JournalTOCs

Children
Number of Followers: 0

This is an Open Access Journal

Open Access journal
ISSN (Online) 2227-9067
Published by MDPI

[258 journals]

Children, Vol. 10, Pages 1831: Predictors of Neurodevelopment in
Microcephaly Associated with Congenital Zika Syndrome: A Prospective Study
- Authors: Adriana M. Mattos, Valmir N. Rastely-Junior, Matheus M. Pires, Juan P. Aguilar, Millani S. A. Lessa, Clarina Regis, Mariana Wanderley, Julio Leony, Joseane Bouzon, Verena Ballalai, Carina Vieira, Gustavo B. S. Carvalho, João R. M. Almeida, Nivison Nery, Rodrigo Leal, Federico Costa, Albert I. Ko, Mitermayer G. Reis, Jamary Oliveira-Filho
  First page: 1831
  Abstract: The municipality of Salvador, situated in Brazil, distinguished itself as the epicenter of the emergence of microcephaly related to congenital manifestations of Zika syndrome. Despite the anticipated significant developmental setbacks in these children, research has indicated a varied range of outcomes, with certain instances even reflecting minimal developmental delay. Our objective was to pinpoint determinants that could forecast developmental anomalies in children diagnosed with microcephaly associated with congenital Zika syndrome (CZS). Methodology: A forward-looking clinical and neurodevelopmental examination was conducted focusing on neonates diagnosed with microcephaly with CZS, birthed between September 2015 and April 2016 at the Hospital Geral Roberto Santos, in Salvador city. That infants were monitored up to their third year by a multiprofessional team. Child development was assessed using the composite Bayley III score. Undertaken by two blinded experts, cranial CT scan analysis was performed during the neonate period for the detection of brain abnormalities and to quantify ventricle enlargement, measured by Evans’ index (EI). Results: Fifty newborns were evaluated with a median head circumference of 28 cm (interquartile range 27–31 cm). EI was associated with neurodevelopmental delay at three years and remained significant after adjustment for head circumference. A 0.1-point increase in EI was associated with a delay of 3.2 months in the receptive language (p = 0.016), 3.4 months in the expressive language (p = 0.016), 3.4 months in the cognitive (p = 0.016), 2.37 months in the gross motor (p = 0.026), and 3.1 months in the fine motor (p = 0.021) domains. Conclusions: EI predicted neurodevelopmental delay in all Bayley domains in children with microcephaly associated with CZS.
  Citation: Children
  PubDate: 2023-11-21
  DOI: 10.3390/children10121831
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1832: Long-Term Effects of Child Early Surgical
Ventricular Septal Defect Repair on Maternal Stress
- Authors: Jennifer Gerlach, Elena S. Decker, Anne-Christine Plank, Stefan Mestermann, Ariawan Purbojo, Robert A. Cesnjevar, Oliver Kratz, Anna Eichler
  First page: 1832
  Abstract: The ventricular septal defect (VSD) represents the most common congenital heart defect (CHD). The diagnosis of and cardiac surgery for their child’s VSD are highly stressful experiences for parents; especially mothers, who are at risk of developing long-lasting stress-related symptoms. This study examined long-term alterations in maternal stress including self-reported psychological and biophysiological stress levels in a case-control design. We investigated 24 mothers of children with an isolated, surgically corrected VSD compared to non-affected controls. Maternal self-reports on psychopathology, everyday stress, parenting stress and hair cortisol concentrations (HCC) were measured during children’s primary school age (6–9 years, t1) and early adolescence (10–14 years, t2). In maternal self-reports, psychopathology and stress symptoms in the VSD-group and controls were comparable at t1, whereas at t2, mothers in the VSD-group even showed a decrease in psychopathology. Maternal HCC levels in the VSD-group were significantly lower (hypocortisolism) than HCC levels of controls at t1. This effect was no longer observed at t2 reflecting an approximation of HCC levels in the VSD-group to controls’ levels. This study highlights the potential for improved stress hormone balance and psychological well-being in mothers following their child’s surgical VSD repair. However, the need for parent-centered interventions is discussed, particularly during peri-operative phases and in early child developmental stages.
  Citation: Children
  PubDate: 2023-11-21
  DOI: 10.3390/children10121832
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1833: Sleep and Inflammation during COVID-19
Virtual Learning in Adolescents with Overweight or Obesity
- Authors: Lindsay M. Stager, Casie H. Morgan, Caroline S. Watson, Aaron D. Fobian
  First page: 1833
  Abstract: (1) Background: Adolescents present as a high-risk group for a range of adverse physical health outcomes during the pandemic, including sleep and C-reactive protein (CRP) levels. As adolescents with overweight or obesity (OWOB) present as an even higher risk group, the present study assessed relationships between sleep and CRP levels before and during COVID-19 in adolescents with OWOB. (2) Methods: Fourteen adolescents with OWOB participated in a pre-COVID1, pre-COVID2, and during-COVID-19 lab visit, measuring sleep and CRP levels. The sample size was limited by the number of participants who provided data before COVID-19 and who were enrolled in virtual school during the recruitment phase. However, our power analyses indicated needing a minimum of 10 participants to achieve adequate power. Pre-COVID1, pre-COVID2, and during-COVID-19 normative expected CRP levels were calculated based on age, sex, race, and body mass index percentile-matched data. Analyses compared pre-COVID1 and pre-COVID2 sleep with during-COVID-19 sleep, during-COVID-19 sleep and during-COVID-19 CRP levels, during-COVID-19 CRP levels with normative expected during-COVID-19 CRP levels, change in CRP levels from pre-COVID1 and pre-COVID2 to during-COVID-19 with normative expected CRP levels during those time periods, and change in CRP levels before COVID-19 with change in CRP levels during COVID-19. (3) Results. During COVID-19, participants experienced decreased sleep efficiency (p = 0.001), later wake time (p < 0.001), longer time in bed (p = 0.021), and onset latency (p = 0.004), compared to pre-COVID1, and decreased sleep efficiency (p = 0.002), longer onset latency (p = 0.006), and later wake time (p < 0.001) and bedtime (p = 0.016) compared with pre-COVID2. During-COVID-19 CRP levels were positively correlated with during-COVID-19 wake times (p = 0.01) and times in bed (p = 0.008). During-COVID-19 CRP levels were greater than normative expected CRP levels (p < 0.001). CRP levels increased more from pre-COVID1 and pre-COVID2 to during-COVID-19 than normative expected changes in CRP levels (p < 0.003). Changes in CRP levels before and during COVID-19 were not significantly different. (4) Conclusions. These findings highlight the consequential effects of COVID-19, including impairments in sleep, on adolescents with OWOB. CRP levels increased more (~5 mg/L) during COVID-19 than normative expected change.
  Citation: Children
  PubDate: 2023-11-21
  DOI: 10.3390/children10121833
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1834: Comparison of Easy-to-Use Bronchiolitis
Scores in the Post-COVID-19 Era—An Observational Study
- Authors: María del Mar Martín-Latorre, Leticia Martínez-Campos, Manuel Martín-González, Gracia Castro-Luna, David Lozano-Paniagua, Bruno José Nievas-Soriano
  First page: 1834
  Abstract: In the post-restrictions COVID-19 period, the incidence of bronchiolitis in infants has increased considerably. Several scores determine the degree of severity of the bronchiolitis episode, but few are clinician-friendly. The main aim of this research was to find the easy-to-use score that most accurately estimated the severity of patients’ infections according to their clinical situations and most accurately predicted the need for hospital admission. An observational cross-sectional study was performed in a reference pediatric hospital during the post-restrictions period of the COVID-19 pandemic (2021 and 2022). A comparison was made between the severity estimate provided by five international acute bronchiolitis scales and the clinical severity of the acute bronchiolitis episode. Three hundred and seventy-seven patients participated in the investigation, with a mean age of 5.68 months; 68.7% of the participants had a mild episode of bronchiolitis, 24.5% had a moderate episode, and 6.9% had a severe episode. The severity estimated by the Tal scale modified by McCallum showed a statistically significant correlation with the clinical severity established by clinical criteria (0.836; p < 0.001). It showed a high correlation with other international scores, such as the Wang score (0.820; p < 0.05) and the Wood–Downes–Ferrés score (0.936; p < 0.001). In the multivariate analysis, the constituent variables of the modified Tal score appeared in the final model that predicts the need for hospital admission. In the context of increased incidence after COVID-19, the Tal score modified by McCallum is an easy-to-use measuring instrument that presents an excellent concordance with the clinical severity estimated at first care contact. It also offers a more significant prediction of the need for hospital admission.
  Citation: Children
  PubDate: 2023-11-21
  DOI: 10.3390/children10121834
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1835: Parent Perspectives: Part
2—Considerations for the Transition Home Post-NICU Discharge
- Authors: Jessica N. DiBari, LaToshia Rouse
  First page: 1835
  Abstract: This paper is part two of a series of papers written by the mothers of Neonatal Intensive Care Unit (NICU) graduates. The companion paper, “Parent Perspectives: Part 1—Considerations for Changing the NICU Culture”, considers all aspects of the NICU experience and provides recommendations for interventions and improvements from a life-course perspective while families are in the NICU. In part two, the focus is the transition home post-NICU stay. The time after NICU discharge is a critical and sensitive developmental period for NICU babies and their families, and an important life course transition. This paper provides a parent’s perspective of how to improve the transition home post-NICU stay. Our perspectives draw on the Life Course Health Development approach, which regards health as an active process that is developed over time based on a person’s internal biologic and physiologic systems, their external environment and circumstances, and the interactions or relationships between them. This paper describes a collaborative care model where parents and their healthcare teams work together to develop shared care plans. It also describes how we can build trust and family capacity to support long-term care, ensure family well-being, and link families to needed resources and support that can ease the transition from the NICU back to the home and optimize family health trajectories.
  Citation: Children
  PubDate: 2023-11-22
  DOI: 10.3390/children10121835
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1836: “Multisystem Inflammatory Syndrome in
Children”-Like Disease after COVID-19 Vaccination (MIS-V) with
Potential Significance of Functional Active Autoantibodies Targeting
G-Protein-Coupled Receptors (GPCR-fAAb) for Pathophysiology and Therapy
- Authors: Marius Schmidt, Steven Hébert, Gerd Wallukat, Rolf Ponader, Tobias Krickau, Matthias Galiano, Heiko Reutter, Joachim Woelfle, Abbas Agaimy, Christian Mardin, André Hoerning, Bettina Hohberger
  First page: 1836
  Abstract: Background: An infection with SARS-CoV-2 can trigger a systemic disorder by pathological autoimmune processes. A certain type of this dysregulation is known as Multisystemic inflammatory syndrome in children (MIS-C). However, similar symptoms may occur and have been described as Multisystemic inflammatory syndrome after SARS-CoV-2 Vaccination (MIS-V) following vaccination against SARS-CoV-2. We report the case of a 12-year-old boy who was identified with MIS-C symptoms without previous SARS-CoV-2 infection after receiving two doses of the Pfizer–BioNTech COVID-19 vaccine approximately one month prior to the onset of symptoms. He showed polyserositis, severe gastrointestinal symptoms and, consequently, a manifestation of a multiorgan failure. IgG antibodies against spike proteins of SARS-CoV-2 were detected, indicating a successful vaccination, while SARS-CoV-2 Nucleocapsid protein antibodies and SARS-CoV-2 PCR were not detected. Several functional, active autoantibodies against G-protein-coupled receptors (GPCR-fAAb), previously associated with Long COVID disease, were detected in a cardiomyocyte bioassay. Immunosuppression with steroids was initiated. Due to side effects, treatment with steroids and later interleukin 1 receptor antagonists had to be terminated. Instead, immunoadsorption was performed and continued with tacrolimus and mycophenolic acid therapy, leading to improvement and discharge after 79 days. GPCR-fAAb decreased during therapy and remained negative after clinical curing and under continued immunosuppressive therapy with tacrolimus and mycophenolic acid. Follow-up of the patient showed him in good condition after one year. Conclusions: Infection with SARS-CoV-2 shows a broad and severe variety of symptoms, partly due to autoimmune dysregulation, which, in some instances, can lead to multiorgan failure. Despite its rarity, post-vaccine MIS-C-like disease may develop into a serious condition triggered by autoimmune dysregulation. The evidence of circulating GPCR-fAAb and their disappearance after therapy suggests a link of GPCR-fAAb to the clinical manifestations. Thus, we hypothesize a potential role of GPCR-fAAb in pathophysiology and their potential importance for the therapy of MIS-C or MIS-V. However, this observation needs further investigation to prove a causative correlation.
  Citation: Children
  PubDate: 2023-11-22
  DOI: 10.3390/children10121836
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1837: How Can Specialist Advice Influence the
Neuroimaging Practice for Childhood Headache in Emergency Department'
- Authors: Alberto M. Cappellari, Gaia Bruschi, Gisella B. Beretta, Maria T. Molisso, Giuseppe Bertolozzi
  First page: 1837
  Abstract: Differentiating between primary and secondary headaches can be challenging, especially in the emergency department (ED). Since symptoms alone are inadequate criteria for distinguishing between primary and secondary headaches, many children with headaches undergo neuroimaging investigations, such as brain CT and MRI. In various studies, the frequency of neuroimaging utilization is influenced by several factors, including teaching status, ownership, metropolitan area, insurance status, and ethnicity of patients. However, only a few studies have considered the role of specialist consultations in ordering neuroimaging studies on childhood headaches. We report the contributions of different specialists to the evaluation of children with headaches admitted to the ED and their influence on neuroimaging decisions. We retrospectively reviewed the medical reports of paediatric patients who presented with headaches to the paediatric ED of the Ospedale Maggiore Policlinico of Milano between January 2017 and January 2022. Overall, 890 children with headaches were evaluated (mean age: 10.0 years; range: 1 to 17 years). All patients were examined by the ED paediatricians, while specialist consultations were required for 261 patients, including 240 neurological (92.0%), 46 ophthalmological (17.6%), and 20 otorhinolaryngological (7.7%) consultations. Overall, 173 neuroimaging examinations were required, of which 51.4 and 48.6% were ordered by paediatricians and neurologists, respectively. In particular, paediatricians required 61.4% of brain CT scans, and neurologists required 92.0% of brain MRI scans. In conclusion, paediatricians were responsible for the management of most children with headaches admitted to the ED, while specialist consultations were required only in about a third of the cases. Although there was no significant difference in the number of neuroimaging studies ordered by specialists, brain CT scans were most often used by paediatricians, and MRI scans by neurologists.
  Citation: Children
  PubDate: 2023-11-22
  DOI: 10.3390/children10121837
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1838: Prescription Practices of Cannabinoids in
Children with Cerebral Palsy Worldwide—A Survey of the Swiss
Cerebral Palsy Registry
- Authors: Sandra Hunziker, Federico Morosoli, Kathrin Zuercher, Anne Tscherter, Sebastian Grunt
  First page: 1838
  Abstract: Cannabinoids are prescribed to children with cerebral palsy despite limited evidence. We aimed to assess cannabinoid prescribing practices in children with cerebral palsy, focusing on indications, types of preparations used, and tolerability. Furthermore, we investigated how physicians acquire knowledge about cannabinoid medication. We asked physicians with expertise in the care of children with cerebral palsy about their prescribing practices for cannabinoids. Data were collected through an online survey, which was distributed by email. In addition to the demographic information of participants, we also inquired about the indications for the prescription of cannabinoids, experiences regarding efficacy, and observed side effects of the therapy. Seventy physicians from Europe, North America, and Australia completed the survey. Forty-seven participants were experienced in treating of children with cerebral palsy with cannabinoids. The most common indication was epilepsy (69%), followed by spasticity (64%) and pain (63%). The preparations and doses prescribed varied considerably. Half of the participants evaluated the effect of the cannabinoids as moderate. Twenty-nine physicians reported side effects, most frequently, drowsiness (26%), somnolence (19%), fatigue (13%), and diarrhea (13%). Despite the lack of evidence to date, cannabinoids are used to treat children with cerebral palsy in a wide variety of indications. Randomized controlled trials in this vulnerable patient group are therefore of utmost importance.
  Citation: Children
  PubDate: 2023-11-23
  DOI: 10.3390/children10121838
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1839: Antiplatelet Effect of Melatonin through
Breastfeeding: A Pediatric Case Report
- Authors: Sonia Iavarone, Michela Massoud, Giovina Di Felice, Fabio Pulcinelli, Novella Rapini, Matteo Luciani
  First page: 1839
  Abstract: We present a pediatric case of the antiplatelet effect of melatonin taken through breast milk in an 18-month-old child. The child was referred to our hematology outpatient clinic because of bleeding episodes that she presented since birth. Blood tests excluded the presence of blood coagulation diseases. The family history was negative for bleeding disorders. The child did not consume any drugs, food supplements, herbal teas or infusions. We performed an aggregation platelet test, which showed a reduced platelet aggregation. Shortly before, the baby had been breastfed. We speculated that breast milk could interfere with the result of the test; therefore, we decided to repeat the test in a fasting state. This time the test showed a normal platelet aggregation time. We learned that the child’s mother was taking a mixture of valerian and melatonin. Thus, we decided to suspend maternal intake of melatonin and perform a new platelet aggregation test after three months. The test results were negative. After the suspension of melatonin, the patient did not present further bleeding events. In this case, melatonin, through the inhibition of platelet aggregation, had an important role on the hemostatic system of the child. Melatonin is considered as a dietary supplement and is mostly available as an alternative medicine without formal prescription and dosage regulation. It is important, especially during breastfeeding, to investigate personal and medication history, including also homeopathic remedies or dietary supplements.
  Citation: Children
  PubDate: 2023-11-23
  DOI: 10.3390/children10121839
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1840: Overburden in Caregivers of Chronically Ill
Adolescents: A Comparative Study between Pulmonological and
Endocrinological Diseases
- Authors: Elvira García-Marín, Selene Valero-Moreno, Konstanze Schoeps, Silvia Postigo-Zegarra, Marián Pérez-Marín
  First page: 1840
  Abstract: Chronic pediatric disease has a major impact on the life of a child and his or her family. In this sense, the figure of the main caregiver is relevant, who may present adjustment difficulties before the disease, accompanied by high levels of stress and emotional discomfort, which interfere with the adolescent’s adjustment before the new situation. The aim of this research was to carry out a comparative study among caregivers of adolescents with various diseases, analyzing the risk and protective factors for the stress presented by this population. For this purpose, a sample of 406 main caregivers of adolescents with an endocrinological or pneumological disease from different hospitals in Valencia was used, where characteristics related to the disease, attachment, type of family, and emotional distress of these caregivers were considered. In general, the results show higher levels of stress in caregivers of adolescents with an endocrinological disease, specifically DM1, and found significant predictors of anxiety-depressive symptomatology, the need for approval, and several variables related to the disease. These data reveal the importance of providing comprehensive care to the family system, offering health skills to overcome diseases, and reinforcing the protective factors offered by the family system.
  Citation: Children
  PubDate: 2023-11-23
  DOI: 10.3390/children10121840
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1841: Pediatric Anesthesia Providers’
Perspective on the Real-Life Implementation of the Philips Visual Patient
Avatar: A Qualitative Study
- Authors: Justyna Lunkiewicz, Daniel Fries, Petar Milovanovic, Christoph B. Noethiger, David W. Tscholl, Greta Gasciauskaite
  First page: 1841
  Abstract: The Philips Visual Patient Avatar represents an alternative method of patient monitoring that, according to computer-based simulation studies, enhances diagnostic accuracy and confidence and reduces workload. After its clinical integration, we assessed pediatric anesthesia providers’ perspectives on this technology. This is a single-center qualitative study, conducted at the University Hospital Zurich using in-depth individual interviews. We aimed to identify the advantages and limitations of the Visual Patient Avatar in pediatric anesthesia and to assess children’s and parents’ reactions from caregivers’ perspectives. Thematic analysis was used to identify the dominant themes. Fourteen members of the institution’s pediatric anesthesia team were interviewed. The most prevalent themes were children’s positive reactions towards the Visual Patient Avatar (92.9%) and enhanced speed in problem identification (71.4%). Additionally, 50% of participants reported finding the Visual Patient Avatar useful for diverting children’s attention during anesthesia induction, and 50% suggested that its vital sign thresholds should be adaptable for different age groups. The study revealed that the Visual Patient Avatar was recognized as a tool in pediatric anesthesia, enabling prompt identification of underlying issues and receiving positive feedback from both children and parents. The most commonly voiced wish for improvement in the study was the ability to customize the Visual Patient Avatar’s thresholds for different age groups.
  Citation: Children
  PubDate: 2023-11-24
  DOI: 10.3390/children10121841
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1842: Comparative Analysis of the GH/IGF-1 Axis
during the First Sixth Months in Children with Low Birth Weight
- Authors: Luciana Pessoa Maciel Diniz, Taisy Cinthia Ferro Cavalcante, Amanda Alves Marcelino da Silva
  First page: 1842
  Abstract: Objective: To analyze the relation between alterations in the growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis during the first 6 months of life and weight in children born in the lower-middle São Francisco region. Methods: This is an analytical cohort and exploratory. Thirty children, were formed two groups, one of low birth weight children (LBW, n = 15) and another of normal weight (NBW = 15) were initially identified in a hospital and reapproached at 3 and 6 months of age. Birth weight and alterations in GH/IGF-1 curves were measured at birth and the third and sixth months of life. Results: Weight gain during the 6 months of follow-up in newborns with a low birth weight was greater compared to newborns with a normal birth weight. All children who were born with a low birth weight had an altered GH/IGF-1 curve at birth (p = 0.002). Most newborns with a low birth weight maintained the alteration in the GH/IGF-1 curve at the third month of life (p = 0.027). Regarding the GH/IGF-1 curve at the sixth month, alteration persisted in greater proportion among children with a low birth weight. Conclusions: Alterations in insulin resistance markers, demonstrated by increased GH without a proportional increase in IGF-1, were observed to be significant in children with a low birth weight with greater adiposity in this group which may increase the risk of metabolic diseases in later life.
  Citation: Children
  PubDate: 2023-11-24
  DOI: 10.3390/children10121842
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1843: The Role of Erythropoietin in Preventing
Anemia in the Premature Neonate
- Authors: Oana Cristina Costescu, Eugen Radu Boia, Marioara Boia, Daniela Mariana Cioboata, Florina Marinela Doandes, Nicoleta Lungu, Mihai Dinu, Emil Radu Iacob, Aniko Maria Manea
  First page: 1843
  Abstract: Recombinant human erythropoietin (rhEPO) treatment is an alternative to red blood cell (RBC) transfusions in neonates presenting anemia of prematurity (AOP). This study assesses the impact of early rhEPO administration on AOP (any stage) incidence, as well as the incidence of individual AOP stages and RBC transfusions. Out of 108 preterm neonates, 49 were administered rhEPO and compared to the remaining group using univariate and multivariate analyses. Univariately, gestational age (GA), birth weight (BW), hemoglobin (Hb), hematocrit (HCT), RBC levels, and iron administration were significantly associated with AOP (p < 0.05 each); however, only the latter remained significant following multivariate analysis (AOR: 2.75, 95% CI, 1.06–7.11). Multinomial analysis revealed rhEPO treatment was associated with a near three-fold reduction in moderate AOP incidence (OR: 0.36, 95% CI, 0.15–0.89). Furthermore, ANCOVA revealed positive correlations between rhEPO administration and 21-day Hb (p < 0.01), HCT (p < 0.05), and EPO (p < 0.001) levels. The results confirm previously reported benefits of rhEPO treatment, such as reduced moderate AOP incidence and increased Hb, HCT, and serum EPO levels.
  Citation: Children
  PubDate: 2023-11-24
  DOI: 10.3390/children10121843
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1844: Involvement and Autonomy of Minors in
Medical Settings: Perceptions of Children Undergoing Surgery and Parents
- Authors: Francisco J. Rodríguez-Domínguez, Teresa Osuna-García, Alberto Guillén, María D. Pérez-Cárceles, Eduardo Osuna
  First page: 1844
  Abstract: Informed consent presupposes competence and represents a formal decision by an informed person who has the legal capacity to accept medical action or participate in research. Our aim was to analyze the perceptions of minors and their parents about the age at which they consider that a minor is competent for making health decisions. A descriptive observational study was carried out in 302 minors between 12 and 17 years of age undergoing elective surgery, and 302 parents (range 30 to 62 years). Two semistructured questionnaires were designed, one for the minors and the other, for the parents. A total of 20.1% of minors and 31.1% of parents believe that patients should not make decisions related to their health until they are 18 years old. A total of 74.9% of the minors surveyed consider that from 16 years of age, the minor is empowered to make decisions. In parents, this percentage is 60%. In the pediatric setting, each case and situation must be examined individually to determine if the minor meets the condition of maturity to decide. The ideal is to promote the minor’s participation in decision-making, giving them the opportunity to participate in the process in a manner appropriate to their capacity.
  Citation: Children
  PubDate: 2023-11-24
  DOI: 10.3390/children10121844
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1845: Management of Pediatric Foreign Body
- Authors: Honoria Ocagli, Danila Azzolina, Andrea Francavilla, Emrah Aydin, Solidea Baldas, Alejandro Cocciaglia, Hugo Rodriguez, Dario Gregori, Giulia Lorenzoni, Maayan Gruber, the COVID-19-Susy Group the COVID-19-Susy Group
  First page: 1845
  Abstract: The COVID-19 pandemic has had direct and indirect effects on daily life. In hospitals, the impact of the pandemic was observed in the diagnostic and therapeutic workflow. In this work, we explored potential changes in activities related to the treatment of foreign body injuries (FBIs) in children and the behavioral habits of physicians during the first wave of the pandemic. An online survey was conducted among physicians of the Susy Safe network. The survey comprised items related to respondent information, reference center characteristics, the treatment of FBIs during the COVID-19 pandemic, and a modified COVID-19 Anxiety Scale (CAS). The survey was distributed among the Susy Safe project international network surveillance registry for FBIs. A total of 58 physicians responded to the survey, including 18 (32%) from Europe and 16 (28%) from South America. The respondents indicated that the estimated number of aspirated foreign bodies during the pandemic was lower than or the same as that before the pandemic (43, 74%), and the same was observed for ingested foreign bodies (43, 74%). In univariable logistic regression, no single predictor was associated with a delay in routine care for children or an increasing tendency of medical personnel to avoid procedures. The workflow of physicians involved in the management of FBIs in children has not changed drastically during the COVID-19 pandemic, especially in emergency departments.
  Citation: Children
  PubDate: 2023-11-24
  DOI: 10.3390/children10121845
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1846: Psychiatric Hospitalization for
Psychopathological Disorders and Self-Injurious Behaviors in Italian
Children and Adolescents during COVID-19
- Authors: Maria Pontillo, Deny Menghini, Roberto Averna, Milena Labonia, Giulia Lazzaro, Maria Cristina Tata, Stefano Vicari
  First page: 1846
  Abstract: The evidence shows that the COVID-19 pandemic dramatically increased the number of urgent psychiatric consultations for children and adolescen for children and adolescentss in hospital emergency departments (EDs). However, what needs to be further investigated are the characteristics of psychiatric hospitalization in children and adolescents admitted to the Child and Adolescent Neuropsychiatry Unit wards in EDs. Specifically, this retrospective study aimed to examine changes in (i) the number of inpatients and (ii) the distribution of psychopathological disorders and self-injurious behaviors in our Child and Adolescent Neuropsychiatry Unit ward during the COVID-19 lockdown in Italy (March–June 2020; October 2020–January 2021) compared with the same months of previous years. We found a significantly lower number of inpatients during the first four quarantine months than the first four reference months and a higher number of inpatients during the second four quarantine months than the second four reference months. Additionally, we found an increased frequency of mood disorders, non-suicidal self-injurious behavior, and suicidal ideation during the COVID-19 lockdown compared to the reference periods. Our findings underline the need to develop psychological healthcare services for future emergency periods in order to identify and treat psychological distress in children and adolescents early, reducing the risk of psychiatric hospitalization.
  Citation: Children
  PubDate: 2023-11-24
  DOI: 10.3390/children10121846
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1847: Linguistic Skills and Socioeconomic Status:
Two Oft Forgotten Factors in Child Metaphor Comprehension
- Authors: Nausicaa Pouscoulous, Alexandra Perovic
  First page: 1847
  Abstract: Metaphor understanding can be tricky for children until mid-childhood, yet some research suggests that pre-schoolers are already competent. Many factors have been proposed to play a role in the development of metaphor comprehension. In this study we focus on two obvious contenders that have been overlooked in recent years: general language skills and socioeconomic status (SES). Two-hundred and seventy-two children, aged from 2;11 to 11;04 (146 girls) were recruited from 21 British schools and nurseries. Their SES was established using a composite measure linked to school location, while general language skills were assessed using a standardised measure of vocabulary comprehension. Novel metaphor comprehension was tested with a simple reference assignment task. Our study confirms that children interpret novel metaphors confidently from the age of 4. Our findings indicate that novel metaphor understanding is associated with age and, importantly, that it is linked to vocabulary skills, as well as SES, but not gender. These two factors should therefore be considered in future research on metaphor development, as well as intervention and education.
  Citation: Children
  PubDate: 2023-11-25
  DOI: 10.3390/children10121847
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1848: Does the Association between Preschool
Media Use and Language Difficulties at School Entry Vary by First Language
of the Child and Parental Education'
- Authors: Chiara Maria Hammrich, Simon Götz, Monika Daseking, Simone Weyers
  First page: 1848
  Abstract: Background: Both media use and social background affect children’s language development. The aim of this study was to explore the association between media use and different aspects of language difficulties (grammar, auditory memory, articulation) and social background (first language (FL), parental education (PE)) in more detail. Methods: We analyzed data from 4015 children from the 2013/14 school entry examination in a Western German city. Media use, FL, and PE were assessed by social history, and language difficulties by sociopediatric screening. We calculated Prevalence Ratios with a 95% Confidence Interval for language difficulties by media use and FL/PE; compared models with and without interaction terms; and estimated the predicted prevalence of language difficulties by media use and FL/PE. Results: Children with non-German FL/low PE had a higher media use and more language difficulties. However, the gradual association between media use and grammatical abilities/recommendation of training was more pronounced in children with German FL and medium/high PE. e.g., especially in the preposition subtest. Conclusions: The association between media use and language difficulties varies regarding different aspects of social background and language difficulties. Still, extensive media use is linked with language difficulties for all children. The media competence of young families remains crucial in times of digitalization.
  Citation: Children
  PubDate: 2023-11-25
  DOI: 10.3390/children10121848
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1849: Maternal Pre-Pregnancy BMI and Gestational
Weight Gain Are Associated with Preschool Children’s
Neuropsychological Outcomes in the APrON Cohort
- Authors: Gillian England-Mason, Alida Anderson, Rhonda C. Bell, Fatheema B. Subhan, Catherine J. Field, Nicole Letourneau, Gerald F. Giesbrecht, Deborah Dewey, The APrON Study Team The APrON Study Team
  First page: 1849
  Abstract: This study examined the associations between maternal pre-pregnancy BMI and gestational weight gain (GWG) and children’s neuropsychological outcomes at 3 to 5 years of age. A total of 379 women and their children from the Alberta Pregnancy Outcomes and Nutrition (APrON) study participated. Covariate-adjusted robust regressions examined associations between maternal pre-pregnancy BMI, GWG class, interaction terms, and child outcomes. Each unit increase in maternal BMI was linked to a 0.48-point decrement (95% CI: −0.75 to −0.21) in children’s Full Scale IQ. Higher pre-pregnancy BMI was related to poorer performance on the other intelligence indexes (B = −0.35 to −0.47, 95% CIs: −0.75, −0.02) and lower performance on measures of language (B = −0.08 to −0.09, 95% CIs: −0.16, −0.02), motor skills (B = −0.08 to −0.11, 95% CIs: −0.18, −0.01), and executive function (B = −0.09 to −0.16, 95% CIs: −0.26, −0.01). GWG below the recommended range was associated with a 4.04-point decrement (95% CI: 7.89, −0.11) in Full Scale IQ, but better performance on a spatial working memory test (B = 0.27, 95% CI: 0.02, 0.52). GWG above the recommended range was associated with lower language (B = −0.79, 95% CI: −1.52, −0.06) and memory scores (B = −0.93, 95% CI: −1.64, −0.22). Interactions were found between pre-pregnancy BMI and GWG on measures of intelligence and executive function. Maternal pre-pregnancy BMI and GWG are related to children’s performance in various neuropsychological domains and may interact to predict outcomes. Optimizing maternal health and weight prior to conception and during pregnancy may enhance children’s neuropsychological outcomes.
  Citation: Children
  PubDate: 2023-11-25
  DOI: 10.3390/children10121849
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1850: Sports Practice, Body Image Perception, and
Factors Involved in Sporting Activity in Italian Schoolchildren
- Authors: Luciana Zaccagni, Luca Rosa, Stefania Toselli, Emanuela Gualdi-Russo
  First page: 1850
  Abstract: Regular physical activity is generally deemed to positively affect health, but studies on children are scarce. Among the kinds of physical activity, sports practice is the most common and easiest to quantify and report by children. This cross-sectional study aimed to compare the two genders and evaluate the association between organized sports practice and body dissatisfaction in a sample of 214 Italian schoolchildren (55.6% males) aged 5 to 12. Body image perception and data on sports practice expectations and facilitators were collected in individual face-to-face interviews; weight and stature were directly measured. Girls tended to be sportier than boys (91.6% of girls vs. 86.3% of boys practiced sports), with an earlier start in sports (5.48 ± 1.47 vs. 5.72 ± 1.38 years) and a greater amount of weekly sports (3.41 ± 2.95 vs. 3.01 ± 2.11 h/week). In both genders, the ideal silhouette was more slender than the feel silhouette, and in girls more than in boys. According to the outcomes of multiple regression models, years of organized sports participation were a significant predictor of the weekly amount of sports in both genders, in addition to the feel weight status minus actual weight status inconsistency score, fun in sports, and parental support only in boys and teacher support only in girls. Children’s needs and interests and sports facilitators should be considered to promote an early active lifestyle.
  Citation: Children
  PubDate: 2023-11-25
  DOI: 10.3390/children10121850
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1851: Environmental Influences on Individuals
with Autistic Spectrum Disorders with Special Emphasis on Seasonality: An
Overview
- Authors: George Botsas, Eirini Koidou, Konstantinos Chatzinikolaou, George Grouios
  First page: 1851
  Abstract: This paper offers an in-depth exploration of the intricate relationship between environmental factors and autism spectrum disorder (ASD), with a special emphasis on seasonality. It reviews existing research, providing a comprehensive summary of findings and highlighting the multifaceted dimensions of several environmental factors influencing the etiology of ASD. The discussion encompasses various elements, including birth months, maternal health, dietary choices, and vitamin D deficiency, delving into the intricate interplay of seasonality with environmental influences such as viral infections and solar radiation. The present study raises essential questions regarding the timing of environmental influences and the factors contributing to the rising prevalence of ASD. Ultimately, it underscores the need for future epidemiological research to incorporate more extensive investigations of environmental risk factors and employ advanced statistical analyses. This comprehensive overview contributes to a deeper understanding of how environmental factors, particularly seasonality, may be linked to the occurrence of ASD and its increasing prevalence, recognizing the multifaceted and diverse nature of these interactions.
  Citation: Children
  PubDate: 2023-11-25
  DOI: 10.3390/children10121851
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1852: Associations between School-Level
Disadvantage, Bullying Involvement and Children’s Mental Health
- Authors: Julia R. Badger, Mirela Zaneva, Richard P. Hastings, Matthew R. Broome, Rachel Hayes, Paul Patterson, Naomi Rose, Suzy Clarkson, Judy Hutchings, Lucy Bowes
  First page: 1852
  Abstract: Bullying is a modifiable risk factor for poor mental health across childhood and adolescence. It is also socially patterned, with increased prevalence rates in more disadvantaged settings. The current study aimed to better understand whether school-level disadvantage is associated with different types of bullying roles, and whether it is a moderator in the association between bullying and children’s mental health. Cross-sectional data were used from 4727 children aged 6–11 years, from 57 primary schools across England and Wales. The child data included previous bullying involvement and bullying role characteristics (bully, victim, bully–victim, reinforcer, defender, outsider), and the teacher-reported data included each child’s mental health (emotional symptoms and externalizing) problems. School-level disadvantage was calculated from the proportion of children in the school eligible to receive free school meals (an indicator of disadvantage). Children in more disadvantaged schools were more likely to report being bully perpetrators, bully–victims, and engage less in defending behaviors during a bullying incident. Children from more disadvantaged schools who reported bullying others showed fewer emotional symptoms than those from less disadvantaged schools. There was no other evidence of moderation by school-level disadvantage between bullying roles and emotional and externalizing problems. The findings highlight the potential for school-based interventions targeting children’s emotional and social development, targeting bullying, and promoting defending behaviors, particularly in more disadvantaged settings.
  Citation: Children
  PubDate: 2023-11-25
  DOI: 10.3390/children10121852
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1853: Engaging Parents Affected by Mental Health
Problems in Pediatric and Gynecologic Practices—Implications of the
KID-PROTEKT Study
- Authors: Désirée Sigmund, Viola Loew, Silke Pawils
  First page: 1853
  Abstract: Children of parents with mental illness are at higher risk of developing cognitive, mental health or physical health difficulties. Previous studies have described several barriers for reaching parents with mental health problems (MHPs) and their utilization of psychosocial services. We conducted a cluster randomized controlled study in 24 pediatric and gynecologic practices to evaluate KID-PROTEKT, a psychosocial healthcare intervention that comprises a psychosocial assessment to identify families with psychosocial needs and refer them to support services. In this paper, we analyzed whether psychosocially distressed parents with additional MHPs (identified by the PHQ-9 and GAD-7) had higher support needs, could be referred to support and utilized it in comparison to parents with psychosocial burden only. In total, 178 pregnant women and mothers with psychosocial burden were included, of whom 55 had MHPs. Participants with MHPs were distressed in their relationships more often and medical staff rated their level of support needs higher compared to parents without MHPs. There were no significant differences between the groups regarding whether they were referred to support services or utilized the recommended services. All participants were most frequently referred to family or parent counseling/care or childcare assistance. The results indicate that despite existing barriers, parents with MHPs could be reached and identified by the KID-PROTEKT psychosocial assessment. A psychosocial intervention like KID-PROTEKT can help to provide support for mentally ill parents.
  Citation: Children
  PubDate: 2023-11-26
  DOI: 10.3390/children10121853
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1854: Physicians’ Self-Perceived Competence
on Breaking Bad News to Parents of Children with Neurodisabilities
- Authors: Ophélie Fiorellino, Christopher John Newman
  First page: 1854
  Abstract: Delivering difficult news to parents of children with neurodisabilities, often involving new diagnoses, prognosis changes, or declines in function or health, presents a complex task. Our aim was to assess physicians’ self-perceived competence in breaking bad news (BBN) within this context. An online survey was administered to neuropediatricians and developmental and rehabilitation pediatricians in Switzerland. Among 247 invited physicians, 62 (25.1%) responded (age of 51 ± 11 years; M/F ratio of 2:3). They rated their BBN competence at 7.5 ± 1.6 out of 10. Factors significantly associated with self-perceived competence in uni- and multivariate analyses included years of professional experience (≤10 years: 6.2 ± 1.8; >10 years: 8.2 ± 0.8), and region of pregraduate training (Switzerland: 7.3 ± 1.6; European Union: 8.3 ± 0.9). The respondents highlighted the positive roles of professional and personal experience, quality relationships with families, and empathy in BBN. In summary, physicians generally expressed a sense of competence in delivering difficult news to parents of children with neurodisabilities. They underscored the significance of life experiences and certain individual qualities in their effectiveness. These findings provide valuable insights into enhancing professional training and support in this crucial yet underexplored aspect of medical practice.
  Citation: Children
  PubDate: 2023-11-26
  DOI: 10.3390/children10121854
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1855: Eye Movement Evidence for Simultaneous
Cognitive Processing in Reading
- Authors: Argyro Fella, Maria Loizou, Christoforos Christoforou, Timothy C. Papadopoulos
  First page: 1855
  Abstract: Measuring simultaneous processing, a reliable predictor of reading development and reading difficulties (RDs), has traditionally involved cognitive tasks that test reaction or response time, which only capture the efficiency at the output processing stage and neglect the internal stages of information processing. However, with eye-tracking methodology, we can reveal the underlying temporal and spatial processes involved in simultaneous processing and investigate whether these processes are equivalent across chronological or reading age groups. This study used eye-tracking to investigate the simultaneous processing abilities of 15 Grade 6 and 15 Grade 3 children with RDs and their chronological-age controls (15 in each Grade). The Grade 3 typical readers were used as reading-level (RL) controls for the Grade 6 RD group. Participants were required to listen to a question and then point to a picture among four competing illustrations demonstrating the spatial relationship raised in the question. Two eye movements (fixations and saccades) were recorded using the EyeLink 1000 Plus eye-tracking system. The results showed that the Grade 3 RD group produced more and longer fixations than their CA controls, indicating that the pattern of eye movements of young children with RD is typically deficient compared to that of their typically developing counterparts when processing verbal and spatial stimuli simultaneously. However, no differences were observed between the Grade 6 groups in eye movement measures. Notably, the Grade 6 RD group outperformed the RL-matched Grade 3 group, yielding significantly fewer and shorter fixations. The discussion centers on the role of the eye-tracking method as a reliable means of deciphering the simultaneous cognitive processing involved in learning.
  Citation: Children
  PubDate: 2023-11-26
  DOI: 10.3390/children10121855
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1856: Feasibility of Using the International
Classification of Functioning, Disability and Health for Children and
Youth (ICF-CY) as a Framework for Aquatic Activities: A Scoping Review
- Authors: Merav Hadar-Frumer, Huib Ten-Napel, Maria José Yuste-Sánchez, Isabel Rodríguez-Costa
  First page: 1856
  Abstract: (1) Background: In recent years, reviewing studies of aquatic activities for children with developmental delays has been a complex task due to the multitude of indices and professional languages. (2) Aim: To determine if the ICF-CY framework can be used as the unifying language in AA studies of children with DD. (3) Methods: Part One—A systematic review of selected studies focusing on goals that were found to be positive. These goals were linked to the ICF-CY categories. Part Two—Review of all studies using the ICF-CY’s functioning components. (4) Results: Most of the positive goals were properly linked to ICF-CY and made it possible to review the 71 articles in a uniform language. (5) Conclusions: It is feasible to use the ICF framework as a universal structure and language.
  Citation: Children
  PubDate: 2023-11-26
  DOI: 10.3390/children10121856
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1857: When the Media Omits or Includes Scientific
Evidence in Its Publications: Science and Battles on X about Child Sexual
Abuse
- Authors: Ane Olabarria, Ana Burgués-Freitas, Ane López de Aguileta, Harkaitz Zubiri-Esnaola, Elisabeth Torras-Gómez, Mar Joanpere, Garazi López de Aguileta, Garazi Álvarez-Guerrero, Emilia Aiello, Cristina Pulido, Gisela Redondo-Sama
  First page: 1857
  Abstract: Scientific evidence of social impact demonstrates how violence against children is successfully prevented. Currently, the scientific research on social impact has a focus on the analysis of actions that succeed in the implementation of such scientific evidence. This article is based on scientific research that looks at which media actions help or hinder the implementation of evidence-based actions to solve the most sensitive social problems. The social media analytics methodology has identified the posts and reposts generated during two consecutive days by news articles published by three newspapers about the official report on child sexual abuse in Spain. Their analyses have been made through communicative methodology, including voices of adult victims or survivors of child sexual abuse. The results indicate that media information that omits scientific evidence of social impact provokes battles between diverse ideological groups, while information based on scientific evidence of social impact generates consensus among people from different ideologies and actions oriented to overcome the problem.
  Citation: Children
  PubDate: 2023-11-26
  DOI: 10.3390/children10121857
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1858: Optimization of Radiation Protection in
Pediatric Interventional Radiology in Latin America and the Caribbean:
Development, Advancements, Challenges and Achievements of the OPRIPALC
Program
- Authors: Carlos Ubeda, Elise Vano, María Perez, Pablo Jimenez, Emilie van Deventer, Raúl Ramirez, Alejandro Nader, Patricia Miranda
  First page: 1858
  Abstract: This article presents the development, advancements, challenges and achievements of the “Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean” (OPRIPALC) program. This international initiative is led by the World Health Organization, the Pan American Health Organization and the International Atomic Energy Agency. The main objectives of OPRIPALC are to foster a culture of radiological protection in pediatric interventions, enhance these procedures’ quality, and define optimization strategies such as the use of diagnostic reference levels (DRLs). Currently, 33 centers from 12 countries participate actively in the program. Significant progress has been made towards the proposed objectives, overcoming the challenges posed by the COVID-19 pandemic. Through many virtual meetings for coordination, planning, training and follow-up, a comprehensive set of DRLs for both diagnostic and therapeutic procedures, categorized by weight and age, have been established and are in use. A consensus document on good practices is in the final stage of development. The program’s continuation into at least a second phase is essential to address pending issues, including the integration of automatic dose management systems, the levels of occupational radiation doses, their correlation with pediatric patient doses, and strategies to reduce them.
  Citation: Children
  PubDate: 2023-11-27
  DOI: 10.3390/children10121858
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1859: Teachers’ Perceptions of Bullying in
Saudi Arabian Primary Public Schools: A Small-Sample, Qualitative Case
Study
- Authors: Mohaned G. Abed, Lowai G. Abed, Todd K. Shackelford
  First page: 1859
  Abstract: Bullying among primary school students is a serious problem that often has multiple negative effects including poor academic performance and mental health problems. The current study used qualitative methodology to determine the role of communication in creating awareness and preventing bullying in a school setting through stakeholder intervention and bullying-prevention programs. If teachers are aware of bullying, then they are likely to take adequate measures to reduce or prevent future bullying. The researchers conducted semi-structured interviews with 15 teachers working in public primary schools in Jeddah, Saudi Arabia. The results provide an initial step in the Saudi Arabian context toward identifying the forms and types of school bullying, helping administrators, teachers, parents, and students reduce bullying and develop long-term plans for addressing bullying. Consideration of teachers’ perceptions may enable the development and implementation of new programs for addressing bullying in primary school students. The discussion highlights future research directions and the limitations of the current research.
  Citation: Children
  PubDate: 2023-11-27
  DOI: 10.3390/children10121859
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1860: The Effects of an Order-Assist Mobile
Application on Pediatric Anesthesia Safety: An Observational Study
- Authors: Jung-Woo Shim, Chang-Jae Kim, Ji-Yeon Kim, Ji-Yeon Choi, Hyungmook Lee
  First page: 1860
  Abstract: Pediatric anesthesia requires the rapid creation, communication, and execution of anesthesia orders, and there is a risk of human error. The authors developed an order-assisted mobile application (app) to reduce human error during pediatric anesthesia preparation. The authors conducted an observational study that compared the effects of the application by comparing anesthesiologists’ errors, nurses’ errors, nurses leaving the operating room, and delays in surgery, between the Conventional group (n = 101) and the App group (n = 101). The app was associated with reduced human error by anesthesiologists and nurses, and it lowered the frequency and duration of nurses leaving the operating room during anesthesia. In addition, the authors surveyed anesthesia nurses regarding the effectiveness of the app. The nurses confirmed that the app was convenient and reduced human error. This study revealed that the order-assisted mobile app developed by a pediatric anesthesiologist could reduce human errors by anesthesiologists and nurses during pediatric anesthesia preparation.
  Citation: Children
  PubDate: 2023-11-27
  DOI: 10.3390/children10121860
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1861: Bone Fracture in Rett Syndrome: Mechanisms
and Prevention Strategies
- Authors: Carla Caffarelli, Antonella Al Refaie, Caterina Mondillo, Michela De Vita, Leonardo Baldassini, Giuseppe Valacchi, Stefano Gonnelli
  First page: 1861
  Abstract: The present study aimed to evaluate the burden and management of fragility fractures in subjects with Rett syndrome. We searched all relevant medical literature from 1 January 1986 to 30 June 2023 for studies under the search term “Rett syndrome and fracture”. The fracture frequency ranges from a minimum of 13.9% to a maximum of 36.1%. The majority of such fractures occur in lower limb bones and are associated with low bone mineral density. Anticonvulsant use, joint contractures, immobilization, low physical activity, poor nutrition, the genotype, and lower calcium and vitamin D intakes all significantly impair skeletal maturation and bone mass accrual in Rett syndrome patients, making them more susceptible to fragility fractures. This review summarizes the knowledge on risk factors for fragility fracture in patients with Rett syndrome and suggests a possible diagnostic and therapeutic care pathway for improving low bone mineral density and reducing the risk of fragility fractures. The optimization of physical activity, along with adequate nutrition and the intake of calcium and vitamin D supplements, should be recommended. In addition, subjects with Rett syndrome and a history of fracture should consider using bisphosphonates.
  Citation: Children
  PubDate: 2023-11-27
  DOI: 10.3390/children10121861
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1862: Management of Traumatic Nerve Palsies in
Paediatric Supracondylar Humerus Fractures: A Systematic Review
- Authors: Christy Graff, George Dennis Dounas, Maya Rani Louise Chandra Todd, Jonghoo Sung, Medhir Kumawat
  First page: 1862
  Abstract: Purpose: Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide clinicians regarding the timing of investigations and/or surgical interventions for traumatic nerve palsies after this injury. Methods: A formal systematic review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and PRISMA guidelines. Manuscripts were reviewed by independent reviewers against the inclusion and exclusion criteria, and data extraction, synthesis, and assessment for methodological quality were undertaken. Results: A total of 51 manuscripts were included in the final evaluation, reporting on a total of 510 traumatic nerve palsies in paediatric SCHFs. In this study, 376 nerve palsies recovered without any investigation or intervention over an average time of 19.5 weeks. Comparatively, 37 went back to theatre for exploration beyond the initial treatment due to persistent deficits, at an average time of 4 months. The most common finding at the time of exploration was entrapment of the nerve requiring neurolysis. A total of 27 cases did not achieve full recovery regardless of management. Of the 15 reports of nerve laceration secondary to paediatric SCHFs, 13 were the radial nerve. Conclusions: Most paediatric patients who sustain a SCHF with associated traumatic nerve injury will have full recovery. Delayed or no recovery of the nerve palsy should be considered for exploration within four months of the injury; earlier exploration should be considered for radial nerve palsies.
  Citation: Children
  PubDate: 2023-11-27
  DOI: 10.3390/children10121862
  Issue No: Vol. 10, No. 12 (2023)
Children, Vol. 10, Pages 1763: Managing Dental Phobia in Children with the
Use of Virtual Reality: A Systematic Review of the Current Literature
- Authors: Alessio Rosa, Alberto Maria Pujia, Raffaella Docimo, Claudio Arcuri
  First page: 1763
  Abstract: Background: It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments. Methods: The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations. Results: Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered. Conclusions: this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.
  Citation: Children
  PubDate: 2023-10-30
  DOI: 10.3390/children10111763
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1764: Neuromodulation in Pediatric Migraine using
Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study
- Authors: Corinna Börner-Schröder, Magdalena Lang, Giada Urban, Erik Zaidenstadt, Jacob Staisch, Ari Hauser, Iris Hannibal, Kristina Huß, Birgit Klose, Matthias F. Lechner, Nico Sollmann, Mirjam N. Landgraf, Florian Heinen, Michaela V. Bonfert
  First page: 1764
  Abstract: Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.
  Citation: Children
  PubDate: 2023-10-30
  DOI: 10.3390/children10111764
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1765: Coding Dyadic Behavior in
Caregiver–Child Interaction from a Clinical Psychology Perspective:
How Should Multiple Instruments and Outcomes Be Dealt with'
- Authors: Anne Jung, Nina Heinrichs
  First page: 1765
  Abstract: The experiences children have in the interactions with their caregivers influence their developmental outcomes. To target caregiving and optimize intervention effects, the assessment of caregiver–child interactions is highly relevant for families affected by parental mental disorders. Behavioral observation is a widely used method for assessing family dynamics, and the literature offers a wide variety of instruments with which to code such data. However, a structured overview of behavioral observation instruments (BOIs) is lacking, and the multitude of types of dyadic behaviors (DBs) assessed within each BOI are complicating their application. We aim to provide an overview of the BOIs applied to families affected by mental disorders and suggest a DB taxonomy that may be used across BOIs. We first conducted a systemic literature search to identify the most frequently used BOIs and the DBs they capture in clinical psychology. Second, we asked 13 experts to sort DB terms based on perceived conceptual similarity and analyzed these results using multidimensional scaling. We found approximately 450 different terms for DBs, and we argue that DBs can be classified within two overarching dimensions, i.e., in terms of structure and in terms of reaction to a child’s signals. These efforts can facilitate the coding and application of BOIs in clinical practice.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111765
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1766: 2D vs. 3D Ultrasound Diagnosis of Pediatric
Supracondylar Fractures
- Authors: Jessica Knight, Fatima Alves-Pereira, Christopher E. Keen, Jacob L. Jaremko
  First page: 1766
  Abstract: Supracondylar fractures are common injuries in children. Diagnosis typically relies on radiography, which can involve long wait times in the ED, emits ionizing radiation, and can miss non-displaced fractures. Ultrasound (US) has the potential to be a safer, more convenient diagnostic tool, especially with new highly portable handheld 2D point of care US (POCUS). This study aimed to determine the reliability of 2D POCUS for the detection of supracondylar fractures and elbow joint effusions, to contrast the accuracy of 2D POCUS vs. 3DUS vs. radiographs, and to determine whether blinded image interpretation could produce similar results to non-blinded real-time imaging. Fifty-seven children were scanned with 2D POCUS and 3DUS on the affected elbow. US scans were then read by three blinded readers, and the results were compared to gold-standard radiographs. Compared to a gold standard of 30-day radiographic diagnosis, readers of 2D POCUS detected supracondylar fracture and effusion with sensitivities of 0.91 and 0.97, respectively, which were both higher than with 3DUS. Inter-rater reliability of fracture detection was moderate for 2D POCUS (k = 0.40) and 3DUS (k = 0.53). Consensus sensitivities, although high, were lower than reports from some non-blinded studies, indicating that clinical presentation serves as an important factor in detection rates. Our results from consensus US diagnosis support the validity of using 2D POCUS in children for supracondylar fracture and elbow effusion diagnosis.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111766
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1767: Gut Microbiota to Microglia: Microbiome
Influences Neurodevelopment in the CNS
- Authors: Jeffery Bettag, Daniel Goldenberg, Jasmine Carter, Sylvia Morfin, Alison Borsotti, James Fox, Matthew ReVeal, Dylan Natrop, David Gosser, Sree Kolli, Ajay K. Jain
  First page: 1767
  Abstract: The brain is traditionally viewed as an immunologically privileged site; however, there are known to be multiple resident immune cells that influence the CNS environment and are reactive to extra-CNS signaling. Microglia are an important component of this system, which influences early neurodevelopment in addition to modulating inflammation and regenerative responses to injury and infection. Microglia are influenced by gut microbiome-derived metabolites, both as part of their normal function and potentially in pathological patterns that may induce neurodevelopmental disabilities or behavioral changes. This review aims to summarize the mounting evidence indicating that, not only is the Gut–Brain axis mediated by metabolites and microglia throughout an organism’s lifetime, but it is also influenced prenatally by maternal microbiome and diet, which holds implications for both early neuropathology and neurodevelopment.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111767
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1768: Safety and Feasibility of Functional
Repetitive Neuromuscular Magnetic Stimulation of the Gluteal Muscles in
Children and Adolescents with Bilateral Spastic Cerebral Palsy
- Authors: Leonie Grosse, Julian F. Schnabel, Corinna Börner-Schröder, Malina A. Späh, Anne C. Meuche, Nico Sollmann, Ute Breuer, Birgit Warken, Matthias Hösl, Florian Heinen, Steffen Berweck, Sebastian A. Schröder, Michaela V. Bonfert
  First page: 1768
  Abstract: Background: For children and adolescents affected by bilateral spastic cerebral palsy (BSCP), non-invasive neurostimulation with repetitive neuromuscular magnetic stimulation (rNMS) combined with physical exercises, conceptualized as functional rNMS (frNMS), represents a novel treatment approach. Methods: In this open-label study, six children and two adolescents (10.4 ± 2.5 years) with BSCP received a frNMS intervention targeting the gluteal muscles (12 sessions within 3 weeks). Results: In 77.1% of the sessions, no side effects were reported. In 16.7%, 6.3% and 5.2% of the sessions, a tingling sensation, feelings of pressure/warmth/cold or very shortly lasting pain appeared, respectively. frNMS was highly accepted by families (100% adherence) and highly feasible (97.9% of treatment per training protocol). A total of 100% of participants would repeat frNMS, and 87.5% would recommend it. The Canadian Occupational Performance Measure demonstrated clinically important benefits for performance in 28% and satisfaction in 42% of mobility-related tasks evaluated by caregivers for at least one follow-up time point (6 days and 6 weeks post intervention). Two patients accomplished goal attainment for one mobility-related goal each. One patient experienced improvement for both predefined goals, and another participant experienced improvement in one and outreach of the other goal as assessed with the goal attainment scale. Conclusions: frNMS is a safe and well-accepted neuromodulatory approach that could improve the quality of life, especially in regard to activity and participation, of children and adolescents with BSCP. Larger-scaled studies are needed to further explore the effects of frNMS in this setting.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111768
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1769: Lifestyle Behaviours, Self-Esteem and
Academic Performance in Primary Education Students—A Structural
Equation Model According to Sex and School Type
- Authors: Gracia Cristina Villodres, Federico Salvador-Pérez, Ramón Chacón-Cuberos, José Joaquín Muros
  First page: 1769
  Abstract: (1) Background: The present study aimed to examine the relationship between physical activity (PA), screen time (ST), maximal oxygen uptake (VO2max), Mediterranean diet (MD) adherence, self-esteem (SE) and academic performance (AP) in primary education students. In order to address this aim, an explanatory model was developed to examine the existing relationships between PA, ST, VO2max, MD adherence, SE and AP. Further, the proposed structural model was examined via multi-group analysis as a function of sex and school type. (2) Methods: A non-experimental, descriptive, comparative and cross-sectional study was designed with a total sample of 269 Spanish students (11.29 ± 0.62). Validated questionnaires were administered to collect data on study variables. (3) Results: Relative to boys, girls reported better academic grades and showed a stronger positive relationship between MD adherence and AP, MD adherence and PA, and VO2max and SE. Likewise, girls showed a stronger negative relationship between ST and VO2max, and ST and MD adherence. At the same time, mixed funding school (MFS) students reported higher PA engagement than state school (SS) students. However, SS students reported better MD adherence, ST and AP than MFS students. Further, a stronger positive relationship was found in SS students between MD adherence or VO2max and SE than in MFS students. Also, within the former group, ST was more negatively related to MD adherence and VO2max. (4) Conclusions: Scientific and educational communities must develop future strategies that consider potential determinants in order to target more desirable outcomes.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111769
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1770: Assessment and Diagnostic Classification
Using DC:0-5 in Early Childhood Mental Health Clinics: The Protocol for
the Developmental Psychiatry Diagnostic Challenges Study (DePsy)
- Authors: Katja Bödeker, Laura M. Watrin-Avino, Annick Martin, Franziska Schlensog-Schuster, Marius Janssen, Lennart Friese, Maria Licata-Dandel, Volker Mall, Juliane Teich-Bělohradský, Yonca Izat, Christoph U. Correll, Eva Möhler, Frank W. Paulus
  First page: 1770
  Abstract: Mental health problems in early childhood are common, but there is a lack of psychiatric research on this age group. DC:0-5 is a multiaxial classification system for mental disorders in early childhood, providing a framework for standardizing clinical practice and research. However, research on the validity of DC:0-5 is scarce. The Developmental Psychiatry Diagnostic Challenges Study (DePsy) is a multi-site, prospective clinical study including six German early childhood mental health (ECMH) clinics. The main objective of the study is to contribute to the validation of Axis I and Axis II of DC:0-5. A second aim of the study is to describe the population of the participating clinics regarding diagnoses, family context, and treatment outcomes. Additionally, the impact of environmental risk factors, including parental Adverse Childhood Experiences (ACEs) and media use, on child psychopathology and caregiver–child relationships will be examined. Over two years, patients aged 0.0–5.9 years old will be enrolled in the study. Assessments include ICD-10 and DC:0-5 diagnoses, developmental tests, video-based observations of caregiver—child interactions, and questionnaires on child psychopathology, media use, parental stress, and treatment satisfaction. Study results will promote the standardization of assessment and treatment in ECMH clinics aiming to improve the development of patients and their families.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111770
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1771: Laparoscopic Cholecystectomy in Children:
The Experience of Two Centers Focusing on Indications and Timing in the
Era of “New Technologies”
- Authors: Francesca Destro, Ugo Maria Pierucci, Eleonora Durante, Anna Maria Caruso, Vincenza Girgenti, Carlotta Paola Maria Canonica, Irene Degrassi, Alessandro Campari, Alessandro Pellegrinelli, Marta Barisella, Manuela Nebuloni, Marco Brunero, Elia Mario Biganzoli, Valeria Calcaterra, Gloria Pelizzo
  First page: 1771
  Abstract: Background: In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. Aims: This study aims to describe current indications and timing for LC in pediatric patients. Methods: Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020–2023. Results: In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Conclusions: Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111771
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1772: Lengthening Patients Previously Treated for
- Authors: Laura Campanacci, Luca Cevolani, Marco Focaccia, Giovanni Luigi Di Gennaro, Barbara Dozza, Eric Staals, Federica Zuccheri, Giuseppe Bianchi, Davide Maria Donati, Marco Manfrini
  First page: 1772
  Abstract: The objective of this study was to determine the efficacy of the PRECICE 2® nail in the treatment of lower limb length discrepancy in patients with a history of bone tumors. This study reports on outcomes, complications, and the safety of the PRECICE 2 limb lengthening nail in a cohort of pediatric patients with limb length discrepancy after surgery for bone tumors. Seventeen patients were treated with intramedullary magnetic nails. The average patient age at the time of surgery was 19 (range 11–32). The PRECICE 2 nail was used on 14 femurs (6 retrograde and 8 anterograde) and 3 tibias. The average consolidation time was 141 days (range 50–360) with a mean CI of 31 ± 12 days/cm. The ASAMI bone score showed 14 (82%) excellent results, 1 (6%) good result, and 2 (12%) poor results. The ASAMI functional score showed 13 (84.6%) excellent results, 3 (11.5%) good results, and 1 (3.8%) fair result. Patients treated with chemotherapy for bone cancer did not show any increase in distraction time or consolidation time. A total of 3 (17%) problems, 1 obstacle (5.5%), and 1 complication (5.5%) were encountered in our case series. The PRECICE 2 nail allows for effective and accurate lengthening preserving the range of motion in patients treated for bone tumors.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111772
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1773: Pediatric Hyperglycemic Hyperosmolar
Syndrome: A Comprehensive Approach to Diagnosis, Management, and
Complications Utilizing Novel Summarizing Acronyms
- Authors: Naser Zahran, Shaheen Jadidi
  First page: 1773
  Abstract: This paper focuses on hyperglycemic hyperosmolar syndrome (HHS), a unique hyperglycemic state requiring divergent diagnosis and treatment approaches from diabetic ketoacidosis (DKA) despite some shared characteristics. We introduce the mnemonic DI-FF-ER-EN-CE-S to encapsulate unique HHS management and complications. ‘DI’ emphasizes the need to delay and decrease initial insulin therapy until serum glucose decline is managed by fluid resuscitation alone. ‘FF’ stresses the importance of double fluid replacement compared to DKA due to severe dehydration and ‘ER’ electrolyte replacement due to profound losses and imbalances. ‘EN’ denotes the potential for encephalopathy and the requirement for a controlled serum osmolality reduction. ‘CE’ indicates cerebral edema, a rare complication in HHS. ‘S’ signifies systemic multiorgan failure. We categorize the associated risks into three mnemonic groups: the 3Rs (renal failure, respiratory distress, rhabdomyolysis), the 3Hs (heart failure, hypercoagulation, hyperthermia), and AP (arrhythmias, pancreatitis) to facilitate awareness and screening of HHS.
  Citation: Children
  PubDate: 2023-10-31
  DOI: 10.3390/children10111773
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1774: Does Acupuncture Hurt' A Retrospective
Study on Pain and Satisfaction during Pediatric Acupuncture
- Authors: Jeffrey I. Gold, Monika Kobylecka, Nhat H. Ngo, Christopher T. Lin, Caitlyn N. Hurray
  First page: 1774
  Abstract: Previous studies have shown the benefit and safety of pediatric acupuncture, but it is often rejected by patients and their caregivers due to the perception of needling pain associated with acupuncture. A retrospective cohort study of 230 unique patients (1380 sessions) aged 8 to 21 underwent Kiiko Matsumoto Style acupuncture in an outpatient pain clinic. Patients completed a post-acupuncture survey, including the Faces Pain Scale-Revised and Likert-like scales about overall satisfaction, relaxation, and anxiolysis. Univariate analyses were conducted on all outcomes of interest. The mean needling pain score was 1.3 out of 10 with 57.7% of patients reporting no needling pain during their first acupuncture session. The mean score for overall satisfaction was 8.4 out of 10, relaxation was 8.2 out of 10, and anxiety reduction was 7.7 out of 10. The overall satisfaction, relaxation, and anxiolytic effect of acupuncture was increased in patients with more sessions (p = 0.003, 0.022, 0.004, respectively). There was no change in needling pain scores in patients with an increased number of acupuncture sessions (p = 0.776). Patients experience minimal needling pain during acupuncture needling and are highly satisfied with acupuncture. Those with more treatment sessions report feeling increased satisfaction and relaxation.
  Citation: Children
  PubDate: 2023-11-01
  DOI: 10.3390/children10111774
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1775: Analysis of Adverse Drug Reactions in
Pediatric Patients with Epilepsy: An Intensive Pharmacovigilance Study
- Authors: Ernestina Hernández García, Lizbeth Naranjo, Luz Adriana Pichardo-Macías, María Josefa Bernad Bernad, Lucila Isabel Castro-Pastrana, Matilde Ruíz García, Tanya Alejandra García Bernal, Jessica Lizbeth Mendoza Solís, David Calderón Guzmán, Luisa Díaz-García, Julieta Griselda Mendoza-Torreblanca, Juan Luis Chávez Pacheco
  First page: 1775
  Abstract: Epilepsy is a chronic neurological disease characterized by the presence of spontaneous seizures, with a higher incidence in the pediatric population. Anti-seizure medication (ASM) may produce adverse drug reactions (ADRs) with an elevated frequency and a high severity. Thus, the objective of the present study was to analyze, through intensive pharmacovigilance over 112 months, the ADRs produced by valproic acid (VPA), oxcarbazepine (OXC), phenytoin (PHT), and levetiracetam (LEV), among others, administered to monotherapy or polytherapy for Mexican hospitalized pediatric epilepsy patients. A total of 1034 patients were interviewed; 315 met the inclusion criteria, 211 patients presented ADRs, and 104 did not. A total of 548 ASM-ADRs were identified, and VPA, LEV, and PHT were the main culprit drugs. The most frequent ADRs were drowsiness, irritability, and thrombocytopenia, and the main systems affected were hematologic, nervous, and dermatologic. LEV and OXC caused more nonsevere ADRs, and PHT caused more severe ADRs. The risk analysis showed an association between belonging to the younger groups and polytherapy with ADR presence and between polytherapy and malnutrition with severe ADRs. In addition, most of the severe ADRs were preventable, and most of the nonsevere ADRs were nonpreventable.
  Citation: Children
  PubDate: 2023-11-01
  DOI: 10.3390/children10111775
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1776: Preference for Comprehensive Dental
Treatment under General Anesthesia among Parents with Previous Experience:
A Cross-Sectional Study
- Authors: Sara M. Bagher, Heba Jafar Sabbagh, Alaa Nadhreen, Najlaa M. Alamoudi, Abdullah Almushayt, Manal Al-Malik, Maha R. Al Shehri, Heba Mohamed Elkhodary
  First page: 1776
  Abstract: This study aims to assess whether parents of children who previously received comprehensive dental treatment under general anesthesia (GA) would prefer comprehensive dental treatment under GA over regular dental care if any of their other children required comprehensive dental treatment. In this cross-sectional study, parents of children who met the inclusion criteria were interviewed by a trained pediatric resident about parental-related factors as well as their satisfaction with their previous GA experience. Also, the factors related to the previously treated child were obtained from dental records. Statistical analysis was carried out, and the p value was set to 0.05. A total number of 306 parents were included. Although most parents, 293 (95.8%), showed satisfaction with the previous GA, 170 (58%) of the satisfied parents preferred regular care. Parents of children who were previously treated under GA for medical-related reasons (p = 0.018), fathers working in a governmental sector (p = 0.021), and families with low-average monthly income (p = 0.017) significantly preferred regular care. In conclusion, most parents were satisfied with the previous GA experience. Family income, fathers’ occupation, and medical-related factors can influence parental preference for comprehensive dental treatment under general anesthesia if any of their other children require comprehensive dental treatment.
  Citation: Children
  PubDate: 2023-11-02
  DOI: 10.3390/children10111776
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1777: Preparing for Death While Investing in
Life: A Narrative Inquiry and Case Report of Home-Based Paediatric
Palliative, End-of-Life, and After-Death Care
- Authors: Michelle Noyes, Angela Delaney, Meagan Lang, Mellissa Maybury, Susan Moloney, Natalie Bradford
  First page: 1777
  Abstract: Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind’s Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.
  Citation: Children
  PubDate: 2023-11-02
  DOI: 10.3390/children10111777
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1778: Positive Parenting and Sociodemographic
Factors Related to the Development of Chilean Children Born to Adolescent
Mothers
- Authors: Laura Léniz-Maturana, Rosa Vilaseca, David Leiva, Rodrigo Gallardo-Rodríguez
  First page: 1778
  Abstract: The lack of economic resources has a negative effect on the maternal role of younger mothers. In Chile, the majority of adolescent pregnancies occur in socially and economically vulnerable contexts. The current study aimed to examine the relationship between demographic variables within the family context and parenting behaviors among Chilean adolescent mothers (including affection, responsiveness, encouragement, and teaching). These factors were correlated with communication, problem-solving abilities, and personal–social development in typically developing infants. The study included a sample of 79 Chilean adolescent mother–child dyads with children aged 10 to 24 months. Communication, problem-solving, and personal–social development were assessed using the Ages and Stages Questionnaire-3, along with a demographic information questionnaire. The parenting behaviors mentioned above were observed using the Spanish version of Parenting Interactions with Children: Checklist of Observations Linked to Outcomes. The findings indicated that mothers in employment and those who had not dropped out of school had children with better problem-solving skills. Additionally, children residing with their fathers and female children performed better in communication, problem-solving, and personal–social development. Maternal responsiveness was associated with communication and problem-solving, while maternal encouragement was linked to improved problem-solving skills. Maternal teaching was connected to communication, problem-solving, and personal–social development. The study emphasized the significance of parenting and sociodemographic factors among adolescent mothers and their influence on their children’s development.
  Citation: Children
  PubDate: 2023-11-02
  DOI: 10.3390/children10111778
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1779: The Relationship between Dietary Habits and
Periodontal Pathogens in a Sample of Romanian Children and Adolescents: A
Cross-Sectional Study
- Authors: Georgiana Veronica Motoc, Raluca Iulia Juncar, Abel Emanuel Moca, Ovidiu Motoc, Rahela Tabita Moca, Ioan Andrei Țig, Luminița Ligia Vaida, Mihai Juncar
  First page: 1779
  Abstract: The role of diet in shaping oral microbiota and its potential contribution to the development of periodontal pathogens cannot be understated. This study aimed to explore the correlation between dietary habits and the prevalence of 11 periodontal pathogens among children and adolescents in Oradea, Romania. The identification of these pathogens was performed using the micro-IDent test kit, capable of detecting 11 specific periodontal pathogens. Bacterial sampling was conducted from the crevicular fluid in the morning, prior to brushing, followed by the completion of a brief questionnaire by parents. The questionnaire captured various aspects of the children’s eating habits, including meal frequency, consumption of sweets, and hydration levels. The collected samples were dispatched to the laboratory for analysis, which provided insights into the abundance of microorganisms. The study encompassed 60 participants aged between 2 and 18 years, with the majority reported by their parents to have regulated meal timings, frequent sugar intake, and adequate hydration. The findings revealed significant associations between certain dietary factors and the presence of specific periodontal pathogens. Notably, the absence of breastfeeding was linked with the detection of Tannerella forsythia and Campylobacter rectus. Furthermore, frequent consumption of sweets corresponded with the presence of Capnocytophaga spp., which was particularly observed in individuals consuming sweets 2–3 times a day. Insufficient age-appropriate hydration showed an association with the prevalence of T. forsythia, Peptostreptococcus micros, and Capnocytophaga spp. In this sample, it became evident that eating habits and diet influenced the presence of several periodontal pathogens. The lack of breastfeeding was predominantly associated with positive results for T. forsythia and C. rectus, while inadequate hydration correlated more frequently with the presence of T. forsythia and P. micros. Moreover, frequent consumption of sweets was linked to the presence of Capnocytophaga spp.
  Citation: Children
  PubDate: 2023-11-02
  DOI: 10.3390/children10111779
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1780: Internet Use and Perceived Parental
Involvement among Adolescents from Lower Socioeconomic Groups in Europe:
An Exploration
- Authors: Roy A. Willems, Peter K. Smith, Catherine Culbert, Noel Purdy, Jayne Hamilton, Trijntje Völlink, Herbert Scheithauer, Nora Fiedler, Antonella Brighi, Damiano Menin, Consuelo Mameli, Annalisa Guarini
  First page: 1780
  Abstract: Internet usage is a salient developmental factor in adolescents’ lives. Although relevant correlates of Internet use have been documented earlier, there is a lack of information on lower socioeconomic status groups. This is important, as these adolescents have increased risk of negative online experiences. The current survey aimed to explore Internet use and parental involvement amongst adolescents from areas of socio-economic disadvantage in 30 urban schools across five European countries. A total of 2594 students participated, of whom 90% were 14–16 years. Virtually all adolescents of socioeconomic disadvantage had Internet access, with 88.5% reporting spending more than two hours per day online, often on apps such as Instagram, Snapchat, and YouTube. Almost one-third of adolescents did not talk with their parents about their Internet use and almost two-thirds indicated that their parents were only a little or not interested in their Internet use. A consistent finding across countries was that girls more often talked with their parents about their Internet use and more often reported that their parents were interested in their Internet use than boys. The results suggest that parents have an important task in explicitly showing interest in their adolescents’ Internet use, with special attention needed for boys.
  Citation: Children
  PubDate: 2023-11-02
  DOI: 10.3390/children10111780
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1781: Primary Failure Eruption: Genetic
Investigation, Diagnosis and Treatment: A Systematic Review
- Authors: Francesco Inchingolo, Irene Ferrara, Fabio Viapiano, Anna Maria Ciocia, Irene Palumbo, Mariafrancesca Guglielmo, Alessio Danilo Inchingolo, Andrea Palermo, Ioana Roxana Bordea, Angelo Michele Inchingolo, Daniela Di Venere, Gianna Dipalma
  First page: 1781
  Abstract: Aim: The aim of this systematic review is to explore the pathology, diagnosis, treatment, and genetic basis of Primary Failure of Eruption (PFE) in the field of pediatric dentistry and orthodontics. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. The databases PubMed, Science Direct, Scopus, and Web of Science were searched from 1 July 2013 to 1 July 2023, using keywords “primary failure of tooth eruption” OR “primary failure of eruption” OR “tooth eruption failure” OR “PFE” AND “orthodontics”. The study selection process involved screening articles based on the inclusion and exclusion criteria. Results: A total of 1151 results were obtained from the database search, with 14 papers meeting the inclusion criteria. The review covers various aspects of PFE, including its clinical features, diagnosis, treatment options, and genetic associations with mutations in the PTH1R gene. Differentiation between PFE and Mechanical Failure of Eruption (MFE) is crucial for accurate treatment planning. Orthodontic and surgical interventions, along with multidisciplinary approaches, have been employed to manage PFE cases. Genetic testing for PTH1R mutations plays a significant role in confirming the diagnosis and guiding treatment decisions, although some cases may not be linked to this mutation. Conclusions: This systematic review provides valuable insights into the diagnosis, treatment, and genetic basis of PFE. Early diagnosis and personalized treatment planning are crucial for successful management. Genetic testing for PTH1R mutations aids in accurate diagnosis and may influence treatment decisions. However, further research is needed to explore the complex genetic basis of PFE fully and improve treatment outcomes for affected individuals.
  Citation: Children
  PubDate: 2023-11-02
  DOI: 10.3390/children10111781
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1782: Impact of an Educational Clinical Video
Combined with Standard Helping Babies Breathe Training on Acquisition and
Retention of Knowledge and Skills among Ethiopian Midwives
- Authors: Amara J. Heard Stittum, Erika M. Edwards, Mahlet Abayneh, Asrat Demtse Gebremedhin, Delia Horn, Sara K. Berkelhamer, Danielle E. Y. Ehret
  First page: 1782
  Abstract: Helping Babies Breathe (HBB) is an evidence-based neonatal resuscitation program designed for implementation in low-resource settings. While HBB reduces rates of early neonatal mortality and stillbirth, maintenance of knowledge and skills remains a challenge. The extent to which the inclusion of educational clinical videos impacts learners’ knowledge and skills acquisition, and retention is largely unknown. We conducted a cluster-randomized controlled trial at two public teaching hospitals in Addis Ababa, Ethiopia. We randomized small training group clusters of 84 midwives to standard HBB vs. standard HBB training supplemented with exposure to an educational clinical video on newborn resuscitation. Midwives were followed over a 7-month time period and assessed on their knowledge and skills using standard HBB tools. When comparing the intervention to the control group, there was no difference in outcomes across all assessments, indicating that the addition of the video did not influence skill retention. Pass rates for both the control and intervention group on bag and mask skills remained low at 7 months despite frequent assessments. There is more to learn about the use of educational videos along with low-dose, high-frequency training and how it relates to retention of knowledge and skills in learners.
  Citation: Children
  PubDate: 2023-11-04
  DOI: 10.3390/children10111782
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1783: The Prevalence and Characteristics of
Intrafamilial Child and Adolescent Homicides in Greece over 11 Years
(2010–2020)
- Authors: Maria Tsellou, Flora Bacopoulou, Panagiotis Ferentinos, Eric Baccino, Laurent Martrille, Stavroula Papadodima
  First page: 1783
  Abstract: Intrafamilial child/adolescent homicide is the murder of a child/adolescent by one or more family members. This study delves into the medical and sociological consequences of child homicide, shedding light on the broader impact beyond individual families, which extends into the local community. Two Internet search engines and the search engines of major national news websites were surveyed to identify the number of intrafamilial child/adolescent homicide cases that occurred in Greece from January 2010 to December 2020. Over the study period, 34 victims of intrafamilial child/adolescent homicides were identified. The above deaths reflect an intrafamilial child/adolescent homicide rate of 0.15 homicides per year per 100,000 inhabitants. Most of the perpetrators (51.4%) were male, and the victims were equally divided into males and females. The ages of the perpetrators ranged from 13 to 61 years, and the ages of the victims ranged between 0 and 17 years. Most perpetrators (54.5%) had a previous psychiatric history and in many cases, they committed (33.3%) or attempted (15.2%) suicide after the homicide. The most common method of homicide was strangulation (usually combined with suffocation) (25%), followed by abandonment (15.6%). The most commonly reported motives were spousal revenge (26.5%) and psychotic disorders (26.5%). Raising awareness for intrafamilial child and adolescent homicide is of the utmost importance for the prevention of this dreadful phenomenon.
  Citation: Children
  PubDate: 2023-11-04
  DOI: 10.3390/children10111783
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1784: Physical Image Quality Metrics for the
Characterization of X-ray Systems Used in Fluoroscopy-Guided Pediatric
Cardiac Interventional Procedures: A Systematic Review
- Authors: Diego Nocetti, Kathia Villalobos, Kevin Wunderle
  First page: 1784
  Abstract: Pediatric interventional cardiology procedures are essential in diagnosing and treating congenital heart disease in children; however, they raise concerns about potential radiation exposure. Managing radiation doses and assessing image quality in angiographs becomes imperative for safe and effective interventions. This systematic review aims to comprehensively analyze the current understanding of physical image quality metrics relevant for characterizing X-ray systems used in fluoroscopy-guided pediatric cardiac interventional procedures, considering the main factors reported in the literature that influence this outcome. A search in Scopus and Web of Science, using relevant keywords and inclusion/exclusion criteria, yielded 14 relevant articles published between 2000 and 2022. The physical image quality metrics reported were noise, signal-to-noise ratio, contrast, contrast-to-noise ratio, and high-contrast spatial resolution. Various factors influencing image quality were investigated, such as polymethyl methacrylate thickness (often used to simulate water equivalent tissue thickness), operation mode, anti-scatter grid presence, and tube voltage. Objective evaluations using these metrics ensured impartial assessments for main factors affecting image quality, improving the characterization of fluoroscopic X-ray systems, and aiding informed decision making to safeguard pediatric patients during procedures.
  Citation: Children
  PubDate: 2023-11-05
  DOI: 10.3390/children10111784
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1785: The Mirage of Upward Mobility:
Conceptualization and Implications for Teen Dating Violence Prevention
- Authors: Lídia Puigvert-Mallart, Susana León-Jiménez, Mar Joanpere, Mimar Ramis-Salas, Ramón Flecha
  First page: 1785
  Abstract: Alcohol and drug abuse are recognized risk factors in scientific literature that can leave female adolescents vulnerable to experience teen dating violence (TDV) in their relationships. These risk factors are highlighted in prevention campaigns, empowering girls to proactively avoid or decline situations that may put them at risk of such violence. This study delves into an underexplored risk factor for TDV, the Mirage of Upward Mobility (MUM), and its connections to previously established elements: coercive discourse, peer pressure, and the pursuit of status. A total of 146 relevant studies on TDV, and factors related to it, have been reviewed. MUM is conceptualized as the erroneous belief that engaging in relationships with traditionally dominant and disrespectful partners increases social status and attractiveness, although in reality, what happens is that that status and that attractiveness decrease. The study discusses the existence and factors contributing to MUM and underscores its importance as a risk factor for experiencing TDV to include in prevention campaigns.
  Citation: Children
  PubDate: 2023-11-06
  DOI: 10.3390/children10111785
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1786: Relationship between Parental Concerns
about Social–Emotional Reciprocity Deficits and Their
Children’s Final ASD Diagnosis
- Authors: Ronit Saban-Bezalel, Einat Avni, Esther Ben-Itzchak, Ditza A. Zachor
  First page: 1786
  Abstract: Concerns raised by parents regarding their child’s development are compatible with the child’s final diagnosis of autism spectrum disorder. A better understanding of the relationship between parental concerns and a final diagnosis of autism spectrum disorder is therefore critical. In the current study, we compared the frequencies of parental concerns related to DSM-5 criteria for autism spectrum disorder between pair-matched groups with and without a final diagnosis of autism spectrum disorder and determined which parental concerns predicted a final diagnosis of autism spectrum disorder. The cohort included 80 participants (48–154 months of age, IQ > 70) assessed for a possible autism spectrum disorder diagnosis. Parental concerns were retrieved from the free-description portion of the introductory questions of the Autism Diagnostic Interview-Revised and analyzed to assess whether they corresponded to any of the seven DSM-5 criteria for ASD. The two groups only differed in the frequency of parental concerns relating to deficits in social–emotional reciprocity. Parents of children diagnosed with autism spectrum disorder were four times as likely to report deficits in social–emotional reciprocity. This finding highlights the significance of parental concerns regarding deficits in social–emotional reciprocity in predicting a final diagnosis of autism spectrum disorder.
  Citation: Children
  PubDate: 2023-11-06
  DOI: 10.3390/children10111786
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1787: Pupils’ Attitudes toward
Inclusive Education
- Authors: Anna Strnadova, Milon Potmesil, Petra Potmesilova
  First page: 1787
  Abstract: The presented research is a study of the attitudes of adolescents toward individuals with disabilities and a description of the level of knowledge about this issue among a selected group of adolescents. The study is focused on the school social environment, specifically on pupils without disabilities and their attitudes toward pupils with disabilities, which is one of the factors influencing their school success. The target group was 1806 pupils between the ages of 11 and 16 from the entire Czech Republic, approached by random selection. The research tool for the quantitative approach was a questionnaire developed by the authors of this article. The questionnaire section with open questions served for the qualitative part of the research. The results show that 70% of the respondents have basic knowledge about people with disabilities. Furthermore, it was shown that these adolescents have an overall positive attitude toward people with disabilities. This attitude is statistically significantly better among the girls than the boys, and the girls are also more open to discussing individuals with disabilities. At the same time, even if attitudes are positive, they still depend on the type of disability. The greatest uncertainty or discomfort is manifested when interacting with individuals with intellectual disabilities.
  Citation: Children
  PubDate: 2023-11-06
  DOI: 10.3390/children10111787
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1788: A High Copy Number from a Pharyngeal Swab
Is Not Associated with Different Presenting Features in 100 Children with
Acute Adenovirus Infection from a Cluster in Italy
- Authors: Anthea Mariani, Federica Cavallo, Saverio La Bella, Giusi Graziano, Martina Passarelli, Carlo Crescenzi, Daniela Trotta, Maurizio Aricò
  First page: 1788
  Abstract: Human mastadenoviruses, frequently denominated adenoviruses (HAdVs), may cause respiratory tract, gastrointestinal or, less frequently, other involvements. Epidemics of HAdV infections occur globally, in communities, and in closed or crowded settings. In our institution, a cluster of infants and children admitted for HAdV infection was recently observed. The aim of this study was to describe the pattern of their presenting features and investigate the possible correlation between the HAdV copy number and the clinical picture. Two main patterns of clinical presentation were observed: 68 patients had mainly respiratory symptoms (pharyngitis n = 67, cough n = 44; tonsillar exudate n = 17; other respiratory signs n = 4) while 26 patients showed prevalent gastrointestinal involvement (diarrhea n = 26, vomiting n = 8). Patients with respiratory symptoms had a significantly higher count of WBC, PMN, and platelets, while CRP level approached statistical significance (p = 0.07) for higher values in the patients with diarrhea. In order to explore the impact of selected presenting features, the possible association between the level of CRP and the presence of pharyngeal exudate, cough, vomiting, diarrhea, duration of fever, number of neutrophils, and administration of antibiotics was analyzed. Patients falling in the tertile with more elevated CRP values had tonsillar exudate and diarrhea significantly more often, while those in the lower tertile had a 4.4-day duration fever vs. ≥5.0 days in the remaining patients. Antibiotic therapy was administered more frequently to patients with higher values of CRP (p = 0.006). The duration of hospitalization was not associated with the CRP level. The median time from the receipt of a positive HAdV PCR test result to patient discharge was 1 day in 73% of cases. The number of copies of HAdV detected via PCR ranged between 47 million and 15/μL. Falling in the highest tertile of copy number was significantly associated with pharyngitis. The 24 patients with evidence of viral coinfection had no difference in the demographics or presenting features, with the only exception being a significantly higher leukocyte count. The rapid turn-around of the results of the molecular testing of the HAdV genome on a pharyngeal swab allowed us to rapidly diagnose HAdV infection, allowing us to stop antibiotic therapy and immediately discharge the patients, with reduced discomfort for the families and more appropriate use of hospital beds. A high copy number of HAdV from a pharyngeal swab should not be taken as an indicator of worse prognosis, thus allowing for the preferential use of qualitative rather than quantitative assay.
  Citation: Children
  PubDate: 2023-11-06
  DOI: 10.3390/children10111788
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1789: Global Cardiac Surgery—Accessibility
to Cardiac Surgery in Developing Countries: Objectives, Challenges, and
Solutions
- Authors: Salvatore Agati, Ermanno Bellanti
  First page: 1789
  Abstract: Cardiac surgery is a modern science in the history of medicine. The impact of cardiac disease, in terms of treatment and prognosis, has made this discipline indispensable to global health. In recent decades, the greatest investment has been dispensed to technological and material improvements to increase life expectancy. This surgery must address different epidemiological aspects dictated by the geography and economic–social conditions of the global populations. For this reason, it is progressively important to address the cardiac surgery accessibility disparity. Many scientific papers and international meetings have studied how cardiac surgery can be more accessible in various countries around the world. In this review, we analyze all the challenges, solutions, and suggestions that can make this surgery accessible to the entire global population, with the purpose of reducing its disparity across all seven continents. For a long time, high-income countries have invested in technological capabilities and experimental advancements without caring about unequal access in the rest of the world. We believe that it is time to reverse this growth trajectory, placing the accessibility and distribution of surgical science as a priority, which is significant for the right to health of all people worldwide. This is the real new challenge in cardiosurgery.
  Citation: Children
  PubDate: 2023-11-06
  DOI: 10.3390/children10111789
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1790: Surgery in Bilateral Wilms
Tumor—A Single-Center Experience
- Authors: Fernanda Kelly Marques de Souza, Mayara Caroline Amorim Fanelli, Alexandre Alberto Barros Duarte, Maria Teresa de Seixas Alves, Henrique Manoel Lederman, Monica dos Santos Cypriano, Simone de Campos Vieira Abib
  First page: 1790
  Abstract: The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute—GRAACC—Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety.
  Citation: Children
  PubDate: 2023-11-07
  DOI: 10.3390/children10111790
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1791: Flexible Resources Key to Neighborhood
Resilience for Children: A Scoping Review
- Authors: Shawna Beese, Kailie Drumm, Kayla Wells-Yoakum, Julie Postma, Janessa M. Graves
  First page: 1791
  Abstract: Neighborhoods have been the focus of health researchers seeking to develop upstream strategies to mitigate downstream disease development. In recent years, neighborhoods have become a primary target in efforts to promote health and resilience following deleterious social conditions such as the climate crisis, extreme weather events, the global pandemic, and supply chain disruptions. Children are often the most vulnerable populations after experiencing unexpected shocks. To examine and describe conceptually the construct of Neighborhood Resilience, we conducted a comprehensive scoping review using the terms (“resilience” or “resiliency” or “resilient”) AND (“neighborhood”), utilizing MEDLINE (through PubMed) and CINAHL (through EBSCOhost) databases, to assess overall neighborhood themes that impact resilience. A total of 57 articles were extracted that met inclusion criteria. Extracted characteristics included study purpose, country of origin, key findings, environmental protective/risk factors. The analysis revealed a positive relationship between neighborhood resource density, neighborhood resiliency, and individual resiliency. This study reports the finding for studies with a population focus of pre-school age and school age children (1.5–18 years of age). Broadly, we identified that the primary goals regarding neighborhood resilience for childhood can be conceptualized as all activities and resources that (a) prevent trauma during childhood development and/or (b) mitigate or heal childhood trauma once it has occurred. This goal conceptually encompasses antecedents that increase protective factors and reduces risk factors for children and their families. This comprehensive look at the literature showed that a neighborhood’s ability to build, promote, and maintain resiliency is often largely dependent on the flexible resources (i.e., knowledge, money, power, prestige, and beneficial social connections) that are available.
  Citation: Children
  PubDate: 2023-11-07
  DOI: 10.3390/children10111791
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1792: Combining Cardiorespiratory Signals and
Video-Based Actigraphy for Classifying Preterm Infant Sleep States
- Authors: Dandan Zhang, Zheng Peng, Carola Van Pul, Sebastiaan Overeem, Wei Chen, Jeroen Dudink, Peter Andriessen, Ronald M. Aarts, Xi Long
  First page: 1792
  Abstract: The classification of sleep state in preterm infants, particularly in distinguishing between active sleep (AS) and quiet sleep (QS), has been investigated using cardiorespiratory information such as electrocardiography (ECG) and respiratory signals. However, accurately differentiating between AS and wake remains challenging; therefore, there is a pressing need to include additional information to further enhance the classification performance. To address the challenge, this study explores the effectiveness of incorporating video-based actigraphy analysis alongside cardiorespiratory signals for classifying the sleep states of preterm infants. The study enrolled eight preterm infants, and a total of 91 features were extracted from ECG, respiratory signals, and video-based actigraphy. By employing an extremely randomized trees (ET) algorithm and leave-one-subject-out cross-validation, a kappa score of 0.33 was achieved for the classification of AS, QS, and wake using cardiorespiratory features only. The kappa score significantly improved to 0.39 when incorporating eight video-based actigraphy features. Furthermore, the classification performance of AS and wake also improved, showing a kappa score increase of 0.21. These suggest that combining video-based actigraphy with cardiorespiratory signals can potentially enhance the performance of sleep-state classification in preterm infants. In addition, we highlighted the distinct strengths and limitations of video-based actigraphy and cardiorespiratory data in classifying specific sleep states.
  Citation: Children
  PubDate: 2023-11-07
  DOI: 10.3390/children10111792
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1793: An Asymptomatic, Ectopic Mass as a
Presentation of Adrenocortical Carcinoma Due to a Novel Germline TP53
p.Phe338Leu Tetramerisation Domain Variant
- Authors: Justyna Walenciak, Zuzanna Urbanska, Agata Pastorczak, Katarzyna Babol-Pokora, Kamila Wypyszczak, Ewa Bien, Aleksandra Gawlowska-Marciniak, Jozef Kobos, Wieslawa Grajkowska, Joanna Smyczynska, Wojciech Mlynarski, Szymon Janczar
  First page: 1793
  Abstract: Adrenocortical carcinoma (ACC) is a rare cancer in childhood. ACC is frequently associated with germline TP53 variants, with founder effects especially due to the p.Arg337His mutation. ACC leads to the secretion of adrenocortical hormones, resulting in endocrine syndromes, which is the usual trigger for establishing the diagnosis. We present a surprising ACC pathology in a non-secreting, ectopic retroperitoneal tumour in a 4-year-old boy, successfully controlled with chemotherapy and mitotane after microscopically incomplete tumour resection with spillage. Genomic analysis (gene panel sequencing and copy-number microarray) demonstrated a novel p.Phe338Leu tetramerisation domain (TD) TP53 variant in the proband and his cancer-free mother and a monoallelic deletion encompassing the TP53 locus in cancer tissue, consistent with cancer-predisposition syndrome. While the recurrent p.Arg337His variant translates into high ACC risk, residue 338 and, in general, TD domain variants drive heterogeneous clinical scenarios, despite generally being considered less disruptive than TP53 DNA-binding domain mutations.
  Citation: Children
  PubDate: 2023-11-07
  DOI: 10.3390/children10111793
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1794: Multiphasic Personality Assessment in a
- Authors: Giulia Cossu, Arianna Vecchio, Marika Orlandi, Erica Casini, Renato Borgatti, Martina Maria Mensi, The Mondino Foundation Suicidality Research Group The Mondino Foundation Suicidality Research Group
  First page: 1794
  Abstract: Suicide is an important public health issue. To examine the differences in personality characteristics between a group of adolescents with suicidal ideation (SI) and a group with a history of suicidal attempts (SA), we conducted a cross-sectional study. We enrolled 55 adolescents (51 females; 12–18 y.o.) who presented SI and/or SA. Using the Columbia Suicide Severity Rating Scale, we divided the sample into two groups: adolescents with SI and adolescents with SA. All participants filled in the Minnesota Multiphasic Personality Inventory—Adolescent (MMPI-A). Adolescents in the SA group had greater difficulties in social relations, risky behaviors, and more intense suicidal ideation compared to those in the SI group. Adolescents in the SA group scored higher in Omission, in the Lie Scale, the Conduct Problem Scale, the Less Aspirations Scale, the Repression Scale in the MMPI-A, and item 283 of the MAST compared to the other group. The results suggest that using the MMPI-A to assess certain features (e.g., tendency to lie, repression) may be helpful in identifying young people who are at high risk of suicide. However, further research is required to determine the effectiveness of using this instrument.
  Citation: Children
  PubDate: 2023-11-08
  DOI: 10.3390/children10111794
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1795: A Self-Regulation Intervention Conducted by
Teachers in a Disadvantaged School Neighborhood: Implementers’ and
Observers’ Perceptions of Its Impact on Elementary Students
- Authors: Jennifer Cunha, Ana Guimarães, Juliana Martins, Pedro Rosário
  First page: 1795
  Abstract: Self-regulated learning contributes to students’ academic success and their future as citizens. However, self-regulation skills are seldom or poorly promoted during instruction. To address this gap, the current article reports data on the implementation of an evidence-based intervention (i.e., a narrative-based intervention called “Yellow Trials and Tribulations”) in a disadvantaged school neighborhood. Prior studies showed positive results of this intervention in promoting elementary students’ self-regulation skills. Still, the data are mainly quantitative and limited to students’ reports or classroom observations made by researchers. Hence, the current study aimed to explore the implementers’ and observers’ perceptions of the impact of the intervention. Four elementary teachers implemented the intervention in their fourth-grade classes (N = 96 students). For each session, the implementers and observers completed a session sheet collaboratively, as well as individual final reports at the end of the intervention. The records were analyzed through a direct content analysis. The data indicated a perceived increase in knowledge and the use of self-regulation skills in the educational context and in daily life routines. Moreover, the data allowed for the identification of other positive gains of the intervention. The findings extended prior research while helping researchers to further understand the impact of the narrative-based intervention. The implications for research and educational practice are provided.
  Citation: Children
  PubDate: 2023-11-08
  DOI: 10.3390/children10111795
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1796: Association between Serum Lactate and
Morbidity and Mortality in Neonates: A Systematic Review and Meta-Analysis
- Authors: Felipe Yu Matsushita, Vera Lucia Jornada Krebs, Werther Brunow De Carvalho
  First page: 1796
  Abstract: Objective: Lactate is a marker of hypoperfusion in critically ill patients. Whether lactate is useful for identifying and stratifying neonates with a higher risk of adverse outcomes remains unknown. This study aimed to investigate the association between lactate and morbidity and mortality in neonates. Methods: A meta-analysis was performed to determine the association between blood lactate levels and outcomes in neonates. Ovid MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched from inception to 1 May 2021. A total of 49 observational studies and 14 data accuracy test studies were included. The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the QUADAS-2 tool for data accuracy test studies. The primary outcome was mortality, while the secondary outcomes included acute kidney injury, necessity for renal replacement therapy, neurological outcomes, respiratory morbidities, hemodynamic instability, and retinopathy of prematurity. Results: Of the 3184 articles screened, 63 studies fulfilled all eligibility criteria, comprising 46,069 neonates. Higher lactate levels are associated with mortality (standard mean difference, −1.09 [95% CI, −1.46 to −0.73]). Using the estimated sensitivity (0.769) and specificity (0.791) and assuming a prevalence of 15% for adverse outcomes (median of prevalence among studies) in a hypothetical cohort of 10,000 neonates, assessing the lactate level alone would miss 346 (3.46%) cases (false negative) and wrongly diagnose 1776 (17.76%) cases (false positive). Conclusions: Higher lactate levels are associated with a greater risk of mortality and morbidities in neonates. However, our results do not support the use of lactate as a screening test to identify adverse outcomes in newborns. Research efforts should focus on analyzing serial lactate measurements, rather than a single measurement.
  Citation: Children
  PubDate: 2023-11-08
  DOI: 10.3390/children10111796
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1797: Maternal Exercise during Pregnancy Impacts
Motor Performance in 9-Year-Old Children: A Pilot Study
- Authors: Nina Ferrari, Nikola Schmidt, Inga Bae-Gartz, Christina Vohlen, Miguel A Alejandre Alcazar, Konrad Brockmeier, Jörg Dötsch, Esther Mahabir, Christine Joisten
  First page: 1797
  Abstract: The benefits of maternal physical activity during pregnancy are well documented, but long-term effects on the child have been less studied. Therefore, we conducted a pilot follow-up study of a lifestyle intervention during pregnancy that aimed to investigate whether exercise (endurance and strength training) during pregnancy affects motor performance and body composition of children up to 9 years of age, as well as possible influencing factors like brain-derived neurotrophic factor (BDNF) and lifestyle. Eleven mother−child pairs from the intervention and eight mother−child pairs from the control group were included. From birth up to 9 years of age, no differences in body mass index (BMI) or body mass index standard deviation scores (BMI-SDS) were found between the groups. Lifestyle intervention was one of the influencing factors for children’s cardiorespiratory endurance capacity and coordination. Moreover, maternal BDNF in the last trimester was significantly associated with running performance, which may be due to better neuronal development. This is the first study evaluating the effects of a lifestyle intervention during pregnancy on the motor performance 9 years after birth. Children’s participation in exercise programs over the past 9 years was not continuously recorded and therefore not included in the analysis. Even a cautious interpretation of these results indicates that a healthy lifestyle during pregnancy is essential in promoting child health. Larger studies and randomized control trials are necessary to confirm our results, especially those pertaining to the role of BDNF.
  Citation: Children
  PubDate: 2023-11-08
  DOI: 10.3390/children10111797
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1798: Psychometric Performance of Generic
Childhood Multi-Attribute Utility Instruments in Preterm and Low
Birthweight Populations
- Authors: Joseph Kwon, Corneliu Bolbocean, Olu Onyimadu, Nia Roberts, Stavros Petrou
  First page: 1798
  Abstract: Background: Individuals born preterm (gestational age < 37 weeks) and/or at low birthweight (<2500 g) are at increased risk of health impairments from birth to adulthood. This review aimed to evaluate the psychometric performance of generic childhood-specific or childhood-compatible multi-attribute utility instruments (MAUIs) in preterm and/or low birthweight (PLB) populations. Methods: Searches covered seven databases, including studies that targeted childhood (aged < 18 years) and/or adult (≥18 years) PLB populations; provided psychometric evidence for generic childhood-specific or compatible MAUI(s) (any language version); and published in English. Eighteen psychometric properties were evaluated using a four-part criteria rating system. Data syntheses identified psychometric evidence gaps and summarised the psychometric assessment methods/results. Results: A total of 42 studies were included, generating 178 criteria rating outputs across four MAUIs: 17D, CHSCS-PS, HUI2, and HUI3. Moreover, 64.0% of outputs concerned the HUI3 MAUI, and 38.2% related to known-group validity. There was no evidence for five psychometric properties. Only 6.7% of outputs concerned reliability and proxy–child agreement. No MAUI outperformed others across all properties. The frequently applied HUI2 and HUI3 lacked content validity evidence. Conclusions: This psychometric evidence catalogue should inform the selection of MAUI(s) suited to the specific aims of applications targeting PLB populations. Further psychometric research is warranted to address the gaps in psychometric evidence.
  Citation: Children
  PubDate: 2023-11-10
  DOI: 10.3390/children10111798
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1799: Interaction between Akkermansia muciniphila
- Authors: Juan Carlos Ayala-García, Alba Mariel García-Vera, Alfredo Lagunas-Martínez, Yaneth Citlalli Orbe-Orihuela, Ana Cristina Castañeda-Márquez, Cinthya Estefhany Díaz-Benítez, Víctor Hugo Bermúdez-Morales, Miguel Cruz, Margarita Bahena-Román, Ana Isabel Burguete-García
  First page: 1799
  Abstract: Background: Imbalance in the intestinal microbiota can lead to chronic low-grade inflammation. Diet may influence this association. In this study, we aimed to evaluate the interaction between Akkermansia muciniphila (A. muciniphila) and dietary patterns using a proinflammatory index. Methods: We conducted a cross-sectional study with school-aged children. We quantified the relative abundance (RA) of A. muciniphila in feces using a polymerase chain reaction. We collected dietary information through employing a food frequency questionnaire and generated dietary patterns using principal component analysis. We generated a proinflammatory index from serum levels of interleukin-6, interleukin-10, tumor necrosis factor alpha, and adiponectin validated by receptor operating characteristic curves. We evaluated the association between A. muciniphila and the proinflammatory index using logistic regression, including an interaction term with dietary patterns. Results: We found that children with a low RA of A. muciniphila and a high intake of simple carbohydrates and saturated fats had increased odds of being high on the proinflammatory index. However, when the consumption of this dietary pattern is low, children with a low RA of A. muciniphila had decreased odds of being high on the proinflammatory index. Conclusions: Our results suggest that the simultaneous presence of A. muciniphila and diet have a more significant impact on the presence of being high on the proinflammatory index compared to both factors separately.
  Citation: Children
  PubDate: 2023-11-10
  DOI: 10.3390/children10111799
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1800: Teachers’ and Parents’
Assessment of Challenges in Children Exhibiting Sensory Seeking Behavior
and Possible Effects of the Use of Ball Vests: A Pre–Post Study
- Authors: Ann Natasja Nielsen, Karen la Cour, Åse Brandt
  First page: 1800
  Abstract: Children with dysfunction in sensory processing (DSP) may experience challenges, which might affect their participation in activities and potentially also their further development. This study examined the challenges of children with DSP who exhibit sensory seeking behavior, the differences in these challenges between boys and girls, and the possible effects of their use of ball vests. The challenges of 70 pupils (aged 6–12 years) exhibiting sensory seeking behavior were assessed by their parents (n = 66) and teachers (n = 60) by surveys containing items from the ‘Strengths and Difficulties Questionnaire’ (SDQ) and the ‘Five to Fifteen’ (FTF) questionnaire. Differences in the SDQ/FTF scores between boys and girls were explored using chi-square analysis. The potential effects of the ball vest were assessed using a study-specific follow-up survey. Linear mixed model regression analysis was used to examine associations between the extent of use of the vest and the assessed effects. The pupils were assessed for challenges that interfered with their learning (62%), forming friendships (51.7%), and the classroom environment (56.9%). After three weeks, the parents found that some pupils had improved regarding attention (39%), body perception (34%), and hyperactivity and impulsivity (33%). The teachers reported that 30% of the pupils had improved their coping skills in learning.
  Citation: Children
  PubDate: 2023-11-10
  DOI: 10.3390/children10111800
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1801: What Is Helpful and What Is Challenging for
the Caregivers of Young People Receiving Interventions to Prevent Suicide'
Caregivers’ Perspectives—A Rapid Scoping Review
- Authors: Grace Branjerdporn, Ferrell Erlich, Karthikeyan Ponraj, Laura K. McCosker, Sabine Woerwag-Mehta
  First page: 1801
  Abstract: (1) Background: Suicide is a leading cause of death among young people. Preventing suicide in young people is a priority. Caregivers play a vital role in ensuring interventions for young people experiencing suicide ideation and/or attempts are implemented, and that they are maintained over time. Despite this, little is known about what caregivers find helpful and challenging in relation to suicide prevention interventions. This rapid scoping review is the first to address this gap. (2) Methods: Searches were completed on six electronic databases using keywords relating to ‘suicide prevention, ‘young people’, and ‘caregivers’. Ten studies—using both qualitative and quantitative methods, and involving >1400 carers from the United States and Europe—were selected for inclusion. (3) Results: The review shows that caregivers value interventions that are delivered by non-judgmental clinicians, that are suitable to the particular needs of their child, that are available when needed, and that support their confidence and communication. Caregivers experience difficulties with interventions that require their attendance at specific times, and that fail to recognize and/or address their own mental health needs. (4) Conclusions: The findings can be used to inform and improve the intervention design, with the aim of improving outcomes for caregivers and young people.
  Citation: Children
  PubDate: 2023-11-13
  DOI: 10.3390/children10111801
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1802: Comment on Shaniv et al. Neonatal Drug
Formularies—A Global Scope. Children 2023, 10, 848
- Authors: Elisabeth V. Giger, Romy Tilen
  First page: 1802
  Abstract: We read the article by Shaniv D. et al. entitled “Neonatal Drug Formularies—A Global Scope” [...]
  Citation: Children
  PubDate: 2023-11-13
  DOI: 10.3390/children10111802
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1803: A Callout for International Collaboration.
Reply to Giger, E.V.; Tilen, R. Comment on “Shaniv et al. Neonatal
Drug Formularies—A Global Scope. Children 2023, 10, 848”
- Authors: Dotan Shaniv, Anne Smits, Karel Allegaert, on behalf of the Neonatal Drug Formularies Group
  First page: 1803
  Abstract: We are very grateful that the global-scope paper on neonatal drug formularies has received a relevant amount of interest from the readership of the journal [...]
  Citation: Children
  PubDate: 2023-11-13
  DOI: 10.3390/children10111803
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1804: Femoral Occlusion during Neonatal
Cardiopulmonary Resuscitation Improves Outcomes in an Ovine Model of
Perinatal Cardiac Arrest
- Authors: Munmun Rawat, Srinivasan Mani, Sylvia F. Gugino, Carmon Koenigsknecht, Justin Helman, Lori Nielsen, Jayasree Nair, Upender Munshi, Praveen Chandrasekharan, Satyan Lakshminrusimha
  First page: 1804
  Abstract: Background: The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow leading to the return of spontaneous circulation (ROSC). During chest compressions, bilateral femoral occlusion may increase afterload and promote carotid and coronary flow, an effect similar to epinephrine. Our objectives were to determine the impact of bilateral femoral occlusion during chest compressions on the incidence and timing of ROSC and hemodynamics. Methodology: In this randomized study, 19 term fetal lambs in cardiac arrest were resuscitated based on the Neonatal Resuscitation Program guidelines and randomized into two groups: femoral occlusion or controls. Bilateral femoral arteries were occluded by applying pressure using two fingers during chest compressions. Results: Seventy percent (7/10) of the lambs in the femoral occlusion group achieved ROSC in 5 ± 2 min and three lambs (30%) did not receive epinephrine. ROSC was achieved in 44% (4/9) of the controls in 13 ± 6 min and all lambs received epinephrine. The femoral occlusion group had higher diastolic blood pressures, carotid and coronary blood flow. Conclusion: Femoral occlusion resulted in faster and higher incidence of ROSC, most likely due to attaining increased diastolic pressures, coronary and carotid flow. This is a low-tech intervention that can be easily adapted in resource limited settings, with the potential to improve survival and neurodevelopmental outcomes.
  Citation: Children
  PubDate: 2023-11-13
  DOI: 10.3390/children10111804
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1805: Post-Acute Sequelae of COVID-19 (PASC) in
Pediatrics: Factors That Impact Symptom Severity and Referral to Treatment
- Authors: Catherine M. Soprano, Ryan Ngo, Casey A. Konys, Ashley Bazier, Katherine S. Salamon
  First page: 1805
  Abstract: The post-acute sequelae of COVID-19 (PASC) is a complex condition. While there are emerging studies on its effects in adults, there is scarce research regarding the long-term effects of COVID-19 infection among youth. Several researchers have likened long-haul COVID-19 to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and postural orthostatic tachycardia syndrome (POTS). In adults, the prognosis for these diagnoses is less promising than that in youth; however, there is currently very little information available on the presentation of youth with PASC. A better understanding of the specific symptom presentation for youth diagnosed with PASC is necessary. Retrospective chart reviews were conducted collecting demographic data, COVID-19 symptoms and disease progression, and vaccination status. Additional data on referrals to a PASC treatment program and appointments attended were collected. Overall, data suggested that youth present with less severe PASC symptoms than adults, and the role of vaccination is unclear. These youth are often not referred to treatment programs. More exploration is necessary to continue to build an understanding of how best to aid youth diagnosed with PASC.
  Citation: Children
  PubDate: 2023-11-14
  DOI: 10.3390/children10111805
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1806: First-Time Parents’ Bonding with
Their Baby: A Longitudinal Study on Finnish Parents during the First Eight
Months of Parenthood
- Authors: Jessica Toivo, Noora Tulivuo, Mitsuko Kanzaki, Anna-Maija Koivisto, Jari Kylmä, Eija Paavilainen
  First page: 1806
  Abstract: Early positive bonding between parents and babies promotes the development of parenting skills and parents’ sensitivity to their infant’s needs. Positive bonding has been suggested to decrease the risk of maltreatment. There is less research into the differences between primiparae’s and their spouses’ bonding with their baby and changes in the parent-to-infant bonding during the first year of the baby’s life. The aim of this study was to describe bonding with one’s baby and related differences and changes within first-time parents. The data were collected from nine maternal health clinics in 2019–2021 in one city in Finland. The Mother-to-Infant Bonding Scale (MIBS) and the Edinburgh Postnatal Depression Scale (EPDS) were used. The data were collected during pregnancy (T1) and when the baby was aged 1–2 months (T2) and 6–8 months (T3). The questionnaire was completed separately by the primiparae (n = 81 at T1) and their spouses (n = 79 at T1). The findings demonstrated that both parents had positive feelings for their baby. The primiparae’s and their spouses’ MIBS scores were relatively low at T2 and T3. The change between time points or the difference in the parents’ bonding was not statistically significant when examining MIBS total scores. The present study identified a positive weak-to-moderate correlation between the MIBS and EPDS. This association was highlighted in the group of primiparae. The results of this study can be used to develop maternity and child health clinic services, and to promote parents’ equal growth in parenthood.
  Citation: Children
  PubDate: 2023-11-14
  DOI: 10.3390/children10111806
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1807: The Dark Side of Multimedia Devices:
Negative Consequences for Socioemotional Development in Early Childhood
- Authors: Bruno Rocha, Laura I. Ferreira, Cátia Martins, Rita Santos, Cristina Nunes
  First page: 1807
  Abstract: There is growing concern about the relationship between screen use by young children and negative effects on their development, as children with developmental and socioemotional impairments tend to have difficulties in their relationships and increased academic problems. The aim of our study was to analyse the relationship between the use of multimedia devices and paediatric symptoms in children below 5 years old. Data from 534 Portuguese parents of children aged from 18 to 57 months were collected via a self-report questionnaire. Children’s daily exposure to multimedia devices was nearly 2 h per day. Paediatric symptoms were positively associated with watching television and screen time and negatively associated with parents’ working hours. Touchscreen use was more frequent among girls and older children. Parents’ working hours comprised the most significant predictor of paediatric symptoms. Our findings reinforce past findings on the adverse links between the use of multimedia devices and paediatric symptoms and also highlight the influence of other variables like the child’s age and gender, as well as parental factors. The need to both create a more comprehensive framework regarding the long-term effects of multimedia device use and delineate effective strategies for prevention and intervention with parents and children is discussed.
  Citation: Children
  PubDate: 2023-11-14
  DOI: 10.3390/children10111807
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1808: Treatment of Ankyloglossia: A Review
- Authors: Alessandro Frezza, Fatima Ezeddine, Andrea Zuccon, Antonio Gracco, Giovanni Bruno, Alberto De Stefani
  First page: 1808
  Abstract: Aim: The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy. Materials and methods: A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: “lingual”, “frenulectomy”, “frenulotomy”, “frenulum”, “ankyloglossia”, and “laser.” Results: A total of 14 articles were included in this review, including four prospective observational studies, one case–control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table. Conclusions: In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period.
  Citation: Children
  PubDate: 2023-11-14
  DOI: 10.3390/children10111808
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1809: Diagnostic Accuracy of Multiplex Polymerase
Chain Reaction in Early Onset Neonatal Sepsis
- Authors: Anja Stein, Daniel Soukup, Peter-Michael Rath, Ursula Felderhoff-Müser
  First page: 1809
  Abstract: Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex PCR test. Newborns at risk of neonatal sepsis were prospectively screened as recommended per national guidelines. Evaluations included laboratory parameters (CrP, IL6, differential blood count), blood culture, and a molecular multiplex PCR test (ROCHE LightCycler SeptiFastâ) identifying 20 common microbial agents. Blood samples were taken simultaneously from umbilical cord or venous sources on the first day of life. Of 229 infants included, 69% were born preterm. Blood culture and multiplex PCR sensitivity were 7.4% and 14.8%, respectively. Specificity, negative and positive predictive values between methods showed no significant variance, although multiplex PCR had more false positives due to contamination. The limited sensitivity of blood cultures for early onset neonatal sepsis is concerning. Despite quicker results, multiplex PCR does not enhance diagnostic accuracy or antibiotic therapy guidance, thus it cannot be recommended for this indication.
  Citation: Children
  PubDate: 2023-11-14
  DOI: 10.3390/children10111809
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1810: Effects of Smartphone Activities on
Postural Balance in Adolescents with Intellectual Disabilities
- Authors: Ghada Jouira, Cristina Ioana Alexe, Julien Narcis Herlo, Cristina Elena Moraru, Mihaela Bogdan, Dan Iulian Alexe, Gabriel Mareș, Sonia Sahli
  First page: 1810
  Abstract: Considering the rising prevalence of smartphone usage among adolescents with intellectual disabilities and their frequent motor challenges, understanding its impact on their physical well-being is important. This study aims to investigate the impact of smartphone activities on postural balance in adolescents with intellectual disabilities. Two groups of adolescents participated in the study: an intellectual disability group (IDG) (n = 16) and atypical development group (TDG) (n = 12). Static postural balance, using a stabilometric platform on firm and foam surfaces, and dynamic balance, using the Timed Up-and-Go Test (TUGT), were performed under various conditions, such as playing a game, watching videos, video calls, and listening to music. The center of pressure (CoP) values significantly increased (p < 0.05) during all smartphone activities (except listening to music) compared to the control condition in both groups, with the IDG demonstrated a more pronounced increase (p < 0.05) during playing video games and video calls on the firm surface. TUGT scores significantly increased (p < 0.05) during smartphone activities, with greater changes observed in the IDG (p < 0.05), and significantly decreased (p < 0.01) during listening to music in both groups. Our study suggests that adolescents with intellectual disabilities need special tools and guidance to ensure their safety and well-being when using smartphones.
  Citation: Children
  PubDate: 2023-11-14
  DOI: 10.3390/children10111810
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1811: Editorial for “Asthma and Its Impact
in Adolescents” Special Issue
- Authors: Roberto W. Dal Negro
  First page: 1811
  Abstract: Bronchial asthma is a chronic disease related to the atopic condition in most cases but also to other factors (such as infectious diseases; social, economic, environmental, and occupational conditions; exposure to biological irritants; and/or chemical aggressions) [...]
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111811
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1812: The Diverse Genomic Landscape of
Diamond–Blackfan Anemia: Two Novel Variants and a Mini-Review
- Authors: Iordanis Pelagiadis, Ioannis Kyriakidis, Nikolaos Katzilakis, Chrysoula Kosmeri, Danai Veltra, Christalena Sofocleous, Stavros Glentis, Antonis Kattamis, Alexandros Makis, Eftichia Stiakaki
  First page: 1812
  Abstract: Diamond–Blackfan anemia (DBA) is a ribosomopathy characterized by bone marrow erythroid hypoplasia, which typically presents with severe anemia within the first months of life. DBA is typically attributed to a heterozygous mutation in a ribosomal protein (RP) gene along with a defect in the ribosomal RNA (rRNA) maturation or levels. Besides classic DBA, DBA-like disease has been described with variations in 16 genes (primarily in GATA1, followed by ADA2 alias CECR1, HEATR3, and TSR2). To date, more than a thousand variants have been reported in RP genes. Splice variants represent 6% of identifiable genetic defects in DBA, while their prevalence is 14.3% when focusing on pathogenic and likely pathogenic (P/LP) variants, thus highlighting the impact of such alterations in RP translation and, subsequently, in ribosome levels. We hereby present two cases with novel pathogenic splice variants in RPS17 and RPS26. Associations of DBA-related variants with specific phenotypic features and malignancies and the molecular consequences of pathogenic variations for each DBA-related gene are discussed. The determinants of the spontaneous remission, cancer development, variable expression of the same variants between families, and selectivity of RP defects towards the erythroid lineage remain to be elucidated.
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111812
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1813: Auditory Cortex Maturation and Language
Development in Children with Hearing Loss and Additional Disabilities
- Authors: Satu Lamminmäki, Kayla Cormier, Hanna Davidson, Jim Grigsby, Anu Sharma
  First page: 1813
  Abstract: A significant portion of hearing-impaired children have additional disabilities, but data about the maturation of their auditory cortex are scarce. In these children, behavioral tests are often unreliable, and objective tests are needed for diagnostics and follow-up. This study aimed to explore auditory cortical maturation and language development, and the usability of an objective electroencephalogram-based biomarker in children with multiple disabilities. In 65 hearing aid and cochlear implant users (36 females; 36 with multiple disabilities; 44.3 ± 18.5 months of age, mean ± SD), auditory processing was examined using the P1 cortical auditory evoked response biomarker, and language development with the Preschool Language Scales 5th edition (PLS-5). During the study, all of the children received intensive extra language therapy for six months. No significant differences were found between the groups in P1 latency development, the proportion of abnormal P1 latencies, or the number of children whose P1 latencies changed from abnormal to normal during the study. The PLS-5 total language scores, auditory comprehension scores, or expressive communication scores did not differ between groups either. The P1 latencies showed meaningful negative correlations with the language scores. The results suggest that auditory cortex development is similar in hearing-impaired children with/without additional disabilities, and the P1 biomarker is a feasible tool to evaluate central auditory maturation in children with multiple disabilities.
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111813
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1814: The Effect of Saffron Kozanis (Crocus
sativus L.) Supplementation on Weight Management, Glycemic Markers and
Lipid Profile in Adolescents with Obesity: A Double-Blinded Randomized
Placebo-Controlled Trial
- Authors: Eleni P. Kotanidou, Vasiliki Rengina Tsinopoulou, Styliani Giza, Stergianna Ntouma, Chrysanthi Angeli, Michail Chatziandreou, Konstantinos Tsopelas, Ioulia Tseti, Assimina Galli-Tsinopoulou
  First page: 1814
  Abstract: Global rates of adolescent obesity have led the World Health Organization to consider the disease a pandemic that needs focus. In search of new anti-obesity agents, Crocus sativus, popularly known as saffron, is a nutraceutical agent, praised for its beneficial effects. The study aimed to investigate the possible effect of Kozanis saffron administration on weight management of obese prediabetic adolescents. Seventy-four obese prediabetic adolescents participated in a double-blind placebo-controlled trial of three arms, randomly assigned to receive either Kozanis saffron (n = 25, 60 mg/day), metformin (n = 25, 1000 mg/day) or a placebo (n = 24), for twelve weeks. Anthropometry, glycemic markers and lipid profiles were investigated at baseline and post-intervention. Saffron supplementation significantly reduced the weight z-score, BMI, BMI z-score and waist circumference (WC) of obese adolescents; however, this reduction was less significant compared to the effect of metformin. Metformin administration offered a significantly more profound improvement in anthropometry compared to saffron administration. Saffron administration also provided significant improvements in weight, weight z-scores, BMI values, BMI z-scores and WCs compared to the placebo. Saffron supplementation failed to change any glycemic marker, but provided a significant reduction in fasting triglyceride levels and also a significant increase in fasting HDL levels. Saffron Kozanis constitutes a promising nutraceutical option for adolescents and children with obesity and prediabetes in need of weight management.
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111814
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1815: Indices of Narrative Language Associated
with Disability
- Authors: Norah M. Almubark, Gabriela Silva-Maceda, Matthew E. Foster, Trina D. Spencer
  First page: 1815
  Abstract: Narratives skills are associated with long-term academic and social benefits. While students with disabilities often struggle to produce complete and complex narratives, it remains unclear which aspects of narrative language are most indicative of disability. In this study, we examined the association between a variety of narrative contents and form indices and disability. Methodology involved drawing 50 K-3 students with Individual Education Programs (IEP) and reported language concerns from a large diverse sample (n = 1074). Fifty typically developing (TD) students were matched to the former group using propensity score matching based on their age, gender, grade, mother’s education, and ethnicity. Narrative retells and generated language samples were collected and scored for Narrative Discourse and Sentence Complexity using a narrative scoring rubric. In addition, the number of different words (NDW), subordination index (SI), and percentage of grammatical errors (%GE) were calculated using computer software. Results of the Mixed effect model revealed that only Narrative Discourse had a significant effect on disability, with no significant effect revealed for Sentence Complexity, %GE, SI, and NDW. Additionally, Narrative Discourse emerged as the sole significant predictor of disability. At each grade, there were performance gaps between groups in the Narrative Discourse, Language Complexity, and SI. Findings suggest that difficulty in Narrative Discourse is the most consistent predictor of disability.
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111815
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1816: Risk Behaviors among Migrant Adolescents in
Italy
- Authors: Emanuele Koumantakis, Rosanna Irene Comoretto, Paola Dalmasso, Michela Bersia, Patrizia Lemma, Giacomo Lazzeri, Paola Nardone, Alessio Vieno, Tommaso Galeotti, Paola Berchialla, Lorena Charrier
  First page: 1816
  Abstract: Adolescence is a critical period for engaging in health risk behaviors. Migrant adolescents may face unique challenges due to acculturation stress. This study aims to monitor substance use and problem gambling among migrant adolescents living in Italy. Data from the 2017/18 Health Behavior in School-Aged Children survey in Italy were analyzed. The 18,794 participants included 15-year-olds, categorized as native or migrants, with ethnic backgrounds from Western, Eastern European, or non-Western/non-European countries. Girls had higher smoking rates, while boys exhibited higher prevalence of alcohol-related risk behaviors, cannabis use, and gambling. Boys from Eastern European countries displayed a greater risk of drunkenness (OR: 1.58, 95% CI: 1.06–2.37), particularly in the first generation, while those from Western countries showed a higher risk of multiple substance use (OR: 1.44, 95% CI: 1.05–1.96). Girls from Eastern European and non-Western/non-European countries had a lower risk of alcohol consumption (OR: 0.50, 95% CI: 0.29–0.85; OR: 0.55, 95% CI: 0.33–0.91, respectively). Finally, boys, especially those from Eastern European and non-Western/non-European countries, had a significantly higher risk of problem gambling (OR: 1.83, 95% CI: 1.04–3.22; OR: 2.10, 95% CI: 1.29–3.42, respectively). This disparity was more pronounced in the first generation, possibly due to acculturation challenges and socio-economic factors. Risk behaviors in adolescents are influenced by complex interplays of gender, cultural factors, and migration generation. Preventive strategies should consider these factors to effectively address substance use and gambling in this heterogeneous population.
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111816
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1817: Carrot-Induced Systemic Reaction: A Unique
Presentation of Pollen-Food Allergy Syndrome in a Young Boy
- Authors: Weronika M. Balas, Joanna Strzelecka, Aleksandra Godyńska, Adam J. Sybilski
  First page: 1817
  Abstract: Pollen-food allergy syndrome (PFAS) is a common IgE-mediated allergic condition resulting from cross-reactions between pollen and plant food allergens, primarily those in the PR-10 subfamily. Mostly symptoms are limited to the mouth and throat causing oral allergy syndrome (OAS). Systemic reactions are extremely rare. We report an 11-year-old boy who experienced a unique anaphylactic reaction after consuming raw carrot juice. The patient exhibited symptoms within one minute, including abdominal pain, facial and eyelid swelling, dyspnea, a macular rash, choking sensation and drowsiness. Desloratadine alleviated these symptoms, and as his overall condition improved rapidly, there was no need for adrenaline administration. Carrot-specific IgE levels in the patient’s serum were as follows: Dau c: 40.63 kUA/L and Dau c1: 31.5 kUA/L. He had previously been diagnosed with seasonal allergic rhinoconjunctivitis. The high degree of similarity among allergen components within the PR-10 subfamily contributed to cross-reactivity between birch pollen and carrots. It is important to remember that PFAS can manifest systemically, with symptoms ranging from mild skin itching to potentially fatal consequences. This highlights the need for healthcare professionals to be extra cautious and aware of this possibility, especially since carrots are commonly found in a wide range of dishes and snacks.
  Citation: Children
  PubDate: 2023-11-15
  DOI: 10.3390/children10111817
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1818: Fetal-Type Rhabdomyoma of the Cheek: A
Conservative Management
- Authors: Angela Troisi, Valentina Pelliccia, Bruna Malta, Vincenzo Domenichelli, Federico Marchetti
  First page: 1818
  Abstract: Extracardiac rhabdomyomas are rare benign mesenchymal tumors diagnosed upon radiological and hystologic investigations and the treatment of choice is surgical exertion. There aren’t any similar cases managed conservatively reported in literature as in our case, to the best of our knowledge. We present a rare case of fetal cheek rhabdomyoma diagnosed in a healthy 2 months-old boy, with asymptomatic mass over the left masseter. The lesion could not be removed, due to the size and dimensions and the young age of the patient. However, the lesion did not show signs of spreading or progression over a 36 months follow-up. Fetal rhabdomyoma is a benign tumor, often located in the head and neck district, where surgery, especially in very young children, is associated with a high risk of complications and long-term sequelae. Our case report demonstrates the possibility to manage these lesions conservatively in the first years of life with close sonographic and clinical follow-up.
  Citation: Children
  PubDate: 2023-11-16
  DOI: 10.3390/children10111818
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1819: Early-Term Neonates Demonstrate a Higher
Likelihood of Requiring Phototherapy Compared to Those Born Full-Term
- Authors: Teck-Jin Tan, Wan-Ju Chen, Wan-Chun Lin, Ming-Chun Yang, Ching-Chung Tsai, Yung-Ning Yang, San-Nan Yang, Hsien-Kuan Liu
  First page: 1819
  Abstract: Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021–June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24–48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24–48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24–48 h postpartum enhances early prediction and intervention.
  Citation: Children
  PubDate: 2023-11-16
  DOI: 10.3390/children10111819
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1820: Behavioral and Mental Health Problems in
Children
- Authors: Tingzhong Yang, Dan Wu
  First page: 1820
  Abstract: The stimulus, stress, and behavioral and mental response (SSB) model proposes that various stimuli induce stress and behavioral responses, which may, in turn, lead to health problems [...]
  Citation: Children
  PubDate: 2023-11-17
  DOI: 10.3390/children10111820
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1821: Elastodontic Appliances for the
Interception of Malocclusion in Children: A Systematic Narrative Hybrid
Review
- Authors: Vincenzo Ronsivalle, Ludovica Nucci, Nicolò Bua, Giuseppe Palazzo, Salvatore La Rosa
  First page: 1821
  Abstract: Background. Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications. Materials and methods. To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used. Results. The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention. Conclusions. Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits.
  Citation: Children
  PubDate: 2023-11-17
  DOI: 10.3390/children10111821
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1822: Comprehensive Analysis of Risk Factors for
Bronchopulmonary Dysplasia in Preterm Infants in Taiwan: A Four-Year Study
- Authors: Lin-Yi Huang, Ting-I Lin, Chyi-Her Lin, San-Nan Yang, Wan-Ju Chen, Chien-Yi Wu, Hsien-Kuan Liu, Pei-Ling Wu, Jau-Ling Suen, Jung-Sheng Chen, Yung-Ning Yang
  First page: 1822
  Abstract: Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify risk factors for BPD and BPD/mortality in Taiwan using data from the Taiwan Neonatal Network. The BPD criteria were based on the National Institute of Child Health and Human Development standards. Average GA was 27.5 weeks, with 23.7% classified as small for GA (SGA). Multivariate analysis highlighted low GA, low birth weight, and other perinatal factors as significant risk indicators for BPD. For moderate-to-severe BPD, additional risk factors included male gender and SGA, endotracheal intubation (ETT) or cardiopulmonary cerebral resuscitation (CPCR) in initial resuscitation. In the moderate-to-severe BPD/death group, SGA and ETT or CPCR in initial resuscitation remained the only additional risk factors. The study pinpoints male gender, SGA and ETT or CPCR as key risk factors for moderate-to-severe BPD/death in low-birth-weight infants in Taiwan, offering a basis for focused interventions and further research.
  Citation: Children
  PubDate: 2023-11-17
  DOI: 10.3390/children10111822
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1823: An Entangled Relationship between Bullying
Perception and Psychosocial Dimensions in a Sample of Young Adolescents
- Authors: Francesca Mastorci, Maria Francesca Lodovica Lazzeri, Paolo Piaggi, Cristina Doveri, Anselmo Casu, Gabriele Trivellini, Irene Marinaro, Caleb Devine, Cristina Vassalle, Alessandro Pingitore
  First page: 1823
  Abstract: Background: Bullying is a hostile behavior repeated over a time period, affecting children and adolescents in different social settings, mainly small and stable ones like school, with negative effects on mental and physical health. In this study, we aimed to provide the degree of impairment of different variables related to health and well-being in bullying conditions, with attention to sex differences. Methods: Data were obtained from 5390 adolescents (mean age 13.08 ± 1.89; male 2729), and health-related quality of life (HRQoL) was assessed using the KIDSCREEN-52 questionnaire. Results: In all students, mood and emotion, self-perception, and parental relationships are the dimensions more compromised in bullying conditions, while lifestyle habit is the variable less involved. Bullied girls show a significant impairment of all HRQoL variables both with respect to the socially accepted counterpart and to the male population. Conclusions: Our study highlights the strict association between bullying and emotional and social dimensions, suggesting that enhancing them preventively could facilitate earlier detection of problems, thereby reducing health risks.
  Citation: Children
  PubDate: 2023-11-17
  DOI: 10.3390/children10111823
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1824: Assessment of Oral Health in a Child Cohort
of a Rural Zone of Ethiopia
- Authors: Luca Mezzofranco, Francesca Zalunardo, Andrea Magliarditi, Antonio Gracco
  First page: 1824
  Abstract: Health conditions in a developing state such as Ethiopia are precarious; in addition to the extreme spread of infectious diseases such as AIDS, oral health is also affected by the scarce knowledge and possibility of treatment. This analysis considered 77 children aged 7 to 11 from a primary school in Guraghe in Ethiopia. The presence of plaque, calculus, and caries was evaluated. For each caries, the affected tooth and the site of onset were considered. Plaque was detected in 39% of the children, calculus in 22%, and dental caries in 48% of the patients. The cavities were found to be equally distributed between the two arches, with a prevalence of location in the deciduous teeth and in the occlusal area. The implementation of home oral hygiene education and the training of health professionals who successfully promote oral health is necessary.
  Citation: Children
  PubDate: 2023-11-17
  DOI: 10.3390/children10111824
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1825: Impact of Innovative Emotion Training in
Preschool and Kindergarten Children Aged from 3 to 6 Years
- Authors: Anne Lafay, Carole Berger, Laura Alaria, Sonia Angonin, Nathalie Dalla-Libera, Sylvie Richard, Thalia Cavadini, Edouard Gentaz
  First page: 1825
  Abstract: Children’s emotional abilities have been shown to be related to academic performance, peer acceptance, and in-school adjustment. The main objective of this study was to evaluate the effect of innovative emotion training designed to promote the emotional abilities of 316 preschool/kindergarten children aged from 3 to 6 years old enrolled in public schools in the first three levels (L1, L2, and L3). Another objective was to examine the transfer effects on language comprehension and mathematics abilities. The emotion training (eight sessions) focused on the identification, comprehension, and expression of emotions and were co-constructed with teachers. Children were tested before and after the training on emotion, language, and mathematics skills. Results showed an improvement in emotional abilities in young children of L1 (3–4 years) and L2 (4–5 years) in the intervention group compared to those in the non-intervention group. Also, although children’s emotion basic abilities were correlated with their language comprehension and mathematics abilities, the nature of this link was not demonstrated to be causal. Findings are discussed in regard to the influence of the level and in regard to links with academic variables.
  Citation: Children
  PubDate: 2023-11-17
  DOI: 10.3390/children10111825
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1826: The Effectiveness of an Intervention
Programme for Reducing Peer Rejection in Early Childhood Education
- Authors: Paula Molinero-González, Luis J. Martín-Antón, Miguel Á. Carbonero-Martín, Wendy L. Arteaga-Cedeño, José Luis Rodríguez-Sáez
  First page: 1826
  Abstract: In the early years of schooling, peer groups are key to fostering students’ overall learning and development. Yet it has been found that around 10% of children suffer from peer rejection in the classroom, with this problem entailing negative consequences both in the short and long term. The problem proves difficult for adults to detect, which usually leads to a delay in measures being taken to intervene and prevent it. This study applies an experimental design with pre-test and post-test measurements in two groups—experimental and control—in order to address the problem of rejection in the early years of schooling. It explores aspects such as sociometric type, degree of victimisation, social and antisocial behaviour, as well as problematic situations among 637 students at six schools. We then implement an intervention programme for socioemotional competence throughout a school year in an effort to improve students’ social skills and relationships, focusing specifically on preventing and reducing the rejection experienced by some of these children. The programme comprises 35 teaching activities and strategies that promote the development of competences for student inclusion (curbing aggression, encouraging teamwork, fostering self-esteem, etc.) and that seek to involve all students, teachers, and relatives by offering an array of complementary resources that enrich the initiatives applied (a programme calendar, assessment notebook, questionnaires, related website, material resources). After the intervention programme, it was found that the experimental group had reduced the percentage of students who suffered rejection from 9.9% to 7.3%, although the same was not true of the control group, which went from 9.5% of rejected students to 10.2%. The reduction in the percentage of rejected students in the experimental group after the application of the programme is an encouraging result that invites us to continue working on more comprehensive interventions to prevent and reduce this phenomenon.
  Citation: Children
  PubDate: 2023-11-19
  DOI: 10.3390/children10111826
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1827: Asymptomatic Infant Rib Fractures Are
Primarily Non-abuse-Related and Should Not Be Used to Assess Physical
Child Abuse
- Authors: Martin J. C. van Gemert, Marianne Vlaming, Steven C. Gabaeff, Peter G. J. Nikkels, H. A. Martino Neumann
  First page: 1827
  Abstract: Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations related to, e.g., suspicion of the shaken baby syndrome. In a recent systematic literature review (searched in Cochran, Embase, PubMed and Sociological Abstracts), Güvensel questioned the diagnostic accuracy of rib fractures to be caused by abuse, due to lack of sufficient scientific evidence. Further, there is currently a world-wide disagreement between physicians considering themselves child abuse specialized, and physicians that explore non-abuse-related symptoms that may mimic physical abuse, which, it is hoped, will significantly reduce current unjustified child abuse diagnoses. In an attempt to help resolving this disagreement, we hypothesize that the probability of physical child abuse-related infant rib fractures is significantly lower than the probability of all other possible non-abuse-related causes of occult asymptomatic infant rib fractures, e.g., from birth trauma, prematurity, osteogenesis imperfecta, hypermobile Ehlers-Danlos Syndrome, severe chronic placental pathology (e.g., massive perivillous fibrin depositions and severe chronic histiocytic intervillositis), and vitamin-D deficiency. As method, we attempted to assess the incidence of these various causes of infant rib fractures, in the Netherlands and the USA. The results are that the estimated Dutch and USA physical abuse-related infant rib fracture incidences are at least about 250 and 45 times lower than the sum of all the non-abuse-related estimates. Because these latter rib fractures are occult and asymptomatic, it is likely that (many) more could be out there. In conclusion, occult asymptomatic rib fractures develop perinatally, virtually always as birth trauma, in infants with sufficiently weak bones due to vitamin D deficiency, transmitted by their vitamin D deficient pregnant mothers. This group also includes cortical rib cracks due to deformation forces, with an estimated 186/100,000 incidence. And, despite obvious uncertainties in all estimated incidences, we provided strong evidence that our hypothesis has relevance, implying that the abundant occult asymptomatic rib fractures, when found in infants, should not be used to assess potential physical child abuse.
  Citation: Children
  PubDate: 2023-11-20
  DOI: 10.3390/children10111827
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1828: A Scoping Review of Studies on Assistive
Technology Interventions and Their Impact on Individuals with Autism
Spectrum Disorder in Arabic-Speaking Countries
- Authors: Maha Al-Hendawi, Esraa Hussein, Badriya Al Ghafri, Sefa Bulut
  First page: 1828
  Abstract: The rising prevalence of autism spectrum disorder (ASD) in Arab countries necessitates evidence-based interventions. Assistive technology (AT) presents a promising approach. However, data on the pervasiveness of AT use and its effectiveness for individuals with ASD, specifically within Arab countries, remain scarce. Objective: To review the current literature on the AT interventions and outcomes reported for individuals with ASD in Arab countries. Methods: A scoping review adhering to PRISMA guidelines was undertaken to explore the utilization of AT, segmented into three categories: low-technology (low-tech), mid-technology (mid-tech), and high-technology (high-tech) devices. Results: Twelve studies had a pooled sample of 1547 participants, primarily male school-aged children with ASD. The AT applications evaluated ranged from low-tech visual schedules and support to high-tech virtual reality systems. Studies have reported the potential benefits of AT in improving communication, social, academic, adaptive, and functional abilities; however, comparative evidence between AT interventions is limited. The identified barriers to the adoption of AT included caregiver uncertainty about the use of AT and a lack of awareness of AT among professionals and the Arab community in general. Conclusion: Available studies suggest that the adoption of AT can enhance the skills of individuals with ASD in Arab countries. However, more rigorous studies across diverse demographic groups and Arab national regions are needed to strengthen the evidence base and provide appropriate recommendations.
  Citation: Children
  PubDate: 2023-11-20
  DOI: 10.3390/children10111828
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1829: Prevalence and Determinants of Diarrhea,
Fever, and Coexistence of Diarrhea and Fever in Children Under-Five in
Bangladesh
- Authors: Md. Shariful Islam, Mohammad Rocky Khan Chowdhury, Farzana Akhter Bornee, Hasina Akhter Chowdhury, Baki Billah, Manzur Kader, Mamunur Rashid
  First page: 1829
  Abstract: Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017–2018 Bangladesh Demography and Health Survey (BDHS) were analyzed using multivariable stepwise logistic regression with backward selection. This study found that 5.0% for diarrhea, 34.0% for fever, and 3.0% for the coexistence of both illnesses. Common factors associated with childhood diarrhea and fever included the child’s age (12–23 months), and the mother’s education. Diarrhea was associated with households with improved water sources and children in the Barisal division, while fever was linked to underweight children and those from more affluent backgrounds. The coexistence of both was significantly linked to underweight children, higher birth orders, and children from the Rajshahi division. Notably, child illnesses were associated with parental education, higher socio-economic status, and access to improved drinking water sources. Diarrhea affects one in 20 children, fever affects one in three, and the coexistence of both conditions affects one in 35 children in Bangladesh. The findings need further research and policy reviews to develop effective interventions and improve child health in Bangladesh.
  Citation: Children
  PubDate: 2023-11-20
  DOI: 10.3390/children10111829
  Issue No: Vol. 10, No. 11 (2023)
Children, Vol. 10, Pages 1830: Use of the Subcutaneous Triptorelin
Stimulation Test for Diagnosis of Central Precocious Puberty
- Authors: Jungmin Ahn, Youngin Lee, Seongmin Gim, Hwalrim Jeong
  First page: 1830
  Abstract: Background: The gold standard gonadotropin-releasing hormone (GnRH) stimulation test uses the response to intravenously injected gonadorelin to diagnose central precocious puberty (CPP). However, gonadorelin is not always readily available. Objective: This study investigated the diagnostic efficacy of the subcutaneous triptorelin test and the optimal blood sampling time for diagnosis of CPP. Methods: This study retrospectively examined the medical records of 220 girls who had undergone either the triptorelin or gonadorelin test and compared their clinical characteristics. We retrospectively compared clinical parameters between girls diagnosed with CPP (n = 111) and idiopathic premature thelarche (IPT) (n = 109) using three different diagnostic methods: the gonadorelin, triptorelin 120 min, and triptorelin 180 min tests. The diagnostic ability of the stimulated luteinizing hormone (LH) concentration in the triptorelin test for CPP was evaluated using receiver operating characteristic (ROC) analysis. Results: The CPP group exhibited higher basal and peak gonadotropin levels, more advanced bone age, and a lower body mass index standard deviation score than the IPT group. In the gonadorelin test group, all girls with CPP exhibited a peak LH response 30–60 min after intravenous gonadorelin injection. In the triptorelin test group, most girls with CPP exhibited a peak LH response 60–180 min after subcutaneous triptorelin injection (n = 68). On the ROC curve, a peak LH concentration of ≥ 4.52 IU/L at 120 min had the highest CPP diagnostic accuracy, with sensitivity and specificity of 100% and 95.83%, respectively.
  Citation: Children
  PubDate: 2023-11-20
  DOI: 10.3390/children10111830
  Issue No: Vol. 10, No. 11 (2023)