Children-Basel最新文献

Background: Mucous stools in infancy are commonly attributed to non-IgE-mediated gastrointestinal food allergies and are generally considered transient and benign. However, whether mucous stools may indicate an atopy-prone clinical phenotype and relate to later respiratory atopy remains insufficiently explored. Objective: To evaluate the long-term risk of respiratory atopy (asthma and/or allergic rhinitis) in infants presenting with mucous stools during the first year of life and to identify early clinical predictors of this risk. Methods: This retrospective cohort study included infants who presented with mucous stools within the first 12 months of life and were followed for four years. Baseline demographic, clinical, dietary, and laboratory data were extracted from standardized medical records. Mucus severity was graded using a pragmatic 0-3 clinical mucus score. The primary outcome was physician-diagnosed asthma and/or allergic rhinitis at four years. Multivariable logistic regression was used to identify independent predictors, with model discrimination assessed by the area under the receiver operating characteristic curve (AUC). Results: A total of 142 infants with complete follow-up data were analyzed. At four years, respiratory atopy was observed in 45 infants (31.7%). In multivariable analysis, family history of atopy (adjusted odds ratio [aOR] 2.68, 95% CI 1.20-5.98, p = 0.016) and wheezing at presentation (aOR 3.74, 95% CI 1.56-8.94, p = 0.003) were independent predictors of respiratory atopy. The mucus score was associated with respiratory atopy in univariable analysis but did not remain an independent predictor in multivariable modeling. The model showed good discrimination (AUC = 0.769). Conclusions: In this cohort of infants presenting with mucous stools in the first year of life, respiratory atopy was observed in nearly one-third by age 4. While mucous stool burden was associated with the outcome in univariable analyses, it did not remain an independent predictor after adjustment. Early wheezing and a family history of atopy were the strongest clinical predictors and may help identify infants who warrant closer follow-up. These findings should be interpreted as associative and hypothesis-generating in the absence of a mucous-stool-free comparison group.

Background/Objective: Patent Ductus Arteriosus (PDA) is a common congenital heart defect causing high morbidity and mortality in preterm neonates. IV ibuprofen is the standard treatment, with acetaminophen as a potential alternative when ibuprofen is contraindicated. However, evidence for acetaminophen's effectiveness is inconclusive. This study aimed to compare the efficacy and safety of IV acetaminophen versus IV ibuprofen as the initial treatment for PDA closure in preterm neonates. Methods: A retrospective cohort study was conducted at a tertiary Saudi hospital. This study included preterm neonates with a gestational age of ≤32 weeks diagnosed with PDA and treated with IV ibuprofen or IV acetaminophen. The primary outcome was to evaluate the efficacy of ibuprofen versus acetaminophen for treating PDA. Results: A total of 95 courses were included. Of these, 49 neonates received ibuprofen, and 18 neonates received acetaminophen as first therapy. The mean age at the initial course was 5.47 ± 10.30 days for the ibuprofen group and 5.22 ± 6.43 days for the acetaminophen group. In most neonates, the hemodynamic significance of the PDA was confirmed by ultrasound examination. As a result, 35 of 49 neonates treated with ibuprofen experienced successful full PDA closure, with a rate of 71.4%, compared to 10 of 18 in the acetaminophen group, which had a rate of 55.6%. However, this difference was not statistically significant (p-value = 0.35). Conclusions: A trend toward higher PDA closure with ibuprofen was observed compared to acetaminophen, without a statistically significant difference. Both treatments showed comparable safety. Further studies are needed to confirm these findings and optimize acetaminophen dosing.

Background/Objectives: Children and young people with intellectual disability/developmental disorder (ID/DD) face inequities in hospital care, including poor communication, limited reasonable adjustments, and fragmented coordination. This study examined the presence of care coordination elements within staff and caregiver experiences and explored how these practices were influenced by a locally delivered staff training program implemented in a tertiary paediatric emergency department (ED) in New South Wales, Australia (Motivated for Change). Methods: A qualitative pre-post design was used, incorporating staff and caregiver interviews and ED observations to evaluate the program. This study included 22 observations (10 baseline, 12 post-intervention) and 15 interviews (six baseline, nine post-intervention) with staff and caregivers. The intervention included three one-hour training sessions and practical tools such as the digital Top 5 Tile This study represents a secondary use of existing data, applying a previously established care coordination framework and its associated definitions. Data were analysed using the framework method by five members of the research team. Results: Post-intervention, staff more consistently engaged parents and caregivers, made tailored adjustments, and used the Top 5 Tile to support information continuity. Child life therapists played a pivotal role in advocating for families and modelling inclusive practices. The findings mapped strongly to the framework domains of communication, proactive care planning, and aligning resources to needs, though systemic constraints remained. Conclusions: Targeted training and structured tools can strengthen care coordination for children and young people with ID/DD in EDs, improving safety and quality of care. Broader implementation across other departments and evaluation of sustainability are warranted.

Background/objectives: Disruptive behavior problems are common in early childhood, yet access to evidence-based parent training remains limited in many communities due to workforce shortages and service delivery barriers. Behavioral Skills Training for Families (BSF) is a Parent-Child Interaction Therapy (PCIT)-informed, home-based behavioral skills practice model designed to be delivered by bachelor's-level paraprofessionals under close supervision. This pilot study evaluated the feasibility and preliminary caregiver and child outcomes associated with the Child-Directed Interaction (CDI) module of BSF to inform refinement of training and implementation protocols and guide future evaluation.

Methods: Using a non-randomized pre-post design embedded within routine services, caregiver-child dyads (children ages 2-10 years) receiving BSF CDI across community-based agencies in Minnesota were included. Outcomes were assessed using observational coding of caregiver skills (Dyadic Parent-Child Interaction Coding System; DPICS) and caregiver-reported child behavior measures (Eyberg Child Behavior Inventory [ECBI]; Weekly Assessment of Child Behavior-Positive [WACB-P]). Paired-sample t-tests with intent-to-treat analyses examined changes from the baseline to the last attended CDI session.

Results: Caregivers demonstrated statistically significant and large increases in observed positive parenting skills and reductions in negative verbalizations during child-led play. Children showed significant reductions in disruptive behavior intensity and problem scores on the ECBI, reflecting movement toward clinically meaningful improvement. No significant change was observed in caregiver-reported positive child behaviors on the WACB-P. Post hoc analyses were conducted to further explore these differences and found consistent changes in the ECBI for cases, regardless of no reported changes in positive child behaviors on the WACB.

Conclusions: The results provide preliminary evidence that a structured, PCIT-informed CDI skills practice model can be feasibly implemented by paraprofessionals and is associated with meaningful improvements in caregiver behavior and child behavior outcomes in the first 2-3 months following service initiation. The findings support BSF as a promising workforce-embedded approach and inform future controlled studies examining effectiveness, sustainability, and broader implementation outcomes.

Aim: This systematic review compared erbium lasers (Er:YAG/Er,Cr:YSGG) with conventional rotary instruments (dental turbine/high-speed handpiece) for caries removal and cavity preparation in pediatric dentistry, focusing on patient-centered outcomes and short-term restorative performance.

Methods: Following PRISMA guidance, PubMed, Scopus, and Web of Science were searched for studies published between January 2010 and November 2025. Eligible studies were in vivo/human investigations in children with carious primary teeth comparing erbium laser versus rotary instrumentation.

Results: Eleven studies met the inclusion criteria. Across the included trials, erbium laser treatment was consistently associated with reduced intraoperative pain and improved comfort, often accompanied by lower anxiety indicators and higher child acceptance compared with rotary preparation. Several studies also reported a reduced need for local anesthesia in the laser group. In contrast, operative time was generally longer with erbium lasers than with turbines. When restorations were evaluated, clinical performance and short-term success (up to 12 months) were comparable between laser- and bur-prepared cavities, with no consistent disadvantages observed for laser preparation.

Conclusions: Overall, erbium lasers appear to be a clinically effective and child-friendly alternative to conventional turbines, offering superior patient comfort while maintaining comparable short-term restorative outcomes, albeit at the cost of longer procedure duration.

Background: Wide surgical excision is considered the traditional treatment for pilonidal sinus disease but is associated with prolonged wound healing and delayed recovery. This study aims to compare the outcomes of radical surgery versus a minimally invasive alternative in pediatric patients. Methods: A multicenter randomized comparative study was conducted on patients undergoing surgery for pilonidal sinus between January 2023 and December 2024 in four pediatric institutions. Patients were divided into two groups according to the surgical approach: Group 1 (en bloc excision) and Group 2 (endoscopic treatment). Demographic and clinical variables, postoperative complications, and recurrence rates were analyzed. Results: A total of 102 patients were included in this study (Group 1: n = 54; Group 2: n = 48). Baseline demographic and clinical characteristics were similar between groups. Postoperative complications occurred more frequently in Group 1 compared with Group 2 (53.7% vs. 20.8%; p < 0.001). Moreover, Group 1 presented a higher proportion of emergency department visits (44.4% vs. 8.36%; p < 0.001) and a longer median time to complete healing (100 vs. 45 days; p < 0.001). After a median follow-up of 19 months (interquartile range, 10-24 months), no significant differences were observed between groups in recurrence rates (14.8% vs. 16.7%; p = 0.797) or in median time from treatment to recurrence (198 vs. 184 days; p = 0.672). Conclusions: Endoscopic treatment of pilonidal sinus in pediatric patients is associated with fewer postoperative complications and faster recovery compared to radical surgery, with no observed differences in recurrence rates. Longer follow-up is needed to confirm these findings.

Background/objectives: Socio-cultural adversities and health disparities across Asian American origin groups remain understudied, particularly in early childhood. This limits the development of culturally responsive prevention and intervention strategies. A family-based Asian American epidemiologic study is essential to address these gaps and to inform tailored solutions. As an initial pilot effort, this pilot study was designed primarily to assess feasibility and generate preliminary data to inform future hypothesis-driven, large-scale epidemiologic research. The study objectives were to evaluate the feasibility of a remote study protocol and to collect preliminary data on child development and parental factors among Asian Indian, Filipino, and Korean American families with young children.

Methods: A remote pilot study was conducted in 2024-25 among 48 mother-father-child (age 1-4 years) triads residing in Illinois, including 18 Asian Indian, 12 Filipino, and 18 Korean American mothers. Parents completed an online survey, and children wore an ActiGraph accelerometer on their hips. Analyses were conducted to describe child development, parental experiences, and parenting practices among the three ethnic groups.

Results: Of the 48 mothers, 29 (60%) were US-born, and all but 1 had at least a bachelor's degree. All parent pairs completed the survey, whereas only 34 children (71%) provided valid accelerometer data. Disaggregated data showed that, compared to children of Asian Indian mothers, children of Filipino mothers had higher daily screen time (p < 0.10) and higher sleep problem scores (p < 0.05), and children of Korean mothers had higher child-caregiver interaction scores (p < 0.05). Across all three groups, more favorable parenting practices were associated with lower sleep problem scores, higher wellbeing scores, and higher child-caregiver interaction scores (p < 0.01).

Conclusions: The remote study protocol was generally feasible; however, child compliance with hip accelerometer wear was suboptimal. Preliminary data revealed differences in children's physical behaviors and social-emotional development across Asian ethnic groups. A full-scale study should enhance the engagement of socioeconomically diverse families and refine wearable data collection methods to improve data representativeness and completeness.

Background/objectives: Psychotic episodes in adolescents may present as affective psychosis (AP) or non-affective psychosis (NAP), which are clinically overlapping. This single-center, retrospective study aimed to describe and compare adolescents with AP and NAP regarding demographic characteristics, family history, academic functioning, and treatment patterns.

Methods: We retrospectively analyzed medical records of 171 patients aged 11-18 years admitted to the "Prof. Dr. Alexandru Obregia" Clinical Psychiatric Hospital, Bucharest, between 2020 and 2024. Descriptive statistics and univariate analyses were performed to explore associations between episode type and selected clinical and sociodemographic variables. An exploratory multivariate logistic regression was conducted to assess whether associations observed in univariate analyses remained stable after adjustment for relevant covariates. Treatment-related variables were analyzed descriptively and were not included as predictors in the regression model.

Results: AP was more frequent in females (53.2%), whereas NAP predominated in males (62.8%, p = 0.036). Trends toward higher rates of psychiatric family history and better academic performance were observed in the AP group, while school dropout was more frequent in NAP, although these differences did not reach statistical significance. Mood stabilizers were prescribed more frequently in adolescents with AP, reflecting clinical practice patterns; however, this association did not reach statistical significance and was interpreted descriptively. In multivariate analysis, gender remained significantly associated with episode type.

Conclusions: This retrospective study identifies descriptive differences between adolescent AP and NAP in gender distribution, family psychiatric history, academic functioning, and treatment patterns. Findings are exploratory and do not imply causality. Results highlight areas for further research and underscore the importance of considering clinical subtype and functional outcomes when planning interventions in adolescent psychosis.

Background/Objectives: Parental health literacy is linked to child health outcomes, but the evidence relies mainly on parent proxy reports. This study examined the association between parental health literacy and proxy-reported mental health outcomes in children aged 6-10 years and assessed whether these associations reflect general reporting patterns. Methods: This study is a secondary analysis of data derived from a population-based cross-sectional survey conducted in South Tyrol, Italy, including proxy data from 3183 children aged 6-10 years. Parental health literacy was categorized as inadequate, problematic, adequate, or missing/insufficient. The outcomes included emotional and behavioral difficulties, psychosomatic complaints, and perceived social support. Linear regression models were estimated for each outcome, adjusted for children's age, gender, parental age, education, family affluence, migration background, residential setting, and questionnaire language. Selective missingness and insufficient completion of parental health literacy data were examined using logistic regression analysis. Sensitivity analyses were used to adjust the mental health models for social support. Results: Higher parental health literacy was associated with lower emotional and behavioral difficulties (B = -1.40, 95% confidence interval [CI] -1.79 to -1.01), higher psychosomatic complaint scores (B = 0.61, 95% CI 0.40 to 0.081), and higher perceived social support (B = 0.14, 95% CI 0.02 to 0.26). The effect sizes were small. Missing or insufficient parental health literacy data showed social patterns by parental education and age, whereas no systematic predictors of early disengagement were observed among parents who partially completed the health literacy instrument. Sensitivity analyses attenuated but did not eliminate the associations between parental health literacy and child mental health outcomes. Conclusions: Parental health literacy is associated with proxy-reported psychosocial outcomes in children aged 6-10 years. The consistency of the effects across outcomes suggests that parental health literacy may influence how parents report child functioning, underscoring the importance of considering informant characteristics in proxy-based research.

Background: Adolescence is a critical developmental period marked by heightened emotional reactivity and increased exposure to stress, particularly in high-contact sports such as rugby. Maladaptive anger expression can negatively affect young athletes' psychological well-being, behavior, and performance. Mental imagery may support emotional regulation by enabling athletes to rehearse adaptive cognitive and emotional responses. This study examined the effectiveness of a personalized mental imagery training program on imagery ability, resilience, and anger expression in adolescent rugby players and investigated whether resilience mediated the relationship between mental imagery and anger expression. Methods: A total of 120 male adolescent rugby players (mean age = 16.9 ± 2.01 years) were assigned to an experimental group (n = 62) or a time-matched educational control group (n = 58). Results: Mixed-design analyses of variance revealed significant Group × Time interactions for imagery ability, resilience, and anger expression, with medium-to-large effect sizes. Compared with the control group, the experimental group demonstrated greater improvements in imagery vividness and resilience, along with a significant reduction in maladaptive anger expression. Mediation analyses showed that resilience significantly mediated the relationship between mental imagery and anger expression, with full mediation for static imagery and partial mediation for dynamic imagery. Conclusions: Personalized mental imagery training effectively enhances emotional regulation in adolescent rugby players, primarily by strengthening resilience. Imagery-based interventions represent a feasible and effective approach to promoting adaptive emotional regulation and psychological well-being in high-contact youth sports.