European Journal Of Pediatrics[JOURNAL]
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200 papers
Novel activity and participation scales for children, adolescents, and young adults with postacute infection and vaccination syndromes and/or ME/CFS.
Weidmann C, Grabbe A, Eberhartinger M … +6 more , Kircher A, Leone A, Warlitz C, Stojanov S, Behrends U, Mihatsch LL
Eur J Pediatr · 2026 Jun · PMID 42249231 · Full text
Children, adolescents, and young adults (CYP) with postacute infection and vaccination syndromes (PAIVS), and/or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), experience profound loss in activity and parti...
Children, adolescents, and young adults (CYP) with postacute infection and vaccination syndromes (PAIVS), and/or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), experience profound loss in activity and participation. We introduce and psychometrically validate two new brief, age-adapted, and domain-specific questionnaires for clinical use assessing activity and participation in this vulnerable patient group. For this, 91 patients (aged 10-25 years) were assessed at the Munich Chronic Fatigue Center (MCFC) from 12/2022 to 11/2024. We designed the MCFC Activity Scale and MCFC Participation Scale and assessed construct validity using confirmatory factor analysis for both questionnaires. Reliability was evaluated via Cronbach's α. Factor-based MCFC Activity and Participation Scores (0-100) were derived and correlated with Bell Score, FSS, DSQ-PEM, and SF-12 Component Summary Scales (PCS and MCS). Discrimination for ME/CFS was evaluated using ROC analyses. Participants (mean age 15.6 ± 2.4 years) were predominantly female (64%). 65% were diagnosed with ME/CFS. The MCFC Activity Scale showed excellent one-factor fit (comparative fit index, CFI = 1.00) and good internal consistency (α = 0.82). The MCFC Participation Scale showed good internal consistency (α = 0.85) and acceptable one-factor fit (CFI = 0.817). Factor-based activity and participation were strongly correlated yet distinct (r = 0.73). Derived MCFC Activity and Participation Scores differed significantly by ME/CFS diagnosis (p ≤ 0.009). Scores correlated with Bell Score, FSS, DSQ-PEM, and SF-12 PCS (all p ≤ .002). For ME/CFS discrimination, the Activity Score achieved an AUC = 0.78 and the Participation Score an AUC = 0.72.Conclusion: The Activity Scale demonstrated strong construct validity. The Participation Scale showed good internal consistency. Both scores demonstrated good convergent validity with established patient-reported outcome measures, supporting clinical utility. They may serve as pragmatic screening tools for this vulnerable patient group.
Ram cannula vs nasal mask interface for providing CPAP in preterm neonates (< 34 weeks) with respiratory distress syndrome in a low- and middle-income country: an open-label, non-inferiority randomized controlled trial.
Srivastav N, Debata P, Khan AA … +2 more , Yadav B, Bandyopadhyay T
Eur J Pediatr · 2026 Jun · PMID 42249212 · Publisher ↗
UNLABELLED: The present open-label, non-inferiority randomized controlled trial aimed to determine the efficacy and safety of RAM cannula as compared to nasal mask on the need for mechanical ventilation within 72 h of in...
UNLABELLED: The present open-label, non-inferiority randomized controlled trial aimed to determine the efficacy and safety of RAM cannula as compared to nasal mask on the need for mechanical ventilation within 72 h of initiation of nCPAP. Preterm neonates (< 34 weeks) with Silverman-Anderson Score ≥ 3/10 were allocated to either RAM cannula or nasal mask for providing nCPAP. Two hundred and ten neonates were enrolled in the study, 105 each in the RAM cannula group and nasal mask group, respectively. Baseline characteristics were similar between the two groups. The proportion of neonates who needed mechanical ventilation within 72 h of initiation of nCPAP support allocated to the RAM cannula group and nasal mask group were 22 (21%) and 13 (12%), respectively (risk difference 8.57%, 95% CI -1.44 to 18.59). The non-inferiority of RAM cannula could not be established as the upper bound of 95% CI crossed the pre-specified non-inferiority margin of 15%. Other clinical parameters like incidence and severity of nasal injury, duration of CPAP support, mortality, and common neonatal morbidities were comparable. CONCLUSION: RAM cannula is not non inferior as compared to nasal mask in reducing the need for mechanical ventilation within 72 h of initiation of CPAP support in preterm neonates (< 34 weeks) with RDS. TRIAL REGISTRATION: www.ctri.nic.in , id CTRI/2024/06/068826, registered on 12/06/2024. WHAT IS KNOWN: • RAM cannula is not non-inferior to short binasal prongs (SBP) in providing CPAP to preterm infants with RDS. • RAM cannula causes less nasal trauma than SBP. WHAT IS NEW: • RAM cannula is not non-inferior as compared to nasal mask in reducing the need for mechanical ventilation within 72 h of initation of CPAP support in preterm neonates (< 34 weeks) with RDS. • The incidence of nasal injury is comparable between RAM cannula and nasal mask.
Use of proton pump inhibitors in children in a tertiary hospital in Belgium.
Tommelein E, Wuyts S, Bockstal F … +5 more , Viljoen M, Keuler N, Simon M, Cornu P, van Berlaer G
Eur J Pediatr · 2026 Jun · PMID 42247080 · Publisher ↗
UNLABELLED: Proton pump inhibitors (PPIs) are frequently prescribed in paediatrics, yet increasing evidence suggests that their use is often inconsistent with clinical guidelines and may be associated with significant sa...
UNLABELLED: Proton pump inhibitors (PPIs) are frequently prescribed in paediatrics, yet increasing evidence suggests that their use is often inconsistent with clinical guidelines and may be associated with significant safety concerns. We conducted a retrospective study using the dispensing database of a tertiary care hospital in Brussels, Belgium. All PPI dispensed to children under 18 years of age between January 1, 2022 and January 31, 2024 were extracted. Subsequent administrations of the PPIs were linked with clinical data from electronic medical files. Appropriateness of use was assessed using regulatory labelling and the Dutch paediatric pharmacotherapy reference, Kinderformularium. Data were stratified by age category. The main outcomes included indication, dose appropriateness, treatment duration, and deprescribing practices. A total of 658 children received at least one PPI. PPIs were used across all paediatric age groups (0-18 years), most commonly prescribed by paediatricians (59.5%) and emergency physicians (12.9%). The median duration of treatment was 3 days (IQR: 2-7), being similar across age groups. Only 7.6% of children received PPIs for an officially approved indication. The majority (94.4%) of prescriptions were for off-label indications or lacked documentation of any indication. Dosing appropriateness varied by age and indication. Among children receiving PPIs for on-label indications (n = 50), less than half were prescribed a correct dose. In the off-label group (n = 608), dosing was frequently excessive, especially in younger age groups. As age increased, dose appropriateness improved. When PPIs were discontinued, either during hospitalization or at discharge, cessation was abrupt, with no evidence of tapering strategies. Three percent of children were prescribed a continuation of PPI treatment after discharge. CONCLUSION: These findings highlight significant gaps in guideline adherence and underscore the need for improved prescribing and deprescribing practices in paediatric care. WHAT IS KNOWN: • Proton pump inhibitors (PPIs) are widely used in children, often for off-label indications. • Appropriate prescribing and deprescribing practices in paediatrics remain poorly studied. WHAT IS NEW: • This study quantifies off-label use, inappropriate dosing, and unstructured deprescribing of PPIs in hospitalized children. • Findings highlight the urgent need for paediatric-specific evidence-based guidelines on PPI use and deprescribing.
Hepatic steatosis in pediatric obesity: association with cardiometabolic profile and considerations regarding alanine aminotransferase screening.
Recio Linares A, Botija G, Bezanilla López C … +8 more , Barasoain Millán A, Del Olmo Segura P, Férreo Santos P, Cano Dorao FC, Gonzalez-Hoyuela M, Carrero Álvaro JC, Garcia Hernando T, Pérez Fernández EP
Eur J Pediatr · 2026 Jun · PMID 42243551 · Publisher ↗
PURPOSE: Hepatic steatosis is the most common chronic liver disease in children with obesity and is associated with an adverse cardiometabolic profile. This study aimed to estimate the prevalence of cardiometabolic risk...
PURPOSE: Hepatic steatosis is the most common chronic liver disease in children with obesity and is associated with an adverse cardiometabolic profile. This study aimed to estimate the prevalence of cardiometabolic risk factors and ultrasound-guided attenuation parameter (UGAP)-diagnosed hepatic steatosis in children with obesity, evaluate variables associated with steatosis, and explore the diagnostic performance of alanine aminotransferase (ALT). METHODS: This single-center, cross-sectional study included 91 children aged ≥ 9 years with obesity recruited from pediatric endocrinology and gastroenterology outpatient clinics between July 2023 and July 2025. Anthropometric, blood pressure, biochemical, and UGAP measurements were collected. Hepatic steatosis was defined as UGAP ≥ 0.680 dB/cm/MHz. Elevated ALT was defined as ≥ 44 U/L in females and ≥ 52 U/L in males. Associations with hepatic steatosis were assessed using Poisson regression. RESULTS: The prevalence of UGAP-diagnosed hepatic steatosis was 28.6%. Higher BMI z-score, larger waist circumference, elevated ALT, arterial hypertension, dyslipidemia, insulin resistance, and metabolic syndrome were significantly associated with hepatic steatosis. Elevated ALT showed low sensitivity (19.2%) and high specificity (93.8%) for detecting hepatic steatosis. ALT discriminatory performance differed by sex, with an AUC of 0.816 in females and 0.582 in males. Exploratory ALT cutoffs showed limited clinical applicability, particularly in males because of very low specificity. CONCLUSION: Children with obesity and UGAP-diagnosed hepatic steatosis showed a more unfavorable cardiometabolic profile. ALT alone may miss a substantial proportion of children with hepatic steatosis, supporting the need for improved screening strategies. WHAT IS KNOWN: • Pediatric hepatic steatosis is associated with an adverse cardiometabolic profile in children with obesity. • Screening strategies based on ALT and imaging techniques show variable diagnostic performance in pediatric populations. WHAT IS NEW: • UGAP-diagnosed hepatic steatosis in children with obesity was associated with an unfavorable cardiometabolic profile in a Spanish secondary-care cohort. • ALT showed sex-specific differences and limited usefulness as a standalone screening tool for hepatic steatosis, particularly in males, when UGAP was used as the reference method.
Growth hormone therapy and near-final height in SHOX deficiency and turner syndrome: a real-world single-center retrospective cohort study.
Oktay MA, Döğer E, Uğurlu AK … +4 more , Kayhan G, Karaoğuz MY, Çamurdan MO, Bideci A
Eur J Pediatr · 2026 Jun · PMID 42243538 · Full text
UNLABELLED: Short stature homeobox-containing (SHOX)-gene haploinsufficiency causes short stature both in isolated SHOX deficiency and in Turner syndrome (TS), yet head-to-head data on growth-hormone (GH) outcomes remain...
UNLABELLED: Short stature homeobox-containing (SHOX)-gene haploinsufficiency causes short stature both in isolated SHOX deficiency and in Turner syndrome (TS), yet head-to-head data on growth-hormone (GH) outcomes remain scarce. We therefore compared growth response and near-final height (NFH) after GH therapy between girls with SHOX deficiency and those with TS. Single-centre retrospective cohort study. In this single-centre retrospective cohort, we reviewed 44 pre-pubertal girls who received daily GH (mean 0.045 mg/kg/day) between 2015 and 2024 and subsequently reached NFH (bone age ≥ 14 y; height velocity < 2 cm/year). Ten had molecularly confirmed SHOX deficiency and 34 had karyotype-proven TS. Baseline auxology, annual height velocity, pubertal timing, treatment duration, NFH standard-deviation score (SDS) and total height SDS gain were analysed. Mean chronological and bone ages at GH initiation were similar (10.7 ± 1.9 vs 10.4 ± 2.7 years). Baseline height SDS was lower in TS (-3.51 ± 1.0) than in SHOX (-2.66 ± 0.8). First-year growth velocity was higher in SHOX (8.55 ± 1.4 cm/year) than TS (6.72 ± 1.9 cm/year; p = 0.01). Puberty began earlier in SHOX (11.6 ± 1.3 years) than TS (13.7 ± 1.5 years; p < 0.01), and GH exposure was shorter (2.00 ± 0.4 vs 4.38 ± 2.3; p < 0.01). Observed NFH-SDS was similar between groups (SHOX - 2.46 ± 1.2 vs TS - 2.47 ± 1.0). Unadjusted height-SDS gain was greater in TS (1.04 ± 0.1 vs 0.20 ± 0.2; p = 0.04). In exploratory ANCOVA models adjusting for baseline age, baseline height SDS, and GH treatment duration, adjusted height-SDS gain did not differ significantly between groups. CONCLUSIONS: TS was associated with a greater unadjusted height-SDS gain, whereas SHOX deficiency was characterized by earlier puberty and shorter GH exposure. Although observed NFH-SDS was similar, these findings highlight how differences in pubertal timing and treatment duration may influence growth outcomes in routine clinical practice and should be interpreted as reflecting real-world growth trajectories rather than intrinsic biological responsiveness to GH therapy. WHAT IS KNOWN: • Growth hormone therapy is an established treatment for short stature in both SHOX deficiency and Turner syndrome. • Treatment response is influenced by several factors, including age at treatment initiation and pubertal development. WHAT IS NEW: • This study provides a real-world comparison of growth hormone treatment outcomes in girls with SHOX deficiency and Turner syndrome. • Spontaneous pubertal progression in SHOX deficiency versus medically induced puberty in Turner syndrome may substantially influence the duration of the therapeutic growth window and the observed growth response.
Trending ability of electrical cardiometry for non-invasive cardiac output monitoring in preterm neonates during the transitional period: a polar plot analysis.
Martini S, Annunziata M, Lenzi J … +3 more , Coppi E, van Wyk L, Corvaglia L
Eur J Pediatr · 2026 Jun · PMID 42240728 · Full text
UNLABELLED: Electrical cardiometry (EC) enables continuous, non-invasive monitoring of cardiac output (CO) in neonates. The ability of this technique to track CO changes over time compared to transthoracic echocardiograp...
UNLABELLED: Electrical cardiometry (EC) enables continuous, non-invasive monitoring of cardiac output (CO) in neonates. The ability of this technique to track CO changes over time compared to transthoracic echocardiography (TTE) remains poorly studied in the neonatal population. Using polar plot analysis, we aimed to assess the trending ability of EC compared with TTE in preterm neonates during the transitional period. CO measurements were performed on preterm infants < 32 weeks' gestation and/or < 1500 g on day 1, 2 and 3 of life. Paired changes in CO (ΔCO) between consecutive days of life were calculated for both EC and TTE and used for polar plot analysis. Overall, 55 paired ΔCO measurements were available for day 1-2 and 45 for day 2-3. After excluding changes < 20% of the mean absolute ΔCO value, 46 and 41 pairs were included in the polar analysis. EC demonstrated good trending performance, with 87% and 88% of points falling within ± 30° for day 1-2 and day 2-3, respectively. The mean angular bias was 0.6° (95% CI - 5.7° to 6.8°) for days 1-2 and - 7.2° (95% CI - 16.4° to 2.0°) for days 2-3, indicating minimal systematic directional disagreement between methods. CONCLUSION: Our findings suggest a good trend tracking performance of EC for non-invasive CO monitoring during the transitional period in preterm neonates, supporting its potential role as a continuous monitoring tool for neonatal hemodynamic assessment. WHAT IS KNOWN: • Electrical cardiometry (EC) allows continuous, non-invasive cardiac output (CO) monitoring in neonates. • While EC accuracy for CO assessment has been previously investigated, little is known on its trending ability. WHAT IS NEW: • EC showed good ability to track CO changes in preterm neonates when compared to transthoracic echocardiography. • Over 85% of paired ΔCO were within ±30°, with minimal angular bias.
Correction to: Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure and clinical severity in children: a prospective observational study.
Naseem M, Anand V, Das R … +1 more , Rathia S
Eur J Pediatr · 2026 Jun · PMID 42240687 · Publisher ↗
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Quality of life among asthmatic schoolchildren in Saudi Arabia: a mixed-method study.
Alfaleh A, Alkattan A, Alzaher A … +5 more , Alhabib D, Almutairi M, Noufal R, Sagor K, Ibrahim MH
Eur J Pediatr · 2026 Jun · PMID 42240678 · Publisher ↗
One of the optimal asthma management goals is to improve patients' quality of life. Limited Saudi studies assessed quality of life (QoL) among vulnerable groups like schoolchildren. This study conducted quantitative and...
One of the optimal asthma management goals is to improve patients' quality of life. Limited Saudi studies assessed quality of life (QoL) among vulnerable groups like schoolchildren. This study conducted quantitative and qualitative approaches to examine asthma-related QoL in Saudi adolescent students. A mixed-approach study was conducted among guardians of Saudi schoolchildren with confirmed asthma disease during May and November 2025. Based on in-depth asthma QoL interviews, a qualitative approach was completed, and quantitative methods were applied for comprehensiveness. Both approaches were influenced by the reliable and verified Arabic PedsQL Asthma Module. MAXQDA was used to assess guardians' comprehensive responses, and the PedsQL Asthma Module scale was used to categorize and analyze the conclusion responses. Qualitative and quantitative analyses include 46 interviews. As some feelings of anxiety and worry among children were shown to be linked with asthmatic symptoms and complications, it appears that this nervousness impacts guardians and might affect their QoL. Some found asthma to be challenging to manage, leading to anxiety and fear of complications. The quantitative approach revealed a substantial effect size of high asthma QoL compared to moderate to poor QoL (Hedges' g = - 0.690, p 0.001). Conclusion: This study shows that Saudi asthmatic adolescents have moderate QoL, but clinical and school-based care gaps exist. QoL is driven by asthma symptoms and management, which may create worry in children and parents. Furthermore, environmental differences in Saudi Arabia may affect asthmatic students' respiratory health. These issues should be addressed to improve asthmatic adolescents' QoL.
Body piercing and adolescent risk-taking: association or expression?
Ileri M, Yücel H, Yücel D … +6 more , Tokan R, Şahiner A, Ozen G, Cetinkaya S, Güven AG, Aycan Z
Eur J Pediatr · 2026 Jun · PMID 42234241 · Full text
UNLABELLED: This study aimed to investigate the relationship between body piercing and risk-taking behaviors among adolescents, while assessing their knowledge and attitudes regarding piercing practices, hygiene, and pot...
UNLABELLED: This study aimed to investigate the relationship between body piercing and risk-taking behaviors among adolescents, while assessing their knowledge and attitudes regarding piercing practices, hygiene, and potential complications. This cross-sectional descriptive study was conducted among 141 adolescents aged 12-19 years attending an adolescent health clinic between February and November 2025. Participants were divided into two groups: adolescents with at least one body piercing (n = 71) and controls without piercings (n = 70). Data on sociodemographic characteristics, risk-taking behaviors, and mental health status were collected using a structured questionnaire. Risk behaviors were defined as meeting in person with someone first met online, driving without a seat belt, getting into a stranger's vehicle, experimenting with cigarettes, alcohol, or substances, and having suicidal thoughts. Suicide risk was evaluated using the "Ask Suicide-Screening Questions." Knowledge regarding piercing procedures, hygiene, and complications was assessed through an 18-item survey, and scores were calculated on a 100-point scale. Adolescents with piercings demonstrated significantly higher engagement in risk-taking behaviors compared to controls, including smoking (73.2% vs. 11.4%), alcohol use (63.4% vs. 8.6%), substance use (11.3% vs. 0%), and non-suicidal self-injury (42.3% vs. 4.3%) (all p < 0.001). Positive suicide risk screening was also more frequent in the piercing group (45.1% vs. 7.1%, p < 0.001). Nearly half of the pierced adolescents reported local complications such as hyperemia, swelling, or pain, and only 49.3% had their procedures performed in licensed studios. The overall knowledge score was moderate (mean = 59.4 ± 14.2), with the lowest accuracy in the "Site and Setting of Application" domain. None of the participants answered all questionnaire items correctly. CONCLUSION: Although body piercing has become a normalized form of self-expression among adolescents, it remains associated with significantly higher rates of risk-taking behaviors and psychological vulnerability. Moreover, adolescents demonstrated insufficient knowledge about safe piercing practices, sterilization, and complications, and most had not received information from health professionals. These findings highlight the need for targeted educational interventions and counseling to promote safer body modification practices and to use piercing as an opportunity for psychosocial assessment in adolescent health care. WHAT IS KNOWN: • Body piercing is a common form of self-expression among adolescents and has been previously linked to certain risk taking behaviors like smoking and substance use. • Adolescents generally demonstrate insufficient knowledge regarding hygiene, sterilization, and health complications associated with body modifications. WHAT IS NEW: • This study explicitly details a alarmingly high rate of positive suicide risk screening and non-suicidal self-injury specifically among pierced adolescents. •It quantifies a distinct gap in knowledge regarding the Site and Setting of Application, revealing that more than half of adolescents utilize unlicensed studios without professional health guidance. •Body piercing should serve as a practical, visible trigger for pediatricians to initiate comprehensive psychosocial and mental health screenings in clinical settings.
Establishing a preliminary normative database of oral efficiency for children: the Test of Masticating and Swallowing Solids Application (ToMaSSApp).
Willocks AG, Bykova KM, Moltchanova E
Eur J Pediatr · 2026 Jun · PMID 42234178 · Full text
UNLABELLED: The Test of Masticating and Swallowing Solids (ToMaSS) is a diagnostic tool that measures oropharyngeal efficiency of solid bolus consumption through the number of bites, mastication cycles, swallows, and tim...
UNLABELLED: The Test of Masticating and Swallowing Solids (ToMaSS) is a diagnostic tool that measures oropharyngeal efficiency of solid bolus consumption through the number of bites, mastication cycles, swallows, and time taken. An application (ToMaSSApp™) has been used to administer the assessment. The project aimed to establish a preliminary normative database for the ToMaSS-C in children administered with the ToMaSSApp™ and to make comparisons to previously manually collected data. A total of 114 healthy children (57 boys and 57 girls) aged 4 to 19 years (M = 9 years, SD = 4.6 years) were asked to consume a cracker. The efficiency measures were obtained via the ToMaSSApp™. A generalized linear regression model was fitted for each measure and used to obtain normative tables from the data. Equivalence testing was used to compare the data collected via ToMaSSApp™ to the older manually collected data. A normative dataset for the ToMaSS-C in children was established based on the data collected using the ToMaSSApp™. Within the normative dataset, age affected boys and girls similarly and had a statistically significant effect on ToMaSS-C measures (p < 0.05). No equivalence was found between the historical manual and App-based test administration for any ToMaSS-C parameters with larger differences for younger ages. CONCLUSION: The ToMaSSApp™ is shown to be a feasible and efficient tool in the administration of the ToMaSS-C in the paediatric population. Establishing normative data for the ToMaSS-C is essential for understanding typical processes of oropharyngeal efficiency of solid food consumption as well as identifying and managing dysphagia or oral motor delays. WHAT'S KNOWN: • ToMaSS can be administered to children (ToMaSS-C) using a manual recording method. • The ToMaSSApp™, as a digital alternative, has recently been used to establish a normative dataset in adults. WHAT IS NEW: • The ToMaSSApp™ is feasible for paediatric ToMaSS-C administration. • A preliminary normative dataset for children was established using the App-based recording method.
Early effect of CFTR modulators on the mental health of patients with cystic fibrosis and parents.
Yetişgin H, Akyan Soydaş ŞS, Özkan Tabakçı S … +12 more , Bilgiç I, Kürtül Çakar M, Akca Dinç G, Ünlü A, Yıldırım Ç, Çetin MA, Tuğcu GD, Ademhan Tural D, Eryılmaz Polat S, Şenses Dinç G, Çöp E, Cinel G
Eur J Pediatr · 2026 Jun · PMID 42234158 · Publisher ↗
UNLABELLED: The cystic fibrosis transmembrane conductance regulator (CFTR) modulators were shown to improve clinical symptoms in patients with cystic fibrosis (CF). However, the effects of modulator therapy on the mental...
UNLABELLED: The cystic fibrosis transmembrane conductance regulator (CFTR) modulators were shown to improve clinical symptoms in patients with cystic fibrosis (CF). However, the effects of modulator therapy on the mental health of patients with CF remain uncertain. We aimed to investigate the impact of the CFTR modulator therapy on the mental health of children with CF and their parents. This prospective observational study was conducted on children with CF who used modulator therapy (Group 1, n = 24) and those who did not (Group 2, n = 29) and parents (n, 53). Cystic Fibrosis Quality of Life Questionnaire (CFQ-R), Children's Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED) were applied to patients. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and World Health Organization Quality of Life Scale-Short Form (WHOQOL-BREF) were administered to parents. There was no significant difference between the groups in demographics. SCARED scores were higher in patients who did not use modulator therapy (p = 0.016). Anxiety and depression scores of BDI and BAI scales applied to parents were found to be statistically significantly higher in parents of patients who did not use modulator therapy (p = 0.006, p = 0.002, respectively). WHOQOL-BREF scores were higher among parents of patients who used modulator therapy, but the difference was not statistically significant (p = 0.060). CONCLUSION: These findings suggest a possible association between CFTR modulator use and lower anxiety and depression scores in both patients and parents, though causal conclusions cannot be drawn from this observational study. WHAT IS KNOWN: • CFTR modulator therapies have been increasingly used in recent years with demonstrated beneficial effects on clinical outcomes. • The effects of CFTR modulator therapies on mental health are not yet clearly defined. WHAT IS NEW: • CFTR modulator use was associated with lower anxiety scores in children with cystic fibrosis and lower anxiety and depression scores among their parents. • These findings suggest a potential early psychosocial benefit of CFTR modulator therapy for both patients and caregivers; however, they should be interpreted cautiously because the observational design does not allow causal conclusions.
Psychometric evaluation of Patient-Reported Outcomes Measurement Information System (PROMIS) in pediatric sickle cell disease in Europe.
Houwing ME, Luijten MAJ, Muntendam MJ … +5 more , van Muilekom MM, Heijboer H, Fijnvandraat K, Haverman L, Cnossen MH
Eur J Pediatr · 2026 Jun · PMID 42231025 · Full text
UNLABELLED: Sickle cell disease has a profound impact on the physical, mental and social health of affected children. Currently, there is considerable variability among the available patient reported outcomes measures (P...
UNLABELLED: Sickle cell disease has a profound impact on the physical, mental and social health of affected children. Currently, there is considerable variability among the available patient reported outcomes measures (PROMs) used in children with sickle cell disease, and no consensus has yet been achieved. We aim to assess the psychometric properties of the generic pediatric and proxy Patient-Reported Outcomes Measurement Information System (PROMIS®) measures in children with sickle cell disease living in the Netherlands. Dutch children with sickle cell disease aged 5-17 years old and their caregivers were eligible. The following self-report and proxy-report PROMIS® item banks were evaluated: Anger, Anxiety, Depressive Symptoms, Fatigue, Mobility, Pain Interference, Peer Relationships, Cognitive Functioning, and Global Health. We assessed unidimensionality through confirmatory factory analysis, convergent validity with subscales from the Pediatric Quality of Life Inventory, discriminant validity, reliability, and inter-rater reliability. The study enrolled 102 patients and 102 caregivers, of which 71 were dyads. All item banks displayed sufficient unidimensionality and convergent validity. Discriminant validity was hypothesized and found for "Global Health," "Mobility" (d > 0.3), "Fatigue," and "Pain Interference" (d > 0.3), although some comparisons were non-significant. Reliability was acceptable (a > 0.80, SEM < 0.44) for all PROMIS® measures. Inter-rater reliability was moderately-strong for all item bankss (ICC 0.60-0.78) except for "Peer Relationships" (ICC = 0.47, r = 0.31) and "Global Health" (ICC = 0.26, r = 0.16), which scored lower on correlation. CONCLUSION: PROMIS® measures displayed sufficient psychometric properties for use in pediatric sickle cell disease care and research. Proxy-reports seem viable as alternative to self-report forms of PROMIS®. WHAT IS KNOWN: • Sickle cell disease has a profound impact on the physical, mental and social health of affected children and identifying early signs of decline is crucial to intervene before complications arise. • No consensus has yet been achieved among the available patient reported outcomes measures (PROMs) used in children with sickle cell disease living in Europe. WHAT IS NEW: • This study provides evidence that PROMIS® measures displayed sufficient psychometric properties for use in European pediatric sickle cell disease care and research. • Proxy-reports seem viable as alternative to self-report forms of PROMIS®.
Lung ultrasound combined with C-reactive protein for identifying a bacterial component in children hospitalized with acute lower respiratory tract infections: a prospective observational study.
Fremuth J, Fremuthová T, Huml M … +14 more , Sládková E, Schwarzová V, Sýkora J, Rosolová Z, Forejt J, Kormunda S, Amlerová J, Chudějová K, Windrichová J, Vondráková R, Baxa J, Pešta M, Topolčan O, Rajdl D
Eur J Pediatr · 2026 Jun · PMID 42230808 · Full text
UNLABELLED: Acute lower respiratory tract infections (ALRTIs) remain a major cause of pediatric morbidity and antibiotic use. Early identification of a bacterial component is crucial for rational treatment decisions. We...
UNLABELLED: Acute lower respiratory tract infections (ALRTIs) remain a major cause of pediatric morbidity and antibiotic use. Early identification of a bacterial component is crucial for rational treatment decisions. We evaluated the diagnostic performance of lung ultrasound (LUS), alone and combined with C-reactive protein (CRP), for identifying a clinically adjudicated bacterial component in children hospitalized with ALRTIs. In this prospective study, 160 children (1 month-19 years) hospitalized with ALRTIs underwent LUS within 24 h of admission. LUS-based presumptive classification (viral, bacterial, combined) was assigned using predefined criteria. Final etiological classification was determined independently by three senior pediatricians blinded to LUS findings, using an adjudicated composite reference standard integrating clinical course, laboratory markers, microbiology, and chest radiography. No prespecified biomarker thresholds were applied. Diagnostic performance for identifying a bacterial component (bacterial or combined vs. viral) was assessed using ROC analysis. Seventy-five children (47%) were classified as viral, 60 (37%) as combined, and 25 (16%) as bacterial/atypical according to the adjudicated composite reference standard. Large consolidations (≥ 20 mm), bronchograms, confluent B-lines, and pleural effusions were associated with a bacterial component, whereas viral cases showed small bilateral subpleural consolidations and non-confluent B-lines. LUS demonstrated good diagnostic accuracy (AUROC 0.89, 95% CI 0.84-0.94; sensitivity 83.5%; specificity 94.6%). CRP ≥ 40 mg/L showed comparable performance (AUROC 0.91, 95% CI 0.87-0.96; sensitivity 75.3%; specificity 94.7%). CONCLUSION: In children hospitalized with ALRTIs, LUS-particularly alongside CRP-may support early bedside identification of a clinically adjudicated bacterial component and assist treatment decisions. WHAT IS KNOWN: • Clinical exams and chest X-rays (CXR) poorly distinguish bacterial and combined from viral ALRTIs. • Lung ultrasound (LUS) is validated for diagnosing pneumonia, but its role in identifying the etiology is less studied. WHAT IS NEW: • LUS may help identify the presence of a bacterial component in children hospitalized with ALRTIs. • CRP was the laboratory marker most strongly associated with bacterial component, and its combination with LUS may support early bedside etiological assessment and more rational antibiotic decision-making.
Comparison of LISA and INSURE techniques for surfactant administration: a multicentre retrospective study.
Panza R, Caravita R, Valenzano L … +6 more , Martinelli D, Farella I, Guida P, Quercia M, Latorre G, Laforgia N
Eur J Pediatr · 2026 Jun · PMID 42230381 · Full text
UNLABELLED: NIV and early targeted endotracheal surfactant administration play a pivotal role in the treatment of RDS and other respiratory conditions in neonates. LISA and INSURE are the most widely used techniques for...
UNLABELLED: NIV and early targeted endotracheal surfactant administration play a pivotal role in the treatment of RDS and other respiratory conditions in neonates. LISA and INSURE are the most widely used techniques for surfactant delivery. This multicentre retrospective registry-based cohort study, conducted in three Southern Italy Neonatal Intensive Care Units between January 2024 and March 2025, aimed to compare their effectiveness. Neonates who received NIV soon after birth and rescue surfactant via either INSURE or LISA were included. Treatment failure was defined as the need for a second dose of surfactant or the need for intubation and mechanical ventilation within 72 h of life. The secondary outcomes were the incidence of BPD at 36 weeks post-menstrual age or at discharge and impact of the applied NIV mode on outcomes within the LISA subgroup. Sixty-one neonates were enrolled: 29 LISA group (48%) and 32 INSURE group (52%). No significant differences were observed in the need for a second surfactant dose (LISA 38% vs INSURE 19%, p = 0.095) or mechanical ventilation within the first 72 h of life (LISA 17% vs INSURE 9%, p = 0.460). BPD incidence was low and comparable between groups (LISA 7% vs INSURE 3%, p = 0.600). In LISA-treated neonates, HFNC, nCPAP, and NIPPV showed comparable effects on primary and secondary outcomes, while oxygen supplementation duration was significantly shorter with NIPPV (p = 0.014). CONCLUSION: LISA and INSURE are equally effective modalities for surfactant administration in neonates with no significant differences. WHAT IS KNOWN: • Less invasive surfactant administration (LISA) is currently recommended by the latest European guidelines as the preferred method for surfactant delivery in spontaneously breathing infants on non-invasive ventilation (NIV). • Previous studies suggested that LISA and INSURE have similar safety and effectiveness, with comparable short- and long-term outcomes. WHAT IS NEW: • In this study, the need for a second dose of surfactant was explicitly considered as a marker of LISA failure. • LISA and INSURE techniques are comparable in reducing the need for mechanical ventilation and have similar major clinical outcomes, including BPD. There was a trend toward a higher rate of surfactant retreatment in the LISA group, without reaching statistical significance (p = 0.095). This was not associated with increased intubation or adverse outcomes, suggesting a potential stepwise non-invasive management strategy rather than true therapeutic failure.
Clinical and genetic spectrum of SHOX deficiency: phenotypic heterogeneity and the "Jumping SHOX" phenomenon.
Doğan Arı AB, Arı H, Çakar EŞ … +6 more , Solmaz TM, Taşdelen E, Büyükyılmaz G, Gürbüz F, Savaş Erdeve Ş, Kılıç E
Eur J Pediatr · 2026 Jun · PMID 42230379 · Publisher ↗
UNLABELLED: Short stature homeobox gene (SHOX) deficiency disorders, caused by deletions or duplications involving the SHOX gene or its enhancer regions, as well as pathogenic variants, exhibit a broad phenotypic spectru...
UNLABELLED: Short stature homeobox gene (SHOX) deficiency disorders, caused by deletions or duplications involving the SHOX gene or its enhancer regions, as well as pathogenic variants, exhibit a broad phenotypic spectrum ranging from Langer mesomelic dysplasia (LMD) to Léri-Weill dyschondrosteosis (LWD) and idiopathic short stature (ISS). In this study, we aimed to highlight the phenotypic and genetic heterogeneity of SHOX deficiency disorders, with particular emphasis on the rare "jumping SHOX" phenomenon. Genetic diagnosis was performed using karyotyping, fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, and chromosomal microarray analysis. A total of 41 patients from 23 unrelated families were included, comprising 25 children and 16 adults. The mean age was 11.7 years in children and 40.1 years in adults. LWD was diagnosed in 24 patients, ISS in 12, and LMD in two. The current median height SDS was - 6.3 in patients with LMD, - 2.4 in those with LWD, and - 2.1 in those with ISS. Additionally, three other patients with a SHOX deletion were identified: two had mosaic Turner syndrome (one with severe short stature), and one had 45,X/46,XY mosaicism. The "jumping SHOX" phenomenon was observed in four families. Growth hormone therapy was administered to 15 patients, and the mean height SDS improved from - 2.5 before treatment to - 2.0 after therapy. Dual diagnoses were identified in six patients: four related patients had a 9q34.3 duplication (EHMT1), one had DiGeorge syndrome with craniosynostosis, and one with cortical dysplasia and thin corpus callosum had a 16q22.2 duplication. CONCLUSION: Our findings expand both the clinical and genetic spectrum of SHOX deficiency disorders and highlight the phenotypic heterogeneity of the condition. The presence of the "jumping SHOX" phenomenon should be considered during genetic counseling. In addition, the possibility of dual diagnoses should be kept in mind in patients presenting with atypical clinical features. WHAT IS KNOWN: • SHOX deficiency disorders, caused by deletions, duplications, or pathogenic variants involving the SHOX gene or its enhancer regions, exhibit a broad phenotypic spectrum ranging from Langer mesomelic dysplasia to Léri-Weill dyschondrosteosis and idiopathic short stature. WHAT IS NEW: • In the present study, we describe the clinical and genetic characteristics of 41 patients with SHOX deficiency disorders. Notably, the "jumping SHOX" phenomenon was observed in four families, and dual diagnoses were identified in six patients. These findings underscore the marked genetic and phenotypic heterogeneity of SHOX deficiency.
Is it time to focus on expiratory muscle training in children with asthma? A randomized controlled trial.
Kaya M, Ucgun H, Gemici Karaaslan B … +2 more , Kiykim A, Denizoglu Kulli H
Eur J Pediatr · 2026 Jun · PMID 42230356 · Full text
UNLABELLED: Respiratory muscle dysfunction contributes to reduced pulmonary and extrapulmonary outcomes in children with asthma. Although inspiratory muscle training has been widely studied, the effects of expiratory mus...
UNLABELLED: Respiratory muscle dysfunction contributes to reduced pulmonary and extrapulmonary outcomes in children with asthma. Although inspiratory muscle training has been widely studied, the effects of expiratory muscle training (EMT) in pediatric asthma remain unclear. This study investigated the effects of EMT on pulmonary function, respiratory and peripheral muscle strength, peak cough flow (PCF), functional capacity, and asthma control in children with asthma. This prospective, single-blinded randomized controlled trial included 30 clinically stable children with asthma aged 8-18 years. Participants were randomly assigned to an experimental group (EG) receiving EMT in addition to a home-based chest physiotherapy program or a sham group (SG) performing the same program with minimal resistance. EMT was performed once daily for 8 weeks at 30% of maximal expiratory pressure (MEP) with weekly load adjustments. Pulmonary function, respiratory and peripheral muscle strength, PCF, functional capacity, and asthma control test (ACT) scores were assessed at baseline and after 8 weeks. FVC and FEV₁ improved significantly only in the EG, whereas PEF increased in both groups with greater improvement in the EG. MIP increased in both groups, while MEP and MEP (% predicted) improved only in the EG. PCF, quadriceps strength, and 6MWT distance improved in both groups, with greater gains in the EG. ACT scores increased significantly in both groups but improved more in the EG. CONCLUSION: Adding 8 weeks of EMT to chest physiotherapy improved pulmonary function, respiratory and peripheral muscle strength, cough effectiveness, functional capacity, and asthma control in children with asthma. EMT appears to be a safe and effective adjunct to pediatric asthma management. TRIAL REGISTRATION: The study was prospectively registered on the ClinicalTrials.gov website (registration number: NCT07169071; Date: 09/05/2025). WHAT IS KNOWN: • Respiratory muscle dysfunction is common in children with asthma and may contribute to reduced pulmonary function, ineffective cough, and decreased exercise capacity. • Most respiratory muscle training studies in asthma have focused primarily on inspiratory muscle training, while the role of expiratory muscle training remains largely unexplored. WHAT IS NEW: • This randomized controlled trial investigates the effects of expiratory muscle training (EMT) in children with asthma when combined with a home-based chest physiotherapy program. • The addition of 8 weeks of EMT resulted in greater improvements in pulmonary function, respiratory muscle strength, cough effectiveness, functional capacity, and asthma control compared with sham training.
Family presence and engagement during physiotherapy in pediatric intensive care units: a systematic review and critical evidence gap analysis.
Shamsi H, Nasiri M, Ahmadizadeh SN
Eur J Pediatr · 2026 Jun · PMID 42228142 · Publisher ↗
The objective of this study is to assess whether family presence or engagement during PICU rehabilitation is associated with improved child mobility or function, and to identify evidence for structured family-delivered p...
The objective of this study is to assess whether family presence or engagement during PICU rehabilitation is associated with improved child mobility or function, and to identify evidence for structured family-delivered physiotherapy. PRISMA 2020-compliant systematic review of six databases (2000-March 2026) is guided by an unregistered internal protocol. Tier 1 included PICU rehabilitation interventions with an explicit family component; Tier 2 included observational studies of family presence/participation and mobility outcomes. The primary outcome of the study is child motor and functional recovery. Risk of bias was assessed with design-specific tools, certainty with GRADE. Seven primary studies were included. Across four point-prevalence cohorts (2737 patient-days), family presence/participation was associated with out-of-bed mobility (aOR 3.31-7.83), without causal inference. In a nested US safety cohort (4658 events), serious adverse events were rare (device dislodgement 0.3%). A pediatric liberation bundle with structured family engagement increased mobilisation and reduced benzodiazepine exposure. No primary study evaluated structured family-delivered physiotherapy with validated motor endpoints. An RCT of early protocolised rehabilitation showed earlier PT/OT/SLP involvement but no 6-month functional differences. Conclusion Family presence during PICU mobilisation is feasible and associated with increased mobility, but no primary study has tested structured family-delivered physiotherapy with validated motor outcomes. A pragmatic hybrid Type 1 effectiveness-implementation trial is needed.
Avoiding false-positive adrenal insufficiency diagnoses in children: insights from cortisol kinetics during pediatric low-dose ACTH stimulation test.
Tepe D, Çetin SK, Gökdemir İ … +3 more , Kocaay P, Deligozoglu D, Gürbüz F
Eur J Pediatr · 2026 Jun · PMID 42228004 · Publisher ↗
UNLABELLED: The low-dose ACTH stimulation test (LDST) is widely used to evaluate hypothalamic-pituitary-adrenal (HPA) axis function in children; however, optimal cortisol sampling times and interpretation strategies rema...
UNLABELLED: The low-dose ACTH stimulation test (LDST) is widely used to evaluate hypothalamic-pituitary-adrenal (HPA) axis function in children; however, optimal cortisol sampling times and interpretation strategies remain controversial. Reliance on early or single time-point measurements may lead to false-positive diagnoses of adrenal insufficiency (AI). The aim of the study is. to characterize the timing of peak cortisol responses during LDST in children without AI and to assess the incremental diagnostic contribution of extended sampling and time-specific cortisol thresholds. We retrospectively analyzed 177 pediatric patients who underwent LDST for suspected central adrenal insufficiency at a single tertiary center. Serum cortisol was measured at baseline and at 15, 30, 45, and 60 min following intravenous administration of 1 µg ACTH. Adrenal sufficiency was defined as a peak cortisol ≥ 18 µg/dL(497 nmol/L). Peak timing distribution, basal predictors, incremental diagnostic contribution of additional time points, number needed to test (NNT), and false-positive rates using fixed versus time-specific cutoffs were evaluated. Peak cortisol occurred most frequently at 15 min (48.6%), followed by 30 min (28.8%), baseline (10.7%), 45 min (9.0%), and 60 min (2.8%). Termination of testing at 30 min would have misclassified 11.9% of patients as insufficient despite normal later responses. Extension to 45 min provided meaningful diagnostic improvement, whereas routine extension to 60 min presented only marginal additional benefit (NNT = 30). Higher basal cortisol levels were independently associated with earlier peak responses (p = 0.021), while demographic and auxological factors showed no association. Application of time-specific, percentile-based cortisol thresholds reduced false-positive classifications nearly fivefold at 30 min compared with a uniform 18 µg/dL cut-off. CONCLUSION: LDST cortisol responses in children show substantial interindividual variability in peak timing. Extension of sampling to 45 min and use of time-specific interpretation thresholds significantly improve diagnostic accuracy and reduce false-positive AI diagnoses in pediatric practice. WHAT IS KNOWN: • The low-dose ACTH stimulation test (LDST) is widely used to evaluate HPA axis function in children, but optimalcortisol sampling times and interpretation strategies remain controversial. • Reliance on early or single time-point cortisol measurements can lead to false-positive diagnoses of adrenal in sufficiency. WHAT IS NEW: • Peak cortisol timing varies substantially between children, and terminating the LDST at 30 min would misclassify~12% of patients as insufficient despite normal later responses; higher basal cortisol independently predicts earlier peaks. • Extending sampling to 45 min and applying time-specific, percentile-based cortisol thresholds markedly improve diagnostic accuracy, reducing false-positive classifications nearly fivefold at 30 min compared with a uniform 18μg/dL cut-off.
Trends and methods of emergency department visits related to suicide attempts in adolescents: a 16-year retrospective observational study (2010-2025).
Aygün E, Kabil B, Polatdemir B … +4 more , Tan MY, Seçinti DD, Altinbilek E, Şahin A
Eur J Pediatr · 2026 Jun · PMID 42223680 · Publisher ↗
UNLABELLED: Emergency presentations for suicide attempts in adolescents are a major public health concern, but knowledge about their patterns and whether these have changed over time remains limited. This study aimed not...
UNLABELLED: Emergency presentations for suicide attempts in adolescents are a major public health concern, but knowledge about their patterns and whether these have changed over time remains limited. This study aimed not only to describe emergency presentations of adolescents with suicide attempts but also to provide a longitudinal perspective on temporal trends and shifts related to the COVID-19 pandemic. We conducted a retrospective review of adolescents (10-18 years) presenting to our Level 1 pediatric emergency department (tertiary referral, 24/7 pediatric emergency unit) after a confirmed suicide attempt between 01/01/2010 and 12/31/2025. Patients were categorized into pre-COVID, COVID, and post-COVID periods. Binary logistic regression models identified predictors of repeat attempt and ICU admission. A total of 1111 cases were included; roughly three-quarters were female. Medication ingestion was the most common method, differing significantly by sex but not by age. Higher median age and more prior psychiatric diagnosis were observed in the post-COVID-19 period. The distribution of admission months differed significantly between the two periods (χ = 23.30; p = 0.016). Winter months were the most represented. Family history of suicide was the strongest independent predictor of repeat attempt. CONCLUSION: Adolescent suicide attempts show a sex- and method-specific profile, with the pandemic period associated with increased psychiatric burden. Family history of suicide and prior psychiatric diagnosis should remain central to risk assessment. WHAT IS KNOWN: • Adolescent suicide attempts are a major public health concern, and medication ingestion is the most commonly reported method in emergency department presentations. • Previous psychiatric disorders and family-related psychosocial factors are recognized risk factors for recurrent suicidal behavior in adolescents. WHAT IS NEW: • In this 16-year retrospective study, family history of suicide was identified as the strongest independent predictor of repeat suicide attempts. • The post-COVID period was associated with an older age profile and a higher prevalence of previous psychiatric diagnoses among adolescents presenting after suicide attempts.
Comparative effects of exercise modalities on ectopic fat reduction in overweight and obese children and adolescents: a narrative review.
Jiang J, Qin L, Shen Y
Eur J Pediatr · 2026 May · PMID 42223679 · Publisher ↗
Childhood overweight and obesity have dramatically increased worldwide, affecting tens of millions of children and adolescents and paralleling increases in type 2 diabetes, fatty liver, and cardiovascular diseases. Of pa...
Childhood overweight and obesity have dramatically increased worldwide, affecting tens of millions of children and adolescents and paralleling increases in type 2 diabetes, fatty liver, and cardiovascular diseases. Of particular concern is ectopic fat-lipid stored within visceral, hepatic, intramuscular, pancreatic, and perivascular tissues-which independently promotes metabolic dysfunction beyond total body fat. Exercise represents a cornerstone in the management of obesity, yet aerobic, resistance, high-intensity interval training (HIIT), combined training, and novel modalities such as yoga, mind-body, and neuromuscular stimulation uniquely activate the muscular, hormonal, and metabolic axes. Here, in this narrative review, we review the evidence from pediatric exercise trials that compare these modes of exercise for depot-specific fat loss in overweight/obese adolescents. High-intensity and aerobic exercise have shown promising effects in several pediatric trials on mobilizing visceral fat and liver fat, respectively, though they do not always surpass resistance training alone. Combined training may produce broader improvements in multiple depots when sustained for the longer term, while nontraditional modes can serve as useful adjuncts to core exercise by improving adherence or targeting less well-studied depots. Key limitations include the narrative (rather than systematic) design of this review, the overall paucity of high-quality long-term pediatric randomized controlled trials, reliance on adult and preclinical data for mechanistic insights, heterogeneity in measurement techniques, and sparse evidence for certain ectopic depots. We emphasize practical implications for the design of youth exercise programs and enumerate knowledge gaps in the extant literature, including pancreatic and pericardial fat, and age- and sex-based tailoring. What is Known: • Childhood and adolescent obesity is strongly associated with increased ectopic fat deposition (visceral, hepatic, and intramuscular fat), which contributes to metabolic disorders such as insulin resistance, type 2 diabetes, and cardiovascular disease. • Exercise interventions, including aerobic, resistance, and high-intensity interval training (HIIT), are effective in reducing overall adiposity, but their comparative effects on specific ectopic fat depots in pediatric populations remain incompletely understood. What is New: • This narrative review synthesizes and compares evidence across multiple exercise modalities (aerobic, resistance, HIIT, combined, and mind-body approaches) specifically focusing on depot-specific ectopic fat reduction in overweight and obese children and adolescents. • It highlights that combined training may offer broader multi-depot fat reduction, while emerging modalities (e.g., yoga and neuromuscular approaches) may enhance adherence and target underexplored fat depots such as pancreatic and pericardial fat.
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