BMC Pediatrics[JOURNAL]
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200 papers
Genotypic and phenotypic features of 23 Egyptian patients with tuberous sclerosis complex.
Othman AA, Sadek AA, Aladawy MA … +14 more , Aziz SP, Sedky A, Mansour TMM, Younis MMS, Abdelatif RG, Hassan AEM, Aboelmagd MA, Mohamed M, Mohamed KR, Elkousy SM, Montaser Elkady NM, Khang R, Ryu SW, Abdelkreem E
BMC Pediatr · 2026 Jun · PMID 42265631 · Full text
BACKGROUND: Tuberous sclerosis complex (TSC) is a multisystem disease caused by pathogenic variants in TSC1 or TSC2 genes. Although features of TSC have been described in various populations, genetic data from Egypt rema...
BACKGROUND: Tuberous sclerosis complex (TSC) is a multisystem disease caused by pathogenic variants in TSC1 or TSC2 genes. Although features of TSC have been described in various populations, genetic data from Egypt remain scarce. This study aimed to characterize the phenotypic and molecular features of TSC among a cohort of Egyptian patients. METHODS: This observational study included patients clinically diagnosed with TSC at two Egyptian centers between 2022 and 2025. All participants underwent a comprehensive evaluation, including demographic profiling, clinical assessment, imaging studies, and whole-exome sequencing. Identified TSC1 and TSC2 variants were cross-referenced with public databases, analyzed using bioinformatics tools, and classified according to the American College of Medical Genetics and Genomics guidelines. RESULTS: The cohort contained 23 cases from 20 unrelated families (16 males and 7 females; median age: 8.1 years). Parental consanguinity and positive family history were present in 13 and 12 cases, respectively. The median age at initial presentation was 8 months (interquartile range: 3-24 months). Patients exhibited various manifestations, including hypomelanotic macules (100%), cortical tubers (96%), seizures (87%), TSC-associated neuropsychiatric disorders (78%), facial angiofibromas (65%), shagreen patches (48%), renal angiomyolipomas (44%), and cardiac rhabdomyomas (39%). Eighteen distinct variants were identified (16 in TSC2, 2 in TSC1), including nine novel variants. These comprised nine deletions/insertions, five splice-site, three nonsense, and one missense variant. Most variants (89%) were "private", each observed in a single family. CONCLUSION: This study provides the first comprehensive genetic analysis of TSC in Egypt. The findings expand the demographic, phenotypic, and genetic spectrum of TSC in an underrepresented population.
Childhood and adolescent poisoning: a prospective analysis from the largest poison control centre.
Soomar SM, Awais M, Qadir MA … +7 more , Sohail A, Irfan O, Abdullah A, Qamar MA, Irfan B, Sultan MO, Khan NU
BMC Pediatr · 2026 Jun · PMID 42265621 · Full text
BACKGROUND: Childhood and adolescent poisoning is a significant health problem globally, especially in low- and middle- income countries. Globally, around a million childhood cases of poisoning were reported in 2019. In...
BACKGROUND: Childhood and adolescent poisoning is a significant health problem globally, especially in low- and middle- income countries. Globally, around a million childhood cases of poisoning were reported in 2019. In Pakistan, unintentional childhood and adolescent poisoning is higher, including organophosphates, snake bites, and animal bites. Therefore, this study aims to identify the most common agents causing poisoning, risk factors, management, and outcomes of childhood and adolescent poisoning incidents. METHODS: This study included childhood and adolescent poisoning cases from March to May 2025 presented at Jinnah Postgraduate Medical Center Karachi, Pakistan. A total of 110 children were included in the study between the ages of 0-18 years. Exposure was poisoning, and there were two outcomes: length of hospital stay (days) and status on follow-up (alive/dead). Acute poisoning was suspected in children who presented a clear history of recent exposure, fast onset of symptoms, and clinical characteristics such as vomiting, altered level of consciousness, convulsions, respiratory distress, aberrant pupil size, or distinctive odor. Organophosphate poisoning was diagnosed based on clear exposure history, identification of substance containers, presence of classical cholinergic toxidrome (vomiting, salivation, lacrimation, pinpoint pupils, fasciculations) and clinical response to atropine. Chi-square and Fisher's exact test were performed, considering a p-value < 0.05 being significant. RESULTS: The median age was 17 years with an equal distribution of males and females. Organophosphate poisoning (60.91%) was the most reported poisoning, followed by snake bites (21.82%). Only one (0.91%) case had prior poisoning history. Around 82.00% of poisoning cases occurred at home, and 58.18% of cases occurred due to deliberate intent. Organophosphate poisoning (p < 0.001), median respiratory rate of 20 (p = 0.034), and heart rate of 100 (p = 0.007), were significantly associated with longer hospital stay. CONCLUSION: This study highlights organophosphate poisoning as the most common cause, often intentional and occurring at home due to easier access and unsafe storage. This study helps in the identification of patients who are prone to a longer hospital stay than others, providing clinicians with a means to personalize patient care.
Cytokine patterns in very low birth weight infants under different cord clamping strategies: preliminary EXPLAIN trial data.
Kuehne B, Majjouti M, Wilhelm J … +5 more , Butzer SK, Kribs A, Alcazar MAA, Mahabir E, Oberthuer A
BMC Pediatr · 2026 Jun · PMID 42260466 · Full text
BACKGROUND: Delayed umbilical cord clamping (DCC) improves survival and hematologic outcomes in preterm infants. Strategies that provide initial respiratory support before cord clamping may prolong intact placental circu...
BACKGROUND: Delayed umbilical cord clamping (DCC) improves survival and hematologic outcomes in preterm infants. Strategies that provide initial respiratory support before cord clamping may prolong intact placental circulation beyond standard time-based DCC in very low birth weight (VLBW) infants. Whether prolonged intact placental circulation modifies neonatal cytokine patterns remains unclear. METHODS: This pre-specified secondary analysis of a single-center randomized controlled trial (Extrauterine Placental Transfusion in Resuscitation of VLBW Infants [EXPLAIN]) included preterm infants with a birth weight < 1500 g and gestational age > 23 6/7 weeks delivered by cesarean section between May 2019 and June 2021. Infants were randomized to either extrauterine placental perfusion (EPP group) with intact placental circulation or time-based DCC (DCC group). Samples were obtained from umbilical cord blood at cord clamping (d0) and venous blood on postnatal day 28 (d28). Twenty-seven cytokines were quantified using multiplex ELISAs. RESULTS: Samples were available from 44 infants; 1 infant was excluded a priori because of neonatal sepsis, leaving 43 infants in the cytokine analysis set. Mean time until cord clamping was 469.6 s in the EPP group and 40.8 s in the DCC group (p < 0.001). At d0, significant relative differences between groups were observed for IL-1ra, IL-17, and IP-10. At d28, EPP was associated with lower IP-10 concentrations than DCC. No broad or consistent differences in cytokine profiles were observed between groups. CONCLUSIONS: In this small exploratory secondary analysis, EPP was not associated with broad cytokine changes compared with DCC in VLBW infants, despite markedly prolonged placental circulation. These findings may support the biological feasibility of EPP and may indicate that prolonged placental perfusion is not associated with major systemic cytokine perturbation. Given the limited sample size, the results should be considered hypothesis-generating and require confirmation in larger studies. TRIAL REGISTRATION: Clinicaltrials.gov (NCT03916159, registered April 05, 2019).
Coping as a mediator between family stressors and behavioural adjustment in siblings of children with progressive life-limiting conditions: a multilevel longitudinal study.
Tay J, Widger K, Stremler R … +1 more , Pole JD
BMC Pediatr · 2026 Jun · PMID 42260458 · Full text
BACKGROUND: Siblings of children with progressive life-limiting conditions face elevated emotional and behavioural risks. Although multiple family stressors are known, how cumulative stress shapes sibling adjustment is u...
BACKGROUND: Siblings of children with progressive life-limiting conditions face elevated emotional and behavioural risks. Although multiple family stressors are known, how cumulative stress shapes sibling adjustment is unclear. This study examined how illness-related family stressors affect sibling behavioural outcomes and whether active versus passive coping strategies are associated with these relationships. METHODS: We conducted secondary analysis of longitudinal data from the Charting the Territory (CTT) study, examining 70 siblings (aged 7-18 years) from 58 families with a child diagnosed with progressive life-limiting conditions. Families were categorized into two treatment-duration groups based on time since first seeking medical treatment for the ill child (≤ 1 year vs. > 1 year). Using multilevel exploratory factor analysis, we empirically derived a latent "Siblings' Stressor" construct from nine potential variables. Multilevel mediation models examined relationships between Siblings' Stressor, coping strategies (Kidcope), and three behavioural outcomes (Child Behaviour Checklist): internalizing, externalizing, and total behaviour problems across baseline (defined as each family's first assessment wave at study enrollment), 6-month, and 12-month assessments. RESULTS: The Siblings' Stressor construct comprised parental stress, anxiety, depression, and caregiving burden. Significant direct effects emerged between Siblings' Stressor and all behavioural outcomes. Coping associations differed by treatment-duration group. For internalizing problems, active coping provided consistent protection across early (≤ 1 year: -.052, 95% CI [-.103, -.001]) and longer-term families (> 1 year: -.109, 95% CI [-.121, -.097]), while passive coping demonstrated risk effects. However, for externalizing and total behaviour problems, active coping showed different associations by treatment-duration group, being protective in early-treatment families (≤ 1 year) and positively associated with externalizing (.048, 95% CI [.021, .075]) and total behaviour problems (095, 95% CI [.053, .136]) in longer-treatment families (> 1 year). Passive coping was linked to elevated externalizing and total behaviour problems in both groups, with particularly strong associations in families within their first year of treatment. CONCLUSION: Parental psychological distress and caregiving burden were associated with sibling adjustment across all behavioural outcomes, with coping strategies showing differential patterns by treatment-duration group. Active coping was related to fewer internalizing difficulties, while passive coping was associated with elevated risk. These findings support family-centred approaches that address parental mental health and promote developmentally appropriate coping strategies across the illness trajectory.
LUMINEX technology detects plasma inflammatory factor expression levels in children with severe and non-severe community acquired pneumonia.
Yang Q, Xie J, Li H … +1 more , Du F
BMC Pediatr · 2026 Jun · PMID 42260456 · Full text
OBJECTIVE: This study aimed to evaluate the clinical utility of LUMINEX technology in detecting plasma inflammatory factor expression levels (IL-1β, TNF-α, and IL-10) in children with severe and non-severe community-acqu...
OBJECTIVE: This study aimed to evaluate the clinical utility of LUMINEX technology in detecting plasma inflammatory factor expression levels (IL-1β, TNF-α, and IL-10) in children with severe and non-severe community-acquired pneumonia (CAP), comparing its performance with traditional ELISA methods for disease severity assessment and prognosis prediction. METHODS: This study enrolled 72 pediatric patients diagnosed with community-acquired pneumonia at our institution between January 2023 and December 2024, comprising 28 severe cases and 44 non-severe cases, along with 80 age-matched healthy controls. Inflammatory marker concentrations [interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10)] were quantified in plasma and serum samples using LUMINEX multiplex analysis and ELISA techniques. Comparative analyses examined inflammatory mediator expression patterns across disease severity groups and evaluated their diagnostic discrimination capacity, while prognostic assessments investigated the predictive value of plasma inflammatory markers. RESULTS: Comparative analysis revealed significantly elevated concentrations of IL-1β, TNF-α, and IL-10 in both plasma and serum samples from severe cases compared to non-severe patients (P < 0.05), with non-severe patients also showing higher levels than healthy controls (P < 0.05). Both LUMINEX-based plasma analysis and ELISA serum measurements demonstrated comparable diagnostic accuracy for severe pneumonia identification. Prognostic evaluation indicated that patients with unfavorable outcomes exhibited increased plasma inflammatory marker levels relative to those with favorable prognoses (P < 0.05). ROC analysis showed superior predictive performance for TNF-α and IL-10 (higher AUC values) compared to IL-1β in forecasting clinical outcomes. CONCLUSION: The detection of plasma inflammatory cytokines in children with community-acquired pneumonia by LUMINEX technology is helpful to determine the condition and evaluate the prognosis of children, and it is worth promoting.
Early adverse outcomes of neonatal hypoxic-ischemic encephalopathy in a resource-constrained setting.
Onyeje CK, Onyeje BT, Udennaka C … +7 more , Edokwe ES, Echendu ST, Ngonadi SC, Ikeabbah AO, Ezeike-Obi OA, Obi UC, Emmanuel SI
BMC Pediatr · 2026 Jun · PMID 42260449 · Full text
BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and long-term neurological disability, particularly in resource-limited settings. Understanding factors associated with earl...
BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and long-term neurological disability, particularly in resource-limited settings. Understanding factors associated with early adverse outcomes is crucial for optimizing management strategies. OBJECTIVE: To identify maternal and neonatal factors associated with early adverse outcomes in newborns with HIE in a Nigerian tertiary health institution. METHODS: A prospective hospital-based cross-sectional study was conducted at Nnamdi Azikiwe University Teaching Hospital, Nnewi, from September 2023 to May 2024. Seventy term newborns with HIE admitted within 72 h of delivery were enrolled. HIE diagnosis was based on abnormal neurological examination using the Thompson score. Data on demographic characteristics, maternal factors, and biochemical parameters were collected and analyzed using SPSS version 25. Fisher's exact test and Chi-square analysis was used to determine associations between variables, with p < 0.05 considered significant. RESULTS: Among 70 newborns, 45.7% (32/70) experienced short-term adverse outcomes. The case fatality rate was 17.1% (12/70), while 28.6% (20/70) developed complications including seizures (80%), absent nutritive suckling (65%), poor Moro reflex (25%), respiratory distress (20%), and altered consciousness (15%). Place of delivery was significantly associated with adverse outcomes (p = 0.001), with outborn neonates exhibiting a higher risk compared with inborn neonates. Both HIE severity and a 5-minute Apgar score < 7 were significantly associated with adverse outcomes (p < 0.0001 for both). Maternal factors significantly associated with adverse outcomes included mode of delivery (p = 0.006) and maternal occupation (p = 0.026). Random blood glucose levels showed significant association with outcomes (p < 0.0001), while serum magnesium levels did not (p = 0.980). CONCLUSION: HIE severity, a low 5-minute Apgar score, outborn delivery status, and abnormal blood glucose levels were significantly associated with early adverse outcomes in neonatal HIE. These findings emphasize the importance of skilled birth attendance, early recognition, and prompt glucose monitoring in improving outcomes for affected newborns in resource-limited settings.
Frequency of complications of DKA in children admitted in PICU.
Sharifzadeh M, Mohammadpour M, Yaghmaee B … +5 more , Hassani SA, Najafi Z, Beirami F, Pazouki R, Baroughi M
BMC Pediatr · 2026 Jun · PMID 42260447 · Full text
OBJECTIVE: Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes mellitus in children, frequently requiring admission to the pediatric intensive care unit (PICU). The treatmen...
OBJECTIVE: Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of diabetes mellitus in children, frequently requiring admission to the pediatric intensive care unit (PICU). The treatment of diabetic ketoacidosis has long been problematic, divisive, and fraught with uncertainty. Understanding the frequency of associated complications is essential for improving clinical management and outcomes. The aim of this study was to determine the frequency and severity of DKA in pediatric patients admitted to the PICU, to identify the pattern of electrolyte abnormalities, and to evaluate the association between DKA severity, electrolyte disturbances, and the risk of cerebral injury and other acute complications. METHODS: This cross-sectional retrospective study was conducted on pediatric patients aged 1 month to 16 years admitted with DKA to the PICU of a tertiary referral center between December 2018 and December 2022. DKA was defined according to ISPAD criteria. Data on demographic characteristics, laboratory findings, and clinical outcomes were extracted from medical records. The frequency of complications, including electrolyte disturbances, cerebral injury, and acute kidney injury (AKI), was evaluated. RESULTS: A total of 161 patients were included, with a mean age of 8.22 ± 4.08 years. The most common electrolyte abnormality was hypophosphatemia (60.9%), followed by hypokalemia (50.9%) and hyponatremia (46.6%). Hypernatremia and hyperkalemia were observed in 15.5% and 19.3% of patients, respectively. Cerebral injury occurred in 8.1% of patients, while AKI was observed in 3.7%. Patients with severe DKA had a significantly higher risk of cerebral injury compared to those with moderate DKA. Hypernatremia was also associated with an increased risk of cerebral injury. CONCLUSION: Complications of DKA, particularly electrolyte disturbances and cerebral injury, are relatively common among children admitted to the PICU. Severe DKA and hypernatremia are associated with a higher risk of cerebral injury. Early recognition and careful management of these complications are crucial to improving patient outcomes.
Mapping the physical condition, peer and parental support, and MVPA: a network analysis in schoolchildren from the ACTIBESE project.
Rodríguez-Rodríguez F, Mota J, Aguilar-Farias N … +1 more , de Martins CM
BMC Pediatr · 2026 Jun · PMID 42260446 · Full text
BACKGROUND: Active behaviour denotes any type of movement that enhances overall physical well-being, a trend that has seen a gradual decline among schoolchildren globally. This study aimed to examine the complex interpla...
BACKGROUND: Active behaviour denotes any type of movement that enhances overall physical well-being, a trend that has seen a gradual decline among schoolchildren globally. This study aimed to examine the complex interplay between physical condition, peer and parental support, and moderate and vigorous physical activity, both inside and outside school, using network analysis in a sample of Chilean children and adolescents. METHODS: The sample includes 655 schoolchildren aged 8 to 16. Instruments used include a questionnaire for sociodemographic and physical activity (PA) variables, assessing factors like gender, age, socioeconomic level, PA levels, self-perceived physical condition, and parental and peer support for PA. Descriptive statistics were used alongside linear regression to establish associations. Network Analysis, utilising the Fruchterman-Reingold algorithm, was employed to visualise relationships between variables. Centrality indices were calculated to determine variables' influence within the network, while sparsity values indicated network density. RESULTS: In children, recess-related activity strongly correlates with moderate-to-vigorous PA (MVPA), whereas in adolescents, MVPA is associated with activities during recess, lunchtime, and physical education classes. Parental support plays a significant role, particularly in adolescents. Outside school PA is well connected among peer support nodes in both children and adolescents, while adolescents show stronger connections with parental support, socioeconomic variables, and physical condition nodes. Notably, friends' encouragement and parental support were significantly associated with PA behaviours in both age groups. CONCLUSION: Outside school PA, parental and peer support have a strong association with MVPA in children and adolescents.
Selumetinib in the treatment of plexiform neurofibromas in neurofibromatosis type 1: a 6-year prospective case series with review of the literature.
Baldo F, Messana L, Andresani A … +11 more , Magnolato A, Murru FM, Spezzacatene A, Cattaruzzi E, Maestro A, Paternuosto G, Zanon D, Diplotti L, Michieletto P, Barbi E, Bruno I
BMC Pediatr · 2026 Jun · PMID 42260435 · Full text
BACKGROUND: Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder characterized by pigmented lesions, cutaneous neurofibromas, and brain and peripheral nerve tumors. Plexiform neurofibromas (PNs) are c...
BACKGROUND: Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder characterized by pigmented lesions, cutaneous neurofibromas, and brain and peripheral nerve tumors. Plexiform neurofibromas (PNs) are congenital tumors whose growth tends to accelerate in the pediatric age. Selumetinib, a MEK1/2 inhibitor, is the first pharmacological treatment that has shown efficacy in reducing the size of PNs by inhibiting their key pathway, with few and moderate adverse events. The purpose of this study is to describe the effect of selumetinib in a large cohort of patients with NF1. METHODS: This is a prospective case series that describes the patients affected by NF1 with inoperable, symptomatic, or disfiguring PNs treated with selumetinib at the Institute for Maternal and Child Health IRCCS "Burlo Garofolo" in Trieste, from January 2017 to June 2023. To determine the patients' response to selumetinib, we compared the MRI volume of the PN before the beginning of the treatment with the last one available. RESULTS: Twenty-three patients with PNs were treated with selumetinib. During the follow-up period (mean time 1085 days), a tumor reduction above 20% was observed in 13 patients (57%), while 7 subjects (30%) had a tumor stabilization and 3 (13%) had a tumor growth. The median volumetric reduction was 23%. No significant correlations were found between the patients' response to treatment and the other variables considered. No severe adverse events were recorded. CONCLUSIONS: In this prospective case series selumetinib appeared to be a useful drug for the treatment of PNs.
Impact of a minimal handling care protocol on intraventricular hemorrhage in preterm infants: a retrospective cohort study.
Uygun SS, Ozturk M, Soylu H … +1 more , Konak M
BMC Pediatr · 2026 Jun · PMID 42252429 · Full text
BACKGROUND: Premature birth is associated with a high risk of mortality and neurodevelopmental morbidity, with intraventricular hemorrhage (IVH) remaining a major cause of brain injury in preterm infants. Neuroprotective...
BACKGROUND: Premature birth is associated with a high risk of mortality and neurodevelopmental morbidity, with intraventricular hemorrhage (IVH) remaining a major cause of brain injury in preterm infants. Neuroprotective care bundles focusing on minimal handling have been proposed to reduce physiological stress and cerebral hemodynamic instability. While such bundles have been associated with reduced rates of severe intraventricular hemorrhage, evidence regarding the isolated impact of minimal handling-particularly on other neonatal morbidities-remains limited. METHODS: This retrospective comparative cohort study was conducted in a tertiary-level neonatal intensive care unit between January 2020 and December 2023. Preterm infants with a gestational age ≤ 32 weeks and birth weight ≤ 1500 g were included. Outcomes were compared between a pre-bundle period (2020-2021) and a post-bundle period (2022-2023), following the unit-wide implementation of a structured minimal handling care protocol during the first 72 h of life. The primary outcome was the incidence and severity of IVH diagnosed by cranial ultrasonography. Secondary outcomes included major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent risk factors for IVH. RESULTS: A total of 112 infants were included (46 pre-bundle, 66 post-bundle). The overall incidence and severity distribution of IVH did not differ significantly between groups. Rates of necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, sepsis, and mortality were also comparable. In multivariable analysis, maternal diabetes and nosocomial sepsis were identified as factors associated with IVH. CONCLUSION: Implementation of a minimal handling care bundle was feasible and safe in a tertiary neonatal intensive care unit. However, due to the limited sample size and low number of IVH events, its effect on the incidence and severity of IVH could not be clearly delineated.
Comparison of C-reactive protein/albumin ratio and neutrophil/lymphocyte ratio with conventional biomarkers for predicting septic shock in pediatric sepsis.
Zheng Y, Liu T, Wei D … +2 more , Wang P, Fan X
BMC Pediatr · 2026 Jun · PMID 42251342 · Full text
BACKGROUND: This study aimed to investigate the clinical utility of the C-reactive protein/albumin ratio (CAR) and the neutrophil/lymphocyte ratio (NLR) in evaluating the severity of sepsis in pediatric patients. METHODS...
BACKGROUND: This study aimed to investigate the clinical utility of the C-reactive protein/albumin ratio (CAR) and the neutrophil/lymphocyte ratio (NLR) in evaluating the severity of sepsis in pediatric patients. METHODS: A retrospective cohort study was conducted involving 174 pediatric patients hospitalized between June 2022 and November 2025. Sepsis and septic shock were defined according to the 2024 Phoenix criteria. Patients were stratified into a sepsis group (n = 123) and a septic shock group (n = 51). CAR and NLR were calculated from blood samples collected within 24 h of admission. A two-sided p < 0.05 was considered statistically significant. Independent associated factors for septic shock were identified using binary logistic regression analysis. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of CAR, NLR, and other relevant biomarkers.The study was conducted in accordance with the STROBE guidelines. RESULTS: Univariate analysis revealed significantly elevated white blood cell (WBC) count, CAR, and NLR levels in the septic shock group compared to the sepsis group (all p < 0.05). Binary logistic regression analysis confirmed that elevated CAR (OR = 2.893, p < 0.001) and NLR (OR = 1.232, p < 0.001) were independent associated factors for progression to septic shock. ROC curve analysis demonstrated that a model combining CAR and NLR exhibited superior discriminative performance compared to either biomarker alone, with a higher AUC (0.802), sensitivity (74.50%), and specificity (74.80%). CONCLUSION: CAR and NLR appear to be significant independent biomarkers for assessing severity and predicting septic shock in children with sepsis. The combination of CAR and NLR provides improved predictive accuracy compared with either marker alone, suggesting its potential utility in guiding early clinical decisions.
Nutritional disparities between urban poor and non-poor Malaysian children under five in the context of the COVID-19 pandemic: a cross-sectional study.
Choo MY, Lum LCS, Jalal MIA … +6 more , Ooi KS, Foo C, Zaini AA, Mohammad NM, Jalaludin MY, Child Health Research Group:
BMC Pediatr · 2026 Jun · PMID 42249358 · Full text
BACKGROUND: Rapid urbanisation in Asia has widened intra-urban nutritional disparities, particularly among urban-poor children during periods of compromised food security. METHODS: This cross-sectional study aimed to inv...
BACKGROUND: Rapid urbanisation in Asia has widened intra-urban nutritional disparities, particularly among urban-poor children during periods of compromised food security. METHODS: This cross-sectional study aimed to investigate nutritional disparities among children under five in an urban locality during the COVID-19 pandemic. We recruited 717 children aged 6-59 months from July 2020 to June 2023 across three sites in Selangor, Malaysia. Preterm or small-for-gestational-age children and those with incomplete data were excluded. Dietary intake was assessed by 24-h recall adapted from WHO-IYCF and FAO-WDD tools. Anthropometric indices were weight-for-age, length/height-for-age, and weight-for-length/height z-scores. Malnutrition indicators were WHO-defined underweight, stunting, wasting, and overweight. Associations of sociodemographic factors and minimum dietary diversity with malnutrition indicators were analysed. RESULTS: 357 urban-poor and 360 urban non-poor children were recruited. Urban-poor children had lower mean weight and height z-scores than urban non-poor children (-0.77 [SD 1.20] vs -0.46 [SD 1.17], p < 0.001; -0.73 [SD 1.06] vs -0.46 [SD 1.21], p = 0.002). Underweight prevalence was higher among urban-poor children (13.2% vs 7.0%, p = 0.009). Among children aged 6-23 months, dietary diversity scores were lower in the urban-poor group (mean DDS 5.02 vs 5.60, p < 0.001), with lower breastfeeding prevalence (47.5% vs 59.8%, p = 0.007). Intake of sugar-sweetened beverages and foods was higher in both urban-poor age groups (52.9% vs 30.0%, p < 0.001; 80.4% vs 59.7%, p = 0.003). In multivariable models, urban poverty increased the odds of underweight (adjusted OR 1.99 [95% CI 1.19, 3.32], p = 0.008). Higher birth weight z-scores were protective against underweight (adjusted OR 0.65 [95% CI 0.47, 0.91], p = 0.013) and wasting (adjusted OR 0.68 [95% CI 0.49, 0.94], p = 0.018), while higher birth length z-scores were protective against stunting (adjusted OR 0.65 [95% CI 0.49, 0.87], p = 0.004). Achieving minimum dietary diversity was protective against underweight (adjusted OR 0.46 [95% CI 0.23, 0.92], p = 0.029). CONCLUSION: Urban-poor children had lower anthropometric z-scores, higher underweight prevalence, poorer early-childhood dietary diversity, and higher intake of sugar-sweetened beverages and foods. Targeted socioeconomic and nutrition support is needed for urban-poor families.
The interactions between sleep difficulties and clinical features in children with rare genetic syndromes: a structural equation modelling approach.
O'Sullivan R, Thompson P, Bissell S … +10 more , Bagshaw AP, Wade K, Pearson E, Murray C, Smith K, Berry E, Crawford H, Moss J, Waite J, Richards C
BMC Pediatr · 2026 Jun · PMID 42249343 · Full text
BACKGROUND: Sleep difficulties are common in children with rare genetic syndromes and are associated with clinical features such as behaviours that challenge and mental health difficulties. This study aimed to further cl...
BACKGROUND: Sleep difficulties are common in children with rare genetic syndromes and are associated with clinical features such as behaviours that challenge and mental health difficulties. This study aimed to further clarify the role of sleep difficulties in children's clinical outcomes by (1) describing profiles of sleep difficulties in syndromes that had received little or no detailed sleep investigation, such as KBG and Kleefstra syndrome; (2) statistically controlling the interactions between clinical features when examining the associations with sleep difficulties; and (3) exploring the associations between sleep difficulties and demographic characteristics. Overall, this study aimed to describe the profiles of sleep difficulties experienced within genetic syndromes and examine the associations between sleep difficulties, clinical features, and demographic characteristics. METHODS: Caregivers of children with rare genetic syndromes (N = 251, aged 1-18 years) completed questionnaires that assessed sleep difficulties and various clinical features. Profiles of sleep difficulties were described by syndrome and compared via odds ratios to typically-developing children. Structural equation modelling was used to examine the associations between sleep difficulties, clinical features, and demographic characteristics, whilst controlling for interactions between clinical features. RESULTS: Across most syndromes, night wakings, bedtime resistance, sleep-disordered breathing, parasomnias, and sleep duration difficulties were elevated compared to typically-developing children, although several syndrome-specific profiles of sleep difficulties were also observed. Across syndromes, sleep difficulties were significantly, positively associated with anxiety and depressed mood, autism-related characteristics, overactivity and impulsivity, epilepsy severity, and the severity of physical health conditions. Of the demographic characteristics, sleep difficulties were associated with socioeconomic status. CONCLUSION: These findings have several implications. Firstly, the profiles of sleep difficulties described in syndromes with little prior sleep investigation (e.g. Coffin-Siris, KBG, and Kleefstra syndrome) highlights the need to investigate sleep in more detail in these groups and further informs the phenotypes of the syndromes. Secondly, sleep difficulties were associated with numerous clinical features, even after controlling for other predictors, highlighting the importance of sleep as a clinically modifiable variable that could improve clinical outcomes in rare syndromes. Thirdly, the association between sleep difficulties and socioeconomic status highlights the need to examine environmental determinants of poor sleep in children with rare genetic syndromes.
Lipoblastoma of the head and neck in children: a single-institution study.
Li Y, Zhang G, Sun N … +6 more , Liu Q, Zhang X, Liu Z, Wang J, Ni X, Wang S
BMC Pediatr · 2026 Jun · PMID 42249336 · Full text
OBJECTIVE: Lipoblastoma is a rare benign tumour, with a higher recurrence rate in the head and neck region owing to complex anatomy. The study summarizes the clinical features, surgical risks, and complications of paedia...
OBJECTIVE: Lipoblastoma is a rare benign tumour, with a higher recurrence rate in the head and neck region owing to complex anatomy. The study summarizes the clinical features, surgical risks, and complications of paediatric lipoblastoma in various anatomical domains of the head and neck, aiming to improve diagnosis and management. METHODS: A retrospective review was conducted on children who were treated for lipoblastoma of the head and neck between 2016 and 2023. Data assessed included location, demographics, clinical presentation, imaging, treatment, complications, recurrence, and follow-up. RESULTS: A total of 32 patients with lipoblastoma were retrospectively analyzed. These lipoblastomas located in the face (n = 2, 6.3%), nuchal region (n = 3, 9.4%), anterior neck (n = 6, 18.8%), lateral neck (n = 1, 3.1%), parapharyngeal region (n = 6, 18.8%), cervicomediastinal region (n = 4, 12.5%), and cervicoscapular-axillary region (n = 10, 31.3%). Complete resection was achieved in twenty-four cases. Residual lesions were confirmed in eight patients (25.0%). During a mean follow-up of 64.2 months, residual lesions regressed in two patients, remained stable in four, and progressed in two parapharyngeal cases that required secondary surgery via a transcervical approach. No recurrence was observed after complete resection. CONCLUSION: A location-based approach aids in understanding surgical risk and prognosis in pediatric head and neck lipoblastoma. Given the benign nature and favorable outcomes, maximal safe resection with preservation of critical neurovascular structures is recommended. Complete excision may be technically challenging in deep head and neck spaces, and careful surgical planning is essential.
Impact of an institutional guideline on post-discharge follow-up for neonatal hyperbilirubinaemia: a before-and-after cohort study.
Pipatkullachart T, Lakornpol K, Aeimcharnbanchong K
BMC Pediatr · 2026 Jun · PMID 42249305 · Full text
BACKGROUND: Neonatal hyperbilirubinaemia requires timely post-discharge follow-up to prevent bilirubin-induced neurological injury while minimising unnecessary healthcare utilisation. Implementation of the 2022 American...
BACKGROUND: Neonatal hyperbilirubinaemia requires timely post-discharge follow-up to prevent bilirubin-induced neurological injury while minimising unnecessary healthcare utilisation. Implementation of the 2022 American Academy of Pediatrics (AAP) guideline at our institution was associated with increased follow-up visits and variability in clinical practice, particularly among low-risk infants. To optimise resource utilisation while maintaining patient safety, we developed an institutional guideline integrating the 2021 Bhutani nomogram with the 2022 AAP guideline, incorporating selective follow-up criteria and simplified phototherapy threshold tools. This study evaluated the impact of the institutional guideline on follow-up practices and neonatal hyperbilirubinemia management outcomes. METHODS: We conducted a retrospective-prospective before-and-after cohort study at Panyananthaphikkhu Chonprathan Medical Center, Thailand, comparing outcomes before (June-November 2024) and after (December 2024-May 2025) guideline implementation. Eligible newborns were ≥ 35 weeks' gestation and discharged without phototherapy. Categorical variables were compared using χ or Fisher's exact tests, and continuous variables using Student's t-test. Clinical outcomes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs). All tests were two-sided, with p < 0.05 considered statistically significant. Statistical analyses were performed using Stata version 19. The primary outcome was the proportion scheduled for post-discharge follow-up, and secondary outcome was hospital readmission for hyperbilirubinaemia. RESULTS: A total of 274 neonates were included (137 pre-implementation, 137 post-implementation). Post-discharge follow-up was reduced after guideline implementation (34.3% vs 49.6%; RR 0.69, 95% CI 0.52-0.92; p 0.010). Readmission rates were similar between groups (3.6% vs 2.9%; RR 1.24, 95% CI 0.33-4.55; p = 1.00). All readmitted infants required phototherapy and no cases of exchange transfusion occurred. CONCLUSIONS: Implementation of an institutional follow-up guideline reduced post-discharge follow-up without any preliminary signal of harm. Local adaptation of international guidelines may improve efficiency and standardisation of care, particularly in resource-constrained settings.
Paediatric refraction practices: access to cyclopegia, barriers, and disparities among eye care professionals in Kuala Lumpur.
Bin Hashim E, Waheeda-Azwa H, Mokhtar A … +1 more , Morjaria P
BMC Pediatr · 2026 Jun · PMID 42243835 · Full text
BACKGROUND: Accurate paediatric refraction is essential for detecting and managing vision issues, including latent hyperopia, amblyopia, accommodative esotropia, and progressive myopia. Cycloplegic agents are critical fo...
BACKGROUND: Accurate paediatric refraction is essential for detecting and managing vision issues, including latent hyperopia, amblyopia, accommodative esotropia, and progressive myopia. Cycloplegic agents are critical for obtaining precise measurements in children, yet their use varies due to professional, regulatory, and systemic barriers. In Malaysia, where refractive services are divided between the public and private sectors, limited data exist on how eye care professionals implement cycloplegic refraction in paediatric practice. METHODS: This cross-sectional study employed a self-administered questionnaire to survey licensed ophthalmologists, optometrists, and opticians within a 50-km radius of Kuala Lumpur. Participants were recruited through electronic invitations and purposive field visits. Descriptive statistics summarised paediatric refraction practices by profession and sector, and exploratory chi-square, Fisher's Exact, and trend analyses assessed sectoral differences. RESULTS: Among 222 respondents (61.3% private; 38.7% public), analysis revealed a statistically significant sectoral divide in practice patterns (p < 0.001). Public-sector optometrists administered cycloplegia to 82.3% of children aged 5-9 years, compared with 15.7% in private practice, representing an Odds Ratio of 24.97 (95% CI 10.35-60.21; χ² = 63.84, df = 1, p < 0.001). Private opticians reported 0% cycloplegia use across all age groups, while 79.5% of private optometrists who never used cycloplegia cited 'prohibited by law.' Public ophthalmologists commonly delegated refraction, with only 8.3% performing refraction in children aged 5-9 years. Free-text responses highlighted additional barriers, including workflow constraints, limited training, and misconceptions about the role of cycloplegia. CONCLUSIONS: Paediatric refraction practices in Kuala Lumpur vary substantially across sectors and professional groups. Despite its clinical importance, cycloplegia remains under-utilised-particularly in private practice. These exploratory findings highlight the need to improve access to cycloplegic agents, clarify professional scope, and address legal and institutional barriers as priorities for strengthening paediatric eye care in Malaysia.
Clinical efficacy of single-port transscrotal laparoscopic orchiopexy combined with hernia needle for palpable undescended testes in children.
Lin Q, Li S, Zhang W … +4 more , Zhang J, Ding Q, Wang X, Shang H
BMC Pediatr · 2026 Jun · PMID 42243819 · Full text
OBJECTIVE: To investigate the clinical efficacy and safety of single-port transscrotal laparoscopic orchiopexy combined with a hernia needle (SPLT-Orchiopexy) in children with palpable middle- and low-position undescende...
OBJECTIVE: To investigate the clinical efficacy and safety of single-port transscrotal laparoscopic orchiopexy combined with a hernia needle (SPLT-Orchiopexy) in children with palpable middle- and low-position undescended testes. METHODS: A retrospective analysis was conducted on 200 children with palpable middle- and low-position undescended testes who underwent surgical treatment at our hospital between March 2021 and April 2023. Patients were categorized into two groups according to the surgical technique used: the conventional laparoscopic surgery (CLS, n = 120) group and the SP-Orchiopexy group (n = 80). Perioperative indicators, postoperative pain assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Scar outcomes at 6 months postoperatively were evaluated using the Observer Scar Assessment Scale (OSAS) and the Patient Scar Assessment Scale (PSAS), which were compared between two groups. The incidence of postoperative complications was also compared between groups. Logistic regression analysis was performed to identify factors associated with postoperative complications. RESULTS: The SPLT-Orchiopexy group showed significantly shorter operative time, less intraoperative blood loss, earlier ambulation, and shorter length of hospital stay (t = 11.15-16.91, all P < 0.001). FLACC scores at 6, 12, and 24 h postoperatively were significantly lower in the SPLT-Orchiopexy group (Z = 4.67-6.91, all P < 0.001). At 6-month follow-up, both OSAS and PSAS scores were lower in the SPLT-Orchiopexy group (Z/t = 7.31-7.65, all P < 0.001). The overall incidence of postoperative complications was lower in the SPLT-Orchiopexy group (χ² = 4.68, P = 0.031). The surgical approach did not reach statistical significance as an independent predictor of postoperative complications, but it demonstrated a trend toward reduced complication risk (Wald = 1.49, P = 0.222). CONCLUSION: SPLT-Orchiopexy may provide advantages in terms of minimal invasiveness, postoperative recovery, pain relief, cosmetic outcomes, and postoperative complications in children with palpable middle- and low-position undescended testes. Further prospective studies are warranted to validate these findings.
Clinical spectrum and documentation patterns of cerebral palsy among children at Arthur Davison Children's Hospital and Kitwe Teaching Hospital, Zambia: a retrospective record review.
Sinkala A, Ngala EM, Mandona E … +1 more , Lungu S
BMC Pediatr · 2026 Jun · PMID 42243818 · Full text
BACKGROUND: Cerebral palsy (CP) is the most common cause of childhood physical disability and is frequently accompanied by comorbidities such as epilepsy and feeding difficulties. In many low-resource settings, hospital-...
BACKGROUND: Cerebral palsy (CP) is the most common cause of childhood physical disability and is frequently accompanied by comorbidities such as epilepsy and feeding difficulties. In many low-resource settings, hospital-based evidence describing CP clinical subtypes, associated impairments, and care patterns is limited, constraining service planning for rehabilitation and pediatric neurology. We aimed to describe the clinical spectrum, associated impairments, interventions, and documentation patterns of CP at two tertiary referral hospitals in Zambia's Copperbelt Province. METHODS: We conducted a multi-centre, hospital-based retrospective record review of children with clinically documented CP at Arthur Davison Children's Hospital (ADCH), Ndola, and Kitwe Teaching Hospital (KTH), Kitwe. CP motor subtype (spastic, dyskinetic, ataxic, mixed) and topographical distribution were extracted where documented. Associated impairments (including epilepsy) and management (rehabilitation and medications) were recorded based on explicit documentation, with undocumented fields treated as missing rather than absent. Categorical variables were summarized as frequencies and percentages. Between-hospital comparisons used chi-square or Fisher's exact tests. Statistical significance was set at α = 0.05. RESULTS: A total of 195 children with CP were identified (ADCH n = 150; KTH n = 45). This study did not estimate incidence or prevalence. Among records with documented subtype, spastic CP predominated at both sites, while dyskinetic CP was the second most frequently documented subtype and accounted for a higher proportion at ADCH than at KTH. CP motor subtype distributions differed significantly between hospitals (χ²=8.28, p = 0.041). Topographical distribution did not differ significantly (χ²=2.51, p = 0.285), with quadriplegia most commonly recorded at both sites. Epilepsy prevalence differed markedly among records with documented epilepsy status (KTH 40.0% vs. ADCH 84.1%; Fisher's exact p = 0.000025; OR for KTH vs. ADCH = 0.126). Physiotherapy was frequently documented at both hospitals. Documentation completeness varied substantially across sites, particularly for epilepsy status, associated impairments, and functional severity measures (GMFCS) at ADCH. CONCLUSIONS: In this hospital-based cohort from Zambia's Copperbelt Province, CP subtype patterns differed between ADCH and KTH, and epilepsy was highly prevalent (especially at ADCH), underscoring the need for integrated rehabilitation and epilepsy services. Substantial variability in documentation completeness suggests a systems-level opportunity to standardize CP assessment and recording to support clinical management and service planning.
Determinants of BMI in parents and children: the roles of food insecurity and Mediterranean diet adherence.
Açar Kuru Y, Esin K, Ayyıldız F
BMC Pediatr · 2026 Jun · PMID 42243775 · Full text
BACKGROUND: Increasing food insecurity among children is associated with poorer diet quality, unhealthy dietary patterns, and adverse health outcomes. This study aimed to examine the relationships between food insecurity...
BACKGROUND: Increasing food insecurity among children is associated with poorer diet quality, unhealthy dietary patterns, and adverse health outcomes. This study aimed to examine the relationships between food insecurity, adherence to the Mediterranean diet, childhood obesity, and socio-demographic factors among school-aged children in Türkiye. METHODS: This cross-sectional study was conducted in Türkiye, among 775 parents aged 18-65 and their children aged 6-14 who were attending primary and secondary school. Data were collected via an online survey. The questionnaire assessed demographic and socio-economic characteristics, anthropometric measurements of parents and children, meal patterns, adherence to the Mediterranean diet, and food insecurity status. Household food insecurity status was assessed using the 18-item USDA Household Food Security Survey Module (HFSSM), and children's adherence to the Mediterranean diet was assessed using the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). The obesity status of children was assessed using body mass index (BMI)- for-age percentile values from the WHO growth reference standards. RESULTS: Food insecurity was identified in 27.9% of households. Households experiencing food insecurity had larger household sizes, more children, and fewer employed individuals (p < 0.01). The prevalence of overweight and obesity was higher among parents experiencing food insecurity, and parental BMI was significantly associated with food insecurity (p < 0.05). Among children, the food-insecure group had higher rates of overweight and obesity based on BMI-for-age classification (p < 0.05). No significant difference in total KIDMED scores was observed across food insecurity status or BMI categories (p > 0.05). In the regression analysis, the number of children and total income were significantly associated with household food insecurity (p = 0.001). CONCLUSION: This study shows that food insecurity among school-aged children in Türkiye remains an important public health issue. It was associated with a higher prevalence of overweight and obesity in both parents and children, as well as with larger household size and lower socio-economic status. The findings indicate the need to assess childhood food insecurity and to implement targeted interventions for at-risk groups.
Antibiotic lock therapy for catheter-related bloodstream infections in pediatric hemato-oncology: a retrospective analysis.
Kaçabeti B, Şahin RS, Taşpınar P … +6 more , Erbaş G, Karaman S, Karakaş Z, Somer A, Hançerli S, Tanyıldız G
BMC Pediatr · 2026 Jun · PMID 42243769 · Full text
PURPOSE: This study aims to comprehensively evaluate the efficacy and safety of Antibiotic Lock Therapy (ALT) in pediatric patients and to better clarify its role in catheter management. METHODS: This retrospective singl...
PURPOSE: This study aims to comprehensively evaluate the efficacy and safety of Antibiotic Lock Therapy (ALT) in pediatric patients and to better clarify its role in catheter management. METHODS: This retrospective single-center study was conducted between October 2021 and October 2024. Of 53 eligible patients, 47 received ALT and constituted the primary analysis population for treatment outcomes; 6 patients underwent immediate catheter removal without ALT and were excluded from the ALT efficacy analysis. Demographic, clinical, and microbiological data from all patients were collected. RESULTS: A total of 70 catheter-related bloodstream infection (CRBSI) episodes were identified among 47 patients, corresponding to an incidence rate of 12.79 per 1,000 catheter-days. The most frequently isolated pathogens were coagulase-negative staphylococci (CoNS), followed by gram-positive bacilli and Klebsiella spp. Antibiotic Lock Therapy (ALT) was administered to 47 patients and was successful in 70.2% of these cases (33/47) (p = 0.038). Among patients who did not receive ALT and required catheter removal, Klebsiella spp. and methicillin-resistant CoNS (MRCoNS) were the predominant organisms associated with sepsis and infection. In patients requiring catheter removal despite receiving ALT, gram-negative organisms were the most common pathogens, followed by gram-positive bacilli. Notably, infections most frequently developed between days 11 and 45 of catheter use, indicating a critical high-risk window for catheter-related infections. CONCLUSION: Catheter-related infections remain a significant clinical challenge in pediatric hematology-oncology patients. Our findings suggest that ALT was associated with catheter retention in a considerable proportion of patients; however, given the retrospective design and potential for confounding by indication, this observation should be interpreted cautiously rather than as a definitive efficacy claim. The identification of a high-risk period between days 11 and 45 may support closer monitoring and earlier intervention. Further prospective studies with standardized selection criteria are required to validate and standardize the use of ALT in this vulnerable population.
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