BMC Pediatrics[JOURNAL]
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200 papers
Predictors of in-hospital mortality among critically ill neonates admitted to a tertiary NICU in Ecuador.
Noboa-Salgado M, González-Andrade F
BMC Pediatr · 2026 Jun · PMID 42304294 · Full text
BACKGROUND: Neonatal mortality remains a major challenge in low- and middle-income countries, where locally derived evidence from neonatal intensive care units is limited. We aimed to identify factors associated with in-...
BACKGROUND: Neonatal mortality remains a major challenge in low- and middle-income countries, where locally derived evidence from neonatal intensive care units is limited. We aimed to identify factors associated with in-hospital mortality among critically ill neonates admitted to a tertiary NICU in Quito, Ecuador, and to evaluate an internally validated mortality prediction model. METHODS: We conducted a retrospective cohort study of inborn neonates aged ≤ 28 days admitted to the NICU of Isidro Ayora Gynecology and Obstetrics Hospital from January 1 to December 31, 2022. Maternal, perinatal, neonatal, early clinical severity, laboratory, respiratory support, clinical course, and resource utilization variables were extracted from medical records. The primary outcome was in-hospital mortality. Bivariate analyses and multivariable logistic regression were performed. Model performance was assessed using discrimination, calibration, bootstrap internal validation, and decision curve analysis. RESULTS: Among 220 critically ill neonates, 87 (39.5%) died. Small-for-gestational-age status was independently associated with mortality after adjustment for birth weight category, gestational age, sex, congenital malformations, and antenatal corticosteroid exposure (adjusted OR, 2.57; 95% CI, 1.29-5.14; P=.01). Birth weight < 1400 g was associated with greater clinical severity and resource use but not independently with mortality. Early hemodynamic instability, metabolic acidosis, higher lactate, higher FiO₂, thrombocytopenia, and higher oxygenation index were more frequent among non-survivors. The final model showed good discrimination (apparent AUC, 0.870; optimism-corrected AUC, 0.854) and acceptable calibration. Among survivors, each additional day of invasive mechanical ventilation was associated with longer NICU stay. CONCLUSION: In this tertiary Ecuadorian NICU cohort, small-for-gestational-age status was independently associated with mortality. These findings support fetal growth assessment, early severity evaluation, and locally validated neonatal risk stratification.
Predictive value of bronchoalveolar lavage fluid interleukin-25, interleukin-33, and thymic stromal lymphopoietin levels for asthma development in children with recurrent wheezing.
Zhao Y, Ling Y, Fu Z … +1 more , Zou W
BMC Pediatr · 2026 Jun · PMID 42304287 · Full text
OBJECTIVE: To investigate the predictive value of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) levels in bronchoalveolar lavage fluid (BALF) for the development of asthma in chi...
OBJECTIVE: To investigate the predictive value of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) levels in bronchoalveolar lavage fluid (BALF) for the development of asthma in children under 6 years of age with recurrent wheezing. METHODS: A prospective cohort study was conducted from May 1 to September 30, 2024. Fifty children under 6 years of age with recurrent wheezing were enrolled as the wheezing group from the Department of Respiratory Medicine at Children's Hospital of Chongqing Medical University, while 51 age-matched children with bronchial foreign bodies were recruited as controls during the same period. Levels of IL-25, IL-33, and TSLP in BALF were measured by enzyme-linked immunosorbent assay (ELISA). Children in the wheezing group were followed for one year and were subsequently categorized into an asthma group or a non-asthma group based on the follow-up outcomes. Integrating these clinical data with BALF cytokine levels, we constructed a predictive model for asthma development using receiver operating characteristic (ROC) curve analysis. RESULTS: Univariate analysis revealed significant differences between the wheezing group and the control group in terms of clinical characteristics (the number of wheezing episodes, age, history of allergy, breastfeeding), peripheral blood eosinophil count, BALF parameters (nucleated cells, red blood cells, neutrophils, macrophages), and cytokine levels (IL-25, IL-33, TSLP) (P < 0.05). Of the 47 children in the wheezing group who completed the follow-up, 17 were diagnosed with asthma (asthma group) and 30 did not develop asthma (non-asthma group). Univariable analysis revealed significant differences between these two groups in terms of age, the number of wheezing episodes, levels of IL-25, IL-33, and TSLP in BALF (P < 0.05). Logistic regression analysis confirmed that these factors were significant predictors for the progression to asthma in children with recurrent wheezing (P < 0.05).ROC curve analysis demonstrated that the combination of the number of wheezing episodes with IL-25, IL-33, or TSLP levels yielded higher predictive values, with area under the curve (AUC) values of 0.90 (95% CI: 0.788-1.000), 0.946 (95% CI: 0.855-1.000), and 0.86 (95% CI: 0.698-1.000), respectively. These were superior to predictions based on wheezing episodes alone (AUC: 0.705) or individual cytokine levels (IL-25 AUC: 0.779; IL-33 AUC: 0.857; TSLP AUC: 0.841). CONCLUSION: In children under 6 years with recurrent wheezing, the levels of IL-25, IL-33, and TSLP in BALF are elevated and hold predictive value for the subsequent development of asthma, providing a reference for the early clinical identification of at-risk children.
Parent-reported benefits, barriers, and experiences of augmentative and alternative communication use among children with autism in Nablus, Palestine: a cross-sectional study.
Jarrar H, Malhis L, Munawer A … +6 more , Omareya M, Deek N, Abutair R, Dodeen S, Khadeje SM, Abu-Shamat Z
BMC Pediatr · 2026 Jun · PMID 42304277 · Full text
BACKGROUND: Children with autism may have communication needs that require individualized support. Augmentative and Alternative Communication (AAC) can support functional communication, but little is known about parent-r...
BACKGROUND: Children with autism may have communication needs that require individualized support. Augmentative and Alternative Communication (AAC) can support functional communication, but little is known about parent-reported AAC implementation in Palestine. This study examined parent-reported perceived benefits, barriers, and experiences of AAC use among children with autism in Nablus, Palestine. METHODS: A descriptive cross-sectional study was conducted among 75 parents or primary caregivers of children with autism who were using or receiving structured AAC training. Participants were recruited from specialized autism centers in Nablus. Data were collected using a structured questionnaire covering child and family characteristics, perceived AAC benefits and barriers, and experiences during AAC implementation. The perceived benefit score was calculated from six yes/no items. The final AAC experience score was calculated from seven positively worded items after two negatively worded acceptance-difficulty items were analyzed separately. Descriptive statistics, Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman's correlations were used. RESULTS: The perceived AAC benefit score had a median of 6 (IQR 4-6) out of 6. The most frequently endorsed perceived benefit was increased communication opportunities (73/75, 97.3%), followed by perceived better behavior-related interaction inside the home (65/75, 86.7%) and improved understanding of the child's needs (64/74, 86.5%). Reported barriers included difficulty integrating AAC into daily routines (53/75, 70.7%) and difficulty accessing AAC programs (51/75, 68.0%). Awareness of alternative AAC systems was limited (25/75, 33.3%), and 23/74 parents/caregivers (31.1%) agreed that AAC systems are suitable for all children. The seven-item AAC experience score showed good internal consistency (Cronbach's α = 0.841) and had a median of 16.0 (IQR 12.75-19.0) out of 21. A positive correlation was observed between perceived benefit score and AAC experience score (rs = 0.426, p < 0.001). CONCLUSION: Parents/caregivers commonly reported AAC-related perceived benefits, but barriers to access and daily integration were frequent and awareness of alternative systems was limited. Findings should be interpreted cautiously because of the cross-sectional parent-report design, but they support structured parent education, individualized AAC selection, and continued professional follow-up.
Base deficit and alactic base excess are promising early biological markers in pediatric sepsis.
Assaad A, Majdalani M, Ismail A … +1 more , Moukhaiber J
BMC Pediatr · 2026 Jun · PMID 42304271 · Full text
BACKGROUND AND AIMS: The diagnosis and management of pediatric sepsis remain challenging and time-sensitive. Early biological markers that may identify patients at risk of progression to septic shock are needed. Base def...
BACKGROUND AND AIMS: The diagnosis and management of pediatric sepsis remain challenging and time-sensitive. Early biological markers that may identify patients at risk of progression to septic shock are needed. Base deficit (BD) has been associated with adverse outcomes in adult sepsis, while alactic base excess (ABE) reflects non-lactate metabolic acidosis. This study aimed to evaluate the performance of BD and ABE compared with lactate in pediatric sepsis and to assess their association with time to progression to septic shock. METHODS: This retrospective single-center cohort study included pediatric patients with sepsis between January 1, 2020, and September 1, 2024. Biomarkers were obtained at initial presentation prior to resuscitation. BD and ABE were categorized into normal, abnormal, and extremely abnormal groups based on distribution thresholds, while lactate was classified as normal (≤2.2 mmol/L) or abnormal (>2.2 mmol/L). Diagnostic performance was assessed using ROC curve analysis. Time-to-event analyses were performed using Kaplan-Meier curves and multivariable Cox regression models adjusted for BMI, CRP, albumin, and Phoenix Sepsis Score. RESULTS: A total of 44 patients were included, of whom 30 (68.18%) developed septic shock. Lactate demonstrated lower discriminative performance (AUC 0.624, 95% CI 0.447-0.800) compared with BD (AUC 0.940, 95% CI 0.875-0.999) and ABE (AUC 0.905, 95% CI 0.813-0.997). Both BD and ABE showed higher sensitivity and specificity for identifying patients who progressed to septic shock. In adjusted analyses, abnormal and extremely abnormal ABE and BD were associated with an increased hazard of progression to septic shock. Median time to shock was shortest in patients with extremely abnormal BD and ABE (approximately 8-9 hours), followed by abnormal lactate (13 hours), abnormal ABE (17 hours), and abnormal BD (18 hours). CONCLUSIONS: BD and ABE were associated with progression to septic shock in pediatric sepsis and may provide clinically relevant information for early risk stratification. In this cohort, these markers demonstrated stronger discriminative performance than lactate and may reflect metabolic disturbances present earlier in the disease course. However, these findings should be interpreted cautiously given the retrospective design and require prospective multicenter validation before clinical implementation.
Multifactorial analysis of allergen-specific IgE sensitization in children with allergic diseases in Suzhou, China.
Zhang H, Zhou L, Chen B … +5 more , Qiu W, Zhang Y, Zhu H, Wang H, Zhang Y
BMC Pediatr · 2026 Jun · PMID 42304267 · Full text
BACKGROUND: Allergic diseases represent a major public health challenge among children. Allergen sensitization patterns may be influenced by factors such as age, gender, season, and disease phenotype. This study aimed to...
BACKGROUND: Allergic diseases represent a major public health challenge among children. Allergen sensitization patterns may be influenced by factors such as age, gender, season, and disease phenotype. This study aimed to systematically evaluate the associations of these factors with allergen sensitization patterns in children. METHODS: We studied 2,434 symptomatic children who underwent allergen testing at a district-level hospital in Suzhou, China, using the ImmunoCAP Phadia 250 system. Seventeen common airborne allergens (AAs) and food allergens (FAs) were assessed. The primary definition of sensitization was sIgE ≥ 0.35 IU/mL, whereas robustness analyses were additionally performed at thresholds of ≥ 0.70 and ≥ 3.50 IU/mL. Multivariable logistic regression models were used to evaluate associations with age, gender, and season, with false-discovery rate correction using the Benjamini-Hochberg method. RESULTS: Positivity rates varied systematically according to the sIgE threshold. As thresholds increased from grade ≥ 1 to ≥ 2 and ≥ 3, absolute positivity rates decreased as expected, whereas the direction of age-, gender-, and season-related patterns remained consistent. AA sensitization was more common than FA sensitization, with Dermatophagoides pteronyssinus and Dermatophagoides farinae representing the predominant sensitizers, whereas milk and egg were the leading food allergens. With increasing age, AA sensitization increased whereas FA sensitization declined; these patterns persisted after multivariable adjustment and at higher positivity thresholds. Males showed higher odds of sensitization, particularly for mite allergens. Seasonal variation was most evident for mite allergens, with higher positivity during summer-autumn than winter, broadly paralleling local humidity patterns. Across disease phenotypes, AA sensitization was more common in asthma and rhinitis, whereas FA sensitization was relatively more common in atopic dermatitis and the food-allergy group; mixed diseases showed a higher overall sensitization burden. CONCLUSIONS: In this single-center referred cohort, the findings describe allergen test positivity among clinically tested children rather than population-level prevalence. Age, gender, season, and disease phenotype were associated with distinct sensitization patterns, supporting greater attention to mite-focused assessment and environmental control from school age onward, particularly during humid seasons, as well as milk and egg evaluation during early childhood. The overall findings remained consistent at stricter sIgE positivity thresholds.
Machine learning model based on clinical and imaging features for predicting fungal infections in children with leukemia.
Ge P, Qian XS, He Y … +2 more , Dai YK, Guo WL
BMC Pediatr · 2026 Jun · PMID 42304264 · Full text
BACKGROUND: Due to immunosuppression, mucosal barrier injury, and prolonged neutropenia resulting from both the disease and chemotherapy, along with the frequent use of broad-spectrum antibiotics and glucocorticoids, chi...
BACKGROUND: Due to immunosuppression, mucosal barrier injury, and prolonged neutropenia resulting from both the disease and chemotherapy, along with the frequent use of broad-spectrum antibiotics and glucocorticoids, children with leukemia are at a high risk of invasive fungal disease (IFD). The present study aimed to develop an effective machine learning model to predict fungal infections in children with leukemia. METHODS: A total of 247 pediatric patients diagnosed with leukemia and concurrent infections were evaluated. Five distinct ML classifiers-Random Forest, Logistic Regression, Support Vector Machine (SVM), Naïve Bayes, and K-Nearest Neighbors-were employed to construct predictive classification models. These models were trained using three distinct feature sets: (1) clinical features exclusively, (2) imaging features exclusively, and (3) an integrated feature set comprising both clinical and imaging data. The predictive model was validated prospectively in an independent cohort of 61 patients. Model performance was evaluated through cross-validation techniques to ensure robustness and generalizability. To validate the clinical applicability of the ML models, their diagnostic performance was systematically compared against that of three radiologists with varying experience levels: Reader A (3 years), Reader B (6 years), and Reader C (11 years). RESULTS: Among the five classifiers evaluated, models using both clinical and imaging features consistently outperformed those relying solely on either clinical or imaging features. Notably, the SVM algorithm exhibited the highest overall predictive performance. Within the SVM algorithm, the validation set achieved the mean area under the curve (AUC) values of 0.825 with clinical features alone, 0.852 with imaging features alone, and 0.947 when both clinical and imaging features were combined. The corresponding mean AUC values for the test set were 0.777, 0.797, and 0.879. Furthermore, a comparative analysis between the classification results of the SVM model and the diagnostic assessments provided by three radiologists demonstrated that the SVM consistently outperformed the radiologists across key performance metrics. CONCLUSIONS: The SVM algorithm demonstrates robust efficacy in predicting fungal infections among pediatric patients diagnosed with leukemia. Within the predictive model, the variables that exhibited the greatest influence included pleural thickening, neutropenia, hormone therapy, CRP level, mediastinal lymphadenopathy, and the presence of pleural effusion.
Chronic non-bacterial osteomyelitis presenting as fever of unknown origin in a child: a diagnostic pitfall.
Yang X, Jing S, Li S … +3 more , Zhang Y, Dong L, Zou T
BMC Pediatr · 2026 Jun · PMID 42304260 · Full text
BACKGROUND: Chronic non-bacterial osteomyelitis (CNO), also referred to as chronic recurrent multifocal osteomyelitis (CRMO), is a rare autoinflammatory bone disorder in children and adolescents. Bone pain is the most co...
BACKGROUND: Chronic non-bacterial osteomyelitis (CNO), also referred to as chronic recurrent multifocal osteomyelitis (CRMO), is a rare autoinflammatory bone disorder in children and adolescents. Bone pain is the most common presenting symptom, whereas prolonged recurrent fever of unknown origin is uncommon and may mimic infection or malignancy, leading to extensive diagnostic evaluations, including invasive procedures. CASE PRESENTATION: We report a 12-year-old girl who presented with recurrent fever as the predominant symptom, accompanied by delayed and intermittent musculoskeletal pain. Extensive infectious, rheumatologic, and oncologic investigations, including repeated cultures, metagenomic next-generation sequencing, and bone marrow examination, were unrevealing. Magnetic resonance imaging demonstrated multifocal bone marrow edema, and positron emission tomography-computed tomography showed multifocal FDG-avid skeletal lesions, with a maximum SUV of 6.85 among the focal skeletal lesions, raising concern for malignancy. Histopathological examination of a femoral bone biopsy revealed lymphoplasmacytic infiltration with focal fibrosis and no evidence of infection, granulomatous inflammation, necrosis, or malignancy. Based on the clinical course, imaging findings, exclusion of infection and malignancy, and histopathological findings, a diagnosis of CNO/CRMO was established. The patient improved after stepwise treatment with naproxen, methotrexate, and prednisone. CONCLUSION: This case illustrates an uncommon fever-dominant presentation of pediatric CNO/CRMO with multifocal skeletal lesions mimicking malignancy. CNO/CRMO should be considered in children with fever of unknown origin accompanied by delayed musculoskeletal symptoms or multifocal bone marrow lesions. In typical cases, biopsy may be avoided when clinical and imaging findings are characteristic; however, in atypical presentations with systemic symptoms and malignancy-like imaging findings, bone biopsy may remain necessary to exclude infection and neoplastic disease.
Cross-cultural adaptation of the Spanish version of the Swimming with Independent Measure (SWIM).
Gaviña-Barroso MI, Pacheco-da-Costa S, Rodríguez-Costa I … +3 more , García-Pérez-de-Sevilla G, Martínez-Caro L, Sánchez-Sánchez B
BMC Pediatr · 2026 Jun · PMID 42304257 · Full text
BACKGROUND: Assessing aquatic functional abilities is essential for designing effective interventions for children and adolescents who undergo aquatic activities and/or therapy. However, there is a lack of validated inst...
BACKGROUND: Assessing aquatic functional abilities is essential for designing effective interventions for children and adolescents who undergo aquatic activities and/or therapy. However, there is a lack of validated instruments in Spanish addressing this need. The Swimming with Independent Measure (SWIM) assesses functional performance in aquatic environments across typical and atypical development. This study aimed to cross-culturally adapt and to evaluate content equivalence and face validity of the SWIM for use with Spanish-speaking professionals working in aquatic environments with children and adolescents. METHOD: A methodological study was conducted to perform the cross-cultural adaptation of the SWIM and evaluate its content equivalence and face validity. Cross-cultural adaptation followed Beaton's six-phase methodology: translation, synthesis, back-translation, expert committee review, and pilot testing. Two translators and two back-translators performed the linguistic adaptation. A multidisciplinary expert committee (n = 5) evaluated content equivalence, and 20 professionals meeting predefined eligibility criteria participated in pilot testing. Content equivalence was assessed during the expert committee review, while face validity was evaluated during pilot testing. RESULTS: After two expert committee rounds, 83.6% of items were classified as conceptually equivalent and 16.4% as similar. Content equivalence indices improved from Ave-CVI = 0.93 to 1.00 and UA-CVI = 0.73 to 1.00. Pilot testing with 20 professionals confirmed adequate comprehensibility, requiring minor revisions to a few items. The final Spanish version showed adequate content equivalence and satisfactory face validity. CONCLUSIONS: The Spanish version of the SWIM was cross-culturally adapted, demonstrating semantic, conceptual, idiomatic, and content equivalence with the original, and showed adequate face validity.
Static and dynamic balance performance and associated factors among children with and without hearing impairment in Addis Ababa, Ethiopia: a comparative cross-sectional study.
Ayalsew HA, Admass ZE, Shiferaw MT … +1 more , Leminie AA
BMC Pediatr · 2026 Jun · PMID 42304256 · Full text
BACKGROUND: Balance is essential for daily activities, motor development, and overall well-being. The vestibular system plays a key role in balance control, and impairments associated with hearing loss may negatively aff...
BACKGROUND: Balance is essential for daily activities, motor development, and overall well-being. The vestibular system plays a key role in balance control, and impairments associated with hearing loss may negatively affect balance in children. However, balance assessment is not routinely performed in children with hearing impairment. OBJECTIVES: This study assessed static and dynamic balance performance and associated factors among children with and without hearing impairment in selected public schools in Addis Ababa, Ethiopia. METHODS: A comparative cross-sectional study was conducted from September 2023 to June 2024 among 148 schoolchildren aged 7-18 years (74 with hearing impairment and 74 sex-matched peers with normal hearing). Balance performance was evaluated using the single-leg stance test (eyes open and closed), functional reach test, and Pediatric Balance Scale. Data were analyzed using independent t-tests, Pearson's correlation, and regression analyses in SPSS version 27. Statistical significance was set at p < 0.05. RESULTS: Children with hearing impairment scored significantly lower than their normal-hearing peers in the single-leg stance (eyes open and closed), functional reach test, and pediatric balance scale (all p < 0.001). When analyzed by sex, males with hearing impairments had significantly lower scores in single-leg stance (eyes open and closed, p < 0.001), functional reach test (p < 0.002), and pediatric balance scale (p < 0.001) compared to males with normal hearing. Similarly, females with hearing impairments demonstrated significantly lower scores in single-leg stance (eyes open and closed, p < 0.001), functional reach test (p < 0.003), and pediatric balance scale (p < 0.001) compared to females with normal hearing. CONCLUSION: Children with hearing impairment demonstrated significantly lower static and dynamic balance performance than age- and sex-matched peers with normal hearing. These findings highlight the importance of incorporating routine balance assessment in this population.
A 10-year retrospective assessment of prevalence and factors associated with jaundice among neonates in selected facilities in Ondo State.
Okunade A, Ogbeye GB
BMC Pediatr · 2026 Jun · PMID 42298509 · Full text
BACKGROUND: Globally, jaundice affects about 6 in 10 term babies and 8 in 10 preterm newborns in their first week of life; West Africa, has the highest cases of neonatal jaundice, and it remains the leading cause of seve...
BACKGROUND: Globally, jaundice affects about 6 in 10 term babies and 8 in 10 preterm newborns in their first week of life; West Africa, has the highest cases of neonatal jaundice, and it remains the leading cause of severe illnesses such as mental handicap, brain damage, physical disabilities and even early deaths among newborns in the region. METHODS: A hospital-based retrospective study design was conducted from perinatal data collected over 10 years in tertiary hospitals in Ondo State, Nigeria. A structured data extraction form was used to collect retrospective data from records of neonates and their respective mothers from the selected health facilities from 2015 to 2024. Statistical analysis was performed using SPSS version 23. The prevalence of jaundice was presented using a line graph. Participants' socio-demographic and obstetric characteristics were assessed using frequency and percentage. Chi-square analysis was used to ascertain the relationship between the incidence of jaundice and socio-demographic and obstetric characteristics. P-value was set at 5% for significance. RESULTS: Among the 10,182 mother-neonates pairs analyzed, 8% were preterm and 92% were full-term neonates. The prevalence of jaundice among preterm and high-risk full-term between the year 2015-2024 were 37.4% and 5.7% respectively. Among pre-term neonates, jaundice was significantly more prevalent in babies aged 0-4 days, likewise among high-risk full-term neonates with 90.1% of jaundiced cases falling into this group. CONCLUSION: Neonatal jaundice exhibits a pronounced disparity in Ondo State, with preterms dramatically more affected than high-risk full-terms. Low birth weight, prematurity, and structural disadvantages like low maternal education, unemployment, and rural residence were consistent risk amplifiers.
The effect of the philosophy for children (P4C) education program in out-of-school learning settings on preschool children's executive functioning skills.
Deleş B, Aral N
BMC Pediatr · 2026 Jun · PMID 42298497 · Full text
BACKGROUND: This study aims to investigate the impact of the Philosophy for Children (P4C) education program on preschool children's executive functioning skills in an out-of-school learning environment. METHOD: The stud...
BACKGROUND: This study aims to investigate the impact of the Philosophy for Children (P4C) education program on preschool children's executive functioning skills in an out-of-school learning environment. METHOD: The study used a mixed-methods approach, combining a pre-test-post-test control group experimental design with in-depth interviews. Quantitative data were collected using the Executive Functioning Skills Scale (EFSS), developed by the researchers, while qualitative data were gathered through a Semi-Structured Interview Form. The research involved 37 children (17 in the experimental group and 20 in the control group) and 17 parents, who participated in a 16-session Out-of-School Learning Environment Philosophy for Children (OSLE-P4C) program held in various settings, including libraries, museums, and forests. RESULTS: Quantitative analyses conducted after the eight-week OSLE-P4C education program showed a significant improvement in the executive functioning skills of children in the experimental group (p < 0.05). The mean total executive functioning score of the experimental group (x̄ = 52.59) was notably higher than that of the control group (x̄ = 32.85). This large effect size (η = 0.94) supports the program's effectiveness. The retention test (x̄ = 56.71) indicated that the gains remained evident one month after the initial assessment. Qualitative results showed that the program led to tangible, positive changes in children, particularly in socialization, creativity, attention, and planning. CONCLUSION: The quantitative and qualitative findings demonstrate that the OSLE-P4C training program contributes to the development of executive function skills in preschool children. Hands-on learning and exposure to diverse environments enhanced the program's effectiveness.
Effect of birth timing on early morbidity and mortality in very preterm neonates: a single-center retrospective cohort study.
Erdur TL, Erdur A, Acunaş BA
BMC Pediatr · 2026 Jun · PMID 42298496 · Full text
BACKGROUND: Preterm birth is the leading cause of neonatal mortality and morbidity worldwide. Very preterm neonates born between 23 + 0 and 31 + 6 weeks of gestational age are at particularly high risk due to complicatio...
BACKGROUND: Preterm birth is the leading cause of neonatal mortality and morbidity worldwide. Very preterm neonates born between 23 + 0 and 31 + 6 weeks of gestational age are at particularly high risk due to complications requiring immediate intervention. Whether the differential organization of healthcare services during working hours (full staffing) versus off-hours (on-call) affects neonatal outcomes remains debated. This study aims to evaluate the effect of in-hours versus off-hours birth timing on early morbidity and mortality in very preterm neonates. METHODS: This was a single-center, retrospective cohort study conducted in a tertiary neonatal intensive care unit between January 1, 2014 and December 31, 2021. A total of 326 very preterm neonates born between 23 + 0 and 31 + 6 weeks of gestational age were included. Neonates were divided into two groups according to birth timing: Group 1 (In-hours: 08:00-17:00 on weekdays) and Group 2 (Off-hours: 17:01-07:59 on weekdays, weekends, and public holidays). Demographic data and neonatal outcomes were compared between groups, and risk factors for mortality were examined using multivariate logistic regression analysis. RESULTS: No statistically significant difference was found between groups regarding gestational age, birth weight, or in-hospital mortality (Group 1: 25.3% vs. Group 2: 23.2%, p = 0.658). However, maternal risk factors such as gestational hypertension (p = 0.005) and placental insufficiency (p = 0.001) were significantly higher in the in-hours group. In multivariate analysis, low 5-minute Apgar scores and advanced-stage NEC (stage ≥ 3 A) were identified as independent risk factors for mortality in both groups. Advanced-stage NEC showed a high odds ratio in both cohorts, though accompanied by wide confidence intervals due to small event sizes. CONCLUSIONS: Birth timing (in-hours versus off-hours) had no significant effect on overall mortality or major morbidity in very preterm neonates, reflecting the continuity of care standards at our center. Advanced-stage NEC remained a critical predictor of mortality across both groups, independent of birth timing.
Factors contributing to incomplete vaccination among children aged 12 to 59 months in Mbale city, Eastern Uganda: a caregivers and health workers' perspective.
Bwade MA, Olowo S, Nakawuki A … +8 more , Namubiru E, Mbwali I, Adongo PR, Nabirye RC, Oboth P, Nekaka R, Stanley IJ, Ssenyonga LV
BMC Pediatr · 2026 Jun · PMID 42298493 · Full text
BACKGROUND: Vaccination is one of the most effective public health interventions, substantially reducing morbidity, disability, and mortality among children under five years of age from vaccine-preventable diseases. Desp...
BACKGROUND: Vaccination is one of the most effective public health interventions, substantially reducing morbidity, disability, and mortality among children under five years of age from vaccine-preventable diseases. Despite global progress, vaccination coverage remains suboptimal, with the highest burden of incomplete vaccination reported in sub-Saharan Africa. In 2020, an estimated 14 million infants worldwide did not receive the first dose of diphtheria pertussis tetanus (DPT1) vaccine. Children with zero dose vaccination and those who do not receive all types and doses of vaccines remain highly vulnerable to vaccine-preventable diseases, contributing to outbreaks, morbidity, disability, and mortality. This study explored caregivers' and health workers' perspectives on factors contributing to incomplete vaccination among children aged 12-59 months in Mbale City, Eastern Uganda. MATERIALS AND METHODS: A descriptive qualitative study was conducted in Namatala (Industrial Division) and Nakaloke (Northern Division), Mbale City, Eastern Uganda. Ethical approval was obtained from the Busitema University Research and Ethics Committee. Participants were selected using purposive sampling. Data were collected from 18 caregivers and 30 health care workers and analyzed thematically using Colaizzi's seven-step approach. RESULTS: Six major themes emerged: misconceptions about vaccination; perceived susceptibility to and severity of incomplete vaccination; perceived benefits of vaccination; perceived barriers to vaccination; information gaps; and strategies for ending incomplete vaccination. Misconceptions included myths surrounding vaccination, perceived vaccine-related morbidity, and mortality. Limited understanding and misbeliefs regarding the benefits of vaccination were common. Information gaps were driven by misinformation from social media, delayed, unclear, or inadequate communication, and general ignorance. Identified barriers included fear of side effects, transportation challenges, and negative health worker attitudes, lack of partner support, peer influence, multiple injections, child illness, and caregivers' busy schedules. Proposed solutions included training village health teams (VHTs), continuing medical education (CMEs) for health workers, intensified community sensitization, male partner involvement, and improved accessibility to vaccination services. CONCLUSION: Factors contributing to incomplete vaccination are multifaceted, involving individual, community, and health system related challenges. Strengthening collaboration between health teams and religious and cultural leaders, alongside targeted interventions such as mobile vaccination clinics to address access barriers, is essential to improving vaccination completion rates in this setting.
Are there other undiagnosed tick-borne infections in children being evaluated for Lyme neuroborreliosis?
Hillerdal H, Lager M, Grankvist A … +4 more , Nilsson K, Wennerås C, Henningsson AJ, Skogman BH
BMC Pediatr · 2026 Jun · PMID 42298473 · Full text
BACKGROUND: There is an increasing amount of reported clinical cases of emerging tick-borne diseases (eTBDs) such as human granulocytic anaplasmosis, neoehrlichiosis, babesiosis and rickettsiosis. The incidence of eTBDs...
BACKGROUND: There is an increasing amount of reported clinical cases of emerging tick-borne diseases (eTBDs) such as human granulocytic anaplasmosis, neoehrlichiosis, babesiosis and rickettsiosis. The incidence of eTBDs in children is rather unknown, potentially due to low awareness regarding these diseases among health professionals. The clinical picture may be unspecific and access to laboratory tests limited. We aimed to investigate the incidence and clinical manifestations of eTBDs, including possible co-infections, within a pediatric patient group evaluated for Lyme neuroborreliosis (LNB). METHODS: In a cohort of Swedish children being evaluated for LNB (n = 235) during 2011-2014, samples and data on clinical manifestations and laboratory findings were prospectively collected. Plasma samples were analysed by real-time polymerase chain reaction (PCR) for detection of Anaplasma phagocytophilum, Neoehrlichia mikurensis, Babesia species (spp.) and Rickettsia spp. Cerebrospinal fluid from a subset of the patients was also analysed for Rickettsia spp. by real-time PCR. RESULTS: No evidence of eTBDs, nor tick-borne co-infections, was found in the analysed samples from children evaluated for LNB. CONCLUSIONS: We conclude that no evidence for potential eTBDs was found within a Swedish pediatric patient group with potential high exposure to tick-borne pathogens. However, given the indications of the emergence of ticks and several tick-borne pathogens, we suggest that eTBDs should be considered as differential diagnoses in patients with non-LNB, atypical LNB or unexplained fever and skin rashes, including a complete blood count and liver enzymes in the diagnostic workup.
Otological conditions and autism spectrum disorder in Medicaid beneficiaries aged 1 to 20 years: a cross-sectional study.
Zhang LL, DiGuiseppi C, Blanchard A … +4 more , Ing C, Russell MT, Lalwani AK, Li G
BMC Pediatr · 2026 Jun · PMID 42298469 · Full text
BACKGROUND: Otological conditions are known to be a contributing factor for delayed diagnosis of autism spectrum disorder (ASD). The co-occurrence of otological conditions and ASD, however, has not been adequately studie...
BACKGROUND: Otological conditions are known to be a contributing factor for delayed diagnosis of autism spectrum disorder (ASD). The co-occurrence of otological conditions and ASD, however, has not been adequately studied. This study aims to estimate the prevalence of ASD in children according to otological conditions and to assess the associations of otological conditions with ASD. METHODS: A cross-sectional study of Medicaid beneficiaries aged 1 to 20 years using 2020 data on diagnoses and beneficiary demographics from the Transformed Medicaid Statistical Information System of the Medicaid and Children's Health Insurance Program was performed. Otological conditions examined included otitis media, sensorineural and conductive hearing loss, tinnitus, and hyperacusis. Prevalence and odds ratios of ASD adjusted for age group, sex, and race and ethnicity (aORs) were estimated according to otological conditions. RESULTS: Of 40,990,295 participants, 10.4% were diagnosed with at least one otological condition. The prevalence of ASD was 2.79% in those with any otological condition and 1.73% in those without (aOR, 1.78 [95% confidence interval, 1.77-1.79]).The aOR of ASD increased 51% in children with otitis media (1.51 [1.50-1.52]), 54% in children with tinnitus (1.54 [1.43-1.65]), 227% in children with sensorineural hearing loss (3.27 [3.19-3.35]), and 274% in children with hyperacusis (3.74 [3.26-4.28]). CONCLUSIONS: ASD prevalence is significantly higher in those with otological conditions. The association with ASD is particularly strong in children with sensorineural hearing loss and hyperacusis. The presence of sensorineural hearing loss and hyperacusis warrants heightened clinical awareness and consideration of neurodevelopmental evaluation and screening for ASD.
Impact of early postoperative enteral nutrition initiation timing on infection rate and nutritional status in children with congenital heart disease.
Ye L, Chen M, Wei Q … +1 more , Wang Y
BMC Pediatr · 2026 Jun · PMID 42298466 · Full text
BACKGROUND: The optimal timing for initiating enteral nutrition after congenital heart disease surgery remains controversial. This study aimed to evaluate the impact of early versus delayed enteral nutrition initiation o...
BACKGROUND: The optimal timing for initiating enteral nutrition after congenital heart disease surgery remains controversial. This study aimed to evaluate the impact of early versus delayed enteral nutrition initiation on postoperative infection rate and nutritional status in pediatric congenital heart disease patients. METHODS: A retrospective cohort study was conducted on 246 children (aged 1 month to 3 years) who underwent congenital heart disease surgery between January 2021 and December 2023. Patients were divided into early enteral nutrition group (enteral nutrition initiated ≤ 24 h postoperatively, n = 128) and delayed enteral nutrition group (enteral nutrition initiated > 24 h postoperatively, n = 118). Primary outcomes included postoperative infection rate and nutritional parameters. Secondary outcomes included ICU length of stay, hospital length of stay, and mechanical ventilation duration. RESULTS: The early enteral nutrition group demonstrated significantly lower nosocomial infection rate (14.84% vs. 27.12%, P = 0.016) and surgical site infection rate (3.91% vs. 10.17%, P = 0.047). Postoperative day 7 serum albumin (35.62 ± 4.18 vs. 32.47 ± 5.23 g/L, P < 0.001) and prealbumin levels (168.35 ± 42.67 vs. 142.58 ± 38.94 mg/L, P < 0.001) were significantly higher in the early enteral nutrition group. The early enteral nutrition group also showed shorter ICU stay (5.38 ± 2.14 vs. 7.25 ± 3.42 days, P < 0.001) and hospital stay (12.45 ± 4.36 vs. 16.82 ± 5.78 days, P < 0.001). Multivariate logistic regression identified delayed enteral nutrition initiation as an independent risk factor for nosocomial infection (OR = 2.18, 95% CI: 1.12-4.24, P = 0.022). CONCLUSIONS: In this retrospective cohort study, early enteral nutrition initiation within 24 h after congenital heart disease surgery was associated with reduced infection rates, improved nutritional status, and shorter hospital stay in pediatric patients, predominantly those undergoing repair of septal defects. These observations suggest a potential benefit of early enteral nutrition in selected pediatric cardiac surgery patients; however, prospective validation is warranted before broad implementation, given the inherent limitations of the retrospective design and the predominantly lower-complexity patient population studied.
Parathyroid adenoma causing hypercalcemic crisis masquerading as acute abdomen in a 7-year-old: a case report.
Zhang W, Zi X, Zhang M … +1 more , Zhang W
BMC Pediatr · 2026 Jun · PMID 42298465 · Full text
BACKGROUND: Hypercalcemic crisis from a functioning parathyroid adenoma (PA) is exceptionally rare in prepubertal children and typically presents with a non-specific complaint such as polyuria or lethargy. We report a 7-...
BACKGROUND: Hypercalcemic crisis from a functioning parathyroid adenoma (PA) is exceptionally rare in prepubertal children and typically presents with a non-specific complaint such as polyuria or lethargy. We report a 7-year-old girl who was urgently referred for acute, colicky abdominal pain and repeated vomiting, which clinically mimicked acute appendicitis. During the work-up, extensive metabolic tests incidentally revealed severe hypercalcemia and elevated intact parathyroid hormone (PTH), which led to the diagnosis of PA-induced hypercalcemic crisis.Her initial manifestation was an acute abdomen rather than renal or neuropsychiatric symptoms. The case underscores that functioning PA should be included in the differential diagnosis of children presenting with unexplained gastrointestinal distress, and illustrates that timely diagnosis and focused parathyroidectomy can effectively reverse biochemical abnormalities, alleviate skeletal symptoms, and mitigate the risk of serious long-term complications. CASE PRESENTATION: We report the case of a seven-year-old female patient who was hospitalized due to complaints of abdominal discomfort accompanied by episodes of recurrent vomiting.Subsequent analysis revealed that these symptoms may represent acute gastrointestinal syndrome in the context of a hypercalcemic crisis.We describe her clinical course, diagnostic workup, and treatment. Laboratory tests revealed severe hypercalcemia (4.67 mmol/L; reference range: 2.1-2.7mmol/L), along with hypophosphatemia, hypomagnesemia, and markedly elevated PTH (268.1 pg/mL).Thyroid ultrasound revealed a nodule in the inferior aspect of the right lobe of the thyroid gland, which was subsequently confirmed by contrast-enhanced CT.After urgent management of hypercalcemia-including intravenous fluids, furosemide, salmon calcitonin, and pamidronate-the patient underwent surgical excision of the right inferior parathyroid gland.Histopathological examination confirmed the diagnosis of a benign PA. Serum calcium and PTH levels normalized within 24 hours postoperatively, with complete resolution of clinical symptoms. Marked hypocalcemia developed within several days postoperatively and was corrected. During follow-up to date, serum calcium,PTH levels, and ultrasound examination of the parathyroid have been normal. CONCLUSIONS: PA represents an uncommon yet manageable cause of hypercalcemic crisis in pediatric patients. Timely assessment of serum calcium and PTH levels in individuals presenting with unexplained gastrointestinal symptoms-such as nausea, vomiting, or abdominal pain-facilitates swift diagnosis, thereby reducing the need for unnecessary diagnostic procedures like extensive imaging or invasive tests.Surgical resection of the PA is the first-line treatment. Postoperatively, prevention of hungry bone syndrome and long-term follow-up are required.
Health-related quality of life in parents of adolescents in 2019, 2021 and 2023.
Rohde G, Haraldstad K, Helseth S … +3 more , Hagen M, Skarstein S, Mikkelsen HT
BMC Pediatr · 2026 Jun · PMID 42298450 · Full text
PURPOSE: The objective of the present study is to describe levels of HRQOL in parents of adolescents over a span of four years (2019, 2021, and 2023) and identify which of selected sociodemographic variables associated w...
PURPOSE: The objective of the present study is to describe levels of HRQOL in parents of adolescents over a span of four years (2019, 2021, and 2023) and identify which of selected sociodemographic variables associated with HRQOL over time. In addition, we compared all HRQOL domains with norm data from the general Norwegian population. METHODS: A longitudinal study involving 556 parents (at baseline) of adolescents from the general Norwegian population was conducted. Data were collected at baseline in 2019, in 2021 (when the COVID-19 pandemic was ongoing) and in 2023. HRQOL was assessed using RAND-36. Data were analysed using independent samples t-tests and linear mixed model for repeated measures. RESULTS: During the four-year (2019-2023), we observed a small but statistically significant decline in most HRQOL domains, and no domains increased again after the COVID-19 pandemic. Higher education, being in paid work and having a high household income were the most important associates of high HRQOL scores. We identified some statistical differences in HRQOL between the parents in the current study and Norwegian norms at all time points, although these were of limited clinical relevance. CONCLUSION: Over four years, parents of adolescents experienced a small but persistent decline in HRQOL from before the COVID-19 pandemic through 2023, particularly in mental health domains, with no full return to pre-pandemic levels. Higher education, household income, and paid employment were consistently associated with better HRQOL.
Mesenteric cyst: an unusual cause of recurrent abdominal pain in a child.
Okunade IA, Biu NB, Adeogun OD … +2 more , Owolabi MB, Adeniran JO
BMC Pediatr · 2026 Jun · PMID 42298445 · Full text
Mesenteric cysts are a rare cause of intra-abdominal swellings in the paediatric age group. They are benign lesions with non-specific presentations ranging from incidental findings to features of an acute abdomen. The ra...
Mesenteric cysts are a rare cause of intra-abdominal swellings in the paediatric age group. They are benign lesions with non-specific presentations ranging from incidental findings to features of an acute abdomen. The rarity of the condition and the non-specificity of its symptoms underscore the importance of adequate knowledge for prompt diagnosis and appropriate management. Here we present a 5-year-old preschooler from the Southeastern part of Nigeria with recurring abdominal pain of 3 years' duration. She was initially managed for symptomatic umbilical hernia and underwent herniorrhaphy. However, due to the persistence of her symptom, she was referred to the Paediatric Surgery Unit of the Teaching Hospital. Physical examination revealed a freely mobile soft mass in the right lumbar region, subsequently confirmed on imaging studies. She eventually had complete excision of the mass with a segmental jejunal resection and jejunojejunal anastomosis. The child is currently being followed up and has no evidence of recurrence.
Effect of core strengthening exercises on pain and quality of life in females with primary dysmenorrhea: a scoping review.
Kamble DSN, Prabha SPP, Ghorpade AS … +2 more , Pise O, Palekar DTJ
BMC Pediatr · 2026 Jun · PMID 42289667 · Full text
BACKGROUND: Dysmenorrhea is characterized by recurrent lower abdomen or pelvic pain that may radiate to the legs, inner thighs, and lower back. It is divided into two categories: primary dysmenorrhea (PD) and secondary d...
BACKGROUND: Dysmenorrhea is characterized by recurrent lower abdomen or pelvic pain that may radiate to the legs, inner thighs, and lower back. It is divided into two categories: primary dysmenorrhea (PD) and secondary dysmenorrhea (SD). When the ovulatory cycle is established, which usually happens in the first two years following menarche, PD is defined as menstrual discomfort without any visible pelvic disease. Many teenage girls suffer from primary dysmenorrhea, or excruciating period cramps, which can seriously interfere with their everyday activities, social contacts, and attendance at school. By engaging intrinsic musculature that supports spinal load and neuromuscular control, core strengthening aims to improve lumbar stability. Deep stabilizing muscles are isolated and conditioned by core strength training, which enhances functional stability. Strong core muscles are more resilient to everyday biomechanical strains, such as those brought on by menstruation. OBJECTIVE: To map and synthesize the existing evidence regarding the effectiveness of core strengthening exercises on pain intensity and quality of life in females with primary dysmenorrhea. ELIGIBILITY CRITERIA: This scoping review included randomized controlled trials, experimental studies, and quasi-experimental studies published in English between 2019 and 2025 that investigated the effects of core strengthening or lumbopelvic stabilization exercises in females with primary dysmenorrhea. Studies primarily focusing on pharmacological management or unrelated physiotherapy modalities were excluded. SOURCES OF EVIDENCE: Electronic databases including PubMed, Scopus, MEDLINE, Google Scholar, and ClinicalKey were searched. CHARTING METHODS: Data were charted using a predefined extraction framework including study design, participant characteristics, intervention details, outcome measures, and key findings. METHODS: A comprehensive literature search was conducted between January 2019 and March 2025 using keywords including "primary dysmenorrhea," "core strengthening," "core stability," "lumbopelvic exercises," and "exercise therapy" with Boolean operators ("AND," "OR"). Eleven studies met the inclusion criteria, comprising randomized controlled trials, comparative studies, and quasi-experimental designs, with a total sample size of 445 participants. The most commonly used outcome measures were the Visual Analog Scale (VAS), Numerical Pain Rating Scale (NPRS), WaLIDD scale, and quality of life questionnaires. RESULTS: Most included studies demonstrated significant reductions in pain intensity following core strengthening interventions lasting between 6 and 12 weeks. Several studies also reported improvements in quality of life, functional ability, sleep quality, and psychological well-being. Comparative studies showed that core strengthening exercises were more effective than stretching exercises alone in reducing dysmenorrhea symptoms. Studies incorporating lumbopelvic stabilization and pressure biofeedback reported enhanced neuromuscular control and superior pain reduction outcomes. Despite generally positive findings, heterogeneity in study design, exercise protocols, outcome measures, and limited long-term follow-up reduced the overall strength of evidence. CONCLUSION: The findings of this scoping review suggest that core strengthening exercises may be an effective non-pharmacological intervention for reducing pain intensity and improving quality of life in females with primary dysmenorrhea. Core stabilization programs appear to enhance lumbopelvic stability and functional outcomes while presenting minimal adverse effects. However, further high-quality randomized controlled trials with standardized protocols and long-term follow-up are required to strengthen the current evidence base.
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