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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>
        <generator>Frontiers Feed Generator,version:1</generator>
        <pubDate>2026-08-15T13:43:27.113+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1884107</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1884107</link>
        <title><![CDATA[Epidemiology, temporal trends and co-infection of 13 respiratory pathogens in 32,125 children: a 3-year retrospective study]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yu Zhang</author><author>Siyu Wang</author><author>Xiaoming Huang</author>
        <description><![CDATA[BackgroundPediatric acute respiratory tract infections bring heavy global disease burden. Clarifying post-pandemic epidemiological features guides clinical management and public health prevention.MethodsThis retrospective study enrolled patients under 18 years receiving 13-pathogen multiplex PCR at West China Second University Hospital from 2023 to 2025. We extracted laboratory data and calculated pathogen positivity, single/co-infection proportions. Stratified analyses by year, season, age and sex and statistical collation of co-infection patterns were completed.ResultsIn total, 32,125 children were included. The total pathogen positive rate reached 63.4%, including 49.8% single infection and 13.6% co-infection dominated by dual infection. Human rhinovirus (22.9%) ranked first, followed by respiratory syncytial virus (15.2%). Pathogens varied obviously across seasons and ages: HRV surged in spring and autumn; parainfluenza, adenovirus and coronavirus prevailed in summer; syncytial virus and influenza peaked in winter. Respiratory syncytial virus mainly affected infants; rhinovirus and parainfluenza were prevalent in toddlers and preschoolers; Mycoplasma pneumoniae rose with age and peaked among school-age children. Dual infection occupied nearly all co-infections; the top non-influenza combinations were HRSV–HRV and HRV–HAdV. Infections with three or more pathogens were rare.ConclusionsHRV and HRSV dominated pediatric respiratory pathogens with obvious seasonal and age clustering. Most co-infections occurred in winter and young kids. HRV detection requires careful explanation for potential asymptomatic carriage. Local epidemiological characteristics should inform age-and seasonal-targeted diagnosis and targeted prevention including HRSV prevention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1900187</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1900187</link>
        <title><![CDATA[Implementation of a risk-stratified perioperative safety pathway for children undergoing elective ERCP: a single-center real-world retrospective cohort study]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Tian-Hang Wu</author><author>Yun-Xia Zhang</author><author>Shi-Qin Qi</author><author>Ran Tang</author>
        <description><![CDATA[BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is increasingly used in children with pancreaticobiliary diseases. Although pediatric ERCP is feasible in experienced centers, perioperative adverse events, delayed recognition of early warning signs, and drainage-related problems remain important safety concerns. This study evaluated the real-world implementation of a risk-stratified perioperative safety pathway in children undergoing elective ERCP.MethodsThis single-center retrospective historical cohort study included consecutive children who underwent elective ERCP at Anhui Provincial Children's Hospital between June 2022 and December 2025. Children treated from June 2022 to June 2023 received routine perioperative management, whereas those treated from July 2023 to December 2025 were managed under a risk-stratified perioperative safety pathway. The pathway incorporated structured preoperative risk assessment, procedure-related handover, early warning-based postoperative monitoring, standardized nasobiliary drainage management, and family-centered perioperative education. The primary outcome was the proportion of children who experienced at least one prespecified in-hospital perioperative adverse event. Secondary outcomes included postoperative recovery indicators and caregiver-reported care experience.ResultsA total of 63 children were included, with 30 in the routine management group and 33 in the risk-stratified pathway group. Baseline demographic and disease characteristics were comparable between groups. Compared with routine management, the pathway group had a shorter time to first flatus (20.3 ± 5.1 vs. 27.5 ± 6.2 h, P < 0.01), earlier resumption of oral intake (33.6 ± 7.9 vs. 44.2 ± 8.7 h, P < 0.01), and a shorter length of hospital stay (5.2 ± 1.8 vs. 7.5 ± 2.1 days, P < 0.01). The proportion of children with at least one in-hospital perioperative adverse event was lower in the pathway group than in the routine management group (24.2% vs. 53.3%, P = 0.017). Nasobiliary drainage-related complications were less frequently observed in the pathway group (6.1% vs. 23.3%, P = 0.046).ConclusionsIn this single-center retrospective historical cohort, implementation of a risk-stratified perioperative safety pathway was associated with faster postoperative recovery, fewer in-hospital perioperative adverse events, and better caregiver-reported care experience. Exploratory findings for individual adverse-event components, including nasobiliary drainage-related complications, should be interpreted cautiously because of the small sample size, multiple comparisons, and potential temporal confounding. Prospective multicenter studies are needed to validate these associations.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1895967</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1895967</link>
        <title><![CDATA[Explainable machine learning for diagnosing severe Mycoplasma pneumoniae pneumonia in children: model development and internal validation]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yu Zhang</author><author>Guihua Chen</author><author>Hui Wang</author><author>Xinyi Li</author>
        <description><![CDATA[BackgroundMycoplasma pneumoniae pneumonia (MPP) is common in children, but severe MPP (SMPP) may progress rapidly and is difficult to distinguish from non-severe disease because clinical, laboratory, and radiographic findings overlap. We aimed to develop and internally validate machine-learning models for adjunctive SMPP risk stratification using routine data while minimizing circular reasoning.MethodsWe retrospectively included consecutive children with MPP admitted from January 1, 2015, to January 1, 2026. Demographic, clinical, laboratory, and radiographic variables were collected. Variables overlapping with the severity definition, severity-proximal biomarkers, and model-derived leakage variables were excluded before modeling. Eight supervised algorithms were developed in a training cohort and evaluated in an internal test cohort using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, F1-score, calibration, Brier score, and decision curve analysis.ResultsThe cohort included 1,046 children, of whom 205 had SMPP; 784 were assigned to the training set and 262 to the internal test set, including 51 SMPP cases. In the strict non-overlap test set, the support vector machine achieved the highest AUC of 0.947 [95% confidence interval (CI), 0.907–0.980], with accuracy of 0.924, sensitivity of 0.784, specificity of 0.957, F1-score of 0.800, and Brier score of 0.058. Random forest achieved an AUC of 0.926 (95% CI, 0.878–0.964), accuracy of 0.897, sensitivity of 0.824, specificity of 0.915, and Brier score of 0.094. It was retained for calibration, decision-curve, threshold, and feature-importance analyses because of its interpretability and balanced performance. Important predictors included aspartate aminotransferase, alanine aminotransferase, albumin, cough duration, blood urea nitrogen, white blood cell count, platelet count, age, wheezing, and lung rales.ConclusionAfter exclusion of leakage variables and severity-definition-overlapping predictors, machine-learning models maintained good internal performance for classifying SMPP in children with MPP. They should be considered adjunctive risk-stratification tools rather than standalone early diagnostic tools. Multicenter external validation and prospective workflow evaluation are required before clinical implementation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1858862</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1858862</link>
        <title><![CDATA[Real-world use of maralixibat in biliary atresia: a case series]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Natasha Dilwali</author><author>Douglas B. Mogul</author><author>Shannon M. Vandriel</author><author>Tony Tokman</author><author>Catherine A. Chapin</author><author>Bertrand Roquelaure</author><author>Rossitsa Rousseva</author><author>Johanna Ferreira</author><author>Mercedes Martinez</author><author>Benno Kohlmaier</author>
        <description><![CDATA[Biliary atresia (BA) is the most common cause of cholestasis in infants, and pruritus may be a prominent and debilitating complication. Maralixibat is the first US Food and Drug Administration–approved drug for the treatment of cholestatic pruritus in children with Alagille syndrome and has been subsequently approved for treatment of progressive familial intrahepatic cholestasis as well. Several patients with BA have received maralixibat as part of a compassionate use program. We report the use of maralixibat for the treatment of cholestatic pruritus in BA for six patients. Demographics, past medical history, laboratory markers, and medications were collected. Pruritus was assessed using the Clinician Scratch Scale (CSS) at baseline and last clinical follow-up. All patients reported improved CSS with no increased usage of other antipruritic medications, and the medication was well tolerated.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1910298</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1910298</link>
        <title><![CDATA[Association between cytokine levels and disease relapse in newly diagnosed childhood-onset primary nephrotic syndrome]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chenxi Wei</author><author>Chang Zheng</author><author>Tingyu Shen</author><author>Lijun Jiang</author><author>Xingjie Qi</author><author>Zanhua Rong</author>
        <description><![CDATA[ObjectiveAlthough most pediatric patients with primary nephrotic syndrome (PNS) are steroid-sensitive, some develop steroid dependence and experience disease relapse. Therefore, identifying risk factors associated with PNS relapse is clinically important.MethodsThis retrospective study included 74 children with newly diagnosed PNS and 39 healthy children as controls. Patients with PNS were classified into relapse and non-relapse groups according to whether relapse occurred within 6 months after disease onset. Serum cytokine levels and peripheral blood lymphocyte subsets were measured using enzyme-linked immunosorbent assays and flow cytometry, respectively.ResultsDemographic characteristics and laboratory findings did not differ significantly between male and female children with PNS. Compared with healthy controls, patients with PNS exhibited abnormal white blood cell and platelet counts, an elevated erythrocyte sedimentation rate, and increased absolute counts of peripheral blood lymphocyte subsets (all P < 0.05). The interleukin-1β (IL-1β) positivity rate was significantly higher in the relapse group than in the non-relapse group (P < 0.05). IL-1β positivity was significantly associated with an increased risk of disease relapse (odds ratio = 9.727, 95% confidence interval: 1.650-102.224, P = 0.012; area under the curve = 0.591; Brier score = 0.177). PNS relapse was positively correlated with increased IL-1β levels (r = 0.321, P = 0.005).ConclusionsIL-1β positivity is associated with relapse within 6 months of onset in children with newly diagnosed PNS. Further studies are required to validate this association and elucidate the underlying mechanisms.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1838275</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1838275</link>
        <title><![CDATA[Characteristics of head injuries in children at King Abdullah Specialized Children's Hospital, Jeddah: a cross-sectional study]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sara Abed</author><author>Bashaer Gutah</author><author>Fatma Nasraldin</author><author>Ghaidaa Gadi</author><author>Muhammad Anwar Khan</author><author>Mansour Al Qurashi</author>
        <description><![CDATA[IntroductionHead injuries in children are a leading cause of death and long-term disability worldwide. However, detailed data on the characteristics of pediatric head injuries across different regions of Saudi Arabia remain limited. In this study, conducted at King Abdullah Specialized Children's Hospital (KASCH) in Jeddah, we aimed to identify the distinctive patterns of head injuries in children.MethodsThis retrospective cross-sectional study included 308 pediatric patients aged <14 years who presented to KASCH between 2016 and 2023. Patients were categorized into three age groups (<1, 1–6, and >6–14 years). Data on demographics, injury types and causes, clinical presentation, imaging modalities, disabilities, Pediatric Glasgow Coma Scale scores, ophthalmologic findings, and hematological profiles were extracted from the BESTCare system. Comparisons across age groups were performed for injury mechanisms, types, and clinical presentation, and associations between injury type and length of hospital stay were evaluated.ResultsMost patients were male (67.9%), with a mean age of 4.07 ± 3.9 years. Among patients aged <1 year, falls (76.3%), subgaleal hematoma (27.7%), and head swelling (43.5%) were the most common. In those aged 1–6 years, falls (63.8%), lacerations (74.7%), and bleeding (75%) predominated. In patients aged >6–14 years, motor vehicle accidents (42.7%), subgaleal hematoma (24.1%), and bleeding (22.8%) were the most frequent. Lacerations and concussions were associated with shorter hospital stays, whereas other injury types were associated with longer stays.DiscussionAge-stratified differences in injury characteristics underscore the importance of age-specific approaches to prevention, diagnosis, and management of pediatric head injuries.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1944386</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1944386</link>
        <title><![CDATA[Editorial: Advances and challenges in pediatric immune disorders: from pathogenesis to personalized therapy]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Yan Pan</author><author>Fuyong Jiao</author><author>Hong Wang</author><author>Weihua Zhang</author><author>Bilal Haider Shamsi</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1915688</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1915688</link>
        <title><![CDATA[Real-world retrospective analysis of clinical outcomes in pediatric acquired aplastic anemia: a single-center 10-year cohort study]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Shanshan Li</author><author>Kai Chen</author><author>Hui Jiang</author><author>Na Zhang</author><author>Jingwei Yang</author><author>Xuelian Liao</author><author>Ting Zhang</author><author>Shayi Jiang</author><author>Jingbo Shao</author>
        <description><![CDATA[IntroductionPediatric aplastic anemia (AA), a rare and potentially fatal disease, demonstrates significant heterogeneity in pathogenesis, disease severity, therapeutic regimens, and clinical outcomes.MethodsIn this study, clinical features and outcomes of 70 children with AA, including severe AA (SAA, n = 30), very severe AA (vSAA, n = 21) and nonsevere AA (nSAA, n = 19), were retrospectively analyzed, with a median follow-up of 60.7 months (range, 0.4-136.5 months).ResultsPatients with nSAA were mainly treated with cyclosporine A, whereas SAA/vSAA patients primarily received allogeneic hematopoietic stem cell transplantation (HSCT) followed by standard immunosuppressive therapy (IST). Ultimate therapy regimens differed significantly between patients with SAA/vSAA and nSAA (p = 0.001). SAA/vSAA group exhibited a higher overall response rate at the 2-year follow-up (85.5% vs. 55.6%, p = 0.019). The 2-year overall survival (OS) and event-free survival (EFS) for the entire cohort were 97.1% and 48.5%, respectively. In patients with SAA/vSAA, HSCT was associated with higher and faster cumulative complete response (CR) rate (p < 0.0001) and superior EFS (p = 0.0297) compared with IST. Two IST-resistant patients were observed to achieved CR with eltrombopag (EPAG) salvage therapy.Discussionpediatric AA carries excellent OS but suboptimal EFS. HSCT tends to yield more favorable EFS compared with IST in SAA/vSAA patients, and EPAG may act as an effective salvage option for appropriately selected IST-resistant individuals. Further multicenter prospective research is warranted prior to implementing these findings in routine clinical practice.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1914065</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1914065</link>
        <title><![CDATA[Feasibility, uptake, and exploratory outcomes of an individualized exercise program in pediatric oncology: a prospective single-center pilot study]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Christina Schuster</author><author>Elena Loos</author><author>Thomas Traunwieser</author><author>Michael C. Frühwald</author><author>Michaela Kuhlen</author>
        <description><![CDATA[IntroductionExercise interventions may help mitigate treatment-related physical impairment in pediatric oncology, but implementation in routine care remains challenging, particularly during active treatment and in heterogeneous patient cohorts.PatientsThis prospective single-center pilot study evaluated an individualized exercise program for children and adolescents aged 4–17 years undergoing cancer treatment during the COVID-19 pandemic.MethodThe program combined supervised in-hospital exercise, personalized home-based training, and an optional video-based SMART-Sport component introduced from month 3. The primary focus was feasibility, uptake, safety, and acceptability. Motor performance, six-minute walk distance, health-related quality of life (HRQoL), and neuropsychological functioning were assessed at baseline and six months as secondary exploratory outcomes.ResultsTwenty participants were enrolled; 15 completed at least one six-month follow-up assessment. Overall, 348 of 583 scheduled in-hospital exercise opportunities were attended, corresponding to a scheduled-session attendance of 59.7% using a conservative denominator. No serious program-related adverse event occurred. Movement diaries were available for 15 participants and documented 361 home-training sessions, of which 262 (72.6%) occurred during the first three months. Four participants documented use of SMART-Sport, completing 14 sessions. Exploratory complete-case analyses showed nominal within-participant improvements in hand-eye coordination, reaction time, six-minute walk distance, and selected HRQoL domains. Neuropsychological findings were inconclusive.DiscussionThe findings support the feasibility and safety of supervised individualized in-hospital exercise under the conditions of a specialized pediatric oncology center with a dedicated sports therapist. Feasibility was component-specific: home-training documentation decreased over time, and uptake of the optional video-based component was limited.ConclusionThis pilot study provides preliminary implementation data supporting further development of individualized exercise programs in pediatric oncology. Exploratory outcome findings should be interpreted as hypothesis-generating and require confirmation in larger controlled studies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1858985</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1858985</link>
        <title><![CDATA[Comparative analysis of infection-associated and non-infection-associated pulmonary embolism in children: a multicenter retrospective cohort study]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Fengqin Liu</author><author>Sixian Liu</author><author>Lejia Zhang</author><author>Zhilang Lin</author><author>Jing Zhang</author><author>Huijuan Xu</author><author>Bing Liu</author><author>Tian Shen</author><author>Yuan Wen</author><author>Mengze Hu</author><author>Lirong Sun</author><author>Gang Liu</author><author>Xiaochuan Wu</author><author>Yi Zhang</author><author>Rong Liu</author><author>Xiaoyun Jiang</author><author>Xing Chen</author><author>Juan Xiao</author>
        <description><![CDATA[BackgroundPediatric pulmonary embolism (PE) exhibits distinct risk factors, with respiratory infections playing a predominant yet understudied role in children.MethodsThis multicenter, retrospective study analyzed pediatric patients with PE from 8 Chinese tertiary hospitals between 2003 and 2023. Patients were stratified into infection-associated PE (I-PE) and non-infection-associated PE (NI-PE) groups based on systemic infection status for comparative analysis.ResultsAmong 196 pediatric patients diagnosed with PE, I-PE was predominant at 75.5%, vs. 24.5% for NI-PE. The vast majority of I-PE group (77.0%) were associated with respiratory infections, among which 20.3% were attributable to Mycoplasma pneumoniae. Clinically, the I-PE group had higher inflammatory markers (CRP: 45.1 mg/L, ESR: 41 mm/h; P < 0.05) and more frequent chest pain (31.8% vs. 16.7%) and hemoptysis (19.6% vs. 0%; P < 0.05 for both). Low-risk stratification predominated in both groups (91.2% vs. 89.6%). Anticoagulation safety profiles were comparable (bleeding events: 5.4% vs. 4.2%), while the I-PE group without comorbidities demonstrated faster resolution of emboli (44 vs. 345 days). The PE-related mortality rate was 2.6% (below expected), with 10 (5.1%) cases developing late cardiopulmonary dysfunction.ConclusionsThis study revealed a predominance of school-age children within the identified PE cohort, whose actual prevalence exceeding prior estimates. The association between infection, particularly acute respiratory infection, and PE in this cohort supports consideration of PE in children with respiratory infection and concerning features. I-PE presents with marked inflammation, a higher proportion of markedly elevated D-dimer (≥5 μg/mL), and typical symptoms (chest pain/hemoptysis), yet demonstrates better short-term outcomes. NI-PE correlates with underlying diseases and warrants long-term complication monitoring. Recognizing these differences is vital for enhancing outcomes in children with respiratory diseases. PE should be considered in children with severe pneumonia who present with disproportionate inflammation or chest pain.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1866647</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1866647</link>
        <title><![CDATA[Clinical correlation of A2063G gene mutation in mycoplasma pneumoniae pneumonia in children: a retrospective analysis]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jianshan Huang</author><author>Xiating Huang</author><author>Zhanpeng Qiu</author><author>Hui Li</author>
        <description><![CDATA[ObjectiveTo investigate the correlation between the A2063G point mutation in the 23S rRNA resistance gene and the clinical features of Mycoplasma pneumoniae pneumonia (MPP) in children.MethodsA retrospective analysis was conducted on 279 children diagnosed with MPP and hospitalized at Xiamen Hospital of Traditional Chinese Medicine from 2023. Based on the results of drug resistance gene sequencing, the patients were divided into a non-mutation group and a mutation group, and their clinical data were compared.ResultsNo significant differences were observed between the two groups regarding symptoms of productive cough and wheezing, or in laboratory indicators including white blood cell count (WBC), creatine kinase (CK), creatine kinase-MB (CK-MB), alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), and serum creatinine (Scr) (P > 0.05). The total fever duration and hospital stay were significantly longer in the mutation group than in the non-mutation group (P < 0.05). Levels of C-reactive protein (CRP), D-dimer (D-D), and lactate dehydrogenase (LDH) were significantly higher in the mutation group (P < 0.05). No significant differences between the two groups of children regarding antibiotic regimen selection and the use of fiberoptic bronchoscopy (P > 0.05). The usage rate of glucocorticoids in the mutation group was significantly higher than that in the non-mutation group, and the difference was statistically significant (P < 0.05). Multivariate analysis indicated that elevated levels of CRP, D-D, LDH and Glucocorticoid Therapy were independently associated with the A2063G mutation.ConclusionThe A2063G mutation may be associated with prolonged hospital stay, total fever duration, glucocorticoid use, and elevated serum CRP, D-D, and LDH levels. Furthermore, certain independent correlations are present between these clinical parameters. Early identification of this mutation during the initial stages of the disease could provide crucial guidance for adjusting clinical management strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1838914</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1838914</link>
        <title><![CDATA[Development and validation of a machine learning-based risk prediction model for PICC-associated bloodstream infections in preterm infants: a retrospective multicenter study]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ruiqing Song</author><author>Zhirui Li</author><author>Denghui Ma</author><author>Xiaomin Yin</author><author>Lingxi Li</author><author>Junge Li</author><author>Kun Wang</author>
        <description><![CDATA[ObjectiveTo develop and validate a machine learning–based model for predicting the risk of peripherally inserted central catheter (PICC)–associated bloodstream infection (CRBSI) in preterm infants.MethodsThis retrospective multicenter study included 151 preterm infants with CRBSI and 302 matched controls from a tertiary hospital (2017–2024), randomly divided into a training set (n = 317) and an internal validation set (n = 136). An additional 96 cases from four tertiary hospitals were used for external validation. Eight significant predictors identified by univariate analysis were used to construct five models: Logistic Regression (LR), Extreme Gradient Boosting (XGBoost), Decision Tree (DT), Support Vector Machine (SVM), and Random Forest (RF). Model performance was evaluated using the area under the curve (AUC), accuracy, precision, recall, and F1 score. The Shapley Additive Explanations (SHAP) was applied for model interpretation.ResultsEight variables were identified as key predictors, including puncture duration, catheterized vein, duration and frequency of mechanical ventilation, catheter dwell time, fetal distress, hypoalbuminemia, and antibiotic use within 24 h after birth. Infection rates increased markedly with prolonged puncture duration (6% for < 30 min vs 78% for 30–60 min vs 93% for >60 min) and catheter dwell time (21% for <14 days vs 32% for 14–21 days vs 47% for >21 days). Femoral vein catheterization showed the highest infection rate (82%). In the internal validation set, the AUCs of LR, XGBoost, DT, SVM, and RF were 0.89, 0.86, 0.87, 0.88, and 0.95, respectively; in the external validation set, they were 0.89, 0.88, 0.87, 0.93, and 0.96. The RF model achieved the highest accuracy in both internal (0.91) and external (0.90) validation sets, while SVM showed the highest external accuracy (0.92). Precision ranged from 0.79 to 0.89, recall from 0.27 to 0.31, and F1 scores from 0.42 to 0.45. SHAP analysis showed that puncture duration was the most important predictor, followed by catheterized vein and mechanical ventilation–related variables.ConclusionsThe RF model demonstrated superior performance in predicting CRBSI risk in preterm infants with PICC placement. This model may facilitate early identification of high-risk patients and support clinical decision-making.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1865167</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1865167</link>
        <title><![CDATA[Advances in the diagnosis and management of abdominoscrotal hydrocele: a narrative review]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Fangyuan Li</author><author>Lina Zhang</author><author>Yalong Ma</author><author>Jinsong Sun</author><author>Baohua Yu</author>
        <description><![CDATA[Abdominoscrotal hydrocele (ASH) is a rare variant of hydrocele characterized by contiguous scrotal and abdominal fluid collections communicating through the inguinal canal. Its pathogenesis remains poorly understood, and the available evidence is derived primarily from case reports and small retrospective case series, leaving continued uncertainty over its diagnosis, timing of intervention, and operative strategy. This narrative review summarizes and critically discusses the current literature on the pathogenesis, clinical presentation, imaging evaluation, differential diagnosis, and management of pediatric ASH. In children presenting with an apparently simple hydrocele, an unusually large, tense, or progressively enlarging inguinoscrotal swelling, ipsilateral lower abdominal fullness, or cross-fluctuation should prompt ultrasonographic assessment extending from the scrotum through the inguinal canal. Direct demonstration of continuity between the scrotal hydrocele and an abdominal fluid collection supports the diagnosis of ASH. Magnetic resonance imaging may be useful when the proximal extent or anatomical origin of the lesion remains unclear. Proposed mechanisms include pressure-driven cephalad extension of a scrotal hydrocele and persistent patency of the processus vaginalis, although neither mechanism fully accounts for all reported cases. Observation may be appropriate in carefully selected asymptomatic infants with close follow-up, whereas progressive, symptomatic, compressive, or diagnostically uncertain lesions generally warrant surgical intervention. Inguinal, scrotal, and laparoscopic approaches are all feasible, but the available evidence does not demonstrate the superiority of any single technique. Multicenter studies with standardized diagnostic criteria and long-term outcome reporting are needed to inform risk-stratified management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1911394</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1911394</link>
        <title><![CDATA[Association of early oxygen therapy parameters with retinopathy of prematurity stages in preterm infants with respiratory distress syndrome: a gestational age-stratified analysis]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Shanshan Chen</author><author>Rong Li</author><author>Na Shi</author><author>Qinxing Xie</author><author>Wenqiang Liu</author>
        <description><![CDATA[ObjectiveTo investigate the associations between early oxygen-related parameters and ROP severity in preterm infants with respiratory distress syndrome (RDS), and to evaluate their discriminative performance for severe ROP.MethodsThis retrospective study included 825 preterm infants (24–<37 weeks) with RDS stratified by gestational age (32–<37, 28–<32, and 24–<28 weeks). Early oxygen parameters during the first 7 days after birth included cumulative oxygen duration, mean and maximum FiO2, SpO2 target range time proportion (91%–95%), and intermittent hypoxia frequency. Correlation analysis, multivariable logistic regression, and ROC analyses were performed.ResultsROP incidence was 12.97% (107/825) and increased with decreasing gestational age (1.21%, 25.80%, and 59.57%, respectively; P < 0.001). Compared with mild ROP, severe ROP showed longer oxygen duration, higher FiO2 exposure, more intermittent hypoxia episodes, and lower SpO2 target range time proportion (all P < 0.05). After adjustment for gestational age, birth weight, and surfactant use, none of the oxygen-related parameters remained independently associated with severe ROP. ROC analysis among infants with ROP showed moderate discrimination for individual oxygen parameters (AUC: 0.705–0.761), whereas models incorporating oxygen parameters showed limited improvement beyond gestational age and birth weight.ConclusionEarly oxygen-related parameters were associated with ROP severity but showed limited independent discriminative value beyond gestational age and birth weight. They may represent candidate markers for risk characterization, although prospective validation is required before clinical application.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1886291</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1886291</link>
        <title><![CDATA[Sensory afferent electrical stimulation to improve upper limb function in children with hemiparesis – a randomised controlled trial (SenseUp study protocol)]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Alisa Gschaidmeier</author><author>Kim Lory</author><author>Kevin Möri</author><author>André Moser</author><author>Tobias Nef</author><author>Kathleen Seidel</author><author>Cristina Simon-Martinez</author><author>Miriam Von Gunten</author><author>Jonathan Wermelinger</author><author>Roland Wiest</author><author>Regula Everts</author><author>Sebastian Grunt</author>
        <description><![CDATA[BackgroundChildren with hemiparesis present with sensory and motor deficits, which negatively affect quality of life. Sensory Afferent Electrical Stimulation (SAES) triggers action potentials in afferent nerve fibers, leading to increased sensorimotor afferent input. While proven effective in adults after stroke and safe in children with cerebral palsy through small studies, a systematic and large-scale investigation in the pediatric population is still missing. This protocol describes a study designed to investigate the efficacy and mechanisms of SAES.MethodsWe will recruit 34 children and adolescents with spastic hemiparesis to participate in the prospective, single center, randomized controlled Bayesian phase II trial with a 5-week intervention period and a follow-up examination after 12 weeks. Participants will be randomly assigned to a 5-week SAES intervention or a control group consisting of treatment as usual. Before and after the SAES as well as at 12-week follow-up, clinical measures will be used to assess bimanual and unimanual hand functions (primary outcome: Assisting Hand Assessment AHA). Accelerometry and contactless motion tracking will be applied to evaluate everyday life upper limb functions. Neurophysiological methods such as structural and functional Magnetic Resonance Imaging and Transcranial Magnetic Stimulation will be performed to gain insight into neuroplastic mechanisms underlying SAES and are considered secondary outcomes.DiscussionPrevious studies were limited by small cohorts and narrow outcome measures. Our study addresses these gaps while additionally investigating underlying neurophysiological mechanisms in children using MRI and TMS, providing a scientific basis for implementing such stimulation in practice.Clinical Trial Registrationclinicaltrials.gov, identifier (NCT06536634); kofam.ch, identifier (SNCTP000005950).]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1887012</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1887012</link>
        <title><![CDATA[Prognostic implications of CD123 in pediatric B-cell acute lymphoblastic leukemia: a single-center retrospective analysis]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Zheng Li</author><author>Qinfa Chen</author><author>Zhiyong Zhou</author><author>Fei He</author>
        <description><![CDATA[IntroductionAcute lymphoblastic leukemia (ALL) is the most common pediatric hematologic malignancy, with the majority of cases being of B-cell origin. While many patients respond favorably to therapy, a subset experiences early relapse or poor outcomes, underscoring the critical need for reliable prognostic biomarkers. This study investigated the significance of CD123 expression in diagnosing the disease, evaluating therapeutic efficacy, and predicting prognosis in pediatric B-cell ALL (B-ALL).MethodsThis retrospective study included 305 pediatric patients with B-ALL admitted to our hematology department from January 2016 to December 2021. All patients were treated following the CCCG-ALL-2015 protocol. Based on flow cytometric evaluation, patients with ≥20% or <20% CD123-expressing blasts were stratified into CD123-positive (CD123+) and CD123-negative (CD123−) groups, respectively.ResultsCD123 was expressed on the leukemic blasts of 60.3% of patients, exhibiting a strong positive correlation with CD34 expression (P < 0.001). CD123 positivity was substantially associated with specific genetic abnormalities. Specifically, the frequencies of the ETV6::RUNX1 and TCF3::PBX1 fusion genes were significantly lower in the CD123+ group than in the CD123− group. The 5-year event-free survival (EFS) rate was significantly higher in the CD123+ group than in the CD123− group (P = 0.027). This favorable prognostic impact was particularly pronounced in patients exhibiting minimal residual disease (MRD) positivity on day 19 (P = 0.006). Furthermore, combining CD123 status with day 19 MRD enabled more accurate identification of patients with a poor prognosis.DiscussionCD123 positivity on leukemic blasts correlates with distinct genetic profiles and favorable clinical outcomes in pediatric B-ALL. Ultimately, integrating CD123 status with early treatment response facilitates accurate risk stratification and guides personalized therapeutic strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1947631</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1947631</link>
        <title><![CDATA[Correction: Birth weight, ototoxic medication, and surgical history predict individual hearing loss risks: a systematic review and meta-analysis]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Correction</category>
        <author>Hanwen Luo</author><author>Jianghua He</author><author>Dapeng Chen</author><author>Xiaoming Xu</author><author>Jing Zhao</author><author>Xiaoyan Yang</author><author>Jing Shi</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1912583</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1912583</link>
        <title><![CDATA[Herlyn-Werner-Wunderlich syndrome in three infants: a case report of surgical treatment]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jiarong Chen</author><author>Youcai Feng</author><author>Jiabo Chen</author><author>Danping Zeng</author><author>Hua Li</author><author>Hongjun Gao</author>
        <description><![CDATA[Oblique vaginal septum syndrome (Herlyn-Werner-Wunderlich syndrome) is a congenital reproductive tract malformation frequently accompanied by ipsilateral renal dysplasia. During infancy, it can lead to urinary tract infections, dysuria, and abdominal masses. Delayed intervention predisposes patients to hydronephrosis and even renal failure. Current treatment primarily involves incision and drainage; however, traditional transvaginal surgery in infants is limited by a restricted surgical field and a lack of standardized protocols. This case report presents the clinical data of three affected infants (age range: 5 days to 4 months and 15 days) treated at our institution, evaluating the efficacy of two minimally invasive surgical approaches. During a follow-up period of 1–12 months postoperatively, all patients achieved complete recovery of normal voiding function, with no recurrence of urinary tract infections, and no instances of intestinal injury, hemorrhage, or restenosis were observed. Transvaginal direct incision is considered suitable for patients presenting with vulvar masses caused by a low-positioned oblique septum, whereas a laparoscopy-assisted approach effectively optimizes surgical conditions for cases involving a high-positioned oblique septum or those with significant inflammation following repeated punctures. Both techniques resulted in symptom relief without major complications. We emphasize the importance of early and precise intervention, as well as the avoidance of blind puncture, to preserve renal function.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1894739</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1894739</link>
        <title><![CDATA[Thumb posterior rotation deformity: a neglected deformity in children with thumb polydactyly]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>ZiHua Lin</author><author>Lin Ye</author><author>LiuQing Liao</author><author>DiHao Tang</author><author>XueMei Lin</author><author>WeiZhe Shi</author><author>JianQun Wang</author><author>YiQiang Li</author>
        <description><![CDATA[PurposeTo investigate the incidence and risk factors of thumb posterior rotation deformity in children with thumb polydactyly.MethodsA retrospective analysis was conducted on the clinical data of 479 patients (521 thumbs, mean age 13.1 ± 12.7 months) with thumb polydactyly. Clinical data including gender, age, and affected side were collected. Clinical appearance photographs and x-ray images of all patients were obtained. Thumb posterior rotation deformity was determined on clinical appearance photographs. The ulnar deviation angle of the thumb was measured on anteroposterior thumb radiographs.ResultsAccording to the Wassel classification, 13 thumbs (2.5%) were Type I, 55 thumbs (10.6%) Type II, 92 thumbs (17.7%) Type III, 186 thumbs (35.7%) Type IV, 138 thumbs (26.5%) Type V, 34 thumbs (6.5%) Type VI, and 3 thumbs (0.6%) Type VII. According to the Wu classification, 222 thumbs (42.6%) were type A, 27 thumbs (5.2%) were type B, 121 thumbs (23.2%) were type C, and 151 thumbs (29%) were type D. A total of 35 hands (6.7%) presented with varying degrees of thumb posterior rotation deformity, with a mean rotational angle of 14.1°±9.0° (range, 5°–30°). Wassel classification and Wu classification were correlated with the incidence of thumb posterior rotation deformity. Patients with thumb posterior rotation deformity had a significantly larger ulnar deviation angle of the thumb (19.3°±17.5°) than those without (11.4°±15.7°). Logistic regression analysis demonstrated that both the level and the type of the bifurcation of the duplicated thumb and ulnar deviation angle of the thumb were independent risk factors for the occurrence of thumb posterior rotation deformity (P < 0.05).ConclusionsThumb posterior rotation deformity is a common malformation in pediatric thumb polydactyly. The incidence of thumb posterior rotation deformity is significantly increased in patients with Wassel types IV, V, and VI thumb polydactyly, and thumb ulnar deviation also significantly elevates the risk of thumb posterior rotation deformity.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1907180</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1907180</link>
        <title><![CDATA[Periventricular leukomalacia-related litigation in Japan: a qualitative analysis of causation under clinical uncertainty]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Shigeo Iijima</author>
        <description><![CDATA[IntroductionPeriventricular leukomalacia (PVL) is a leading cause of cerebral palsy in preterm infants. However, its multifactorial pathogenesis and uncertainty regarding the timing of brain injury make causal attribution in medical litigation inherently complex. Despite its clinical significance, little is known about how courts evaluate causation and responsibility in PVL-related cases. This study aimed to clarify the clinical and judicial characteristics of PVL-related medical litigations in Japan.MethodsCases were identified using a nationwide legal database. A qualitative analysis of judicial decisions was performed, focusing on obstetric and neonatal management, breach of duty, causation, and informed consent. Seven litigation cases involving preterm infants were included.ResultsDespite substantial heterogeneity in clinical presentation and perinatal course, cross-case analysis identified several recurring patterns in judicial reasoning regarding causation and responsibility. Disputed issues arose across multiple phases of perinatal care, including the timing of delivery, fetal monitoring, maternal transfer, postnatal care systems, and respiratory management. Although judicial decisions showed considerable variability, the recognition of causation emerged as the pivotal determinant of liability. In some cases, causation was acknowledged only partially, despite persistent clinical uncertainty regarding the timing and mechanisms of injury. In contrast, in cases involving clearly identifiable intrapartum hypoxic events, courts were more likely to affirm causation by linking clinical events in a coherent temporal sequence despite the underlying medical uncertainty.DiscussionThese findings demonstrate that PVL-related litigation may involve disputes across multiple phases of perinatal care because of the multifactorial nature of PVL and the uncertainty regarding the timing and etiologies of injury. Under such conditions of clinical uncertainty, legal responsibility is assessed not only through isolated medical acts but also through broader clinical decision-making processes involving critical decisions across multiple phases of perinatal care. Moreover, the results highlight a fundamental divergence between medical reasoning based on scientific evidence and legal reasoning. The findings underscore the importance of transdisciplinary decision-making, careful documentation, and effective communication in managing medico-legal risk in perinatal practice.]]></description>
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