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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>2026-08-18T07:07:46.422+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1888678</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1888678</link>
        <title><![CDATA[Microbial etiology and antimicrobial resistance patterns in neonates admitted to a tertiary neonatal intensive care unit in Mogadishu, Somalia]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ali Kutta ÇELİK</author><author>Tigad Abdisad Ali</author><author>Farah Abdullahi Ismail</author><author>Suad Abdikarim ISSE</author><author>Mucahit TÜRKAN</author><author>Abdıkarım Abdı Adam</author><author>Liban Ade Hussein</author><author>Edanur Yeşil</author><author>Mohammed A. M. Ahmed</author>
        <description><![CDATA[ObjectiveNeonatal sepsis continues to be one of the leading causes of morbidity and death, particularly in low- and middle-income countries (LMICs). This study aimed to evaluate the microbiological etiology, temporal trends, and antibiotic resistance patterns in a tertiary neonatal intensive care unit (NICU) over a six-year period.MethodsThis retrospective study included neonates admitted to a tertiary neonatal intensive care unit between 2018 and 2024. Early-onset infections were defined as infections occurring within the first 72 hours of life, while late-onset infections were defined as infections occurring after 72 hours. Logistic regression analysis was used to assess temporal trends and identify factors associated with multidrug-resistant infection.ResultsMicrobial growth was observed in 891 (30.0%) of the total samples. A total of 891 isolates (30.0% of all samples) with complete data were included in the final study after duplicate and contaminated isolates were removed. Among these isolates, 472 (53.0%) were Gram-positive bacteria, 366 (41.1%) were Gram-negative bacteria, and 53 (5.9%) were Candida spp. isolates. isolates. In addition to a greater proportion of Gram-negative organisms (43.6% vs. 35.4%) and Candida species (7.5% vs. 2.6%), late-onset infections showed considerably higher culture-positive rates (37.7% vs. 20.7%, p < 0.001) than early-onset infections. On the other hand, Gram-positive organisms predominated in early-onset infections (62.0% vs. 48.9%, p < 0.001). In Multivariate logistic regression analysis, study year was not independently associated with MDR after adjustment (aOR: 1.06, 95% CI: 0.98–1.14, p = 0.169), whereas late-onset infection was still independently linked with MDR infection (aOR: 2.53, 95% CI: 1.84–3.47, p < 0.001). Despite changes in MDR rates throughout the course of the research years, carbapenem resistance demonstrated a significant growing trend over time (p for trend = 0.004). Notably, none of the commonly used empirical antibiotics met the recommended susceptibility level of ≥80%.ConclusionThis six-year study reveals a significant burden of neonatal infections in the NICU, with Candida spp. and Gram-negative organisms predominating in late-onset infections and Gram-positive organisms in early-onset infections. Carbapenem resistance dramatically increased over time, and late-onset infection was independently linked to multidrug resistance. These results highlight the necessity of stronger IPC, localized antimicrobial stewardship, updated empirical treatment guidelines, and regular AMR surveillance.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1892954</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1892954</link>
        <title><![CDATA[Retinopathy of prematurity remains the leading cause of childhood blindness in children attending schools for the blind in Guadalajara: a fifteen-year comparison]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Luz Consuelo Zepeda Romero</author><author>Juan Carlos Barrera de Leon</author><author>⁠José Alfonso Gutiérrez Padilla</author><author>Sofía Jacqueline Baeza Magaña</author><author>Ivana Jimenez Lopez</author><author>Sara Carolina Boyzo Arcadia</author><author>Mariana Padilla Escobar</author><author>Diana Estefanía Gutiérrez Gómez</author><author>Manuel Alejandro Del Callejo Bernal</author><author>Daniel Pérez Rulfo Ibarra</author><author>Guillermo Yanowsky Reyes</author>
        <description><![CDATA[ObjectiveTo identify the main causes of blindness in children attending at 3 schools for blind in the metropolitan area of Guadalajara (MAG), Jalisco, Mexico and to highlight the importance of preventing childhood visual disability.MethodsAn observational, cross-sectional, and descriptive study was conducted in students enrolled in three schools for children with visual disabilities during the period September–December 2025 in Guadalajara, Jalisco, Mexico. Information was obtained from the review of clinical and school records, interviews with parents, and ophthalmologic evaluation, with prior institutional approval from the participating schools. A standardized World Health Organization (WHO) form was used to record sociodemographic variables, perinatal history, ophthalmologic diagnosis, etiology, treatments, and comorbidities. A descriptive analysis with an epidemiological approach was carried out using frequencies and measures of central tendency. Finally, the information was anonymized and handled confidentially, in accordance with ethical research principles.ResultsThis school-based, observational, descriptive cross-sectional study included a total of 106 children, 55 were female (51%) and 51 were male (49%). Retinal disorders constituted the main cause of visual loss with 64 cases (60%), predominantly sequelae of retinopathy of prematurity (ROP) in 50 children (47%). The second cause identified was optic nerve abnormalities with 19 cases (18%). 57 cases (54%) were associated with factors from the neonatal period. 50 children (47%) with diagnosis of ROP, had a mean gestational age of 30.6 weeks and a mean birth weight of 1443 g; 8 children (16%) were outside Mexican screening criteria and 28 (56%) outside United Kingdom criteria. 44 children (88%) with ROP presented blindness and 34 (68%) did not receive treatment and neurodevelopmental comorbidities were identified in 7 children (14%).ConclusionsChildhood blindness in the studied population was predominantly associated with potentially preventable causes, especially sequelae of ROP, positioning itself as the leading cause of childhood blindness in a school-based sample in Guadalajara. It is necessary to strengthen the prevention of retinopathy of prematurity through neonatal care, ensuring timely detection and treatment, as well as adapting neonatal screening programs and criteria to the regional context to reduce the burden of childhood visual impairment. These findings highlight the persistence of preventable ROP-related blindness among children attending specialized schools.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1881684</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1881684</link>
        <title><![CDATA[Development and internal validation of a monocyte-to-albumin ratio-based risk assessment model for coronary artery lesions in Kawasaki disease]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Min-Min Li</author><author>Gao-Min Liu</author>
        <description><![CDATA[IntroductionCoronary artery lesions (CAL) are the most severe complication of Kawasaki disease (KD), yet accurate and practical risk assessment tools remain limited. This study aimed to develop and validate a parsimonious logistic regression model for CAL risk assessment using routine clinical and laboratory parameters.MethodsA total of 324 consecutive KD patients were retrospectively enrolled. Candidate predictors were screened by univariate analysis and a strict consensus-based strategy integrating five feature-selection methods (LASSO, random forest, Boruta, recursive feature elimination, and univariate threshold). Ten machine learning algorithms were compared, and the final model was selected based on performance and interpretability. A nomogram, calibration curve, and an online calculator were developed.ResultsAmong 324 patients, 64 (19.8%) had baseline CAL. Four variables [fever duration, GGT, monocyte-to-albumin ratio (MAR), and ESR] were consistently selected by all five methods. Logistic regression yielded a Brier score of 0.142, with high specificity (0.846), but limited sensitivity (0.421) on the hold-out test set. No significant effect modification was observed in exploratory interaction analyses assessing the association of MAR on CAL across the evaluated covariates (all adjusted P > 0.05). GBM model offered superior sensitivity (0.684) than other models, suggesting a potential exploratory role in sensitivity-driven screening scenarios. An online calculator was deployed strictly for exploratory research purposes.ConclusionsA simple four-variable logistic model incorporating fever duration, GGT, ESR, and MAR provides preliminary CAL risk assessment. However, the modest event count and single-center nature mandate multi-center external validation before any clinical application.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1810586</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1810586</link>
        <title><![CDATA[Exploring the impact of DEP on pediatric Crohn's disease using machine learning and molecular docking methods]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Lei Zhang</author><author>Xingyu Ji</author><author>Su Ma</author><author>Huimin Chen</author>
        <description><![CDATA[BackgroundDiethyl phthalate (DEP) is a prevalent plasticizer with multiple toxic effects and high bioavailability in humans, especially children. Pediatric Crohn’s disease (PCD) is a severe chronic intestinal inflammatory disorder with a rising incidence worldwide. To date, the potential associative relationship between DEP exposure and PCD pathogenesis remains inadequately clarified, lacking systematic transcriptomic and experimental exploration.MethodsIn this study, bioinformatics analysis was performed based on 682 PCD samples and 127 normal samples retrieved from multiple GEO datasets. A series of analytical strategies including differential expression analysis, weighted gene co-expression network analysis (WGCNA), compound target prediction, functional enrichment analysis, machine learning modeling, and molecular docking simulation were comprehensively utilized, followed by preliminary animal validation. All analyses in this study focused on exploring statistical correlation rather than causal relationships, given the absence of individual DEP exposure data and inherent methodological limitations.ResultsThrough differential analysis and WGCNA, 24 differentially expressed genes and 194 chemical targets from ChEMBL were obtained, among which 14 overlapping genes were identified. GO and KEGG analyses indicated that DEP may contribute to PCD toxicity by regulating nucleotide synthesis and amino acid metabolism. Five core genes were screened via machine learning and SHAP analysis. Animal experiments verified that PLAU protein expression in DEP, TNBS, and DEP + TNBS groups was notably higher than in the control colon tissue.ConclusionThis study systematically explores the potential associative links between DEP-related molecular dysregulation and PCD pathological alterations at the transcriptomic and tissue levels. The findings provide preliminary scientific references for understanding DEP-associated pediatric intestinal health risks and developing targeted preventive strategies for children's environmental health protection.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1935719</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1935719</link>
        <title><![CDATA[Serum phoenixin-14 shows no association with metabolic syndrome in children with obesity: a cross-sectional study]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Zafer Bağcı</author><author>Rukiye Uyanık</author><author>Ümmügülsüm Can</author><author>Deniz Yılmaz</author><author>Sadinaz Akdu</author>
        <description><![CDATA[BackgroundPhoenixin is a novel neuropeptide encoded by the SMIM20 gene, implicated in energy homeostasis and reproduction, but its role in pediatric metabolic syndrome remains unknown.MethodsThis cross-sectional study enrolled 98 children and adolescents aged 7–18 years [45 with Metabolic syndrome (MetS) and 53 with obesity without MetS]. MetS was defined by modified International Diabetes Federation criteria. Biochemical analyses included fasting glucose, lipid profile, and liver enzymes on a Beckman Coulter AU5800 analyzer; insulin, cortisol, adrenocorticotropic hormone (ACTH), thyroid, and reproductive hormones on a Roche Cobas e601 electrochemiluminescence immunoassay system; and HbA1c by high-performance liquid chromatography (Bio-Rad D10). Serum phoenixin-14 was quantified by sandwich ELISA (Bioassay Technology Laboratory Cat. No. E7481Hu; sensitivity 8.19 ng/L; intra-assay CV 6.8%, interassay CV 9.2%). Group comparisons were performed using Mann–Whitney U and chi-square tests; a general linear model (GLM) adjusting for age and Tanner stage assessed the independent effect of the MetS and obese groups on serum phoenixin-14.ResultsSerum phoenixin-14 did not differ between the MetS and obese groups (519.75 ± 196.67 vs. 567.86 ± 368.40 pg/mL; p = 0.955). After adjustment for age and Tanner stage by GLM (n = 95), the difference remained non-significant (adjusted difference: −26.5 pg/mL, 95% CI: −152.1 to 99.1; p = 0.676; adjusted means: MetS 529.1 pg/mL vs. Obese 555.7 pg/mL). Tanner stage was a significant covariate (B = 73.04, p = 0.009). Children with MetS were older (13.62 ± 2.51 vs. 12.19 ± 2.65 years; p = 0.010) and had higher median insulin (30.80 vs. 18.20 µIU/mL; p < 0.001), higher triglycerides (172.04 ± 70.94 vs. 106.68 ± 39.27 mg/dL; p < 0.001), lower high-density lipoprotein-cholesterol (38.56 ± 7.73 vs. 47.02 ± 9.99 mg/dL; p < 0.001), and higher ACTH (28.86 ± 14.12 vs. 22.44 ± 11.86 pg/mL; p = 0.018).ConclusionsIn this cohort, serum phoenixin-14 did not differ between obese children with and without metabolic syndrome after adjusting for age and pubertal stage (p = 0.676). These findings do not support a discriminative role for phoenixin-14 in pediatric MetS. Further studies including healthy normal-weight controls are needed to determine whether phoenixin-14 concentrations are altered in pediatric obesity.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1809544</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1809544</link>
        <title><![CDATA[Development of a nomogram to predict acute liver injury in children with Mycoplasma pneumoniae pneumonia]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Shisi Xiong</author><author>Yanlin Tan</author><author>Junmei Bian</author><author>Xingxing Bao</author><author>Jiajun Zhou</author><author>Min Liang</author>
        <description><![CDATA[ObjectiveTo construct and validate a nomogram for predicting acute liver injury in children with Mycoplasma pneumoniae pneumonia (MPP).MethodsThis retrospective study included 964 hospitalized children with confirmed MPP from January 2021 to December 2024. Acute liver injury was defined as the study endpoint. Missing data were handled by multiple imputation (m = 5). The cohort was divided into a training set and a validation set at a ratio of 7:3 using stratified random sampling. Least absolute shrinkage and selection operator (LASSO)-logistic regression was used for feature selection, and the selected variables were entered into multivariable logistic regression to construct a nomogram. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).ResultsAmong the 964 children, 131 developed acute liver injury, corresponding to an incidence of 13.6%. The cohort was divided into a training set of 676 children, including 92 with acute liver injury, and a validation set of 288 children, including 39 with acute liver injury. Baseline characteristics were comparable between the training and validation sets (P > 0.05). LASSO regression identified 11 candidate predictors: gender, age, body temperature ≥37.5 °C, history of allergy, neutrophil percentage, lymphocyte percentage, D-dimer, total protein, γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), and creatine kinase isoenzyme MB (CK-MB). In multivariable analysis, female gender, GGT, LDH, and CK-MB were independently associated with an increased risk of liver injury, whereas age was negatively associated with liver injury. D-dimer showed marginal statistical significance. The nomogram showed good discrimination, with an area under the curve (AUC) of 0.837 in the training set and 0.874 in the validation set. Calibration curves showed acceptable agreement between predicted and observed risks, and DCA suggested potential clinical net benefit within a certain threshold range.ConclusionThis nomogram, based on routinely available clinical and laboratory indicators, may help identify children with MPP at increased risk of acute liver injury and support early liver function monitoring. Further prospective multicenter validation is needed.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1885979</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1885979</link>
        <title><![CDATA[Salmonella Typhimurium infection complicating very early-onset inflammatory bowel disease presenting with Pseudo-intussusception: a case report]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Qian Liu</author><author>Ling Yang</author><author>Xuefeng Sun</author><author>Yishan Liu</author><author>Hui Yang</author>
        <description><![CDATA[The clinical manifestations of acute non-typhoidal Salmonella infection can overlap with underlying very early-onset inflammatory bowel disease (VEO-IBD), complicating early differential diagnosis. We report a 5-year-old boy who presented with fever, paroxysmal abdominal pain, and high-volume watery hematochezia. Initial abdominal ultrasonography revealed a “concentric ring sign” mimicking intussusception, while laboratory tests concurrently demonstrated elevated serum total immunoglobulin E (IgE) levels. Subsequent water-soluble gastrointestinal contrast studies and computed tomography ruled out mechanical intestinal obstruction. Early endoscopy and mucosal biopsy revealed cryptitis and chronic active inflammation from the rectum to the sigmoid colon, and stool cultures isolated Salmonella Typhimurium, with serum total IgE peaking at 2965 IU/mL. Based on these clinical findings, the patient was diagnosed with concurrent acute Salmonella Typhimurium infection and VEO-IBD. The patient received a combined regimen of systemic intravenous cefotaxime sodium and localized therapy comprising dexamethasone retention enemas and mesalazine suppositories, with symptom resolution within 10 days. This case illustrates the value of multimodal imaging and early endoscopy in differentiating overlapping enteric infections from VEO-IBD, and suggests that integrating systemic antimicrobials with localized anti-inflammatory agents may be a feasible therapeutic strategy.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1963583</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1963583</link>
        <title><![CDATA[Editorial: Exploring child abuse from clinical, legal, and forensic perspectives]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Donato Morena</author><author>Emanuela Turillazzi</author><author>Vittorio Fineschi</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1893524</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1893524</link>
        <title><![CDATA[School-age somatic, internalizing, attention, and social difficulties in moderate anthropometric undernutrition: a primary-care case-control study]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Dilek Altun Varmış</author><author>Selda Pamiry</author>
        <description><![CDATA[BackgroundModerate anthropometric undernutrition is associated with developmental risks, but the emotional, behavioral, and functional profiles of children with moderate anthropometric undernutrition managed in outpatient primary care follow-up remain insufficiently characterized.Methods This cross-sectional case-control study examined 60 mother-child dyads in Adana, Türkiye (undernutrition, n = 30; control, n = 30). Children were assessed by age group using the Child Behavior Checklist, and mothers completed parent-proxy measures of quality of life, psychological distress, and parenting-related emotion regulation.ResultsNo statistically significant between-group differences were detected in the measured sociodemographic and general clinical variables, although the sample was not powered to establish equivalence or exclude residual confounding. Children with moderate anthropometric undernutrition were more often described as eating less or showing selective eating, and family relationship quality was less often rated as good. Parent-proxy quality of life, maternal psychological distress, and parenting-related emotion regulation did not differ at the group level. Preschool CBCL scores were comparable. In the CBCL/6-18 subgroup, primary comparisons using age- and sex-normed T-scores identified higher Somatic Complaints, Anxious/Depressed, Social Problems, Attention Problems, Internalizing Problems, and Total Problems scores in the undernutrition group. Somatic Complaints (q = 0.020), Attention Problems (q = 0.036), Anxious/Depressed (q = 0.047), and Internalizing Problems (q = 0.047) remained significant after false-discovery-rate correction; Social Problems and Total Problems did not survive correction and are interpreted as preliminary. Externalizing Problems were not elevated at the group level. Within the undernutrition group, higher internalizing and externalizing T-scores were associated with poorer parent-proxy quality of life in the primary Pearson analyses, although these associations were attenuated and did not survive correction in the all-Spearman sensitivity analysis.ConclusionBecause of the cross-sectional design, the direction of these associations cannot be established; they may reflect nutritional influences on psychosocial functioning, behavioral or feeding difficulties contributing to low weight, or shared antecedents of both. These findings suggest a selective school-age psychosocial screening signal, rather than generalized impairment, in outpatient moderate anthropometric undernutrition. Routine nutrition follow-up may benefit from brief behavioral screening, feeding behavior assessment, and family-sensitive primary care support.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1863943</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1863943</link>
        <title><![CDATA[Breastfeeding difficulties and maternal–infant bonding at three months postpartum in a Turkish cohort]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Bulent Gunes</author><author>Ferit Dogan</author><author>Ahmet Guzelcicek</author><author>Aydin Bozkaya</author><author>S. Songul Yalcin</author>
        <description><![CDATA[BackgroundBreastfeeding difficulties are common in the early postpartum period and have been hypothesized to negatively affect maternal–infant bonding. We aimed to investigate the relationship between breastfeeding problems and mother–infant bonding at 3 months postpartum in a sample of Turkish mothers.MethodsWe conducted a cross-sectional observational study of 257 mothers of 3-month-old infants in Turkey. Participants completed a questionnaire including demographic and obstetric information, breastfeeding practices and difficulties, and the Postpartum Bonding Questionnaire (PBQ) to assess maternal–infant bonding. Bonding difficulty was defined as a PBQ total score >25. Bivariate analyses (chi-square or Fisher's exact tests) compared mothers with and without bonding difficulties, and a multivariable logistic regression model was used to identify independent predictors of bonding problems at 3 months postpartum.ResultsOverall, 33 mothers (12.8%) met criteria for bonding difficulties at 3 months. A total of 144 mothers (56.0%) reported at least one breastfeeding problem during the first 3 months postpartum. In bivariate analyses, breastfeeding difficulties were more common among mothers with bonding difficulties than among those without (81.8% vs. 52.2%, P = .001). Mothers with bonding difficulties were also more likely to have higher education (81.8% vs. 54.9% with ≥ secondary education; P = .003), to be employed outside the home (21.2% vs. 8.9%; P = .06), and to have a female infant (66.7% vs. 38.8% female; P = .003). No significant differences were found by maternal age, parity, or feeding mode (exclusive breastfeeding vs. formula feeding, P = .64). In multivariable logistic regression, breastfeeding difficulties were independently associated with bonding impairment (adjusted odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5–8.0, P = .003). Maternal higher education (adjusted OR 3.0, 95% CI 1.1–8.0, P = .031) and having a female infant (adjusted OR 3.1, 95% CI 1.2–7.5, P = .016) were also independent predictors; maternal employment showed a positive but non-significant association (adjusted OR 2.2, 95% CI 0.9–5.5, P = .081).ConclusionsIn this Turkish sample, mothers who reported breastfeeding difficulties had higher odds of impaired maternal–infant bonding at 3 months postpartum. These findings support routine assessment of breastfeeding-related distress during postpartum care.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1880294</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1880294</link>
        <title><![CDATA[Association between admission undernutrition and mortality rates and adverse outcomes in a pediatric intensive care unit in India: a prospective cohort study]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Vijay Raghunath Kalrao</author><author>Aastha Pramod</author>
        <description><![CDATA[BackgroundUndernutrition is common in critically ill children in resource-limited settings. However, it remains unclear whether its association with pediatric intensive care unit (PICU) outcomes persists after rigorous adjustment for illness severity, particularly with the use of mortality prediction scores developed in high-income populations. Therefore, in this study, we examined whether undernutrition at admission was associated with mortality and adverse outcomes in an Indian tertiary care PICU.MethodsWe conducted a prospective cohort study between August 2022 and June 2024 in a 16-bed mixed medical-surgical PICU at a tertiary university hospital in India. The study included 331 critically ill children aged 1 month to 18 years with complete data. Undernutrition was defined using the World Health Organization and Indian Academy of Pediatrics growth standards (z-score < −2 SD) measured within 24 h of admission. The primary outcome was PICU mortality rate. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression, adjusting for Pediatric Index of Mortality (PIM-3)-predicted mortality, sepsis, age, and chronic comorbidities.ResultsAt admission, 60 (18.1%) children were undernourished. The PICU mortality rate was 13.9% overall, 30.0% among undernourished children, and 10.3% among well-nourished children. After multivariable adjustment, undernutrition was associated with a higher mortality risk [aRR 2.78, 95% confidence interval (CI) 1.58–4.91], corresponding to an adjusted absolute risk difference of 18.6 percentage points. The association persisted in the propensity score–weighted analysis (aRR 2.59, 95% CI 1.34–5.03) but was attenuated when extreme illness severity was excluded from the analysis. Undernutrition was also associated with mechanical ventilation (66.7% vs. 35.4%; aRR 1.84, 95% CI 1.40–2.41), extended PICU stay (61.7% vs. 37.0%; aRR 1.56, 95% CI 1.17–2.09), and the death-or-mechanical ventilation composite (66.7% vs. 36.2%; aRR 1.76, 95% CI 1.35–2.30) in full-cohort analyses designed to avoid survivor-restriction bias. The observed mortality substantially exceeded the PIM-3 predictions (standardized mortality ratio, 4.63), particularly in undernourished children (standardized mortality ratio, 7.90).ConclusionIn this Indian cohort, undernutrition at admission was associated with higher PICU mortality and adverse outcomes after adjusting for illness severity. In high-burden, resource-limited settings, anthropometric screening may aid risk stratification. However, causal inference remains limited by the observational design and substantial miscalibration of the illness severity score.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1916128</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1916128</link>
        <title><![CDATA[Robotic-assisted vs. open and laparoscopic Kasai portoenterostomy for biliary atresia: a systematic review and meta-analysis]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Yuhan He</author><author>Weiwei Liu</author>
        <description><![CDATA[BackgroundBiliary atresia is a progressive neonatal cholangiopathy that requires timely Kasai portoenterostomy to restore bile drainage and improve native liver survival. Robotic-assisted Kasai portoenterostomy (RAKPE) has recently emerged as a potential minimally invasive alternative to open Kasai portoenterostomy (OKPE) and laparoscopic Kasai portoenterostomy (LKPE). However, its comparative efficacy and safety remain uncertain.MethodsWe searched PubMed, EMBASE, and the Cochrane Library for comparative studies published from January 1, 2000, to May 20, 2026. Eligible studies included children with biliary atresia who underwent RAKPE and were compared with patients treated by OKPE and/or LKPE. The primary outcomes were 6-month jaundice clearance and 1-year native liver survival. Odds ratios (ORs) were calculated for dichotomous outcomes, and mean differences (MDs) were calculated for continuous outcomes. RAKPE was analyzed separately against OKPE and LKPE.ResultsFive retrospective comparative studies were included. RAKPE showed short-term clinical outcomes that were generally comparable to those of OKPE and LKPE. The pooled estimates suggested a possible tendency toward higher jaundice clearance after RAKPE, but the differences were not statistically significant. Sensitivity analyses indicated that RAKPE might be associated with less intraoperative blood loss and shorter hospital stay in selected comparisons. These perioperative findings were influenced by individual studies and should therefore be interpreted as preliminary.ConclusionCurrent comparative evidence suggests that RAKPE can achieve jaundice clearance, native liver survival, and postoperative cholangitis outcomes similar to those of OKPE and LKPE in children with biliary atresia. The robotic approach may have advantages in selected perioperative outcomes, but longer operative time remains a consistent drawback. Because the available evidence is based on a small number of retrospective studies, multicenter prospective studies with standardized outcome definitions and longer follow-up are needed before the role of RAKPE can be defined more firmly.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261401089, PROSPERO CRD420261401089.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1918217</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1918217</link>
        <title><![CDATA[Prevalence and risk factors of Helicobacter pylori infection among children attending mercy pediatric hospital and royal hospital, Mogadishu, Somalia: a cross-sectional study]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Omar Sidow Zubair</author><author>Abdifitah Ibrahim Nor</author><author>Abdulwahed Nor Abdi</author><author>Abdikani Yasin Haji Ali</author><author>Farhia Mohamed Mire</author><author>Safia Mohamud</author><author>Nimco Mohamed Ahmed</author><author>Mohamed Hassan Mohamud</author><author>Dunia Haji Ali</author>
        <description><![CDATA[BackgroundHelicobacter pylori (H. pylori) infection is a major cause of peptic ulcer disease and gastric cancer, with the highest global prevalence in Africa. Despite this, pediatric data from Somalia remain critically scarce. This study determined the prevalence and independent risk factors of H. pylori infection among children attending two referral hospitals in Mogadishu, Somalia.MethodsA facility-based cross-sectional study was conducted from 14, February 2026 to 16, April, 2026 (two months) at Mercy Pediatric Hospital and Royal Hospital, Mogadishu. Sociodemographic and risk-factor data were collected through structured caregiver interviews, and H. pylori infection status was determined by stool antigen testing using an immunochromatographic assay. Univariable and multivariable logistic regression analyses were performed using SPSS version 20.0.ResultsUsing consecutive sampling, 175 children were enrolled (Mercy: 117; Royal: 58), 65 (37.1%; 95% CI: 30.0%–44.3%) were positive for H. pylori infection. On multivariable analysis, four factors were independently associated with infection: rural residence (aOR = 3.09; 95% CI: 1.20–7.96; p = 0.020), low parental education (aOR = 2.34; 95% CI: 1.03–5.35; p = 0.043), failure to wash fruits and vegetables before serving (aOR = 2.40; 95% CI: 1.06–5.46; p = 0.036), and street food consumption (aOR = 2.66; 95% CI: 1.29–5.51; p = 0.008). The model demonstrated good fit (Hosmer–Lemeshow χ2 = 5.44; p = 0.709). Soap use, which was strongly associated in univariable analysis, was attenuated to non-significance after multivariable adjustment, a pattern consistent with confounding.ConclusionApproximately one in three children attending these referral hospitals was infected with H. pylori. Infection was independently associated with rural residence, lower parental education, and food-related exposures. Prevention strategies may benefit from system-level responses combining improved water and sanitation infrastructure, targeted caregiver education, and promotion of safe food-handling practices.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1896606</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1896606</link>
        <title><![CDATA[Experiences of families using an early example of a neighbourhood multidisciplinary care team for children and young people in Birmingham, UK: a qualitative exploration of acceptability]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>I. Litchfield</author><author>F. Dutton</author><author>L. Harper</author><author>S. Kaur</author><author>C. Luxmore</author><author>L. Rahman</author><author>C. Wolhuter</author><author>C. Bird</author>
        <description><![CDATA[IntroductionIn the United Kingdom, the National Health Service is attempting to address the increasing prevalence of chronic conditions, including obesity, and mental ill health among children and young people (CYP) by creating neighbourhood multi-disciplinary teams (NMDTs). These challenges to the health and well-being of CYP are particularly pronounced amongst underserved populations and it is expected that combining health services and social care services can help address these ongoing inequalities. Despite this significant shift in the delivery of care, there is a lack of robust evidence on families’ experiences of these integrated services to inform their development. This work helps address this by providing a qualitative exploration of the acceptability to families of an early example of an NMDT for CYP, the “Sparkbrook Children’s Zone”, as delivered in Birmingham, UK.MethodsThe study used data collected from two focus groups conducted with eight parents whose children had been treated by the Sparkbrook Children’s Zone. The data were analysed using a directed content analysis to populate the relevant domains of Sekhon’s theoretical framework of acceptability.ResultsIn summary (by domain), we found that that individuals' awareness of the service was derived from a range of sources and, although understanding that the service was multidisciplinary, they were sometimes unsure of the precise organisations involved (Intervention coherence). Parents described how access was supported by a locally situated and collocated service (Burden), the importance of the personalised relationship they developed with providers (Cultural sensitivity), and finally, the benefits of extended consultation time and the support they received for the family's complex clinical and social needs (Perceived effectiveness).DiscussionParents appeared to be strongly in favour of the collocated multi-disciplinarity of the service over their usual primary care. However, more work was needed with larger sample sizes, a broader range of demographies, and across services that offered alternative staffing models. In this way, service leads and commissioners could better understand the key characteristics of NMDTs that influenced patient and family acceptability and engagement.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1845433</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1845433</link>
        <title><![CDATA[Case Report: Therapeutic plasma exchange for severe unconjugated hyperbilirubinemia with bilirubin-induced neurologic dysfunction in an adolescent with Crigler–Najjar syndrome type II]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Mohanad Jaber</author><author>Ammir Abuzahra</author><author>Ayah Kamel Karajat</author><author>Bara Abu Shama'a</author><author>Lama K. Hunyhen</author><author>Lara Baradia</author><author>Loai Muhtasib</author><author>Ashraf Alzughayyar</author><author>Hasan I. H. Hroob</author><author>Majed Dwaik</author><author>Yousef Al-Takrori</author>
        <description><![CDATA[BackgroundCrigler–Najjar syndrome type II (CNS-II) is a rare inherited disorder of bilirubin conjugation that typically responds to phenobarbital and is less frequently complicated by bilirubin neurotoxicity than CNS-I. During physiologic stress, unconjugated bilirubin may acutely rise, potentially increasing unbound bilirubin and neurologic risk.Case presentationA 15-year-old male with a known history of CNS-II presented with two weeks of progressive abnormal movements and worsening jaundice, followed by decreased consciousness and incoherent speech. Initial testing demonstrated severe isolated hyperbilirubinemia with minimal direct bilirubin fraction and no laboratory evidence of hepatocellular injury or synthetic dysfunction. He was transferred to the medical Intensive Care Unit with suspected bilirubin-induced neurologic dysfunction.InterventionGiven ongoing neurologic deterioration and severe hyperbilirubinemia despite supportive management, therapeutic plasma exchange (TPE) was initiated on the day of ICU admission and performed daily for seven sessions via central venous access with fresh frozen plasma used as the replacement fluid.OutcomeTotal bilirubin declined from 35.0 mg/dL on admission (16-Feb-2025) to 28.8 mg/dL by session 2 (17-Feb-2025),to 27.4 mg/dL by session 3 (18-Feb-2025), to 24 mg/dL by sessions 4-5 (19-20-Feb-2025),to 19.5 mg/dL by sessions 6-7(21-22-Feb-2025) and approximately 18.8 mg/dL after seven sessions (23-Feb-2025), accompanied by clinical improvement in alertness and abnormal movements. Brain MRI obtained after TPE sessions demonstrate no Acute Bilirubin Encephalopathy-pattern or basal ganglia involvement.ConclusionThis case supports consideration of TPE as a rescue strategy for severe unconjugated hyperbilirubinemia with neurologic dysfunction in older children with CNS-II when conventional measures are insufficient or impractical, while underscoring the need for standardized reporting of TPE protocols and longer-term neurodevelopmental outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1908940</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1908940</link>
        <title><![CDATA[Bibliometric analysis of research on pediatric hypothyroidism treatment: a global perspective on trends and emerging fronts (2018–2026)]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Wei Wu</author><author>Zhengyun Sun</author><author>Mengxun Liu</author><author>Yu Huang</author><author>Tingting Liu</author><author>Xiaobing Qiu</author><author>Yuanbiao Wang</author>
        <description><![CDATA[BackgroundPediatric hypothyroidism is among the most prevalent endocrine disorders in childhood, yet no bibliometric analysis has systematically mapped the research landscape of its treatment.ObjectiveThis study aimed to characterize the publication trends, geographic distribution, research hotspots, and emerging fronts in pediatric hypothyroidism treatment research from 2018 to 2026.MethodsA comprehensive search was conducted in the Web of Science Core Collection (WoSCC) as the primary database, with external data validation performed via PubMed. Bibliometric indicators were analyzed using CiteSpace, Python and R. Keyword co-occurrence networks were constructed with Louvain community detection, and burst detection was performed to identify emerging research fronts.ResultsA total of 1,302 publications were included. Annual output grew from 138 (2018) to a peak of 183 (2022). The United States (n = 263, 20.2%), China (n = 203, 15.6%), and Italy (n = 137, 10.5%) were the leading contributors. Five thematic clusters were identified: (1) congenital hypothyroidism and neonatal screening; (2) subclinical hypothyroidism; (3) pregnancy-related thyroid disorders; (4) autoimmune thyroid disease; and (5) comorbidities and genetic syndromes. Burst detection revealed “obesity” (burst strength = 7.2), “COVID-19” (4.0), and “thyroid dyshormonogenesis” (3.2) as emerging fronts.ConclusionsThe field is shifting focus from congenital hypothyroidism screening optimization toward subclinical hypothyroidism management and the recognition of obesity-related TSH elevation as a distinct physiological entity. Future research should prioritize prospective trials on watchful-waiting strategies and obesity-specific TSH reference ranges.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1885428</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1885428</link>
        <title><![CDATA[Diagnostic pitfalls in systemic juvenile idiopathic arthritis: insights from 6 misdiagnosed cases]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xiaona Zhu</author><author>Yinyin Guo</author><author>Jixin Guo</author><author>Jun Yang</author><author>Tingyan He</author>
        <description><![CDATA[ObjectiveSystemic juvenile idiopathic arthritis (sJIA) is a diagnosis of exclusion with nonspecific early manifestations. Misdiagnosis is common due to overlap with infections, autoinflammatory diseases, and malignancies. We aimed to characterize a series of patients initially diagnosed with sJIA who subsequently reclassified following further evaluation were.MethodsWe retrospectively reviewed the clinical records, laboratory findings, genetic analyses, and imaging data of six pediatric patients initially diagnosed with sJIA but later revised to alternative diagnosis after further investigations. These patients were enrolled at Shenzhen Children's Hospital between January 2011 and December 2022.ResultsAll six patients initially fulfilled at least one set of sJIA classification criteria. All patients presented with recurrent fever (100%, 6/6), three had arthritis (50%, 3/6), and five exhibited rash (83.3%, 5/6). Elevated inflammatory markers were observed in all patients (100%, 6/6). The median age at initial sJIA diagnosis was 64 months (IQR, 24–145). The median delay from initial diagnosis to final diagnosis was 9.5 months (IQR, 5–12). Three patients (50%, 3/6) were considered to have refractory sJIA prior to diagnostic revision. Final diagnoses included autoinflammatory diseases (n = 3), Takayasu arteritis (n = 1), inflammatory myofibroblastic tumor (n = 1), and suspected congenital hemophagocytic lymphohistiocytosis (n = 1).ConclusionssJIA is defined by classification criteria and represents a diagnosis of exclusion, requiring long-term dynamic reassessment to distinguish it from other diseases with overlapping clinical features. Early recognition of atypical manifestations and timely comprehensive evaluation are essential to avoid misdiagnosis, particularly in distinguishing monogenic autoinflammatory disorders and malignancies.]]></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.2026.1900187</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>
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        <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>
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