BMC Pediatrics[JOURNAL]
Sun
200 papers
Paternal grandmothers' attitudes and beliefs toward newborn care practices in rural Ghana.
Amankwa AM, Naab F, Asiedua E … +2 more , Armah D, Ani-Amponsah M
BMC Pediatr · 2026 Jun · PMID 42351055 · Full text
BACKGROUND: Newborn care practices, especially in low- and middle-income countries (LMICs) such as Ghana, are influenced by the traditional caregiving roles held by family members, particularly grandmothers. The Theory o...
BACKGROUND: Newborn care practices, especially in low- and middle-income countries (LMICs) such as Ghana, are influenced by the traditional caregiving roles held by family members, particularly grandmothers. The Theory of Planned Behaviour (TPB) was used to explore and describe the attitudes and beliefs associated with newborn care practices among grandmothers in rural Ghana. METHODS: An exploratory descriptive qualitative design was used in this study. Data were purposively collected through semi-structured interviews with 14 grandmothers in Daboya, Ghana, who cared for newborns. Data were analyzed using thematic analysis following Braun and Clarke's six-phase method. RESULTS: The study explored two key themes: grandmothers' attitudes and societal norms towards newborn care practices. A mix of positive, negative, and uncertain attitudes was found among the grandmothers. Many confidently used herbal remedies and immediate bathing based on personal experience, while some rejected harmful practices such as tribal marking and force-feeding. Others combine home care with modern medicine. Strong beliefs about colostrum, pre-lacteal feeds, and infant seclusion, along with a focus on spirituality in protection and naming, reflect the influence of traditional norms and family customs that have been passed down through generations. CONCLUSION: This study explored grandmothers' attitudes toward newborn care, revealing diverse views. Traditional norms and family customs have significantly influenced newborn care practices across generations. Future research should examine the influence of grandparents on newborn care to promote effective practices and safely blend them with modern healthcare for better outcomes.
Evaluation of the epidemiologic triad in the incidence of peritonitis among pediatric patients with chronic kidney disease undergoing peritoneal dialysis: a single-center study in Indonesia.
Tania C, Sihombing AT
BMC Pediatr · 2026 Jun · PMID 42351051 · Full text
INTRODUCTION: Peritonitis is the most common and serious complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) in children. Understanding the interaction of host, agent, and environmental factors-based on the...
INTRODUCTION: Peritonitis is the most common and serious complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) in children. Understanding the interaction of host, agent, and environmental factors-based on the epidemiologic triad-may help reduce its incidence in pediatric populations, especially in resource-limited settings. This study aimed to evaluate host and environmental factors associated with peritonitis among pediatric CAPD patients while descriptively characterizing the causative microorganisms involved. METHODS: This retrospective study included 35 pediatric patients receiving CAPD from 2019 to 2024. Clinical, socioeconomic, nutritional, and environmental data were collected. Peritonitis diagnosis followed ISPD criteria. Peritonitis incidence and peritonitis-free survival were analyzed using Kaplan-Meier curves and bivariate statistical tests. RESULTS: Eleven patients (31.4%) developed peritonitis, with an overall rate of 4.5 episodes per 100 person-months. Low dietary diversity, well water consumption, and low paternal education or labor/driver occupations were associated with higher peritonitis occurence (p < 0.05). Kaplan-Meier analysis showed that low dietary diversity significantly reduced peritonitis-free survival (p = 0.021). Trends were observed for water source and occupation. CONCLUSION: Peritonitis in pediatric CAPD patients results from a multifactorial interplay of nutritional, environmental, and socioeconomic factors. Addressing these determinants through dietary support, hygiene education, and socioeconomic assistance may help reduce peritonitis risk and support better outcomes.
Perioral myoclonia with absences in children: a case report and literature review.
Jin M, Yang F, Qu Y … +4 more , Sun Y, Gao J, Yang X, Sun S
BMC Pediatr · 2026 Jun · PMID 42351044 · Full text
A retrospective analysis was conducted to evaluate the clinical characteristics, diagnostic challenges, and management strategies in a child with perioral myoclonia with absences (PMA). The case involved a 10-year-old bo...
A retrospective analysis was conducted to evaluate the clinical characteristics, diagnostic challenges, and management strategies in a child with perioral myoclonia with absences (PMA). The case involved a 10-year-old boy with a six-month history of intermittent seizure episodes, which had worsened over the previous month. Clinical manifestations included transient blank stares, cessation of movement, unresponsiveness to verbal cues, and rhythmic twitching at the corners of the mouth, without limb rigidity or urinary/fecal incontinence. The duration of the seizures ranged from 10 to 15 s. Video electroencephalography (VEEG) showed bilateral synchronous and symmetrical 3-Hz spike-wave discharges persisting for 10-15 s, with rhythmic twitching captured on perioral EMG. The patient became seizure-free for 8 months only with 1000 mg daily of valproate after 2 weeks treatment. PMA is an idiopathic generalized epilepsy syndrome characterized by typical absence seizures with perioral myoclonia. VEEG monitoring is crucial for definitive diagnosis. For children with typical absence seizures accompanied by perioral twitching, perioral EMG should be performed alongside routine deltoid EMG to clarify seizure type. PMA might be classified either as a special subtype of typical absence or as an independent seizure type. Paying close attention to the special phenomenon will help to clarify the clinical spectrum of this epileptic disorder.
Pheochromocytoma multisystem crisis presenting with abdominal pain in an adolescent: a case report.
Quan X, Wang Z, Zhang L … +2 more , Chen C, Wang F
BMC Pediatr · 2026 Jun · PMID 42351037 · Full text
BACKGROUND: Pheochromocytoma is a rare neuroendocrine tumor in children, typically presenting with hypertension, headache, and palpitations. Presentation with abdominal pain as the sole initial symptom, rapidly progressi...
BACKGROUND: Pheochromocytoma is a rare neuroendocrine tumor in children, typically presenting with hypertension, headache, and palpitations. Presentation with abdominal pain as the sole initial symptom, rapidly progressing to catecholamine-induced cardiomyopathy, cardiogenic shock, and multiple organ dysfunction syndrome (MODS), is exceedingly uncommon and poses significant diagnostic and therapeutic challenges. We report a case of adolescent pheochromocytoma multisystem crisis to highlight the diagnostic pitfalls, pathophysiological cascade, and the dilemma of extracorporeal life support. CASE PRESENTATION: A 13-year-8-month-old male presented with a 3-day history of abdominal pain and poor responsiveness. Initial treatment for acute gastroenteritis was ineffective, and his condition rapidly deteriorated into cardiogenic shock and multiple organ failure, requiring mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) prior to transfer to our hospital. The clinical course was characterized by sustained abdominal pain as the initial manifestation, absence of typical palpitations or headache, transient hypertension (175/109 mmHg) followed by circulatory collapse, and physical findings of a sedated state, mottled skin with extremity ecchymoses, muffled heart sounds, absent bowel sounds, and prolonged capillary refill time of 5 s. Bedside echocardiography revealed a left ventricular ejection fraction of only 26%. Abdominal computed tomography and ultrasonography demonstrated a left adrenal mass. Plasma normetanephrine was markedly elevated at > 20.56 nmol/L (normal ≤ 0.9 nmol/L) and 3-methoxytyramine at 5.47 nmol/L (normal < 0.18 nmol/L), confirming the diagnosis of pheochromocytoma. VA-ECMO and mechanical ventilation were maintained. Multiple sessions of plasma exchange and continuous renal replacement therapy were instituted, alongside vasoactive agents. Surgical resection was planned but never performed due to progressive multiorgan deterioration. Despite 6 days of ECMO support and comprehensive therapy, the patient developed hepatic encephalopathy and digital dry gangrene. The family elected to withdraw care, and the patient died shortly after discharge. CONCLUSIONS: This case illustrates that pheochromocytoma can present with abdominal pain as the sole initial symptom in adolescents, mimicking acute gastroenteritis. The rapid progression from catecholamine storm to irreversible multiorgan failure underscores the critical importance of early recognition of atypical presentations. While VA-ECMO may serve as a bridge to diagnosis and stabilization, it cannot reverse established multiorgan injury when timely surgical source control is not achieved.
Three-dimensional reconstruction-assisted preoperative assessment and surgical planning for pediatric tumors with complex vascular relationships: a report of two cases.
Wang K, Xia N, Wang X … +2 more , Liu Y, Dong Q
BMC Pediatr · 2026 Jun · PMID 42351026 · Full text
BACKGROUND: Pediatric abdominal tumors with complex anatomical relationships are characterized by substantial morphological heterogeneity. Although three-dimensional reconstruction is increasingly used in surgical planni...
BACKGROUND: Pediatric abdominal tumors with complex anatomical relationships are characterized by substantial morphological heterogeneity. Although three-dimensional reconstruction is increasingly used in surgical planning, reports that define its problem-oriented role in children with major vascular involvement remain limited. When a lesion is closely associated with major abdominal vessels, preoperative assessment should focus not only on visualization but also on resectability, preservation of critical vasculature, and perioperative risk stratification. CASE PRESENTATION: In case 1, an upper abdominal tumor was pathologically confirmed as hepatoblastoma after resection. In case 2, a retroperitoneal neurogenic tumor was pathologically diagnosed as ganglioneuroblastoma. Both children underwent preoperative three-dimensional reconstruction, which delineated the spatial relationships between the tumors, adjacent vessels, and surrounding organs, helped determine the sequence of vascular exposure, supported judgment regarding the feasibility of en bloc versus piecemeal resection, and guided dissection planning. Tumor resection was successfully completed in both patients, and short-term follow-up demonstrated favorable recovery. CONCLUSIONS: In pediatric tumors with complex relationships to major vessels, three-dimensional reconstruction enables accurate identification of high-risk anatomical features and improves preoperative risk assessment. Its principal value lies in providing actionable anatomical evidence to support complex surgical decision-making rather than merely improving anatomical visualization or replacing standard pathological diagnosis.
Multidisciplinary approach for treatment of duodenal perforation complicated with gastrointestinal hemorrhage in pediatric patient and relevant literature review.
Zhu R, Zhang Y, Liu J … +4 more , Wang D, Ma X, Dong Q, Hao X
BMC Pediatr · 2026 Jun · PMID 42351018 · Full text
OBJECTIVE: To investigate the key clinical diagnostic and therapeutic points, challenges and corresponding strategies for duodenal perforation complicated with recurrent gastrointestinal bleeding in children, and to prov...
OBJECTIVE: To investigate the key clinical diagnostic and therapeutic points, challenges and corresponding strategies for duodenal perforation complicated with recurrent gastrointestinal bleeding in children, and to provide a clinical reference for managing this rare pediatric acute critical condition. METHODS: The clinical data of a 2-year-and-7-month-old female child with duodenal perforation and recurrent gastrointestinal bleeding were retrospectively analyzed. A systematic review and analysis were conducted from the perspectives of etiology, diagnosis, treatment and postoperative management, combined with relevant domestic and foreign literature over the past decade. RESULTS: A 2-year-and-7-month-old Chinese female child presented with viral enteritis initially, which progressed to duodenal perforation complicated with recurrent gastrointestinal bleeding. She received sequential interventions including duodenal perforation repair, gastroscopic exploration, gastrointestinal reconstruction, and transcatheter gastroduodenal artery embolization. Through whole-course multidisciplinary team (MDT) collaboration and refined comprehensive supportive therapy, the child achieved complete recovery with no recurrent bleeding. CONCLUSION: The diagnosis and treatment of duodenal perforation complicated with recurrent gastrointestinal bleeding in children should focus on the core features of pediatric physiological particularities, etiological complexity, age-stage specificity and targeted management of clinical challenges. Adopting multimodal localization approaches, rationally selecting therapeutic regimens and relying on whole-course MDT collaboration can effectively reduce the risk of rebleeding and improve the prognosis of affected children.
Supporting social-emotional and behavioral skills in preschool children through gymnastics.
Yamaner E, Bal Ö, Girgin M … +3 more , Aktaş K, Kaya NG, Işıktekiner FS
BMC Pediatr · 2026 Jun · PMID 42351015 · Full text
BACKGROUND: This study aimed to evaluate the effects of a structured basic gymnastics education program on the social-emotional and behavioral skills of preschool children. The study sample consisted of 40 typically deve...
BACKGROUND: This study aimed to evaluate the effects of a structured basic gymnastics education program on the social-emotional and behavioral skills of preschool children. The study sample consisted of 40 typically developing children aged 48-69 months who were enrolled in private early childhood education institutions in Çorum province, Türkiye. METHODS: A mixed-method research design was employed, integrating quantitative and qualitative approaches. The quantitative component adopted a pretest-posttest control group quasi-experimental design, whereas the qualitative component was conducted using a case study approach. The experimental group (n = 20) participated in an eight-week structured basic gymnastics education program, whereas the control group (n = 20) continued with the regular preschool curriculum without additional intervention. Group assignment was based on existing classroom structure. Quantitative data were collected through teacher-reported measures, including the Self-Regulation Skills Scale, the Emotion Regulation Scale, and the Social Competence and Behavior Assessment Scale. Qualitative data were obtained via semi-structured interviews with parents. Quantitative analyses were performed using SPSS software. Data normality was examined using the Shapiro-Wilk test, and depending on distributional assumptions, independent samples t-tests, Mann-Whitney U tests, and Wilcoxon signed-rank tests were applied. Effect sizes were calculated using Cohen's d for parametric analyses and r coefficients for nonparametric analyses. RESULTS: Quantitative findings indicated no statistically significant differences between the experimental and control groups at baseline across all outcome variables (all p > .05; d < 0.20), confirming baseline comparability. Posttest comparisons revealed that children in the experimental group achieved significantly higher scores in self-regulation, emotion regulation, and social competence compared to those in the control group (all p < .05). The associated effect sizes ranged from moderate to large (r = .46-0.82), indicating meaningful intervention effects. Within-group analyses further demonstrated significant and substantial improvements across all measured variables in the experimental group from pretest to posttest (all p < .05; r > .80). Consistent with these quantitative findings, qualitative analyses identified themes reflecting notable improvements in children's emotional awareness, self-control, social interaction, and behavioral regulation skills. CONCLUSIONS: The findings suggest that basic gymnastics education represents an effective intervention for supporting the social-emotional and behavioral development of preschool children.
Breaking down breakfast: the relationship between morning meals and learning difficulties in adolescents.
Rahmanian R, Pirbasti AR, Shaygantabar M … +9 more , Javaheri-Tafti F, Bahreini-Boroujeni LZ, Hatami A, Khoshrang A, Sajedi L, Ajami M, Esmaili M, Houshiarrad A, Doaei S
BMC Pediatr · 2026 Jun · PMID 42351010 · Full text
BACKGROUND: Learning difficulties (LDs) impair academic performance and cognitive function. Dietary factors, particularly the composition of breakfast, may influence LDs. OBJECTIVE: To examine the association between bre...
BACKGROUND: Learning difficulties (LDs) impair academic performance and cognitive function. Dietary factors, particularly the composition of breakfast, may influence LDs. OBJECTIVE: To examine the association between breakfast composition and LDs in adolescents. METHODS: A cross-sectional study was conducted among 501 adolescents aged 10-19 from four schools in Jahrom, Iran. Trained dietitians collected dietary data using three non-consecutive 24-hour recalls (two on weekdays and one on a weekend). Weight and height were measured following a standardized protocol. Additionally, LDs were assessed using the validated Colorado Learning Difficulties Score (CLDS) questionnaire. Higher scores of CLDS reflect greater LDs. RESULTS: Using the CLDS, adolescents were classified into four equal quartiles. In all food group analyses, adolescents who consumed fewer than one serving/day were considered the reference group. Adolescents who consumed more than one serving of dairy had lower odds of being in the highest CLDS quartile (1-2 servings: OR 0.42; 95% CI 0.20-0.87; 3-4 servings: OR 0.19; 95% CI 0.07-0.47; >4 servings: OR 0.22; 95% CI 0.05-0.86). Furthermore, adolescents who consumed more than four servings of simple sugar had higher odds of being in the highest CLDS quartile (> 4 servings: OR 3.60; 95% CI 1.09-11.8). CONCLUSION: Our findings suggest that higher dairy intake and lower consumption of simple sugar waere associated with lower odds of LDs in adolescents. Further longitudinal studies are warranted.
Reclassification of SGA and EUGR in very preterm infants after the introduction of Fenton-2025: a retrospective cohort comparison with INTERGROWTH-21st and Fenton-2013.
Gür K, Topcuoğlu S, Dincer E … +2 more , Özalkaya E, Karatekin G
BMC Pediatr · 2026 Jun · PMID 42351008 · Full text
BACKGROUND: In very preterm infants, the classification of small for gestational age (SGA) and extrauterine growth restriction (EUGR) depends on the growth chart used. In this context, the classification implications of...
BACKGROUND: In very preterm infants, the classification of small for gestational age (SGA) and extrauterine growth restriction (EUGR) depends on the growth chart used. In this context, the classification implications of the newly introduced Fenton-2025 curves have not yet been evaluated in this population. We compared SGA and EUGR classification across Fenton-2025, INTERGROWTH-21st, and Fenton-2013, and examined chart-specific associations between EUGR and major neonatal morbidities. METHODS: This retrospective single-centre cohort study included 272 infants born at 24-32 weeks' gestation. SGA was defined as birth weight below the 10th percentile. EUGR was defined as discharge weight-for-age Z score below - 2. Associations between chart-defined EUGR and neonatal morbidities were examined using multivariable logistic regression adjusted for gestational age, birth weight, and sex. RESULTS: SGA rates differed in rank order across the three charts, being lowest with Fenton-2013 (9.9%), intermediate with INTERGROWTH-21st (15.8%), and highest with Fenton-2025 (24.3%). For EUGR, the ordering was different: rates were lowest with INTERGROWTH-21st (26.1%), intermediate with Fenton-2013 (33.5%), and highest with Fenton-2025 (40.8%). Despite this difference in rank order, the three charts showed a nested classification pattern. Compared with INTERGROWTH-21st, Fenton-2025 classified 56% more infants (n = 40) as EUGR. Nevertheless, in adjusted analyses, infants classified as EUGR according to the Fenton 2013 and INTERGROWTH-21st charts were associated with higher adjusted odds (aOR 6.37, 95% CI 2.07-19.57, and aOR 5.03, 95% CI 1.82-13.90, respectively) of necrotising enterocolitis (≥ stage II) compared to non-EUGR infants, and this higher adjusted odds persisted after reclassification using the Fenton 2025 chart (aOR 4.96, 95% CI 1.68-14.64). CONCLUSIONS: Fenton-2025 applies a more inclusionary approach in classifying very preterm infants as SGA and EUGR compared with INTERGROWTH-21st and Fenton-2013. The clinical implications of this broader classification require further outcome-linked validation.
Can ChatGPT provide reliable guidance to families of children with Duchenne Muscular Dystrophy? A dual perspective of parents and experts.
Çelik G, Hekim HH, Filiz MB … +2 more , Toraman NF, Yapar D
BMC Pediatr · 2026 Jun · PMID 42351001 · Full text
BACKGROUND: Artificial intelligence (AI)-driven chatbots, such as ChatGPT, have the potential to improve healthcare communication by providing timely and accessible medical information. Duchenne Muscular Dystrophy (DMD)...
BACKGROUND: Artificial intelligence (AI)-driven chatbots, such as ChatGPT, have the potential to improve healthcare communication by providing timely and accessible medical information. Duchenne Muscular Dystrophy (DMD) is a progressive neuromuscular disorder that significantly impacts patients and their families. Parents of DMD patients seek reliable information on disease progression, complications, and care management. However, the effectiveness of AI-generated medical guidance remains unclear. METHODS: This study evaluated ChatGPT's capacity to provide guidance to DMD patients' families by analyzing expert and parental assessments. Ten frequently asked questions were compiled from parental inquiries and submitted to ChatGPT-4o. Responses were evaluated by physiatrists, pediatric neurologists, and parents using structured rubrics. Experts rated responses based on Accuracy, Currency, Comprehensiveness, Usefulness, and Understandability, while parents assessed them in terms of Satisfaction, Empathy, Comprehensiveness, and Understandability. RESULTS: Experts rated Accuracy highest (4.3 ± 0.6; 91.8% of ratings ≥ 4), followed by Usefulness (4.2 ± 0.6; 88.6%), Currency (4.2 ± 0.7; 87.1%), Comprehensiveness (4.2 ± 0.7; 85.1%), and Understandability (4.2 ± 0.7; 83.4%). Parents rated Understandability highest (4.5 ± 0.8; 86.0%), followed by Comprehensiveness (4.4 ± 0.8; 84.0%) and Satisfaction (4.4 ± 0.8; 83.8%). Empathy received the lowest parental score (4.2 ± 0.9; 75.1%). Although both groups generally evaluated the responses favorably (median scores ≥ 4), experts tended to prioritize technical accuracy, whereas parents placed greater emphasis on clarity and practical usefulness. CONCLUSION: ChatGPT shows promise as an informational tool for parents of DMD, particularly in providing accurate and applicable medical guidance. However, limitations in empathy suggest a need for refinement. While ChatGPT should complement rather than replace human expertise, future improvements could expand its role in patient education and public health. Further research is needed to optimize AI-driven healthcare communication for reliability and ethical considerations.
The hidden bias of missing data: multiple imputation reveals geographic disparities and nutrition-WASH synergy as drivers of childhood diarrhea in Nigeria- a cross-sectional analysis of 33,924 children.
Ashaolu JO, Kaisi LA, Alabi GO … +2 more , Esther OA, Sylvain YM
BMC Pediatr · 2026 Jun · PMID 42350989 · Full text
OBJECTIVE: To investigate the determinants of childhood diarrhea in Nigeria, examining socio-economic, geographic, nutritional, and WASH factors, while systematically comparing Multiple Imputation by Chained Equations (M...
OBJECTIVE: To investigate the determinants of childhood diarrhea in Nigeria, examining socio-economic, geographic, nutritional, and WASH factors, while systematically comparing Multiple Imputation by Chained Equations (MICE) versus Complete Case Analysis (CCA) to demonstrate how missing data methods bias conclusions. METHODS: A secondary cross-sectional analysis was conducted using the latest Nigerian Demographic and Health Survey (2018 NDHS) data on 33,924 under-5 children. The primary outcome was a caregiver-reported diarrhea incidence. Independent predictors were identified using multivariable logistic regression. Robustness was tested by sensitivity analyses through comparison between MICE, CCA and testing principal results under Missing Not at Random (MNAR) assumptions. Multi-dimensional risk heatmaps and correlation networks illustrated interactive risks. RESULTS: Diarrhea prevalence was 12.0%. Profound geo-economic and geographical disparities were uncovered; residing in the North-East was the strongest risk factor (aOR = 2.61), while wealth and maternal education demonstrated protective associations. There was a very high synergistic interaction between poor nutrition and WASH, with combined high-risk categories having the greatest prevalence of diarrhea (15.4%). Intake of eggs had a strong protective association (aOR = 0.87) that persisted under MNAR models. Sensitivity analyses revealed CCA-generated biased estimates, masking protective effects of education and inducing spurious risks for vitamin A and fruit consumption. CONCLUSION: Childhood diarrhea in Nigeria is driven by a complex interplay of interacting factors. Effective control requires a mix of integrated, multi-sectoral interventions involving WASH, nutrition, and poverty concurrently, focusing on high-burden zones. Methodologically, advanced management of missing data is critical to produce valid evidence.
Risk factors for post-ERCP pancreatitis and assessment of stent exchange intervals in children with chronic pancreatitis: a single-center retrospective study.
Zhao G, Wang Y, Zhang G … +5 more , Liu C, Zhao M, Li P, Lv F, Lin Q
BMC Pediatr · 2026 Jun · PMID 42343307 · Full text
BACKGROUND: ERPD serves as the first-line endoscopic interventional therapy for pediatric chronic pancreatitis (CP). However, pediatric-specific risk factors for post-endoscopic retrograde cholangiopancreatography pancre...
BACKGROUND: ERPD serves as the first-line endoscopic interventional therapy for pediatric chronic pancreatitis (CP). However, pediatric-specific risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and the optimal stent exchange intervals remain poorly defined. METHODS: In this single-center retrospective study, pediatric CP patients (≤ 14 years) undergoing ERPD procedures (2015-2024) were enrolled. PEP was diagnosed per ESGE 2020 criteria (new/worsened abdominal pain + amylase/lipase > 3×ULN). Univariate and multivariate logistic regression identified PEP risk factors. Stent exchange intervals (standard interval vs. long interval) were compared for symptoms and acute pancreatitis occurrence. RESULTS: A cohort of 51 pediatric CP patients underwent 131 successful ERPD procedures. PEP occurred in 23 procedures (17.6%), all classified as mild and managed conservatively without severe complications. Univariate analysis revealed potential associations between PEP and several variables and multivariate analysis identified that pancreaticobiliary maljunction (PBM) (Adjusted OR = 4.861, 95% CI: 1.143-20.716, P = 0.032) and small stent diameter (≤ 5 Fr) (Adjusted OR = 3.083, 95% CI: 1.163-9.495, P = 0.047) were associated with increased PEP risk. No significant differences were observed in interval symptoms (standard interval: 22.7% vs. long interval: 27.6%, P = 0.693) or acute pancreatitis episodes (9.1% vs. 10.3%, P = 0.881) between the two groups. CONCLUSIONS: PBM and small stent diameter (≤ 5 Fr) are associated with increased PEP risk, although causality cannot be established. Extending stent exchange intervals beyond 6 months does not increase the risk of symptoms or acute pancreatitis. Individualizing stent replacement schedules to lower procedural burden appears feasible, which requires further validation in prospective studies.
Development and validation of a family-centered care instrument for NICU practice in low resource setting.
Abukari AS, Schmollgruber S, Korsah EK
BMC Pediatr · 2026 Jun · PMID 42343291 · Full text
BACKGROUND: Family-centered care (FCC) has become the gold standard of intensive care practice, especially in the neonatal intensive care units (NICUs), due to its positive impact on family and neonatal health outcomes....
BACKGROUND: Family-centered care (FCC) has become the gold standard of intensive care practice, especially in the neonatal intensive care units (NICUs), due to its positive impact on family and neonatal health outcomes. However, there are few validated instruments specifically designed to assess FCC practices in low-resource NICU settings. This study adopted the Family Systems Theory (FST) as a theoretical framework to develop and validate an instrument for assessing the implementation of FCC in low-resource NICUs. METHODS: This study was an instrument development and validation in a three-phased mixed-method triangulation design. Phase I consisted of a scoping review, 24 interviews, and 12 focus group discussions to generate a 40-item draft. Phase II involved piloting (n = 30) the drafted instrument for two quantitative surveys (n = 446) among family (n = 346) and clinicians (n = 100) for item reduction with exploratory and confirmatory factor analysis. Phase III entailed instrument validation by estimating validity and reliability through a two-round modified Delphi study with experts (n = 25). The study conforms to the STROBE checklist of instrument development and validation. RESULTS: Factor analysis produced a validated 20-item instrument, the Family Acceptance (4 items), Education (6 items), Environmental Design (6 items), and Sufficient Resources (4 items) (FEES) instrument. The instrument has acceptable validity and reliability; Kaiser-Meyer-Olkin (KMO) was 0.943, CFI = 0.969, TLI = 0.995, ω = 0.955, Cronbach's alpha = 0.949, and average Intra-Class Correlation of 0.951. The expert validation of the item-level content validity index (I-CVI) ranged from 0.88 to 0.96, and the scale-level content validity index (S-CVI/Ave) is 0.924. CONCLUSIONS: An instrument has been developed and validated, which demonstrates acceptable psychometric properties, potentially contributing to knowledge and practice in paediatric nursing. The FEES instrument provides a reliable tool to assess FCC practices in NICUs in neonatal care, which could result in the adjustment of nursing interventions to improve healthcare outcomes for critically ill infants and their families. The FEES instrument has further illuminated the importance of FCC in healthcare, especially NICU practice. It could guide the design of future research methodology, instrument development, and advanced statistical analysis to enhance practice and education in nursing science.
RESPIRIAMO - Italian hospital surveillance for lower respiratory tract infections: a multicenter retrospective cohort study of respiratory syncytial virus-associated hospitalizations in children under 2 years of age.
Bozzola E, Piccotti E, D'Auria E … +13 more , Trapani S, Vittucci AC, Tirelli F, Esposito S, Peroni D, Giannattasio A, Corsello G, Nenna R, Badolato R, Coscia A, Del Signore AB, Simonetti A, Respiriamo Study Group
BMC Pediatr · 2026 Jun · PMID 42343269 · Full text
BACKGROUND: Lower respiratory tract infections (LRTIs) are a leading cause of hospitalization in infants, with respiratory syncytial virus (RSV) representing the most important etiologic agent in children under 2 years o...
BACKGROUND: Lower respiratory tract infections (LRTIs) are a leading cause of hospitalization in infants, with respiratory syncytial virus (RSV) representing the most important etiologic agent in children under 2 years of age. Although RSV disease burden is well recognized, multicenter data describing hospitalization characteristics, severity, and risk profiles in Italian infants remain limited, particularly following changes in viral circulation patterns in recent years. The study was established to provide robust hospital-based surveillance data. This study aimed to describe the clinical features and the severity of RSV-associated LRTI hospitalizations in Italian children under 24 months, comparing RSV-positive and RSV-negative cases. METHODS: The study included infants aged 0- < 24 months hospitalized for LRTI between the 2018/2019 and 2020/2021 seasons across 12 Italian pediatric centers. Demographic characteristics, medical history, clinical presentation, laboratory radiologic, and hospitalization data were collected. Patients underwent RSV testing on nasopharyngeal samples and were classified as RSV-positive or RSV-negative. Descriptive statistics and comparative analyses were performed using parametric or non-parametric tests. RESULTS: One thousand five hundred forty-seven infants were included, out of which 1,263 (81.6%) were RSV-positive. RSV-positive infants were significantly younger than RSV-negative infants, more likely to be previously healthy and without a family history of atopy. RSV infection was associated with a more severe clinical course, higher rates of oxygen supplementation (67.6% vs. 39.1%), respiratory support, invasive ventilation, and intensive care unit admission (10.6% vs. 3.1%). Use of RSV prophylaxis (at that time, palivizumab) was rare in both groups. CONCLUSIONS: RSV was the predominant cause of LRTI and was associated with significantly greater disease severity. Most hospitalized infants were previously healthy, underscoring the need for preventive strategies targeting the general infant population.
Agreement between random upper arm circumference and standard mid-upper arm circumference for identifying acute malnutrition among children aged 6-59 months in Southwest Ethiopia.
Husen A, Berhane A, Teshome MS
BMC Pediatr · 2026 Jun · PMID 42343262 · Full text
BACKGROUND: Mid-Upper Arm Circumference (MUAC) is a widely used, rapid, and low-cost anthropometric tool for community-based screening of acute malnutrition among children. However, accurate MUAC assessment requires iden...
BACKGROUND: Mid-Upper Arm Circumference (MUAC) is a widely used, rapid, and low-cost anthropometric tool for community-based screening of acute malnutrition among children. However, accurate MUAC assessment requires identification of the midpoint of the upper arm and proper tape placement, which may contribute to inter-observer variability and inconsistencies in field measurements. Random Upper Arm Circumference (RUAC) has been proposed as a simpler alternative for community screening. Nevertheless, evidence regarding the agreement and validity of RUAC compared with standard MUAC for identifying wasting among Ethiopian children remains limited. Therefore, this study aimed to assess the concordance and validity of RUAC compared with MUAC in identifying wasting among children aged 6-59 months in Southwest Ethiopia. METHODS: A community-based cross-sectional study was conducted among 591 children aged 6-59 months in Southwest Ethiopia from June 2 to June 30, 2023. Participants were selected using simple random sampling from child registration lists used as the sampling frame. Paired RUAC and standard MUAC measurements were obtained from each child to assess agreement between the two methods. Children were classified as wasted using the MUAC cut-off value of < 12.5 cm, and RUAC was categorized using the same threshold. Data were analyzed using SPSS version 26. Agreement between RUAC and MUAC was evaluated using Cohen's Kappa for categorical measures and Bland-Altman analysis for continuous measurements. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curve analysis. Assumptions for statistical analyses were checked before analysis. RESULTS: Among the participants, 61 (10.4%) children were classified as wasted using standard MUAC measurements. Significant agreement was observed between RUAC and standard MUAC classifications (κ = 0.69; 95% CI: 0.60-0.79; p < 0.001). Using standard MUAC as the reference method, RUAC demonstrated a sensitivity of 81.6% (95% CI: 71.9%-89.0%) and specificity of 95.2% (95% CI: 93.1%-96.9%) for identifying wasting among children aged 6-59 months. The positive predictive value and negative predictive value of RUAC were 66.2% (95% CI: 55.0%-76.2%) and 97.8% (95% CI: 96.1%-98.9%), respectively. RUAC also demonstrated excellent diagnostic performance, with an area under the curve of 0.99 (95% CI: 0.98-0.99) for severe acute malnutrition and 0.94 (95% CI: 0.93-0.96) for moderate acute malnutrition. CONCLUSION: RUAC showed substantial agreement with standard MUAC and acceptable diagnostic performance for identifying wasting among children aged 6-59 months in Southwest Ethiopia. However, the evidence is limited to a single-site cross-sectional study, therefore, generalization beyond the study population is not justified. Further validation across different Ethiopian settings is recommended.
Association of concomitant congenital anomalies with long-term renal outcomes in children with posterior urethral valves.
Dereli D, Tokar B
BMC Pediatr · 2026 Jun · PMID 42337722 · Full text
BACKGROUND: Posterior urethral valves (PUV) are the most common cause of congenital bladder outlet obstruction in boys and may result in long-term impairment of both bladder and renal function. In addition to the obstruc...
BACKGROUND: Posterior urethral valves (PUV) are the most common cause of congenital bladder outlet obstruction in boys and may result in long-term impairment of both bladder and renal function. In addition to the obstructive process itself, concomitant congenital anomalies may further influence renal outcome. This study aimed to evaluate the spectrum of associated congenital anomalies in children with PUV and to examine their relationship with clinically significant chronic kidney disease (CKD) during follow-up. METHODS: This retrospective single-center observational study included 103 boys with cystoscopically confirmed PUV who were diagnosed and followed at the Pediatric Urology Clinic of Eskişehir Osmangazi University Faculty of Medicine between January 2014 and December 2024. Patients with incomplete records or follow-up shorter than 12 months were excluded. Demographic characteristics, antenatal findings, presenting symptoms, vesicoureteral reflux (VUR), associated anomalies, imaging findings, interventions, bladder assessment findings, and renal outcomes were reviewed. Descriptive statistical analysis was performed. Clinically significant CKD was defined as persistent estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m² for more than 3 months, corresponding to CKD stage ≥ 2. RESULTS: The median age at diagnosis was 2.4 years. Antenatal hydronephrosis and/or hydroureteronephrosis was present in 42 patients (40.8%), and concomitant VUR was detected in 39 (37.9%). Associated anomalies included hypospadias in 7 patients (6.8%), ureteropelvic junction obstruction in 7 (6.8%), renal hypodysplasia in 5 (4.9%), spina bifida in 5 (4.9%), anorectal malformation in 4 (3.9%), and trisomy 21 in 1 (1.0%). During follow-up, 8 patients (7.8%) developed CKD stage ≥ 2. Most of these patients had antenatal hydronephrosis, high-grade VUR, dysplastic or non-functioning kidneys, or additional congenital anomalies. CONCLUSIONS: In this cohort, clinically significant CKD developed in a minority of children with PUV, but adverse renal outcome was concentrated in patients with severe upper urinary tract abnormalities and additional congenital anomalies. High-grade VUR, reduced functional renal mass, and complex associated anomalies appear to be important markers of poor renal prognosis. Careful long-term multidisciplinary follow-up remains essential in this patient group.
Hypersarcosinemia presenting as acute leukoencephalopathy with restricted diffusion in a young child.
Shi J, Zhang C, Ren S … +3 more , Zhang W, Zhuo X, Ding C
BMC Pediatr · 2026 Jun · PMID 42337718 · Full text
BACKGROUND: Hypersarcosinemia, resulting from sarcosine dehydrogenase (SARDH) gene mutation, is a rare autosomal recessive disorder with variable, often nonspecific clinical presentations, leading to diagnostic difficult...
BACKGROUND: Hypersarcosinemia, resulting from sarcosine dehydrogenase (SARDH) gene mutation, is a rare autosomal recessive disorder with variable, often nonspecific clinical presentations, leading to diagnostic difficulty and low clinical awareness. CASE PRESENTATION: A 6-year-old boy presented with clinical features suggestive of viral encephalitis, including headache, vomiting, intermittent fever, and lethargy. Initial MRI revealed cytotoxic edema in the subcortical white matter and splenium of the corpus callosum. Although symptoms improved transiently with steroid therapy, persistent imaging abnormalities prompted metabolic and genetic evaluations. Metabolic and genetic investigations confirmed a diagnosis of hypersarcosinemia, with markedly elevating sarcosine levels and compounding heterozygous SARDH mutations. Genetic testing identified compound heterozygous mutations in the SARDH gene (c.293G > C and c.679 C > T), confirming hypersarcosinemia. Following initiation of folic acid and mecobalamin, partial radiological improvement was observed, although a causal relationship could not be established. CONCLUSIONS: This case highlights the diagnostic challenge of hypersarcosinemia and its potential mimicry of acquired encephalitis. To our knowledge, this is the first report describing an acute encephalitis-like presentation accompanied by persistent cytotoxic edema on MRI, thereby suggesting a possible expansion of the known clinical and neuroimaging spectrum of this disorder, although this observation requires confirmation in additional cases. However, given the rarity of hypersarcosinemia and the possibility of underreporting, the absence of prior similar reports should be interpreted with caution. In this case, genetic testing was essential for establishing the diagnosis, although the necessity of genetic testing in all cases of unexplained white matter changes cannot be determined from a single report. The temporal association of partial radiological improvement with folic acid and mecobalamin supplementation is hypothesis-generating only and requires further investigation ; no causal or therapeutic conclusion can be drawn from this single case.
Nonlinear association between body mass index and physical fitness in primary school children: a single-school cross-sectional study using generalized additive models.
Zhu J, Zhao M, Zheng M … +2 more , Wang L, Li Q
BMC Pediatr · 2026 Jun · PMID 42337511 · Full text
BACKGROUND: Body mass index (BMI) is associated with physical fitness in children, but the functional form of this relationship is debated. Using routinely collected fitness-monitoring data from a single primary school,...
BACKGROUND: Body mass index (BMI) is associated with physical fitness in children, but the functional form of this relationship is debated. Using routinely collected fitness-monitoring data from a single primary school, this study examined whether BMI is nonlinearly associated with physical fitness in primary school children, treating the analysis as a methodological, single-school demonstration rather than a population-representative survey. METHODS: We analysed records from 1,572 students (808 boys, 764 girls; Grades 1-6) nested within 37 classes in one school in Tianfu New Area, Sichuan, China. BMI was calculated from measured height and weight. Four fitness indicators available for the whole sample-vital capacity, 50-m sprint, sit-and-reach, and 1-min rope skipping-were analysed as the primary outcomes; a composite index (mean of sex- and grade-standardised z-scores, with the 50-m sprint reverse-coded so that higher scores denote better fitness) was retained as a secondary descriptive summary. Quadratic regression and generalized additive models (GAMs; penalised cubic B-splines) adjusted for sex and grade were used to model BMI. Primary overall and sex-stratified models used cluster-robust standard errors at the class level; grade-stratified exploratory models, each based on only a few classes, were assessed with model-based smooth tests. Nonlinearity was quantified with the effective degrees of freedom (EDF) of the BMI smooth and a Wald test, and exploratory subgroup analyses were corrected for multiple comparisons (Benjamini-Hochberg false discovery rate, FDR). RESULTS: The class-level intraclass correlation was non-negligible for BMI (0.124) and the 50-m sprint (0.085), confirming the need to account for clustering. After cluster-robust adjustment, BMI showed a statistically supported nonlinear association with the 50-m sprint (EDF = 4.4, P < 0.001), 1-min rope skipping (EDF = 5.1, P < 0.001), and the composite index (EDF = 5.7, P < 0.001), but not with vital capacity (EDF = 1.0, P = 0.44). For the 50-m sprint the best predicted performance was well localised at a BMI of about 16.2 kg/m²; for 1-min rope skipping the optimum was less precisely located, and for the composite index the cluster bootstrap did not identify a stable interior optimum (it spread the maximum across ≈ 15.7-21.2 kg/m², with a median of ≈ 19.7 kg/m² well above the full-sample point estimate). Predicted performance declined at both lower and higher BMI. The quadratic turning point (~ 18.5 kg/m²) was higher than the GAM peak and moved toward the GAM estimate when sparse BMI tails were trimmed, indicating sensitivity of the parabola to extreme values. In exploratory, FDR-corrected subgroup analyses, nonlinearity remained statistically supported in girls and in Grades 1 and 3 but not in boys or other grades; these subgroup findings are hypothesis-generating only. CONCLUSIONS: In this single-school sample, the BMI-fitness association was nonlinear for speed- and coordination-related tasks; for the 50-m sprint the best predicted performance was well localised at an intermediate BMI (about 16.2 kg/m²), whereas for the composite index no stable single optimum could be identified. Because the data come from one school and lack body-composition and physical-activity measures, the estimated optima are sample-specific descriptive features and should not be read as intervention targets. The study illustrates how routine school fitness data and GAMs can describe BMI-fitness patterns beyond categorical comparisons, and motivates multi-school, longitudinal confirmation.
Time to catch-up: postnatal growth trajectories in preterm infants at a tertiary care hospital in Riyadh, Saudi Arabia.
Alnamnakani MA, Shaiba LA, Hadid A … +7 more , Alshathri R, Alaujan A, Alshibi A, Alwael H, Babtain M, Al Wallan A, Abuhaimed JM
BMC Pediatr · 2026 Jun · PMID 42337509 · Full text
BACKGROUND: Preterm birth remains a significant global health concern, with long-term outcomes closely linked to postnatal growth trajectories. Data regarding the timing of catch-up growth in preterm infants from Middle...
BACKGROUND: Preterm birth remains a significant global health concern, with long-term outcomes closely linked to postnatal growth trajectories. Data regarding the timing of catch-up growth in preterm infants from Middle Eastern populations are limited. This study aimed to assess the time required to achieve catch-up weight and to characterize postnatal growth trajectories across birth-weight categories at a tertiary care hospital in Riyadh, Saudi Arabia. METHODS: This retrospective cohort study included 134 preterm infants (< 37 weeks' gestational age) and 193 term infants born between January 2018 and early 2019 at King Saud University Medical City. Anthropometric measurements were recorded at predefined intervals up to 24 months of corrected age. Growth was evaluated using sex-specific Z-scores based on WHO Child Growth Standards. Catch-up growth was defined as a Z-score increase > 0.67 between two consecutive time points. Longitudinal weight and length trajectories were analyzed using linear mixed-effects models with subject-specific random intercepts and a first-order autoregressive covariance structure, with adjusted estimated marginal means derived over time. Reporting followed the STROBE statement for cohort studies. RESULTS: Preterm infants had significantly lower birth weight (1.72 ± 0.60 kg vs. 2.97 ± 0.66 kg; p < 0.001) and birth length (40.65 ± 5.36 cm vs. 48.27 ± 3.55 cm; p < 0.001) compared with term infants. In mixed-effects models, preterm infants had lower adjusted weight overall (p = 0.006), but the group-by-age interaction was not significant (p = 0.271), indicating parallel weight gain over time. For length, a significant group-by-age interaction (p < 0.001) indicated that linear-growth trajectories differed between groups, with preterm infants remaining shorter throughout follow-up. Weight-for-age Z-scores converged across birth-weight categories by 24 months. Catch-up growth rates were highest among very low birth weight infants (31.8% by 24 months). CONCLUSIONS: Preterm infants demonstrate significant early growth deficits with weight catch-up achieved within the first year of corrected age, while linear growth recovery extends closer to 24 months. These findings underscore the importance of vigilant growth monitoring and individualized nutritional strategies during early infancy.
An updated systematic review of the impact of volume of surgery and specialization in Norwood procedure.
Pachanov A, Zhang Z, Munschek S … +3 more , Asfour B, Mathes T, Pieper D
BMC Pediatr · 2026 Jun · PMID 42337493 · Full text
BACKGROUND: Volume-outcome relationship proposed to exist for high-risk, low-volume procedures, such as the Norwood procedure. A systematic review published in 2014 examined impacts of hospital and surgeon volume, specia...
BACKGROUND: Volume-outcome relationship proposed to exist for high-risk, low-volume procedures, such as the Norwood procedure. A systematic review published in 2014 examined impacts of hospital and surgeon volume, specialization, regionalization and teaching status on the patient-related outcomes of the Norwood procedure. The aim of this systematic review was to update the 2014 work by synthesizing current evidence alongside the original review. METHODS: We searched PubMed, Embase (Elsevier), and the Cochrane Library for peer-reviewed comparative studies published from 1 March 2013 to 30 December 2024 (date of last search) to update the original review covering database inception to March 2013. Citation chasing of relevant reports was performed on 20 March 2025. Mortality-related outcomes were defined as primary and all others as secondary. In studies on the volume-outcome relationship with categorical volume definitions, effect estimates were compared between the highest and lowest categories, as defined in each study. Risk of bias and certainty of evidence were assessed using ROBINS-E and GRADE, respectively. Data were presented in tables and synthesized narratively. RESULTS: Eight additional studies reported in 13 publications were identified, resulting in a total of 18 studies (24 reports). Of these, 15 studies (20 reports), comprising 47 analyses, were included in the final synthesis. The reports were published between 2002 and 2025 and predominantly relied on routinely collected data from North America. Irrespective of statistical significance, 14 of 15 short-term and 4 of 5 long-term hospital-volume analyses, and 3 of 5 short-term and 3 of 3 long-term surgeon-volume analyses of mortality-related outcomes favored higher volume. Among 17 secondary outcome analyses, 14 favored higher hospital or surgeon volume. Evidence on hospital teaching status was limited to two older studies, which reported lower mortality in teaching hospitals. Overall, the certainty of evidence was rated as very low, reflecting heterogeneity in exposure definitions, reliance on routinely collected data, and limited use of analytical approaches that support causal interpretation. CONCLUSIONS: Although most analyses favored higher hospital or surgeon volume and teaching hospital status, the very low certainty of evidence limits its ability to inform clinical practice or policy, underscoring the need for stronger methodological approaches in future research. REGISTRATION: PROSPERO CRD42022385160.
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