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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>2026-08-12T10:13:43.149+00:00</pubDate>
        <ttl>60</ttl>
        <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>
      </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.2026.1887012</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.2026.1894739</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.2026.1911394</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.2026.1902882</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1902882</link>
        <title><![CDATA[Anticoagulation management during low flow states in pediatric bivalirudin extracorporeal membrane oxygenation]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ahmad T. Hamed</author><author>Miranda Edmunds</author><author>Matthew Douds</author><author>Michael Lahart</author><author>Ahmed S. Said</author>
        <description><![CDATA[IntroductionThere is growing utilization of direct thrombin inhibitors (Bivalirudin) for primary pediatric extracorporeal membrane oxygenation (ECMO) anticoagulation. During low-flow states, proteolytic inactivation of bivalirudin decreases its efficacy. We describe our experience with unfractionated heparin (UFH) boluses, prior to and during low-flow and clamp trials, with bivalirudin anticoagulation.MethodsRetrospective chart review of all pediatric ECMO runs from Jan 2020 till May 2021 anticoagulated with bivalirudin, that underwent low-flow or clamp trials. ECMO flows, UFH boluses, bivalirudin infusion rates, anticoagulation profiles, hemoglobin values and blood product administration were recorded before and after trials, as well as circuit interventions and stroke incidence.ResultsThirty-one ECMO runs met inclusion criteria, with 65 low-flow or clamp trials. Median UFH bolus dose was 25 units/kg, inter-quartile range (IQR) of [15, 50]. Median blood product volumes 24 h pre- and post-trial were 15 mL/kg [IQR 13, 20] vs. 15 mL/kg [IQR 10, 20]. Eight post-trial circuit interventions were performed (6 connectors, 2 pump exchanges) in 4 patients, and 3 ischemic strokes occurred in 3 separate patients. There were no significant differences before and after trials in coagulation profiles, bivalirudin infusion rates, or hemoglobin values.ConclusionUFH boluses during low-flow states in pediatric ECMO with bivalirudin anticoagulation are safe, without increased bleeding, circuit deposit burden requiring circuit interventions, or stroke. Prospective multicenter studies are needed to compare this approach to other anticoagulation strategies during low-flow and clamp trials, including UFH alone and bivalirudin without adjunctive UFH, and to further define their optimal dosing and safety profiles.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1921366</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1921366</link>
        <title><![CDATA[A scoping review exploring the health impact and sustainability of collaborative paediatric heart disease treatment programmes in developing countries]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>S. K. Sulaiman</author><author>N. Hamza</author><author>M. Martin-Khan</author>
        <description><![CDATA[IntroductionThe global burden of paediatric heart disease is increasing with widening disparities between developed countries and developing economies. In the last two decades, mortality and morbidity rates have markedly improved in developed nations, however they continue to rise in developing countries. Collaborative treatment programmes are crucial for bridging this gap where the necessary healthcare infrastructure is lacking. This scoping review aims to map the health impact, economic outcomes, and capacity building initiatives of collaborative paediatric heath disease treatment programmes in developing countries.MethodsA comprehensive search was conducted across MEDLINE, Embase and Global Health from inception to May 5th, 2024. Studies were screened by title and abstract, followed by full-text review, applying predefined inclusion and exclusion criteria. Data on patient and programme characteristics, mortality rates, economic impact and capacity-building initiatives were extracted and analysed.ResultsThe review included 35 studies. Thirty studies reported on mortality rates which ranged from 0% to 12.4%. Nine studies reported on mortality pre and post programme with a 4% to 41% reduction in mortality. Many studies included capacity building initiatives within their programmes. This included: Training and Education (n = 26); Infrastructure Development (n = 13); and Systems Strengthening (n = 18). Long-term programmes placed more than double the emphasis on systems strengthening approaches compared to short-term missions.ConclusionOur review extensively maps the various characteristics and approaches of collaborative paediatric heart disease programmes. Overall, the findings suggests that these initiatives have the potential to provide favourable clinical outcomes and if setup appropriately they can support development of local expertise, improve healthcare infrastructure, and promote self-sustaining services in developing countries. A multi-faceted approach is required to improve paediatric cardiac care globally. Evidence evaluating long term impact and sustainability remains limited and further research is required to better understand how collaborative models can be optimised to support equitable and sustainable paediatric cardiac care globally.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1908967</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1908967</link>
        <title><![CDATA[A causal moderated mediation analysis of maternal prenatal bonding and daily infant engagement on postpartum bonding]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Caitlin Dressler</author><author>Stacy Tiemeyer</author><author>Karina M. Shreffler</author>
        <description><![CDATA[BackgroundThe early maternal-infant bond has profound impacts for infant development. Prior research indicates that higher self-reported maternal-fetal bonding predicts greater postpartum bonding, but additional research is needed on the mechanisms that may promote the early maternal-infant relationship. We explored daily engagement in caregiving behaviors as a potential non-pharmacological intervention to promote maternal and infant health.MethodsThis study utilizes a diverse and predominately low-income sample of 114 mothers of infants who were recruited at their first prenatal visit in 2017–2018 and followed through at least six months post-birth. We conducted a causal mediation analysis to examine whether daily engagement at two months postpartum functions as a mediator in the maternal prenatal and postpartum bonding relationship, and additionally tested whether this mediation was moderated by maternal prenatal bonding levels for postpartum bonding.ResultsMaternal prenatal bonding was associated with daily engagement (b = 0.03, SE = 0.01, p < .001) and postpartum bonding (b = 0.28, SE = 0.08, p = .001), controlling for covariates. We also found that daily engagement at two months postpartum was associated with bonding at six months postpartum (b = 3.88, SE = .95, p < .001). Causal mediation analyses indicated a significant indirect effect of prenatal bonding on postpartum bonding through daily engagement among mothers with lower levels of prenatal bonding. There was also evidence of moderation; daily engagement was a stronger predictor of postpartum bonding among mothers with lower prenatal bonding, whereas mothers with higher prenatal bonding showed consistently strong bonding regardless of engagement level (adjusted R2 = .378).ConclusionsThe results of this study indicate that maternal engagement activities may help to facilitate postpartum bonding and may explain the association between prenatal and postpartum bonding. Additionally, engaging in more caregiving activities may strengthen postpartum bonding, particularly among those with lower prenatal bonding. These findings suggest promoting maternal engagement in caregiving behaviors may promote a stronger postpartum bond.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1871728</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1871728</link>
        <title><![CDATA[Diaphragmatic hernia after pediatric liver transplantation: graft-specific incidence, clinical characteristics, and outcomes]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Cansu Altuntaş</author><author>Alaaddin Aydın</author><author>Mey Talip</author><author>Gülden Özek</author><author>Taylan Şahin</author><author>Ali Koçyiğit</author><author>Eryiğit Eren</author><author>Mehmet Tokaç</author><author>Ayhan Dinçkan</author>
        <description><![CDATA[BackgroundDiaphragmatic hernia (DH) is a rare but clinically important complication following pediatric liver transplantation.MethodsThis retrospective single-center study evaluated consecutive pediatric liver transplant episodes. Clinical characteristics, timing, management, and outcomes of DH were assessed. Transplant episodes with and without subsequent DH were compared. The cumulative incidence of DH was estimated using a competing-risk approach, with death before DH diagnosis treated as a competing event.ResultsDiaphragmatic hernia occurred in 16 of 112 pediatric liver transplant episodes (14.3%). All cases occurred following left lateral segment (LLS) transplantation, corresponding to an incidence of 25.0% (16/64) among LLS transplant episodes, whereas no cases occurred after other graft types. Recipients who developed DH were younger at transplantation and had higher graft-to-recipient weight ratio (GRWR) values than those without DH. Approximately half of DH cases were diagnosed within the first 3 postoperative months, and most within the first year. In competing-risk analysis, the cumulative incidence of DH was 7.2% at 3 months, 10.0% at 6 months, and 11.9% at 12 months. Respiratory distress was the most common presentation. All patients underwent surgical repair, and dual mesh reinforcement was used in most cases. Severe postoperative complications were frequent, recurrence occurred in two patients, and no deaths were directly attributable to DH.ConclusionDiaphragmatic hernia is an unexpected and serious complication following pediatric liver transplantation. In our cohort, DH occurred exclusively after LLS transplantation, and affected recipients were younger and had higher GRWR values than those without DH; however, these characteristics are closely interrelated and their independent contributions could not be determined. Most cases were diagnosed early after transplantation, emphasizing the importance of clinical vigilance, timely diagnosis, and prompt surgical management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1915085</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1915085</link>
        <title><![CDATA[Alberta family integrated careTM: a review of a family-integrated care model in neonatal intensive care]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Su Wang</author><author>Yuan Wang</author><author>Xi Kang</author><author>Jie Fu</author><author>Liwen Ding</author><author>Hong Zhou</author><author>Yiyong Fu</author>
        <description><![CDATA[Alberta Family Integrated CareTM (AB-FICareTM) is a standardized, theory-driven model that integrates parents as primary caregivers in neonatal intensive care units (NICUs); however, its clinical effectiveness, implementation determinants, and cross-setting applicability require systematic synthesis. This narrative review aims to evaluate the evidence on AB-FICareTM in Level II NICUs, focusing on neonatal and parental outcomes, implementation barriers and facilitators, and transferability to healthcare systems with distinct organizational and cultural contexts. Following SANRA guidelines, we systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published between January 2020 and June 2026. Ten reports from a single Canadian cluster randomized controlled trial met the inclusion criteria. The findings demonstrate that AB-FICareTM significantly reduced the adjusted length of stay by 2.55 days (95% CI: −4.44 to −0.66, P = 0.02) without increasing readmissions or emergency visits, and improved parental experiences, specifically enhancing trust, engagement, and discharge readiness. However, exclusive human milk feeding at 2 months was lower in the AB-FICareTM group (aOR = 0.51, 95% CI: 0.31–0.83, P = 0.01). Neurodevelopmental outcomes were mixed; while there was a signal for reduced communication delay at 6–24 months, this was not replicated at 18 months, whereas maternal parenting stress consistently predicted developmental delay (aORs > 1.03, P < 0.01). Key implementation facilitators included receptive organizational culture and stakeholder engagement, whereas barriers encompassed training burden and competing institutional priorities. Based on these findings, we propose that AB-FICareTM implementation should move from one-size-fits-all adoption toward context-sensitive adaptation, integrating robust lactation support, post-discharge mental health services, and system-level coordination into a comprehensive framework covering NICU stay through community-based follow-up. Future research should prioritize long-term neurodevelopmental follow-up, formal cost-effectiveness analyses adhering to CHEERS standards, and multi-site validation across diverse healthcare settings to establish the generalizability and sustainability of AB-FICareTM benefits beyond the Canadian context.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1911388</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1911388</link>
        <title><![CDATA[Outcomes and predictors of respiratory morbidity in children with neuromuscular disorders requiring respiratory support: a cohort study from Vietnam]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hung Viet Dau</author><author>Tuoi Nguyen Thi</author><author>Lam Hoang Kim</author><author>Cuong Le Nhat</author><author>Canh Ngoc Hoang</author>
        <description><![CDATA[BackgroundRespiratory failure is a major cause of intensive care admission in children with neuromuscular disorders, but data on outcomes and prognostic factors in mixed pediatric neuromuscular cohorts remain limited. This study aimed to describe short-term outcomes and identify predictors of poor outcomes in children with neuromuscular disorders requiring respiratory support in a tertiary pediatric intensive care unit.MethodsWe conducted a single-center cohort study of children aged 1 month to 16 years with neuromuscular disorders requiring respiratory support admitted to a tertiary pediatric intensive care unit in Vietnam between January 2023 and June 2025. Poor outcome was defined as in-hospital mortality, invasive mechanical ventilation for ≥7 days, tracheostomy, or reintubation.ResultsSixty-three children were included. In-hospital mortality was 14.3% (9/63), and 33 children (52.4%) experienced a poor outcome. Nineteen children (30.2%) required invasive mechanical ventilation for ≥7 days, 10 (15.9%) underwent tracheostomy, and 20 (31.7%) required reintubation. Higher Pediatric Risk of Mortality III (PRISM III) score, shock, lower Glasgow Coma Scale score, and older age were independently associated with poor outcomes.ConclusionsRespiratory morbidity was substantial among children with neuromuscular disorders requiring respiratory support. Early illness severity and physiological instability at PICU admission were independently associated with poor outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1857511</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1857511</link>
        <title><![CDATA[Case Report: Ultra-early nusinersen initiation with pre-procedural spinal ultrasound-assisted intrathecal access in a symptomatic neonate with spinal muscular atrophy]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Ning Xie</author><author>Yan Sui</author><author>Yanyan Zhang</author><author>Leihong Zhang</author><author>Jiashan Li</author><author>Ying Sun</author><author>Xiuxiang Liu</author>
        <description><![CDATA[A full-term neonate presented at birth with generalized hypotonia, markedly reduced spontaneous movement, and tongue fasciculations. These findings raised early suspicion of an underlying severe neuromuscular disorder. Genetic testing confirmed homozygous deletion of SMN1 with two copies of SMN2 on day 5 of life, and intrathecal nusinersen was started on the same day. Because repeated lumbar puncture was required, spinal ultrasound was used before the first three intrathecal administrations during the neonatal period to evaluate lumbar anatomy and plan the puncture level and trajectory. This approach facilitated successful first-attempt intrathecal access during the early neonatal procedures. By day 68 of life, the infant had completed four loading doses without procedure-related complications. Motor function, assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), increased from 6 before treatment to 21 before the third dose and 30 before the fourth dose. Given the short follow-up period, these early changes should be interpreted cautiously. They are more likely to reflect early disease stabilization and preservation of residual motor function than reversal of established motor neuron loss. This case provides an individual-level real-world description of symptomatic neonatal spinal muscular atrophy treated within the first days of life after postnatal diagnosis. It also supports the feasibility of a structured ultrasound-assisted approach for early repeated intrathecal administration during the neonatal period.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1860058</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1860058</link>
        <title><![CDATA[Fluid restriction after pediatric cardiac surgery is independently associated With shorter mechanical ventilation: a retrospective cohort study With adjustment for cardiopulmonary bypass time]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Nicholas Richards</author><author>Joshua Davis</author><author>William V Stein</author><author>Adeeb Khan</author>
        <description><![CDATA[BackgroundCardiopulmonary bypass (CPB) for pediatric cardiac surgery triggers a systemic inflammatory response driving postoperative fluid retention, prolonged ventilation, and acute kidney injury (AKI). The Starship Hospital guideline provides a structured framework for postoperative fluid restriction, but North American observational validation adjusting for CPB time has been lacking.ObjectiveTo evaluate the association between a Starship-derived fluid restriction protocol and clinical outcomes, with adjustment for operative complexity.MethodsRetrospective single-center cohort of 329 pediatric patients undergoing structural CHD surgery with cardiopulmonary bypass (April 2017–February 2025): 259 pre-protocol, 70 post-protocol. Non-CPB lateral thoracotomy cases were excluded a priori. Protocol parameters were embedded in the mandatory order set, substantially standardizing fluid prescribing. Outcomes were analyzed with linear and generalized linear models (gamma; negative binomial for ventilation days), adjusted for age, weight, and STAT category, with prespecified sensitivity analyses adding CPB time, post-CPB TEE ventricular function, and procedure year.ResultsMean CPB time was shorter post-protocol (83.0 vs. 101.2 min; p = 0.008); modified ultrafiltration was not used. Adjusted for age, weight, and STAT, post-protocol status was associated with 49% lower expected ventilation days (IRR: 0.51, 95% CI: 0.37–0.69; p < 0.001), 34% lower LOS (ratio: 0.66, 0.50–0.88; p = 0.005), and 28% lower furosemide exposure (ratio: 0.72, 0.64–0.83; p < 0.001). After adjustment for CPB time, the ventilation effect persisted (IRR: 0.63; p = 0.004); adding post-CPB TEE ventricular function, the effect remained significant (IRR: 0.69, 0.50–0.96; p = 0.026). AKI did not differ unadjusted (42.5% vs. 37.1%, p = 0.49) or adjusted. Postoperative hypernatremia (Na >145) fell from 78.7% to 62.9% (adjusted OR: 0.44, 0.22–0.89; p = 0.022).ConclusionsA Starship-derived fluid restriction protocol was independently associated with shorter mechanical ventilation, reduced furosemide exposure, and reduced hypernatremia, robust to full adjustment for operative covariates. AKI and LOS effects attenuated under full adjustment. Findings are hypothesis-generating and support proactive fluid restriction as a candidate intervention warranting prospective evaluation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1917680</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1917680</link>
        <title><![CDATA[Mediterranean diet adherence in pediatric familial Mediterranean fever: clinical and inflammatory correlates]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hande Ilgaz Tüzen</author><author>Tuncay Aydın</author><author>Zehra Kızıldağ</author><author>Rana İşgüder</author><author>Rüya Torun</author><author>Erbil Ünsal</author><author>Balahan Bora</author>
        <description><![CDATA[Familial Mediterranean fever is an autoinflammatory disease characterized by recurrent episodes of fever and serositis, with subclinical inflammation that may persist between attacks. Although the Mediterranean diet has recognized anti-inflammatory properties, its clinical relevance in pediatric familial Mediterranean fever remains unclear. In this cross-sectional observational study, children aged 7–18 years with a confirmed diagnosis of familial Mediterranean fever who were followed at the Pediatric Rheumatology Clinic of Dokuz Eylül University between June 2022 and February 2023 were evaluated using standardized dietary questionnaires during outpatient visits. A total of 91 patients met the inclusion criteria. Associations between Mediterranean diet adherence, eating behaviors, attack frequency, disease severity, and selected clinical and inflammatory parameters were analyzed using appropriate comparative statistical tests. Eating behavior showed nominal associations with body mass index and exertional leg pain. Leukocyte count differed across the KIDMED categories in the overall comparison; however, no pairwise comparison remained statistically significant after Bonferroni correction. Neither dietary measure was associated with attack frequency or disease severity. In pediatric familial Mediterranean fever, Mediterranean diet adherence and eating behaviors showed nominal exploratory associations with selected clinical and inflammatory parameters but were not associated with attack frequency or overall disease severity. These findings suggest that dietary patterns may be more closely related to inter-attack clinical and inflammatory expression than to acute disease activity and may help inform future prospective studies on modifiable lifestyle factors in pediatric autoinflammatory disease.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1842381</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1842381</link>
        <title><![CDATA[Pulmonary function and risk factors in pediatric chest tightness variant asthma: a case-control study]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ruo-Yu Cao</author><author>Wei-Chao He</author><author>Ya-Bin Yu</author><author>Shan-Shan Tong</author>
        <description><![CDATA[ObjectiveTo investigate the pulmonary function characteristics and risk factors for pediatric chest tightness variant asthma (CTVA).MethodsA retrospective case-control study was conducted. Clinical data of 39 children diagnosed with CTVA in our outpatient department from February 2022 to February 2024 were analyzed. Fifty healthy children undergoing physical examinations during the same period were enrolled as controls. All participants underwent fractional exhaled nitric oxide (FeNO) measurement and pulmonary ventilation function tests at initial diagnosis or physical examination. FeNO levels and pulmonary function parameters were compared between groups. Baseline demographic and clinical data were recorded. Univariate logistic regression analyses were performed to explore factors associated with pediatric CTVA. Due to the limited sample size (39 cases) and an event-per-variable ratio below the recommended minimum of 10:1 for reliable multivariable modeling, multivariate analysis was not performed.ResultsFeNO levels were significantly higher in the CTVA group than in the healthy control group (p = 0.016). FEV1/FVC, PEF, FEF25, FEF50, and FEF75 were significantly lower in the CTVA group (all p < 0.05), whereas FEV1, FVC, and MMEF showed no significant differences (p > 0.05). Significant intergroup differences were observed for obesity, inhalant allergen sensitization, allergic rhinitis, atopic dermatitis, history of recurrent respiratory infections, and family history of allergic diseases (all p < 0.05). Univariate logistic regression analysis confirmed these six factors as significantly associated with pediatric CTVA (all p < 0.05).ntified these six factors as potential independent risk factors for pediatric CTVA (all p < 0.05)ConclusionChildren with CTVA have higher FeNO levels and lower FEV1/FVC, PEF, FEF25, FEF50, and FEF75 compared to healthy peers. Obesity, inhalant allergens, allergic rhinitis, atopic dermatitis, recurrent respiratory infections, and family history of allergic diseases showed significant univariate associations with pediatric CTVA in this exploratory cohort. Combined assessment of FeNO and small airway parameters may aid in the diagnostic evaluation of CTVA, although further diagnostic accuracy studies are needed.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1913335</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1913335</link>
        <title><![CDATA[Pulmonary alveolar proteinosis and Pneumocystis jirovecii infection in an infant with hyper-IgM syndrome caused by a novel CD40LG variant: a case report]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>C. Leclercq</author><author>E. Olinger</author><author>A. Caminoa</author><author>O. Chatzis</author><author>D. Dumitriu</author><author>A. Froidure</author><author>J. Smet</author><author>S. Balbeur</author><author>T. Corbisier</author>
        <description><![CDATA[BackgroundPulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease. While autoimmunity is the leading cause of PAP in adults, the majority of pediatric cases occur secondary to immunodeficiency and opportunistic infections. Secondary PAP associated with CD40 ligand (CD40L) deficiency is extremely rare, and the underlying pathophysiology remains poorly understood.Case presentationWe report the case of a 4-month-old boy admitted due to failure to thrive and severe hypoxemic respiratory failure. Chest computed tomography demonstrated diffuse ground-glass opacities with interlobular septal thickening. Bronchoalveolar lavage yielded clear fluid containing Periodic acid-Schiff-positive material consistent with PAP, and polymerase chain reaction was positive for Pneumocystis jirovecii. An immunologic evaluation showed hypogammaglobulinemia (IgG and IgA), a normal IgM level for his age, an absence of class-switched memory B cells, and significantly reduced CD40L expression on activated T lymphocytes. Targeted genetic testing identified a previously unreported hemizygous CD40LG missense variant [c.137T>C, p.(Leu46Pro)]. Integration of the patient’s immunophenotype, an in silico variant evaluation, and segregation data permitted classification of this variant as likely pathogenic, confirming X-linked hyper-IgM syndrome. The patient improved with ventilatory support, high-dose trimethoprim-sulfamethoxazole, and immunoglobulin replacement therapy.ConclusionsEarly-onset PAP associated with P. jirovecii infection may reveal CD40L deficiency and should prompt evaluation for primary immunodeficiency. An integrated clinico-immunologic assessment coupled with genetic testing is essential to provide a molecular diagnosis, guide management, and prognostication, and to support timely consideration of curative hematopoietic stem cell transplantation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1725474</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1725474</link>
        <title><![CDATA[Using deep learning to monitor children’s nutritional status for child stunting identification]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Shijia Luo</author><author>Yuan Wang</author><author>Rongrong Wu</author><author>Zhaoxin Yang</author><author>Hui Gao</author><author>Jing Yuan</author><author>Zhitao Wang</author>
        <description><![CDATA[IntroductionChildren's nutritional health remains a major public health concern, and accurate early identification of growth related risks is essential for timely screening and intervention. This study proposes a deep learning based framework for monitoring children's nutritional status for child stunting identification.MethodsThe task is formulated as a supervised binary classification problem, in which each child is represented by routinely available demographic and anthropometric variables, including age, sex, height, weight, and body mass index. Based on these structured inputs, the proposed Intelligent Nutritional Monitoring Model (INMM) learns discriminative latent representations and predicts whether a child is stunted. The model adopts a compact feature extraction architecture with feature fusion and hierarchical attention, enabling effective modeling of informative interactions among child level attributes while maintaining computational efficiency. To evaluate the proposed method, experiments are conducted on two public health survey datasets, NHANES and NFHS 5, under a unified preprocessing, training, and evaluation protocol.Results and DiscussionComparative results against traditional machine learning, mainstream deep learning, lightweight tabular modeling, and transformer based tabular baselines show that the proposed method achieves the strongest overall classification performance on both datasets while preserving a favorable effectiveness efficiency trade off. Additional ablation results further confirm the contribution of feature extraction, fusion, attention, and prediction design to the final performance. These findings indicate that the proposed framework provides an effective and scalable solution for data driven child stunting identification from structured health survey data.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1844281</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1844281</link>
        <title><![CDATA[Cleidocranial dysplasia with preserved function under conservative management: a case report]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Huijiao Xu</author><author>Junmei Ma</author><author>Xiaosong Huang</author><author>Siyu Pu</author><author>Fang Hou</author><author>Wenying Liu</author><author>Jiajun Chen</author>
        <description><![CDATA[IntroductionCleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disorder caused by pathogenic variants in the RUNX2 gene and characterized by delayed closure of cranial sutures, clavicular hypoplasia, and dental abnormalities. The clinical phenotype is highly heterogeneous, and data on the long-term natural history of CCD with preserved function remain limited.MethodsWe reviewed the longitudinal clinical data of a male child with genetically confirmed CCD carrying a RUNX2 c.631C > T (p.R211W) variant. CCD-specific evaluation was initiated at approximately 4 years of age because of persistent delayed anterior fontanelle closure and clavicular abnormalities. Assessments included physical examination, cranial CT/MRI, chest imaging, panoramic dental radiography, whole-exome sequencing with parental validation, and endocrine follow-up.ConclusionThis case supports individualized conservative management for selected patients with CCD who have preserved function despite structural abnormalities. Longitudinal multidisciplinary follow-up is essential for guiding dental, endocrine, orthopedic, and functional management.DiscussionDespite typical skeletal and dental manifestations, the patient maintained preserved shoulder and upper limb function through 12 years of age, without recurrent fractures, persistent pain, functional limitation, or need for orthopedic or thoracic surgical intervention. A function-oriented conservative management strategy remained appropriate. Height SDS improved during rhGH-related follow-up; however, this observation should be interpreted cautiously because growth may also have been influenced by hypothyroidism, thyroid hormone replacement, normal development, and pubertal maturation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1862244</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1862244</link>
        <title><![CDATA[Preschool children's sleep duration and parental depressive symptoms in western China: role of children's mental health and socioeconomic factors]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jiali Du</author><author>Xi Zhang</author><author>Wei He</author><author>Mingyue Duan</author>
        <description><![CDATA[BackgroundPreschool children's insufficient sleep is a public health concern in underdeveloped western China, yet its association with parental depressive symptoms remains unclear, particularly whether this relationship varies by socioeconomic context. This study aims to examine this association, explore whether child mental health may partly account for it, and identify vulnerable subgroups.MethodsThis cross-sectional study recruited 21,366 parent-child dyads from 189 preschools in western China. Parent-reported children's sleep duration was categorized into three groups: 10–13 h/d (reference), 8–9 h/d, and <8 h/d. Parental depressive symptoms and children's mental health outcomes (total difficulties) were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Multivariable logistic regression was used to examine the association between children's sleep duration and parental depressive symptoms, and subgroup analyses were performed to assess effect modification by demographic and socioeconomic factors. Indirect effect analysis was conducted to determine the extent to which children's total difficulties account for this association.ResultsIn fully adjusted model, a clear graded relationship was observed that parents of children sleeping 8–9 h/d had 43% higher odds of elevated parental depressive symptoms (OR = 1.43, 95% CI: 1.30–1.56, P < 0.001), while parents of children sleeping <8 h/d had 2.6-fold higher odds (OR = 2.61, 95% CI: 2.13–3.19, P < 0.001) compared with the 10–13 h/d reference group. Subgroup analyses revealed that the strongest associations were found among mortgaged homeowners (OR = 4.21, 95% CI: 2.52–7.04, P < 0.001), urban Hukou registrants (OR = 3.73, 95% CI: 2.62–5.32, P < 0.001), and ever-smokers (OR = 4.50, 95% CI: 2.84–7.12, P < 0.001) for the <8 h/d group. Indirect effect analyses showed that children's total difficulties accounted for 34.3% (95% CI: 25.1%–47.9%) of the association for children sleeping 8–9 h/d, and 39.4% (95% CI: 30.5%–52.9%) for those sleeping <8 h/d.ConclusionShorter sleep duration in preschool children is associated with an increased risk of parental depressive symptoms, and this association is partially accounted for by children's mental health. Future high-quality cohort studies are needed to explore this topic in greater detail.]]></description>
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