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        <title>Frontiers in Pediatrics | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/pediatrics</link>
        <description>RSS Feed for Frontiers in Pediatrics | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-11T19:52:14.611+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1758117</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1758117</link>
        <title><![CDATA[Protocol for a randomized controlled trial investigating the effects of sleep extension on body weight and learning in children (More2Sleep)]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Cecilie H. Rasmussen</author><author>Nadia D. Neesgaard</author><author>Malene Skriver-Bayer</author><author>Caroline S. Muushardt</author><author>Eva Leedo-Townend</author><author>Jonas R. Bjørndal</author><author>Maria I. Rosenkrans</author><author>Andreas Wulff-Abramsson</author><author>Louise Mejer</author><author>Kathrine Skak Madsen</author><author>Line K. Johnsen</author><author>Hartwig R. Siebner</author><author>Nanette M. Debes</author><author>Chantelle N. Hart</author><author>Guy Plasqui</author><author>Anders Grøntved</author><author>Glen Nielsen</author><author>Poul J. Jennum</author><author>Jesper Lundbye-Jensen</author><author>Faidon Magkos</author>
        <description><![CDATA[BackgroundSleep is essential for children's health, cognitive development, academic performance, and overall well-being. Short sleep duration has been associated with several adverse outcomes, including an increased risk of obesity and impaired cognitive functions. Despite these associations, few studies have demonstrated causal links with these outcomes. Objective: To assess the effects of sleep extension on body weight regulation and learning ability in school-aged children with nocturnal sleep below recommendations for their age. Method: More2Sleep is a randomized, controlled, parallel trial involving 142 school-aged children (6–12 years old) who are “short-sleepers” (≤9 h/night). The children will be randomly assigned to a sleep extension group (by ∼45 min/night, achieved by going to bed 60–90 min earlier than usual; n = 71) or a control group (habitual sleep schedule; n = 71) guided by a family advisor for 12 weeks, followed by a 6-month inactive follow-up. All outcomes will be measured at baseline and 12 weeks. Selected outcomes will be reassessed at the 6-month follow-up to evaluate the sustainability of the intervention. Subgroups of children will undergo additional tests (substudy-I: metabolism and appetite; substudy-II: structural, functional, and diffusion MRI) to evaluate the mechanisms by which sleep may affect weight homeostasis and cognitive functions. Co-primary outcomes include the change in BMI z-score and learning ability from baseline to 12 weeks. Secondary outcomes include percent body fat, dietary energy intake, hunger and satiety, physical activity, energy expenditure, brain activity patterns, and cognitive and academic performance. Discussion: This study has broad implications as it can potentially inform future sleep recommendations and treatment strategies to reduce overweight/obesity and improve children's metabolic health and learning abilities.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT06341179, identifier NCT06341179.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1849196</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1849196</link>
        <title><![CDATA[Vesicovaginal reflux: a case report and literature overview]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yuming Wang</author><author>Shuai Sun</author><author>Lei Geng</author><author>Yewen Wang</author><author>Gaofeng Li</author><author>Xiaoliang Xu</author>
        <description><![CDATA[Vesicovaginal reflux (VVR) is a functional voiding disorder characterized by the retrograde flow of urine into the vagina during micturition, often presenting with daytime incontinence or postvoid dribbling. It is commonly underrecognized and may be mistaken for anatomical abnormalities such as vesicovaginal fistula or obstructive hydrocolpos, which require surgical intervention. We report a case of an 8-year-old girl who presented with dysuria, urinary urgency, and fever. Transabdominal and transrectal ultrasounds revealed an anechoic area measuring 7.3 × 3.3 × 4.0 cm in the vagina while urinary bladder was filled, which disappeared after voiding. Pelvic magnetic resonance imaging showed a cystic fluid signal between the bladder and rectum that resolved following urination. Voiding cystourethrography ruled out filling defect, which suggested bladder-vaginal reflux. A literature search of PubMed and Google Scholar from 1972 to the present using the terms “urinary incontinence,” “hydrocolpos,” and “vesicovaginal reflux” identified 13 relevant articles. Including the present case, a total of 58 cases of VVR were reviewed, ranging from children to middle-aged adults. The diagnosis of VVR should be considered when transient fluid collection is observed in the vagina on ultrasound and disappears after complete voiding. Treatment focuses on behavioral therapy, including proper voiding posture and toileting habits, along with weight control when indicated.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1747948</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1747948</link>
        <title><![CDATA[Prediction of atelectasis in Mycoplasma pneumoniae pneumonia using a SHapley Additive exPlanations-interpretable machine learning model]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jia Sun</author><author>Wang Tengfei</author><author>Mengsi Li</author><author>Mian Wang</author>
        <description><![CDATA[ObjectiveThis study aimed to evaluate the performance of three machine learning models—K-nearest neighbors (KNN), support vector machine (SVM), and neural network (NN)—for predicting the risk of atelectasis in children with Mycoplasma pneumoniae pneumonia (MPP). The study also incorporated SHAP (SHapley Additive exPlanations) analysis to interpret model predictions.MethodsBased on the clinical data of 508 pediatric patients, we performed feature selection and developed KNN, SVM, and NN models. Model performance was compared on an independent validation set, and SHAP values were employed to elucidate the predictive logic of the models.ResultsOn the validation set, the neural network (NN) model demonstrated the best overall performance, with an AUC of 0.89 and an accuracy of 0.82. The KNN model showed comparable performance (AUC = 0.88), while the SVM model achieved the highest specificity (0.87). The SHAP analysis consistently identified neutrophil percentage (NEU.pct), serum amyloid A (SAA), and C-reactive protein (CRP) as the most critical variables influencing the predictions.ConclusionThis study demonstrates the effectiveness of different machine learning models in predicting the risk of atelectasis in MPP. The neural network, in particular, exhibited superior performance owing to its powerful non-linear modeling capabilities. These interpretable models provide clinicians with a diverse set of tools to accommodate various clinical priorities, such as overall accuracy or high specificity, thereby facilitating the early identification and stratified management of high-risk children.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1803842</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1803842</link>
        <title><![CDATA[Case Report: Graves' disease in a toddler with maple syrup urine disease: therapeutic challenges and surgical resolution]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Hebah Ghandora</author><author>Mays Khader Alzahrani</author><author>Rewa Lutfi Alsharif</author><author>Haifa Al Zahrani</author><author>Mohammed Al Garni</author><author>Hadeel Jambi</author>
        <description><![CDATA[A two-and-a-half-year-old girl with a known diagnosis of Maple Syrup Urine Disease (MSUD) developed challenging Graves' disease while undergoing liver transplant workup for definitive MSUD management. Initial low-dose methimazole failed to control hyperthyroidism; gradual dose escalation resulted in better control; however, the patient developed hepatotoxicity. Dose reduction caused poorly controlled hyperthyroidism, further complicated by severe neutropenia, necessitating discontinuation. In addition, multiple MSUD catabolic crises further complicated the medical management. A total thyroidectomy was planned after metabolic stabilization and preoperative preparation. Perioperative management included Lugol's iodine, hydrocortisone, and propranolol, but hyperthyroidism paradoxically worsened within 24 h due to the iodine effect. Neutrophil count improved with high-dose hydrocortisone; careful reintroduction of low-dose methimazole, with close monitoring of the ANC, resulted in better control of hyperthyroidism. Another perioperative challenge included strict branched-chain amino acid restriction and high-dose insulin infusion to counter hydrocortisone metabolic risk, with careful special “sick days” management guided by a metabolic specialist to prevent neurological sequelae and metabolic crisis. Total thyroidectomy proceeded uneventfully after multidisciplinary optimization. Postoperative transient hypocalcemia was managed conservatively, and levothyroxine replacement was initiated. The patient successfully underwent liver transplantation several months later.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1822092</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1822092</link>
        <title><![CDATA[From tradition to evidence: medicinal plants used for childhood diseases in the Ehlanzeni District, Mpumalanga Province, South Africa]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Celani Lwazi Mkhabela</author><author>Boikanyo Calvin Mophuting</author><author>Sinorita Chauke</author><author>Nobuhle Cynthia Buthelezi</author><author>Idowu Jonas Sagbo</author><author>Peter Tshepiso Ndhlovu</author>
        <description><![CDATA[Recent studies indicate that about 80% of individuals around the world depend on medicinal plants for healthcare, particularly in rural areas where these plants offer affordability, accessibility, and fewer side effects compared to conventional medicines. Medicinal plants contain phytochemical compounds such as alkaloids, saponins, and tannins, which contribute to their therapeutic properties and are significant to local economies through their commercialization by traditional health practitioners. In Mpumalanga Province, South Africa, many rural communities continue to utilize these plants for various health issues. However, there is limited research regarding the use of medicinal plants for childhood diseases in the region. This study aimed to document the medicinal plants used for treating childhood diseases in the Ehlanzeni District, Mpumalanga Province, South Africa. Data was gathered from online sources, including Google Scholar and Science Direct, using keywords such as cytotoxicity, indigenous knowledge, medical ethnobotany, phytochemicals, and traditional medicine. The inclusion criteria involved studies that examine medicinal plants within the Mpumalanga Province, specifically relating to children aged 0 to 18 years. The study identified 38 plant species from 30 families used for treating 23 childhood diseases. The Fabaceae family was the most common, with roots being the frequently utilized plant part. Decoction was the primary preparation method, and oral administration was the prevalent route. The research found that 12 out of the 38 medicinal plants utilized in the Ehlanzeni District for childhood diseases have not been scientifically examined for their phytochemical properties. Only 31 of the plants have confirmed antibacterial effects, with five showing strong potency (MIC < 15 µg/mL). Moreover, 25 plants were evaluated for their antifungal activity, with Acokanthera oppositifolia proving to be the most effective (MIC: 3.9 µg/mL against Candida albicans). Furthermore, 25 plants have been previously investigated for their cytotoxic effects, with Agapanthus africanus exhibiting significant potency, particularly against SBC-3 cells (IC50 3.7 ± 0.033 μg/mL). The limited scientific validation of phytochemical profiles and biological effects of certain plants highlights the need for further research in this area.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1758098</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1758098</link>
        <title><![CDATA[Systems perspectives on pediatric otitis media: environmental exposures, genetic susceptibility, and biomarker-guided interventions]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Ya Yu</author><author>Rui Yuan</author><author>Jingqi Zhang</author><author>Lu Wang</author><author>Tao Guo</author><author>Hanchao Shen</author><author>Hui Xie</author>
        <description><![CDATA[BackgroundPediatric otitis media remains one of the most common childhood diseases worldwide and is a major cause of hearing impairment, recurrent healthcare utilization, and antibiotic exposure. Its pathogenesis is highly heterogeneous and can no longer be adequately explained by a traditional single-pathogen model.ObjectiveThis review aims to synthesize current evidence on the roles of environmental exposures, host genetic susceptibility, biomarkers, and microbial factors in pediatric otitis media, with particular emphasis on their interactions and translational relevance.ContentCurrent evidence suggests that early-life environmental exposures may contribute to pediatric otitis media through convergent pathways involving epithelial dysfunction, impaired mucociliary clearance, inflammation, oxidative stress, and altered immune regulation, while host genetic variation may further modify susceptibility and disease heterogeneity. Emerging biomarker and microbial studies also support a systems-level understanding of pediatric otitis media and its therapeutic complexity.ConclusionPediatric otitis media should be understood as a multifactorial disorder arising from dynamic interactions among environmental exposures, host susceptibility, and microbial ecology. This integrated framework extends beyond pathogen-centered models and provides a conceptual basis for future biomarker validation, mechanistic stratification, and the development of more precise preventive and therapeutic strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1775415</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1775415</link>
        <title><![CDATA[Reflections on so-called culture-negative osteoarticular infections in pediatric populations]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Ahmer Ahmad Khan</author><author>Giacomo De Marco</author><author>Elio Paris</author><author>Oscar Vazquez</author><author>Christina Steiger-Tuk</author><author>Romain Dayer</author><author>Dimitri Ceroni</author>
        <description><![CDATA[Osteoarticular infections (OAIs) in children persist to be a major clinical concern due to their potential long-term impact on bone growth and joint function. Despite careful sampling, a significant proportion of OAIs remain culture-negative, historically obscuring the true epidemiology of these conditions. At the same time, subacute osteomyelitis is increasingly being detected and recognized as a distinct osteoarticular infection. Subacute hematogenous osteomyelitis (SAHO) is often under-recognized, as it is typically characterized by localized pain, mild or absent systemic manifestations, non-contributory laboratory tests and blood cultures, but positive radiological findings. This review focuses on the phenomenon of so-called culture-negative OAIs, exploring their microbiological basis, the role of fastidious and atypical microorganisms, parallels with subacute osteomyelitis, and the role of modern diagnostic technologies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1791876</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1791876</link>
        <title><![CDATA[Independent association of serum IgA levels with moderate-to-severe obstructive sleep apnea in children with adenotonsillar hypertrophy]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Fei Xia</author><author>Zhongfang Xia</author><author>Tao Huang</author><author>Dong Li</author>
        <description><![CDATA[BackgroundAdenotonsillar hypertrophy (ATH) is the leading cause of obstructive sleep apnea (OSA) in children. While the role of allergic inflammation (IgE-mediated) has been widely studied, the contribution of mucosal immunity—specifically Immunoglobulin A (IgA)—to disease severity remains unclear. This study aimed to investigate the association between serum immune markers and OSA severity and to construct a multivariate diagnostic model for moderate-to-severe disease.MethodsA total of 110 children diagnosed with ATH were enrolled in this cross-sectional study. Based on polysomnography (PSG) results and the 2020 Chinese Guidelines for Diagnosis and Treatment of Childhood OSA, participants were divided into a Mild/No OSA group (n = 65) and a Moderate-to-Severe OSA group (n = 45). Serum immunoglobulins (IgA, IgE, IgG, IgM) and complement components (C3c, C4) were analyzed. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were performed.ResultsThe Moderate-to-Severe group exhibited significantly lower lowest oxygen saturation (LSpO2) [0.85 (0.81, 0.89) vs. 0.89 (0.86, 0.91), P < 0.001], larger adenoids [A/N ratio: 0.77 (0.71, 0.80) vs. 0.65 (0.62, 0.75), P < 0.001], and a higher proportion of Grade III tonsils (28.9% vs. 12.3%, P < 0.001). Notably, serum IgA levels were significantly elevated in the Moderate-to-Severe group (2.05 ± 0.55 vs. 1.79 ± 0.75 g/L, P = 0.032), while IgE showed no significant difference. Multivariate logistic regression identified LSpO2 (OR = 0.853, P = 0.005) as a protective factor, while Tonsillar Hypertrophy (ORs 27.09–45.54) and IgA (OR = 2.520, 95% CI: 1.033–6.146, P = 0.042) were independent risk factors. A combined model incorporating these variables achieved an Area Under the Curve (AUC) of 0.852.ConclusionElevated serum IgA is an independent associated factor of moderate-to-severe OSA in children with ATH, suggesting a potential mechanism involving chronic mucosal inflammation distinct from atopy. A combined diagnostic model involving IgA, anatomical metrics, and oximetry provides high diagnostic value.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1825355</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1825355</link>
        <title><![CDATA[Treatment of pediatric flatfoot: a systematic review-based consensus and guidelines by CPAM-LRC]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Review</category>
        <author> Sharula</author><author>Fei Zhao</author><author>Tianyi Wu</author><author>Qinglin Kang</author><author>Xiang Geng</author><author>Hui Qin</author><author>Yan Zhang</author><author>Jin He</author><author>Lihua Huang</author><author>Jia Xu</author><author>Shengdi Lu</author>
        <description><![CDATA[The purpose of this clinical practice guideline is to provide evidence-based recommendations for the treatment of pediatric flexible flatfoot, developed in accordance with the Appraisal of Guidelines for Research and Evaluation II framework and with evidence certainty assessed using the GRADE framework and the Oxford Centre for Evidence-Based Medicine levels of evidence system. A multidisciplinary guideline development group under the Limb Reconstruction Committee of the Orthopedics Branch of China International Exchange and Promotion Association for Medical and Health Care systematically searched and reviewed evidence from primary studies including randomized controlled trials, cohort studies, and comparative studies, supplemented by existing systematic reviews and expert society surveys, to evaluate the effectiveness of conservative and surgical interventions and to guide clinicians and families on the content of an optimal treatment pathway. The guideline targets children and teenagers with flexible flatfoot and addresses interventions available to orthopedic surgeons, podiatrists, rehabilitation physicians, and orthotists, including observation, rehabilitative exercises, foot orthoses, subtalar arthroereisis, calcaneal osteotomy, and criterion-based progression to surgery. Structured conservative management should be considered the mainstay of care for all symptomatic children, with a minimum 6-month trial before surgical referral. However, there is limited evidence on the optimal type, dose, and duration of conservative treatment, and what constitutes an adequate trial of nonoperative care remains undefined. Foot orthoses can be helpful for symptomatic relief when pain or functional limitation is present, and rehabilitative exercise programs may allow superior normalization rates compared to orthoses alone. Pain-free ambulation and return to unrestricted sport are key milestones for both conservative and surgical pathways. However, no validated progression or discharge criteria exist to guide the transition from one treatment phase to the next. While the certainty of evidence was low to very low for most components of the treatment pathway, all 15 recommendation statements were formulated through two rounds of Delphi consensus polling, with 13 achieving the predefined ≥75% agreement threshold. This guideline also highlights the need for standardized diagnostic definitions, multicenter registry data, and age-stratified surgical indications not systematically addressed in previously published literature.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1798935</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1798935</link>
        <title><![CDATA[Genetic evaluation and pregnancy outcome of fetuses with digestive system malformations: an eight-year single-center retrospective study]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jianlong Zhuang</author><author>Nan Huang</author><author>Wenli Chen</author><author>Yu'e Chen</author>
        <description><![CDATA[BackgroundLimited reports have investigated the genetic etiology of fetuses with digestive system malformations (DSMs). Our initial aim was to describe supplement data of fetal DSMs and further elucidate the genotype-phenotype correlations in fetuses with DSMs.MethodsA total of 7,497 pregnancies with various high-risk factors undergoing prenatal diagnosis were enrolled at Quanzhou Women's and Children's Hospital from 2017 to 2024. Among these, 76 fetuses diagnosed with DSMs via prenatal ultrasound were collected for further analysis. All subjects underwent amniocentesis, followed by karyotype analysis and chromosomal microarray analysis (CMA).ResultsKaryotype analysis identified 3 cases of trisomy-21, 1 case of trisomy-18, and 1 case of balanced translocation t(10;11), reaching a chromosomal aberration detection rate of 6.58% (5/76). The chromosomal aneuploies detected by karyotype were confirmed by CMA. Additionally, CMA identified 6 cases of likely pathogenic/pathogenic CNVs (pCNVs/lpCNVs) that were missed by karyotype analysis, including 17q12 microdeletion/microduplication, 16p11.2 microduplication, 22q11.21q11.22 microdeletion, 2q13 microdeletion, and 16p13.11 microduplication, yielding an incremental diagnostic rate of 7.89% (6/76) for CMA over karyotype analysis (P = 0.031).ConclusionSeveral pCNVs/lpCNVs that associate with DSMs were identified. Our findings may strengthen the association between 16p11.2 microduplication syndrome and DSMs, and the correlation between 16p13.11 microduplication syndrome and intestinal malrotation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1775052</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1775052</link>
        <title><![CDATA[Online registration of neonatal stroke in Shenzhen: protocol for a multicentre, prospective, observational cohort study]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Xiaoli Zhao</author><author>Hongqin Zhang</author><author>Lijuan Sheng</author><author>Zhangbin Yu</author><author>Yanping Guo</author><author>Hanni Lin</author><author>Xuelei Gong</author><author>Xueli Zhang</author><author>Miao Tang</author><author>Jiaoyu Mao</author><author>Genshen Zheng</author><author>YuanYuan Li</author><author>Yan Huang</author><author>Fangshi Zhang</author><author>Zhangcong Liang</author><author>Jing Feng</author><author>Lichun Bai</author><author>Yaping Liu</author><author>Yinsha Cai</author><author>Zhifeng Huang</author><author>Qianshen Zhang</author><author>Aiyun Zhang</author><author>Xiaoyi Fang</author><author>Jingxing Cai</author><author>Xue Tang</author><author>Xufeng Luo</author><author>Jinxing Feng</author><author>Lina Men</author><author>Di Gao</author>
        <description><![CDATA[IntroductionNeonatal stroke remains a primary cause of permanent neurological disability. While global prognostic frameworks, including magnetic resonance imaging (MRI) of the posterior limb of the internal capsule (PLIC), General Movements Assessment (GMA), and the Hammersmith Infant Neurological Examination (HINE), have been established to predict motor outcomes, these tools have not been systematically integrated into large-scale Chinese clinical registries. In regions like Shenzhen, the scarcity of prospective, multicenter data continues to hinder the characterization of stroke incidence, risk factors, and long-term outcomes. This protocol details the establishment of the first dedicated online registry in Shenzhen to address these critical evidence gaps.Methods and analysisThis multicenter, prospective, observational cohort study aims to enroll 300 neonates diagnosed with stroke, including arterial ischemic, hemorrhagic, and cerebral venous sinus thrombosis subtypes from a network of 22 hospitals in Shenzhen, China, between January 2025 and December 2030. Data collection will utilize standardized electronic case report forms (eCRFs), initially managed via a uniform digital system (<br>Supplementary File 1), with a planned transition to a secure web-based registry for broader access. Participants will undergo longitudinal follow-up until age five, with neurodevelopmental outcomes assessed using the Bayley Scales of Infant and Toddler Development (4th Ed., Chinese Version), 3T cranial MRI, and video-EEG. To explore the metabolic-inflammatory nexus of neonatal injury, placental pathology will be integrated into the clinical data, and a biobank of stool and breast milk samples will be established. The primary outcome is the registry-based incidence of neonatal stroke. In contrast, secondary outcomes include characterizing clinical subtypes, identifying prenatal/perinatal risk factors, and developing and internally validating a robust prognostic prediction model.Clinical Trial Registration:https://www.chictr.org.cn, identifier ChiCTR2500097104.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1762616</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1762616</link>
        <title><![CDATA[Case Report: Progressive limb necrosis as a portal to multifocal osteomyelitis in pediatric septic shock: a tissue-oriented management paradigm]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Cheng Yang</author><author>Wansha Zhou</author><author>Ximeng Huang</author><author>Jiawei Li</author>
        <description><![CDATA[BackgroundLimb necrosis in pediatric septic shock may serve as a persistent source of deep infection, but its role in hematogenous dissemination is underrecognized.Case presentationA 12-year-old boy with septic shock developed progressive left foot necrosis. This was followed by septic arthritis, multifocal osteomyelitis with extensive osteolytic destruction and pathological fracture of the femur, recurrent pneumothorax, and deep vein thrombosis, complicated by multidrug-resistant infections.Management strategiesSource control was achieved via ultrasound-guided drainage of septic arthritis, pathogen-directed antibiotics, and multidisciplinary conservative management prioritizing medical treatment over high-risk surgery.ResultsClinical stabilization occurred after more than 90 days of intensive care before transfer to a general ward.ConclusionThis case illustrates that limb necrosis in septic shock may precede disseminated osteomyelitis. Early bedside ultrasound and multidisciplinary source control are essential when deep infection is suspected.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1814470</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1814470</link>
        <title><![CDATA[Nurses’ perspectives on pain management in pediatric care: systematic review and meta-synthesis]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Majd Elmobasher</author><author>Hui Tao</author><author>Jing Guo</author><author>Issam AbuQeis</author><author>Abeer Teeti</author><author>Yu Wang</author><author>Ma Fang</author>
        <description><![CDATA[BackgroundPain remains one of the most frequently misinterpreted, underdiagnosed, and inadequately managed clinical conditions in pediatric populations. An estimated 50%–70% of pediatric patients experience undertreated pain, which can have serious negative effects on their overall health and well-being. Our study aims to identify, appraise, and synthesize qualitative studies exploring nurses’ perspectives on pain management for pediatric patients to develop a conceptual understanding of facilitators and barriers from the nurses’ perspective.MethodsThis review was registered with PROSPERO (CRD420251034205). A comprehensive literature search was conducted across CINAHL, PubMed, and Nursing journals for English-language studies. The SPIDER framework was used to guide the selection of qualitative studies. Inclusion and exclusion criteria were applied following the PRISMA 2020 guidelines, resulting in the inclusion of nine studies in the final synthesis. Confidence in the synthesized findings was assessed using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach.ResultsAnalysis of nine qualitative studies identified five interconnected themes shaping nurses’ perceptions of pediatric pain management. Being Defeated by Pain reflected nurses’ emotional and professional struggles with persistent or poorly managed pain. Family Participation is a Necessity emphasized the vital role of caregivers in assessment and decision-making. Evidence-Based vs. Experience-Based Pain Assessment revealed tension between adherence to clinical guidelines and reliance on personal judgment. Pharmacological vs. Non-Pharmacological Interventions highlighted challenges in selecting appropriate treatment strategies within practical constraints. Culture-Related Pain Management illustrated how cultural beliefs influence both pain assessment and intervention. Collectively, these themes underscore the complex, multifaceted nature of pediatric pain care from the nursing perspective. The GRADE-CERQual assessment indicated high confidence in the findings for “Being Defeated by Pain” and “Pharmacological vs. Non-Pharmacological Interventions,” and moderate confidence for the remaining three themes.ConclusionsNurses face multifaceted challenges in pediatric pain management. Targeted, culturally sensitive strategies are needed to enhance nursing competence and quality of care.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1826262</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1826262</link>
        <title><![CDATA[Clinical spectrum of pediatric-onset Erdheim-Chester disease: insights from a single-center case series]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ying Yang</author><author>Zi-Chao Lyu</author><author>Zheng-Zheng Liu</author><author>Zhuo Li</author><author>Jia-Ying Yang</author><author>Jia-Wen Dai</author><author>Yue-Lun Zhang</author><author>Xin-Xin Cao</author><author>Wei-Hong Zhang</author><author>Juan Xiao</author>
        <description><![CDATA[PurposePediatric-onset Erdheim-Chester disease (PECD) is considerably rarer than the adult-onset Erdheim-Chester disease (AECD). This study aimed to characterize the clinical, laboratory, imaging, and outcome features of PECD and to compare similarities and differences with adult-onset cases treated at the same center.MethodsWe performed a comparative analysis of PECD and AECD patients treated at the same center over the same period, examining differences in clinical presentation, laboratory and imaging findings, treatment responses, and outcomes.ResultsFive pediatric and sixty-seven adult patients were included. Central nervous system and hypothalamic or pituitary involvement were observed in over 50% of children. PECD patients demonstrated distinct organ involvement patterns, including lower rates of bone involvement (60.0% vs. 97.0%; P = 0.022) and cardiac or large-vessel involvement (0% vs. 65.7%; P = 0.007) compared with AECD patients. Analysis of skeletal manifestations revealed significantly less appendicular skeleton involvement in children [1/3 (33.3%) vs. 64/65 (98.5%); P = 0.004]. Osteosclerosis was the predominant radiographic pattern in both groups (66.7% in children vs. 83.9% in adults; P = 0.505), while osteolytic lesions were present in roughly one-third of patients in each cohort. Inflammatory markers were significantly lower in the pediatric group (P < 0.05). PECD patients exhibited trends toward higher progression-free survival (80.0% vs. 35.0%; P = 0.196) and overall survival (100% vs. 80.5%; P = 0.382) compared with adults; however, these findings should be interpreted cautiously due to the extremely small pediatric sample size.ConclusionsPECD and AECD differ in clinical manifestations and the intensity of systemic inflammation. Pediatric patients appear to have more favorable survival outcomes. These findings suggest potential age-related differences in disease presentation and inflammatory burden. Nevertheless, validation in larger multicenter cohorts is required, underscoring the necessity for large-scale, multicenter collaborative investigations to inform the development of pediatric-specific management strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1836614</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1836614</link>
        <title><![CDATA[Clinical characteristics and surgical treatment of congenital gluteal dermal sinus tract in children: a 15-year retrospective single-center clinical experience]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Debao Li</author><author>Shan Zheng</author><author>Xianmin Xiao</author><author>Yangyang Ma</author><author>Qingchi Zhang</author><author>Chenbin Dong</author><author>Weijing He</author><author>Gong Chen</author><author>Chun Shen</author><author>Song Sun</author>
        <description><![CDATA[ObjectiveTo summarize the clinical features, diagnosis, treatment, and prognosis of congenital gluteal dermal sinus tracts in children, providing insights for better clinical management.MethodsA retrospective analysis was conducted on 20 patients diagnosed with congenital gluteal dermal sinus tracts at the Children's Hospital of Fudan University over 15 years. The analysis focused on age, gender, diagnostic delay, diagnostic methods, course and opening of the sinus tract, and postoperative follow-up.ResultsThe study included 6 males and 14 females, with symptom onset ranging from birth to 12 years (median age of 9.5 months). Initial symptoms included abnormal gluteal depression with recurrent infections (n = 8), unexplained recurrent infections (n = 6), and asymptomatic gluteal depression or small holes (n = 6). The time from symptom onset to diagnosis ranged from 1 to 102 months (median: 13.5 months). MRI was positive in 87.5%, identifying the tract in 81.25%. CT scans were positive in all cases, but only 50% identified the tract. Sinus tractography successfully identified the tract in 7 of 10 patients. The sinus tracts were classified into three types based on the opening location. All sinus tracts were excised during surgery, with an average length of 4.95 cm. Two patients experienced recurrence and underwent reoperation, while the remaining 15 had no recurrence.ConclusionCongenital gluteal dermal sinus tracts are more common in females and often misdiagnosed. CT is more sensitive but less specific than MRI. Sinus tractography helps determine the tract's path. Prognosis is generally good after complete excision, with recurrence being the main postoperative complication.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1828908</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1828908</link>
        <title><![CDATA[Construction of a nomogram combining CT and serum markers for predicting macrolide resistance gene mutation status in pediatric Mycoplasma pneumoniae pneumonia]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xinhui Yuan</author><author>Rui Xin</author><author>Lifang Wang</author><author>Jizu Ling</author><author>Yumei Li</author><author>Lihong Pang</author>
        <description><![CDATA[PurposeTo develop and validate a nomogram integrating chest computed tomography (CT) features and serum biomarkers for predicting the mutation status of macrolide resistance genes in pediatric Mycoplasma pneumoniae pneumonia (MPP).MethodsThis retrospective study enrolled children diagnosed with MPP, genetically stratified into macrolide-resistant (MRMP) and macrolide-sensitive (MSMP) groups based on 23S rRNA gene mutations (A2063G/A2064G). Clinical data, chest CT scans obtained within 48 h of admission, and serum biomarker levels (including C-reactive protein [CRP], procalcitonin [PCT], interleukin-6 [IL-6], D-dimer, neutrophil-to-lymphocyte ratio [NLR], and lactate dehydrogenase to albumin ratio [LAR]) measured within 24 h of admission prior to antibiotic therapy were analyzed.ResultsCompared to the MSMP group (n = 283), the MRMP group (n = 145) had longer fever duration (5.91 vs. 4.85 days) and hospital stay (8.77 vs. 7.32 days), higher rates of shortness of breath (35.86% vs. 24.38%) and oxygen requirement (25.52% vs. 13.78%), elevated serum levels of CRP (39.16 vs. 31.74 mg/L), D-dimer (1.51 vs. 1.32 mg/L FEU), NLR (6.15 vs. 5.22), PCT (0.55 vs. 0.35 ng/mL), IL-6 (28.86 vs. 21.35 pg/mL), and LAR (9.19 vs. 8.42), and more frequent CT findings of lobar consolidation (68.28% vs. 45.23%), bilateral involvement (66.21% vs. 51.59%), pleural effusion (32.41% vs. 14.49%), and higher total severity score (9.22 vs. 7.88). The nomogram based on these independent predictors showed excellent discrimination with an area under the curve of 0.869.ConclusionA nomogram combining CT imaging characteristics and serum biomarkers predicted mutation status of macrolide resistance genes in pediatric MPP, potentially aiding early clinical decision-making.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1818097</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1818097</link>
        <title><![CDATA[Efficacy of interventions in peripheral arterial and venous malformations of the limbs in children: protocol for a systematic review]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Zhaokun Guo</author><author>Zhongjing Zhang</author><author>Ying Jiang</author><author>Jun Zhou</author><author>Ke-Heng Deng</author><author>Wen-Xiang Zhu</author><author>Xiangyou Zhao</author><author>Pan Jiao</author>
        <description><![CDATA[BackgroundPeripheral arteriovenous malformations (pAVMs) of the limbs are common in children, with distinct clinical features and high intervention difficulty. Existing research on its interventions is controversial due to non-standardized criteria, small-sample uncontrolled studies and inconsistent efficacy evaluation, leaving clinicians without high-quality evidence-based guidance.Methods and analysisThis study will conduct a PROSPERO-registered systematic review, searching PubMed, Embase and other databases for relevant clinical studies. Two researchers will independently screen literature, extract data and assess evidence quality via GRADE. RevMan 5.4 will be used for qualitative and quantitative statistical analysis, with subgroup and sensitivity analyses to explore heterogeneity. Primary outcome is short-term symptom improvement rate within 3 months post-intervention; secondary outcomes include adverse event incidence and quality of life.Ethics and disseminationEthical approval is not required because this study is a secondary analysis of existing data. We will disseminate the findings through peer-reviewed publications.Clinical Trial RegistrationPROSPERO (CRD420261326988).]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1814850</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1814850</link>
        <title><![CDATA[Efficacy of transumbilical single-port and two-port laparoscopy in the treatment of pediatric inguinal hernia: a systematic review and meta-analysis]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Bo Yang</author><author>Yi Zhou</author><author>Shipeng Tang</author>
        <description><![CDATA[ObjectiveTo systematically evaluate the perioperative efficacy and safety of transumbilical single-port laparoscopic surgery and two-port laparoscopic surgery in the treatment of pediatric inguinal hernia, and to provide high-quality evidence-based medical evidence for the selection of clinical surgical methods.MethodsA comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases to collect relevant controlled studies published from the establishment of the databases to December 31, 2025. After screening the literature and extracting data according to the pre-set inclusion and exclusion criteria, the ROB2 tool and ROBINS-I tool were used to evaluate the risk of bias in RCT and non-RCT studies, respectively. Meta-analysis was performed using RevMan 5.3 software and R software.ResultsA total of 13 studies were included, involving 22,846 children. Meta-analysis showed that the postoperative recurrence rate in the single-port laparoscopic group was significantly lower than that in the two-port laparoscopic group (RR = 0.60, 95% CI: 0.39–0.94, P = 0.02); there were no statistically significant differences between the two groups in terms of operation time (MD = −1.43, 95% CI: −3.42–0.57, P = 0.16), hospital stay (MD = −2.34, 95% CI: −7.73–3.06, P = 0.40), detection rate of contralateral occult hernia (RR = 1.03, 95% CI: 0.94–1.13, P = 0.55), conversion to open surgery rate (RR = 1.57, 95% CI: 0.14–17.93, P = 0.71), and the incidence of various postoperative complications (all P > 0.05). Subgroup analysis showed that in large sample size studies, the operation time in the single-port laparoscopic group was significantly shorter (MD = −4.27, 95% CI: −7.25–1.28, P < 0.001), and in small sample size studies, the recurrence rate advantage of the single-port laparoscopic group was more significant (RR = 0.43, 95% CI: 0.25–0.71, P = 0.001).ConclusionTransumbilical single-port laparoscopic surgery has a significant advantage in reducing postoperative recurrence rate in the treatment of pediatric inguinal hernia. In large sample size studies, its advantage in operation time is more evident, and its safety is comparable to that of two-port laparoscopic surgery. For medical centers with mature single-port operation techniques, single-port laparoscopy can be the preferred surgical method; for complex hernias or when technical conditions are limited, two-port laparoscopy remains a reliable choice.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1774994</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1774994</link>
        <title><![CDATA[Diagnostic performance of wearable acoustic–electrocardiographic indices for screening secundum atrial septal defect in children]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jinyong Pan</author><author>Fengling Zhang</author><author>Yan Guo</author><author>Hu Li</author><author>Yonglin Chen</author><author>Muqing Niu</author><author>Yan Zhang</author><author>Heyun Xiong</author>
        <description><![CDATA[ObjectiveTo evaluate the diagnostic performance of acoustic–electrocardiographic indices derived from a wearable phonocardiogram–electrocardiogram (ECG) sensor for screening secundum atrial septal defect (ASD) in children.MethodsIn this cross-sectional study, 50 children (4–12 years) with secundum ASD and 50 age- and sex-matched healthy controls were enrolled. A wearable patch device recorded synchronized single-lead ECG and phonocardiogram, and S2 splitting time, S1–S2, S1–S2/RR (%), EMAT and EMAT/RR (%) were derived from artifact-free sinus beats at end-expiration. Group differences were assessed using independent-samples t-tests or χ2 tests. Receiver operating characteristic analysis evaluated the ability of S2 splitting time and S1–S2/RR (%) to detect ASD, with optimal cut-offs defined by the Youden index. Multivariable logistic regression examined the independent association of these indices with ASD.ResultsBaseline demographic, anthropometric, and hemodynamic variables were well balanced between ASD and control groups. Compared with healthy controls, children with ASD had significantly prolonged S2 splitting time (39.65 ± 8.37 vs. 28.20 ± 8.91 ms; t = 6.623, P < 0.001) and an increased systolic fraction S1–S2/RR (%) (37.53 ± 2.39% vs. 34.47 ± 2.99%; t = 5.653, P < 0.001), whereas S1–S2 interval, EMAT, and EMAT/RR (%) did not differ significantly between groups. ROC analysis showed that S2 splitting time had good discriminative ability for detecting ASD, with an area under the curve (AUC) of 0.831 [95% confidence interval (CI): 0.752–0.910]. A cut-off value of ≥31.75 ms yielded a sensitivity of 0.90 and a specificity of 0.66. S1–S2/RR (%) demonstrated acceptable discrimination, with an AUC of 0.776 (95% CI 0.686–0.866) and an optimal cut-off of ≥35.25% (sensitivity 0.88, specificity 0.60). In multivariable logistic regression, both S2 splitting time [odds ratio (OR): 1.19 per 1-ms increase; 95% CI: 1.09–1.29; P < 0.001] and S1–S2/RR (%) (OR: 1.58 per 1% increase; 95% CI: 1.25–2.00; P < 0.001) remained independently associated with ASD.ConclusionsWearable acoustic–electrocardiographic monitoring enables quantitative assessment of S2 splitting and systolic time fractions in children. Prolonged S2 splitting time and increased S1–S2/RR (%) are characteristic of secundum ASD and show good diagnostic performance, supporting these simple indices from a patch-type phonocardiogram–ECG sensor as a practical non-invasive tool for pediatric ASD screening.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1802778</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1802778</link>
        <title><![CDATA[Pediatric bronchial Dieulafoy's disease: a biopsy-sparing bronchoscopic approach with selective bronchial artery embolization]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Weiqing Liu</author><author>Jiasi Zhou</author><author>Jia Guo</author><author>Tuanjie Wang</author><author>Yuping Xu</author><author>Shujun Li</author>
        <description><![CDATA[BackgroundBronchial Dieulafoy's disease (BDD) is an exceedingly rare vascular malformation in children, characterized by aberrant submucosal arteries prone to life-threatening hemorrhage. The optimal diagnostic and therapeutic pathway remains undefined due to limited pediatric cases.ObjectiveTo evaluate the feasibility and outcomes of a standardized pathway featuring biopsy-sparing bronchoscopy with typical endoscopic signs as triggers for selective bronchial artery embolization (BAE) in pediatric BDD.MethodsThis single-center retrospective study analyzed consecutive children (<18 years) with hemoptysis who underwent selective angiography and BAE at the First Affiliated Hospital of Xinxiang Medical University from 2021 onwards. A predefined diagnostic pathway prioritizing airway safety, strict avoidance of biopsy at suspicious lesions, and early progression to BAE was implemented. Patients were classified as confirmed BDD (typical bronchoscopic findings without biopsy, angiographically confirmed) or highly suspected BDD (clinical phenotype consistent, angiographic abnormalities, hemostasis after BAE).ResultsThree patients were included (median age 11 years). Two cases demonstrated typical bronchoscopic findings (submucosal elevation without pulsation) with strict biopsy avoidance and were classified as confirmed BDD. One patient bypassed bronchoscopy due to airway instability, classified as highly suspected BDD. All three patients in this cohort showed unilateral bronchial artery abnormalities on selective angiography, and computed tomography angiography (CTA) failed to identify definitive responsible vascular lesions in 100% (3/3) of cases. All patients achieved immediate hemostasis after superselective embolization (microspheres 300–500 μm ± coils). No major complications occurred. During follow-up (3–36 months), no recurrence was observed. Bronchoscopic localization matched angiographic laterality in 2/2 cases where bronchoscopy was performed.ConclusionsA standardized pathway emphasizing biopsy-sparing bronchoscopy and early BAE appears feasible and safe for pediatric BDD management, achieving favorable short-term outcomes even when computed tomography angiography (CTA) is non-localizing or bronchoscopy is bypassed due to clinical instability.]]></description>
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