pain in adolescents to enable early identification and intervention.

Background: The physiologic effects of vasoactive medications on the venous circulation remain incompletely understood. Contemporary bedside management often emphasizes the arterial circulation, whereas Guytonian physiology emphasizes the venous circulation and mean circulatory filling pressure in determining steady-state cardiac output. The primary aim of this study was to characterize the effect of vasoactive medications on mean circulatory filling pressure and venous resistance. Methods: Demographic data and vasoactive data were collected from the electronic health record and collated with high-fidelity physiologic monitoring data. Mean circulatory filling pressure and venous resistance were calculated using clinically validated equations and then were modeled using a random forest regression incorporating postoperative time and infusion doses of epinephrine, norepinephrine, milrinone, vasopressin, phenylephrine, calcium, sodium nitroprusside, and nicardipine. Similar models were constructed for indexed systemic vascular resistance, cardiac index, cerebral oxygen extraction, and renal oxygen extraction. Results: Data from a total of 57 unique patients comprising 9,654,239 data points were analyzed. The model explained 57% of the variance in mean circulatory filling pressure and 59% of the variance in venous resistance. Vasopressin and norepinephrine were the most influential for mean circulatory filling pressure and venous resistance. Conclusions: Vasoactive medications appear to modulate venous tone and impact mean circulatory filling pressure and venous resistance. High-fidelity physiologic data allow for characterizing these effects and guide titration of vasoactive medications at the bedside.

Background/objectives: This study focused on the sub-national regional heterogeneity in childhood obesity prevalence across five countries in south-east Europe and the correlation between this heterogeneity and socioeconomic differences. Previous studies have mainly observed national or cross-national data but this study used a sub-national regional approach that may be beneficial in the further investigation of childhood obesity.

Methods: Nationally representative samples of children from Croatia, Montenegro, North Macedonia, Serbia and Slovenia were selected using the COSI methodology and used to estimate regional childhood obesity prevalence values. The Sub-national Human Development Database provided data on the Sub-national Human Development Index (SHDI). The spatial autocorrelation analysis of childhood obesity prevalence in sub-national regions was performed and its association with sub-national human development was tested with an ordinary least squares regression model.

Results: This study found statistically significant differences in childhood obesity prevalence across sub-national regions in Croatia, Slovenia and Serbia, while no such differences were observed in North Macedonia and Montenegro. There was moderate clustering in childhood obesity rates (Moran's I = 0.337). The results indicated a significant negative association between SHDI and childhood obesity prevalence across the 48 regions (β = -66.63, p < 0.001).

Conclusions: Future public health efforts should take into consideration regional differences in childhood obesity prevalence, and more targeted research is essential for understanding the mechanisms of resilience and vulnerability on a sub-national level.