Children-Basel最新文献

Background/Objectives: This study aims to translate and validate the Selective Control Assessment of the Lower Extremity (SCALE) tool from English into Portuguese. Methods: SCALE was translated into Portuguese independently by two native Portuguese translators and synthesized into a single manuscript: SCALE-BR. Using this test in patients with spastic cerebral palsy, the internal consistency (Cronbach's α), reliability by intra-class correlation (ICC), and validity compared with the Gross Motor Function Classification System (GMFCS) scores were evaluated. Results: 30 patients diagnosed with spastic cerebral palsy were assessed, with a predominance of males (66.7%), a mean age of 12.9 ± 7.9 (4-38 years) and a majority of diparetic patients (73.3%) and GMFCS I (53.3%). Spearman's correlation coefficient, R² = -0.84, p < 0.001, revealed an inverse relationship between the SCALE instrument and the GMFCS, corroborating the findings in the literature. There was an excellent intra- and interobserver agreement (ICC > 0.75). Conclusions: The Portuguese version of the questionnaire was effective, proving to be reproducible and reliable among different evaluators and patients, with an inverse correlation with the GMFCS as expected in the literature.

Background/objectives: Children born small for gestational age (SGA) are at increased risk for impaired growth, metabolic disturbances, and neurodevelopmental difficulties. Although previous research has examined cognitive and behavioral outcomes in this population, findings remain inconsistent. Moreover, limited evidence is available regarding the potential effects of recombinant human growth hormone (rhGH) therapy on cognitive development. We aimed to assess cognitive performance, emotional-behavioral functioning, and neonatal predictors of neurocognitive outcomes in term SGA children compared with age- and sex-matched peers born appropriate for gestational age (AGA). We also explored potential differences in cognitive outcomes between rhGH-treated and untreated SGA children.

Methods: A total of 18 term SGA children and 23 AGA controls underwent anthropometric measurements, biochemical evaluation, cognitive testing using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), and behavioral assessment through the Child Behavior Checklist (CBCL). Birth weight, length, and head circumference were analyzed as potential predictors of cognitive performance.

Results: SGA children demonstrated significantly lower Intelligence Quotient (IQ) scores than AGA peers, with marked weaknesses in Perceptual Reasoning index (PRI) and Processing Speed index (PSI), while Verbal Comprehension and Working Memory were preserved. They also exhibited higher internalizing behavioral symptoms, whereas externalizing behaviors did not differ between groups. Birth head circumference emerged as a strong predictor of PRI and a modest predictor of PSI. No associations were found between rhGH treatment parameters and cognitive outcomes. Larger longitudinal studies are needed to clarify how early growth restriction affects brain development and cognition and whether GH therapy influences these processes.

Background/Objectives: Within Paediatric Palliative Care (PPC), motherhood in the context of severe cognitive impairment is shaped by unique emotional, relational, and identity-related challenges. Traditional understandings of maternal identity are strained when verbal communication and typical developmental milestones are absent. Although caregiving in PPC has been widely studied, the subjective and symbolic dimensions of motherhood in this setting have received far less attention. This study sought to explore how mothers construct, interpret, and make sense of their maternal identity while caring for a child with severe cognitive impairment in a PPC context, and to underscore the clinical relevance of these identity-related processes. Methods: A qualitative study was conducted involving nine mothers of children receiving paediatric palliative care services at a regional centre in Italy. Participants engaged in three online focus groups, totalling 270 min. Reflexive thematic analysis was employed to interpret the transcribed data, using ATLAS.ti software, version 25.0.1 ATLAS.ti Scientific Software Development GmbH, Berlin, Germany, for support. Member reflections were incorporated to validate the findings. Results: Three interconnected themes emerged from the reflexive thematic analysis. First, mothers described the development of a fusion-like, enmeshed mother-child relationship, characterised by embodied attunement, specialised interpretive expertise, and lifelong care dependency. Second, mothers detailed the construction of their maternal role, shaped by emotional labour, identity negotiation, sacrifice, loneliness, and peer support, alongside the construction of the child's role, in which children were perceived as unique, symbolically meaningful beings whose social presence and limited reciprocity shaped maternal identity. Third, mothers articulated a search for meaning that sustained them throughout the caregiving journey, reframing their experience within a broader existential and relational perspective. Conclusions: Maternal caregiving in PPC encompasses distinct emotional, relational, and symbolic dimensions that extend beyond conventional understandings of motherhood. Grasping these identity-related dynamics has direct clinical relevance: it enables more attuned communication, strengthens the therapeutic alliance, and supports personalised, meaning-oriented care. These insights highlight the need for tailored interventions and further qualitative research to inform health care professionals and interdisciplinary practice.

Background: Small-for-gestational-age (SGA) preterm infants are at higher risk for oxidative stress-related complications than appropriate-for-gestational-age (AGA) preterm infants. It has been proposed that HbF may be higher in SGA than in AGA infants due to fetal hypoxia. Aim: The aim of this study was to compare postnatal changes in HbF fractions in very preterm SGA and AGA infants and in subgroups of these patients who had been transfused with red blood cells (RBCs) or not. Methods: We studied 30 SGA and 60 AGA very preterm infants with a gestational age of 27.7 ± 1.6 and 27.9 ± 0.7 weeks, respectively. HbF fractions were recorded daily during the first week of life, at 14 ± 2, 21 ± 2, and 28 ± 2 days of life, and 36 weeks (±3 days of life) of postmenstrual age. Results: The HbF fractions measured from the first day of life to the 36th week of postmenstrual age decreased significantly in both the groups, without differences between the groups. Transfused and non-transfused SGA infants had similar values of HbF fraction, while transfused AGA infants had lower values of HbF fraction than non-transfused infants. Conclusions: HbF fraction decreased similarly in the postnatal period in very preterm SGA and AGA infants. RBC transfusions did not affect hemoglobin fraction (HbF) values in SGA infants but were associated with a reduction in HbF in AGA infants. These findings may be due to the effect of fetal preconditioning hypoxia in very preterm SGA infants.

Survival rates for children treated for malignant diseases continue to improve, yet many survivors face persistent late oral complications that affect function, aesthetics, and quality of life. Oncological therapy, especially at a young age and following head and neck radiotherapy or intensive chemotherapy, can disrupt dental and craniofacial development, resulting in dental developmental disorders, enamel defects, salivary gland dysfunction, caries susceptibility, periodontal problems, trismus, and osteoradionecrosis of the jaw. Although these effects are partially known, they are frequently underrecognized in routine practice, and many children do not receive adequate long-term dental follow-up. A key challenge highlighted in the recent literature is the absence of structured, evidence-based guidelines for monitoring and managing late oral effects. The article emphasizes the need for clearer recommendations, better communication of oncological treatment histories, and stronger integration of dental professionals within survivorship care. Developing standardized follow-up protocols will be essential to ensure timely detection, consistent management, and improved oral health outcomes for childhood cancer survivors. This article is intended as a narrative review, synthesizing available evidence from key publications to highlight clinically relevant late oral complications and gaps in current survivorship care.

Background/Objectives: Socioeconomic stressors, such as financial strain, rising living costs, and perceived price burden, have gained relevance in the post-pandemic period and may adversely affect adolescent mental health. This study examined the association between subjective financial stress and symptoms of depression, anxiety, and emotional/behavioral difficulties among adolescents in Northern Italy. Methods: Data were obtained from the 2025 Corona and Psyche South Tyrol (COP-S) population survey. A total of 2554 adolescents aged 11-19 years and their parents participated; 1598 adolescents provided complete data for analyses of socioeconomic stressors (parent-reported Family Affluence Scale III, adolescent self-reported and parent proxy and self-reported burden due to price increases). Mental health outcomes included depressive symptoms (PHQ-2), generalized anxiety (SCARED-GAD), and emotional/behavioral difficulties (SDQ). Associations were assessed using chi-square tests, Kendall's tau correlations, and two-factor ANOVA models. Results: Elevated depressive symptoms were present in 10.7% of adolescents, emotional/behavioral difficulties in 13.9%, and anxiety symptoms in 27.9% of adolescents. Female adolescents consistently showed higher symptom levels in all domains. Self-reported financial burden was the strongest and most consistent correlate of mental health problems, demonstrating small-to-moderate positive correlations with depressive symptoms (τ = 0.20, p < 0.001), emotional/behavioral difficulties (τ = 0.14, p < 0.001), and anxiety (τ = 0.25, p < 0.001). Parent-reported burden showed weaker and less consistent associations, and the Family Affluence Scale III was not significantly related to any of the mental health outcomes. ANOVA models indicated that adolescents' own perception of financial burden significantly predicted anxiety levels in both age groups (11-14 and 15-19 years), whereas discrepancies between adolescent and parent burden perceptions were particularly relevant among younger adolescents. Conclusions: In this affluent European region, subjective financial strain, especially adolescents' perception of burden due to rising prices, is a stronger determinant of depressive symptoms, anxiety, and psychosocial difficulties than parental burden reports or structural affluence indicators. Adolescents, especially females, appear to be particularly vulnerable. These findings underscore the importance of addressing subjective financial stress in adolescent mental health and public health strategies.

Background/objectives: Magnetic resonance imaging (MRI) can be used to assess muscle function while performing a motion task within the scanner. Quantitative measures such as contraction velocity and strain can be derived from the images. Cine phase contrast (PC) MRI for time-resolved imaging of muscle function relies on the consistently repeated execution of the motion task for several minutes until data acquisition is complete. This may be difficult for patients with neuromuscular dysfunctions. To date, this approach has been applied only in adults, but not pediatric populations. The aim of this pilot study was to investigate the feasibility of PC MRI for assessing calf muscle function during electrically evoked and voluntary motion in children with cerebral palsy (CP) using open-source hardware and software.

Methods: Cine PC MRI was performed at 3T in ambulatory pediatric patients with CP and typically developing children under electrical muscle stimulation (EMS) (n = 14/13) and during voluntary plantarflexion (n = 4/4) using a home-built pedal with a force sensor. A visual feedback software was developed to enable synchronized imaging of voluntary muscle contractions. Muscle contraction velocity and strain were calculated from the MRI data. Data quality was rated by two readers.

Results: During EMS, the velocity data quality was rated as sufficient in 21% of scans in patients compared with 82% of scans in controls. During the voluntary task, all patients demonstrated increased compliance and greater generated force output than during EMS. Voluntary motion imaging was successful in all controls but none of the patients, as motion periodicity in patients was worse during voluntary than during stimulated contraction.

Conclusions: Cine phase-contrast MRI combined with EMS or voluntary motion proved challenging in pediatric patients with CP, particularly in those with more severe baseline muscle dysfunction or reduced tolerance to stimulation. In contrast, the approach was successfully implemented in typically developing children. Although the scope of the patient-based findings is limited by data heterogeneity, the method demonstrates considerable potential as a tool for monitoring treatment-related changes in muscle function, particularly in less severely affected patients. Further refinement of the EMS and voluntary motion protocols, together with a reduction in MRI acquisition time, is required to improve motion periodicity, tolerability, and consequently the overall success rate in the intended pediatric patient cohort.

Background: Congenital diaphragmatic hernia (CDH) is a rare but serious congenital anomaly linked to high mortality rates and significant long-term morbidity. Although numerous prognostic factors for short-term outcomes have been identified through hospital-based studies, data on long-term mortality at the population level are limited. Specifically, nationwide assessments of long-term outcomes for infants with CDH are scarce. This study aimed to estimate the national 5-year all-cause mortality for CDH and to create a population-level risk stratification nomogram utilizing nationwide health insurance claims data. Methods: We conducted a retrospective cohort study of infants with CDH using nationwide insurance claims data from 2002 to 2016, allowing for complete 5-year follow-up. We analyzed population-level demographic and clinical proxy variables with Cox proportional hazards models and developed a nomogram for long-term mortality risk stratification. Results: Factors such as rural residence, middle-to-high SES, respiratory distress in newborns, and CHD were associated with increased 5-year mortality in infants with CDH. The claims-based nomogram, which incorporated sociodemographic and comorbidity variables, demonstrated moderate discriminatory power (AUC 0.76; C-index 0.78) for population-level risk stratification. Conclusions: This nationwide claims-based cohort study provides population-level estimates of 5-year mortality associated with CDH and introduces a nomogram that offers moderate discriminatory ability for long-term risk stratification.

Background and objectives: The aim of this study is to evaluate the effect of positive and negative visual aids used during verbal-active oral hygiene education on oral hygiene-related behaviors in children aged 7 to 14 years.

Materials and methods: In this single-blind design, sixty children were randomly assigned to three groups: G1:Positive visual aid, G2:Negative visual aid, and G3:Verbal-active education. Oral hygiene was evaluated using the Silness-Löe Index (plaque) and Rosenberg Organoleptic Scale (halitosis) at baseline, one week, and one month. Measurements were taken at baseline, at the end of the first week, and at the end of the first month. Data were analyzed using split-plot ANOVA.

Results: The test groups did not show any statistically significant differences in terms of age (F = 0.530, p = 0.449) or gender (χ² = 1.600, p = 0.449). Additionally, the groups were similar in terms of clinical variables, including dentition stage (permanent or mixed) (χ² = 5.566, p = 0.062), presence of malocclusion (χ² = 3.801, p = 0.150), and presence of anterior dental caries (χ² = 1.250, p = 0.535). Significant reductions in both plaque and halitosis scores were observed over time in all groups (p < 0.001), and there were no statistically significant differences between the types of intervention (p > 0.05).

Conclusions: This study demonstrated that both verbal education aided by positive and negative visuals and structured-only verbal education improved children's oral hygiene and halitosis scores in the short term.

Objective: Current data on the association between attention-deficit/hyperactivity disorder (ADHD) and essential hypertension (EH) in pediatric populations are very limited, as most research has focused on adults. This study investigated the long-term prevalence of EH in Israeli youth aged 5-18 years with ADHD, examining also trends in antihypertensive medication use. Methods: A retrospective cohort study was conducted using data from Leumit Health Services. The ADHD cohort (N = 18,558) was compared in a 1:2 ratio to controls (N = 37,116), who were strictly matched for age, gender, birth year and quarter, socioeconomic status (SES), sectors, region, and cumulative years of LHS membership up to the index date. Diagnoses of ADHD and EH were identified using ICD-9/10 codes, depending on the year of diagnosis. Logistic regression analyses were used to assess the associations between ADHD, EH and the use of antihypertensive medications over a 20-year follow-up. Results: ADHD-diagnosed children had a higher prevalence of EH, with odds ratios (ORs) of 3.17 (95% CI: 1.46-7.16, p = 0.0017) at 5 years, 2.94 (95% CI: 1.45-6.09, p = 0.0013) at 10 years, and 1.92 (95% CI: 1.26-2.93, p = 0.0015) at 20 years. ADHD patients showed a greater use of antihypertensive medications, including calcium channel blockers (OR 1.85, 95% CI: 1.02-3.35, p = 0.035), renin angiotensin system blockers (OR 2.20, 95% CI: 1.15-4.25, p = 0.013), and diuretics (OR 1.77, 95% CI: 1.21-2.60, p = 0.0028). Conclusions: These findings highlight an association between ADHD diagnosis and EH, suggesting regular cardiovascular monitoring of children with ADHD. Further studies are needed to uncover the role of stimulant medications and shared biological and behavioral factors involved in the pathogenesis.