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        <title>Frontiers in Pediatrics | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/pediatrics</link>
        <description>RSS Feed for Frontiers in Pediatrics | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-05T17:29:50.134+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1752616</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1752616</link>
        <title><![CDATA[Systemic propranolol and topical moist wound dressings for ulcerated infantile hemangioma of the scrotum: a case report]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jiejun Xia</author><author>Kunshan Chen</author><author>Zhenyin Liu</author><author>Xiaoyun Tan</author><author>Shifeng Xie</author><author>Haibo Li</author>
        <description><![CDATA[BackgroundUlceration is a common complication of infantile hemangioma, and its management poses unique difficulties when the lesion is located in high-risk areas like the scrotum. This case report details the successful management of this condition using topical moist wound dressings combined with propranolol.Case presentationA 5-month-old male presented with a rapidly progressing, ulcerated scrotal infantile hemangioma characterized by purulent exudate. Systemic treatment involved oral propranolol solution (maintenance dose of 2 mg/kg/d). Local wound care was managed using a tailored moist wound healing strategy: alginate dressing combined with recombinant human epidermal growth factor gel, secured with a transparent film dressing. The patient was treated successfully; localized infection was controlled within 3 days. The wound achieved complete epithelialization after a total of 12 days of consistent combined treatment, accompanied by simultaneous regression of the hemangioma volume. Three-month Follow-up confirmed favorable cosmetic results with no significant hypertrophic scarring.ConclusionThis case underscores that a synergistic regimen of systemic propranolol and a customized moist wound healing strategy can significantly accelerate healing timelines and improve the quality of tissue repair in ulcerated infantile hemangiomas.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1779116</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1779116</link>
        <title><![CDATA[Machine learning-based identification of inflammatory biomarkers for predicting pulmonary consolidation in children with Chlamydia pneumoniae infection]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Qianqian Dai</author><author>Zhiyuan Wang</author><author>Junlin Zhao</author><author>Yanan Wang</author><author>Menghua Li</author><author>Aliya Maimaitiniyazi</author><author>Xueli Wang</author><author>Jianjiang Cui</author><author>Zhenzhen Guo</author><author>Shengmeng Qu</author><author>Wen Zhao</author><author>Liang Ru</author>
        <description><![CDATA[ObjectiveThis study aimed to identify core inflammatory biomarkers through machine learning approaches and develop an accessible online risk calculator to predict pulmonary consolidation in children with Chlamydia pneumoniae infection, addressing the current lack of effective early warning tools.MethodsThis retrospective case-control study enrolled 42 children with C. pneumoniae infection (consolidation group: 26 cases; non-consolidation group: 16 cases) between January 2020 and December 2024. Five machine learning algorithms, including least absolute shrinkage and selection operator (LASSO) regression, support vector machine-recursive feature elimination (SVM-RFE), Random Forest, XGBoost, and LightGBM, were employed for feature selection, and core predictive factors were identified through consensus validation across these algorithms. K-means clustering analysis was performed on the key inflammatory markers, and an online risk assessment system based on HTML5 technology was developed.ResultsThe five machine learning algorithms consistently identified lactate dehydrogenase (LDH), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as core inflammatory markers for predicting pulmonary consolidation. All three indicators were significantly higher in the consolidation group compared with the non-consolidation group (P < 0.001). K-means clustering analysis stratified patients into a high-inflammation group (9 cases, 21.4%) and a low-inflammation group (33 cases, 78.6%), with a significant difference in consolidation rates between the two groups (100% vs. 51.5%, P = 0.008). The risk assessment system, constructed based on clustering results, demonstrated excellent predictive performance [area under the curve (AUC) = 0.993, 95% confidence interval (CI): 0.966–1.000], with a sensitivity of 88.9% and specificity of 93.9%. Bootstrap resampling validation (1,000 iterations) confirmed the robustness of the clustering solution (stability: 91.2%) and the risk assessment system (bootstrap AUC: 0.949, 95% CI: 0.881–0.995).ConclusionLDH, CRP, and ESR are key indicators for predicting pulmonary consolidation in children with C. pneumoniae infection. The online risk assessment system developed based on these three routine laboratory parameters demonstrates good clinical usability and practicality, enabling early identification of high-risk patients to guide individualized treatment decisions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1807879</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1807879</link>
        <title><![CDATA[Intubation in children presenting with seizures to a pediatric emergency department in a safety net hospital]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mugdha Mohanty</author><author>Zakir Shaikh</author><author>Hovra Zahoor</author><author>Shivangi Kataria</author><author>N. Paul Rosman</author><author>Alcy R. Torres</author>
        <description><![CDATA[ObjectivePatients seen for uncontrolled seizures in a Pediatric Emergency Department (ED) often undergo tracheal intubation (TI). We looked at factors associated with TI in children in a safety net hospital.MethodsThis was a single-center retrospective case series. Fifty-six patients who had ongoing seizures at the time of arrival to the pediatric ED, between ages 0–21 years, were analyzed for demographics, seizure duration, seizure types, indications for TI, antiseizure medication on discharge, and neurological sequelae.ResultsForty-six percent of patients (26/56) underwent TI. The most common type of seizures in the intubated group was a complex febrile seizure (27%). Forty-two percent were intubated for airway protection and 46% were intubated for respiratory failure.ConclusionsIn all patients presenting to a Pediatric ED with uncontrolled seizures, those undergoing TI most often had complex febrile convulsions, seizures longer in duration (p = 0.036), and seizures needing poly-drug therapy for seizure control (p < 0.001).]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1759935</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1759935</link>
        <title><![CDATA[A literature review: progress in the study of plastic bronchitis]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Huihan Li</author><author>Chi Han</author><author>Danchen Wu</author><author>Yuanyuan Zhang</author>
        <description><![CDATA[This literature review aims to synthesize current evidence on plastic bronchitis (PB), a disease characterized by varying degrees of branching cast formation in the airways. The rationale for undertaking this review stems from the increasing recognition of PB as a potentially life-threatening condition in pediatric populations, coupled with significant recent advances in diagnostic and therapeutic approaches. By systematically searching and analyzing historical literature related to PB from multiple electronic databases, this review examines the current status of PB studies across five critical domains: risk factors, pathology and pathogenesis, clinical features and diagnosis, treatment, and prognosis. Particular emphasis is placed on recent advances in diagnostic imaging, interventional bronchoscopy techniques, and emerging pharmacological therapies. This review provides clinically relevant guidance to enhance awareness and improve management strategies for this rare but serious condition among pediatric practitioners.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1693325</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1693325</link>
        <title><![CDATA[Immune and non-immune hydrops fetalis in a Saudi tertiary center: etiologies, antenatal predictors, perinatal outcomes, and one-year survival in a seven-year cohort]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kamal Ali</author><author>Abdullah Alharbi</author><author>Saleh Alshaibi</author><author>Abdulrahman Almunif</author><author>Sadeem Alnami</author><author>Alwateen Al Abdullah</author><author>Usama Alharbi</author><author>Nadia Al Ghilan</author><author>Saad M. Alshamrani</author><author>Mohammed Khan</author><author>Abdulaziz Homedi</author><author>Ibrahim Ali</author><author>Saif Alsaif</author>
        <description><![CDATA[BackgroundHydrops fetalis encompasses diverse fetal disorders with high perinatal mortality, and contemporary regional data are limited.MethodsWe conducted a single-center retrospective cohort study at a Saudi tertiary referral hospital (2016–2022). Pregnancies with antenatal hydrops (≥2 fluid-filled compartments) that were delivered at our center were included and classified as immune or non-immune hydrops fetalis (NIHF). For NIHF, multivariable logistic regression identified predictors of (i) live birth vs. intrauterine fetal death (IUFD)/termination in the antenatal cohort and (ii) one-year survival among live-born infants.ResultsOf 63,000 deliveries, the hospital-based birth prevalence of antenatally diagnosed NIHF and immune hydrops was 1.84/1,000 and 0.22/1,000, respectively. Among live births, the prevalence was 0.65/1,000 (NIHF) and 0.16/1,000 (immune). In the NIHF antenatal cohort (n = 116), the outcomes were IUFD 56.9% (66/116), termination 7.8% (9/116), and live birth 35.3% (41/116). Of the 41 live-born infants with NIHF, 43.9% (18/41) survived to one year of age. In the multivariable analysis, the antenatal factors that were independently associated with IUFD/termination were earlier gestational age at diagnosis [adjusted odds ratio [aOR] 1.20 per week earlier, 95% confidence interval [CI] 1.09–1.31; p < 0.001] and fetal pleural effusion (aOR 6.11, 95% CI 2.07–17.98; p = 0.001). Among live-born infants with NIHF, gestational age at delivery was the sole independent predictor of one-year survival (aOR 1.55 per additional week, 95% CI 1.09–2.22; p = 0.016). In the immune hydrops subgroup (n = 14), most pregnancies received intrauterine transfusion, and the one-year survival was 71.4% (10/14). Among the ten live-born immune cases, postnatal management was intensive, with intravenous immunoglobulin (IVIG) administration in 100% of cases, double-volume exchange transfusion in 80%, and invasive ventilation in 80%. Forty percent received inhaled nitric oxide, and the median hospital stay was 41 days, reflecting substantial resource use.ConclusionsIn this seven-year cohort, earlier presentation and pleural effusion identified antenatal NIHF pregnancies at high risk for IUFD/termination, whereas maturity at delivery was the key determinant of one-year survival in live-born NIHF. Immune hydrops showed comparatively favorable survival with fetal therapy. These data provide birth-prevalence benchmarks for a Middle East tertiary center, supporting guideline-based evaluation, timely fetal-therapy referral, and multidisciplinary care focused on targeted diagnosis and intervention, as well as safe prolongation of gestation where feasible.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1811275</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1811275</link>
        <title><![CDATA[Prevalence and determinants of fever, diarrhea, and acute respiratory infection among children aged 5–59 months in Somaliland, 2020: insights from a nationwide survey]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Abdilaahi Yusuf Nuh</author>
        <description><![CDATA[BackgroundAcute respiratory infections (ARIs), diarrhea, and fever remain major public health burdens among children in low- and middle-income countries, including Somaliland. These illnesses contribute substantially to childhood morbidity and healthcare utilization. This study aimed to determine the prevalence and determinants of these common childhood illnesses in Somaliland.MethodsSecondary analysis of data from the 2020 Somali Demographic and Health Survey (SDHS), a nationwide cross-sectional survey, was conducted. The analysis focused on children aged 5–59 months. Data on diarrhea, fever, and acute respiratory infection (ARI) in the two weeks preceding the survey were analyzed using binary logistic regression to identify associated factors.ResultsA total of 4,702 children aged 5–59 months were included in the analysis. The prevalence of fever, diarrhea, and ARI was 6.07%, 4.75%, and 3.66%, respectively. Child age was the most consistent determinant: children aged ≥25 months had significantly lower odds of diarrhea (AOR = 0.53; 95% CI: 0.31–0.90), fever (AOR = 0.53; 95% CI: 0.31–0.90), and ARI (AOR = 0.37; 95% CI: 0.20–0.67) compared to those aged ≤12 months. Notable regional variations were identified; children residing in Togdheer demonstrated substantially lower odds of diarrhea (AOR = 0.30; 95% CI: 0.14–0.67; p = 0.003), fever (AOR = 0.30; 95% CI: 0.14–0.68; p = 0.004), and ARI (AOR = 0.29; 95% CI: 0.12–0.71; p = 0.006) in comparison to those in Maroodi-Jeeh. A nomadic lifestyle was associated with decreased odds of diarrhea (AOR = 0.48; 95% CI: 0.31–0.75; p = 0.001), fever (AOR = 0.49; 95% CI: 0.32–0.77; p = 0.002), and ARI (AOR = 0.58; 95% CI: 0.34–0.98; p = 0.042) relative to rural living. Access to healthcare emerged as a significant protective factor against diarrhea (AOR = 0.43; 95% CI: 0.28–0.67; p < 0.001) and fever (AOR = 0.44; 95% CI: 0.28–0.68; p < 0.001), though not for ARI (AOR = 0.81; 95% CI: 0.52–1.27; p = 0.363). Vaccination status did not show a significant association with diarrhea (AOR = 1.12; 95% CI: 0.58–2.16; p = 0.726), fever (AOR = 1.12; 95% CI: 0.58–2.17; p = 0.727), or ARI (AOR = 1.37; 95% CI: 0.65–2.89; p = 0.401).ConclusionsChildhood illnesses remain a public health concern in Somaliland, particularly among younger children. Key determinants include child age, maternal age, geographic location, residence type, and access to healthcare. Targeted interventions focusing on early childhood, improving healthcare access, and addressing regional disparities are essential to reduce morbidity.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1792897</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1792897</link>
        <title><![CDATA[Brain activity as a candidate biomarker for personalised caffeine treatment in premature neonates]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Fatima Usman</author><author>Coen S. Zandvoort</author><author>Shellie Robinson</author><author>Mariska Peck</author><author>Maria M. Cobo</author><author>Tricia Adjei</author><author>Luke Baxter</author><author>Ria Evans Fry</author><author>Annalisa G. V. Hauck</author><author>Richard Rogers</author><author>Gabriela Schmidt Mellado</author><author>Alexandra Scrivens</author><author>Marianne van der Vaart</author><author>Maarten De Vos</author><author>Eleri Adams</author><author>John van den Anker</author><author>Caroline Hartley</author>
        <description><![CDATA[BackgroundCaffeine is one of the most frequently administered medicines in neonatology—prescribed for the management of apnoea of prematurity, to aid extubation and increasingly for conditions such as bronchopulmonary dysplasia. Caffeine guidelines for the management of apnoea of prematurity indicate use based on the age of the infant, but this does not account for individual variation in apnoea rate. Consequently, infants may risk caffeine undertreatment or adverse events due to over-exposure. Apnoea in preterm infants is related to nervous system immaturity, hence, as an essential first step to assess whether brain activity may be a useful biomarker for caffeine treatment, we tested the hypothesis that apnoea rate is related to brain activity.MethodsIn this single-centre prospective observational cohort study, we simultaneously recorded brain activity using electroencephalography (EEG) and respiration using impedance pneumography in 74 infants aged 31–36 weeks postmenstrual age (PMA) on 138 separate occasions. The primary outcome was the association between apnoea rate and brain age gap (defined as the difference between the infant's brain age and their PMA; brain age is calculated from brain activity using a deep learning algorithm). In an exploratory sub-study, we compared the apnoea and desaturation rate in the 7 days after infants stopped caffeine treatment, between those infants with immature and mature brain activity.ResultsWe demonstrate that apnoea rate in moderate/late preterm infants is dependent on brain age gap (p:0.024; β [95% CI]:−0.22 [−0.41 to −0.03]). In contrast, apnoea rate was not correlated with PMA (p:0.58; β [95% CI]:−0.04 [−0.16 to 0.09]). In the exploratory sub-study, we find that when caffeine is discontinued, infants with immature brain activity have more frequent apnoeas and desaturations compared with those with more mature brain function.ConclusionsThese findings provide initial evidence to indicate that brain age is a candidate biomarker for personalised caffeine treatment in preterm infants.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1812750</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1812750</link>
        <title><![CDATA[Gastroenterologically relevant high alert medications prescribed to children with chronic diseases—a consensus-driven single-center pilot study]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Judith Hochrainer</author><author>Rebecca Einspieler</author><author>Andreas Heilos</author><author>Judith Pichler</author><author>Michael Boehm</author>
        <description><![CDATA[IntroductionChildren with chronic diseases, including complex gastroenterological patients, often manage complex home medication regimens, where errors pose significant patient- and medication-related risks. High Alert Medications (HAMs) are those with a particularly high potential for adverse consequences if administered incorrectly.AimThis study used a consensus approach to identify HAMs in the pediatric gastroenterological population, using a new scale to measure medication risk and potential patient harms.MethodsThis secondary analysis included 106 children with chronic diseases discharged from the Medical University of Vienna. Interdisciplinary teams identified relevant medications through a consensus approach and separately evaluated the inherent risk of each medication and the potential harm of its use at the individual patient level using five-level scales. Substances were coded via the Anatomical Therapeutic Chemical classification system (ATC system), ranked, and compared with existing HAM lists.ResultsThirty-two medications were categorized into the highest medication risk categories, and 16 into the highest potential patient harm group. The intersection of these categories identified 12 medications defined as HAMs, with immunosuppressants forming the largest therapeutic class. Notably, 50% of the identified HAMs appeared in only one other published list, and one-third were not previously classified as High Alert.DiscussionImmunosuppressants carry elevated risk due to narrow therapeutic windows, complex drug interactions, and potential for severe organ dysfunction. Discrepancies between HAM lists stem from varied methodologies and local clinical characteristics. This study distinguishes itself by focusing specifically on home care and by including off-label medications. The findings underscore the need for localized HAM lists to address specific risks within the target population. Validation studies and consideration of empirical data are needed to further generalize our findings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1811557</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1811557</link>
        <title><![CDATA[Case Report: Atypical presentations of neonatal and infantile hemophilia B]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Arielle Locke</author><author>Nasrin Samji</author><author>Mihir Bhatt</author><author>Kay Decker</author><author>Sara J. Israels</author><author>Anthony K. C. Chan</author><author>Kyle Mendonça</author>
        <description><![CDATA[Hemophilia B is an X-linked recessive bleeding disorder caused by deficiency or dysfunction of factor IX. It typically presents with spontaneous or trauma-induced bleeding, hemarthrosis, and soft tissue hematomas. We report three cases—two severe neonatal and one moderate infantile case—with atypical presentations: intra-abdominal hemorrhage with hepatic hematoma, a scrotal mass mimicking testicular torsion, and intracranial hemorrhage. None of the patients had a family history of bleeding disorders, and diagnoses were made after these significant bleeding episodes. These cases underscore the importance of considering congenital bleeding disorders in neonates and infants, especially males, who present with unexplained severe bleeding episodes in the absence of trauma or family history. Early recognition, preconception genetic counseling to identify the risk of bleeding disorders in parents, and individualized prophylactic approaches are essential to improve outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1834587</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1834587</link>
        <title><![CDATA[Commentary: A rare case report of Salmonella infection: severe necrotizing pneumonia with empyema in an immunocompetent child]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>General Commentary</category>
        <author>Regina Célia de Souza Campos Fernandes</author><author>Enrique Medina-Acosta</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1771759</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1771759</link>
        <title><![CDATA[Epidemiology of respiratory syncytial virus in a German hospital before, during and after the COVID-19 pandemic – a real world monocentric analysis over ten years]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Svenja Loerch</author><author>Frank Erdnüß</author><author>Beate Frerich</author><author>Thorsten Reineke</author><author>Wolfgang Kamin</author>
        <description><![CDATA[BackgroundRSV infection affects mostly infants and induces a substantial economic and medical burden for our health care systems. To implement effective preventive strategies against RSV the knowledge about its distinct seasonality is crucial.MethodsWe retrospectively studied the epidemiology of RSV infection in pediatric patients admitted to a German hospital over a period of ten years by comparing their clinical data. Inclusion criterion was a laboratory confirmed RSV infection with diagnosis of bronchitis, bronchiolitis, or pneumonia. For analyses six pre-COVID years were cumulated and compared to the pandemic and post-pandemic seasons. Statistical methods included descriptive measures and exploratory tests for comparing seasons (i.e., Fisher's exact test).ResultsOverall, data of 1,220 children below 12 years of age (including 1,040 below 2 years) could be analyzed. The pre-COVID RSV seasons started in December and peaked in January/February. During the pandemic we detected no case in 2020/21. Season 2021/22 started in August and peaked in October, whereas the first post-pandemic season 2022/23 started in October and peaked in November. The need for intensive care and oxygen supply was significantly increased in 2022/23 compared to 2021/22. Moreover, bacterial superinfection and antibiotic treatment appeared to be significantly more frequent, also in comparison to the pre-COVID seasons.ConclusionOur study shows that the usual RSV epidemiology abruptly changed with the start of the COVID-19 epidemic. After a loss of severe RSV associated disease in 2020/21 a catch up effect could be notified in hospitalized patients in the following seasons, ending up in an almost normal season 2024/25. Future RSV monitoring is strongly recommended to calculate the hospital necessary resources, since vaccination programs, i.e., nirsevimab for infants and maternal vaccination during pregnancy, have already been started in Germany.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1799724</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1799724</link>
        <title><![CDATA[RSV-infected children with mixed infections: clinical features and early predictive indicators of codetection with Streptococcus pneumoniae and Haemophilus influenzae]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jingwen Ni</author><author>Junyu Dong</author><author>Lele Li</author><author>Mengxin Zhao</author><author>Zhihui Du</author><author>Jie Li</author><author>Kenan Fang</author><author>Kai-Sheng Hsieh</author>
        <description><![CDATA[BackgroundSince the COVID-19 pandemic, the incidence of respiratory syncytial virus (RSV) infections has significantly increased, and bacterial codetection further exacerbates the disease burden. This study aims to compare the clinical characteristics, laboratory results, and prognostic differences in children with RSV infection who are codetected with Streptococcus pneumoniae and Haemophilus influenzae, and to identify early predictive markers for such codetections.MethodsIn this single-center retrospective study, we collected data from 1,601 children hospitalized with RSV infection at Luoyang Maternal and Child Health Hospital, Henan Province, between January 2023 and March 2025. Children were divided into three groups: non-bacterial codetection, S. pneumoniae codetection, and H. influenzae codetection. We compared demographic characteristics, clinical features, laboratory findings, and prognosis. Logistic regression identified risk factors for codetection of S. pneumoniae and H. influenzae.ResultsA history of wheezing increased the likelihood of codetection with both bacteria. Children with S. pneumoniae codetection were more likely to present with fever, whereas those with H. influenzae codetection were more prone to wheezing and respiratory distress. The presence of extrapulmonary manifestations was a significant common factor for both codetections. Regarding laboratory markers, children with codetection of S. pneumoniae showed significantly elevated levels of WBC, NLR, CRP, PCT, and IL-6. For those codetected with H. influenzae, WBC, NLR, CRP, PCT, IL-6, PLT, and D-dimer levels were all significantly increased. Children with either bacterial codetection required significantly more respiratory support, had higher PICU admission rates, and experienced longer hospital stays. A history of wheezing and elevated IL-6 levels were associated with a higher likelihood of S. pneumoniae codetection, while younger age and higher levels of WBC, CRP, and IL-6 were predictive of H. influenzae codetection.ConclusionsCompared with children with RSV infection alone, those with codetection of S. pneumoniae or H. influenzae exhibit significantly elevated inflammatory markers, especially IL-6. These children are more likely to require PICU admission and respiratory support, and to experience longer hospital stays.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1790456</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1790456</link>
        <title><![CDATA[Early cardiac rehabilitation in ICU for infants after complex congenital heart disease surgery: a retrospective case series]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mingye Yue</author><author>Hongjun Deng</author><author>Jiawei Shi</author><author>Yuting Hu</author><author>Xinghong Liu</author><author>Huihua Wang</author>
        <description><![CDATA[BackgroundComplex congenital heart disease (CHD) has long been a significant cause of infant mortality and severe morbidity. However, pediatric cardiac rehabilitation (CR) is gaining recognition, and evidence regarding postoperative ICU phase CR for infants with CHD remains scarce.MethodsThis was a retrospective case series, we reviewed clinical data for 10 infants with complex CHD who received an early, individualized CR program during the postoperative ICU phase. The rehabilitation was initiated between postoperative days 5–15 (median 9). The program was based on an exercise prescription, and integrated multidimensional interventions, including respiratory training, gross motor function training, nutritional support, and developmental care.ResultsAll infants were critically ill postoperatively requiring various forms of life-support therapy in the ICU. No serious adverse events related to rehabilitation occurred; transient fluctuations in vital signs resolved promptly with temporary pauses in therapy. Eight infants were discharged home after recovery, and two were transferred to other institutions. Functional improvements were observed across respiratory, feeding, neuromotor, and circulatory domains during the ICU stay.ConclusionFor infants with complex CHD, early initiation of a cardiac rehabilitation program during the ICU phase appears safe and feasible when implemented under multidisciplinary assessment and close clinical monitoring. This approach may support functional recovery across cardiopulmonary and neuromotor domains during a critical developmental window.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1769037</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1769037</link>
        <title><![CDATA[Serum LRG1 as a diagnostic marker of necrotizing enterocolitis in preterm infants]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jingtao Bian</author><author>Wenqiang Sun</author><author>Yihui Li</author><author>Xue Liu</author><author>Xinyun Jin</author><author>Minqian Zhou</author><author>Hanghang Peng</author><author>Huawei Wang</author><author>Xueping Zhu</author>
        <description><![CDATA[ObjectiveNecrotizing enterocolitis (NEC) remains a leading cause of morbidity and mortality in preterm infants; however, early diagnosis is limited by the lack of reliable circulating biomarkers. This study aimed to evaluate the diagnostic value of serum leucine-rich α-2 glycoprotein 1 (LRG1) in NEC.MethodsLRG1 was identified through an integrative bioinformatics analysis by intersecting differentially expressed genes from two Gene Expression Omnibus datasets (GSE46619 and GSE64801) with the Secreted Protein Database. A nested case-control study was subsequently conducted in preterm infants (<32 weeks' gestation). Serum LRG1 levels were measured using ELISA, and their associations with clinical and laboratory parameters were analyzed. Machine learning approaches were applied for feature selection, followed by multivariable logistic regression. Diagnostic performance was evaluated using receiver operating characteristic curve analysis.ResultsSerum LRG1 levels were significantly elevated in infants with NEC compared with controls. LRG1 was positively correlated with C-reactive protein and neutrophil count, and negatively correlated with plateletcrit. Higher LRG1 levels were independently associated with NEC. In the predictive model, LRG1 demonstrated moderate diagnostic performance (area under the curve = 0.811).ConclusionSerum LRG1 is a candidate adjunctive biomarker associated with NEC in preterm infants. However, these findings remain exploratory and require validation in larger, multicenter studies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1784387</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1784387</link>
        <title><![CDATA[Merging evans syndrome with mucopolysaccharidosis type II: a case report]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xinrui Wang</author><author>Jing Zhang</author><author>Yanhui Tang</author><author>Chunyan Liu</author><author>Peng Hu</author><author>You Yang</author><author>Hongying Chen</author>
        <description><![CDATA[Mucopolysaccharidosis type II (MPS II) is an X-linked recessive lysosomal storage metabolic disorder caused by pathogenic mutations in the iduronate-2-sulfatase (IDS) gene. Herein, we report the case of a 2-year-old male patient diagnosed with concurrent Evans syndrome (ES) and MPS II, who presented with severe anemia, thrombocytopenia, recurrent respiratory tract infections, and typical clinical manifestations of MPS II. Laboratory examinations showed decreased hemoglobin (Hb) and platelet (PLT) counts, a positive direct Coombs test, presence of anti-platelet antibodies, elevated urinary glycosaminoglycan levels, and complete absence of IDS enzyme activity. Whole exome sequencing identified a novel compound heterozygous nonsense mutation in the IDS gene: c.380_383dup GCTA, p.Y128X. The patient received hematopoietic stem cell transplantation (HSCT) and underwent long-term follow-up. During the follow-up period, the patient's IDS enzyme activity returned to normal levels, and no further recurrence of ES was observed. This study reports a novel pathogenic mutation of the IDS gene, and represents the first documented case of concurrent ES and MPS II in a toddler. HSCT has been confirmed to be an effective therapeutic strategy for this extremely rare comorbid condition. Additionally, we discuss the potential pathogenic association between mucopolysaccharidosis (MPS) and ES, and present a systematic summary of the clinical management of this patient, to provide a reference for improved identification and treatment of similar clinical cases in the future.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1803495</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1803495</link>
        <title><![CDATA[Erector spinae plane block for opioid sparing in children undergoing laparoscopic appendectomy: a randomized controlled trial]]></title>
        <pubdate>2026-05-01T00:00:00Z</pubdate>
        <category>Clinical Trial</category>
        <author>Ming-wen Yang</author><author>Yu-zhu Cai</author><author>Ling-li Zhang</author><author>Jun Wang</author><author>Ran Tang</author><author>Ying-ying Sun</author>
        <description><![CDATA[BackgroundDespite being a minimally invasive procedure, laparoscopic appendectomy (LA) frequently induces substantial postoperative pain in children. While erector spinae plane block (ESPB) has demonstrated efficacy for postoperative analgesia in pediatric open abdominal surgery, its analgesic benefits and safety profile in laparoscopic procedures remain unestablished.PurposeTo evaluate the opioid-sparing effects, analgesic efficacy, and safety of ESPB in children undergoing LA.DesignA single-center, double-blind, randomized, superiority trial.MethodsChildren aged 6–12 years with American Society of Anesthesiologists (ASA) physical status I–II scheduled for LA at Anhui Provincial Children's Hospital were enrolled. Participants were randomly allocated 1:1 using a computer-generated sequence to receive either bilateral ultrasound-guided ESPB at T8 (0.25% ropivacaine, 0.5 mL/kg per side) after tracheal intubation (ESPB group) or no block (Control group). Both groups received standardized multimodal analgesia comprising hydromorphone-based patient-controlled intravenous analgesia (PCIA) and scheduled acetaminophen. The primary outcome was 0–24 h cumulative hydromorphone consumption; secondary outcomes included pain scores, PCIA parameters, rescue analgesia requirements, recovery milestones, parental satisfaction, and adverse events.ResultsOf the 80 children randomized (40 per group), 75 completed follow-up and were analyzed (ESPB, n = 37; control, n = 38). The ESPB group exhibited significantly lower 24 h hydromorphone consumption (32.8 ± 10.1 vs. 72.9 ± 14.5 μg/kg; mean difference: −40.1 μg/kg; P < 0.001), representing a 55% reduction compared with the Control group. Secondary outcomes favoring ESPB included lower pain scores during the early postoperative period (PACU to 6 h; P < 0.05), prolonged time to first PCIA demand (201.0 vs. 58.5 min; P < 0.001), fewer total PCIA presses (10 vs. 17; P < 0.001) and effective presses (9 vs. 17; P < 0.001) within 0–24 h, reduced rescue analgesia requirements (2.7% vs. 21.1%; P = 0.028), and higher parental satisfaction scores (8 vs. 7 points; P = 0.001). No serious block-related complications occurred.ConclusionsIn children undergoing LA, a single-injection bilateral ultrasound-guided ESPB at T8 provides significant opioid-sparing effects and alleviates acute postoperative pain during the first 24 h without increasing adverse event rates, supporting its incorporation as a component of multimodal analgesia for postoperative pain management in this population.Clinical Trial Registration: https://www.chictr.org.cn, identifier ChiCTR2500108148, Date of Registration: August 26, 2025.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1724445</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1724445</link>
        <title><![CDATA[Transumbilical laparoscopic-assisted appendectomy: a feasible minimally invasive option for pediatric acute appendicitis with comparable outcomes to three-port laparoscopic appendectomy]]></title>
        <pubdate>2026-05-01T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yifan Li</author>
        <description><![CDATA[ObjectiveThis study aimed to compare the safety and feasibility of transumbilical laparoscopic-assisted appendectomy (TULAA) vs. three-port laparoscopic appendectomy (TPLA) for the treatment of acute appendicitis in children.Materials and methodsA retrospective analysis was conducted on pediatric patients who underwent appendectomy at Maternity&Child Healthcare Hospital of Longgang District, Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College) between January 2022 and June 2025. Patient demographics, operative times, postoperative recovery parameters (time to first flatus, length of hospital stay), and complication rates were compared between the two surgical groups.ResultsA total of 171 patients were enrolled in the study, with 109 cases in the TULAA group and 62 cases in the TPLA group. There were no significant differences between the TULAA and TPLA groups in baseline characteristics including age, gender, weight, height, BMI, white blood cell count, or CRP levels (p > 0.05). The mean operative time was comparable between groups (TULAA: 54.94 ± 24.97 min vs. TPLA: 58.65 ± 25.58 min, p = 0.356). However, the TULAA group demonstrated a significantly shorter average hospital stay (4.83 ± 1.53 days vs. 5.35 ± 1.19 days, p = 0.022). Conversely, the time to first postoperative flatus was significantly longer in the TULAA group (25.81 ± 11.00 h vs. 21.13 ± 10.01 h, p = 0.006). The overall complication rate showed no significant difference (TULAA: 4.6% vs. TPLA: 6.5%, p > 0.05), with all cases managed conservatively.ConclusionFor pediatric acute appendicitis, TULAA is a safe and feasible minimally invasive technique, resulting in a significantly reduced hospital stay compared to TPLA despite a slightly delayed return of bowel function. Both techniques demonstrate comparable operative times and overall complication rates. TULAA represents a valuable surgical option within the pediatric minimally invasive arsenal.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1800632</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1800632</link>
        <title><![CDATA[Metabolic maturity patterns in neonates: dissecting the interactive effects of gestational age and birth weight on metabolic profiles]]></title>
        <pubdate>2026-05-01T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hua Tang</author><author>Yanqiong Ma</author><author>Ying Zhou</author><author>Huiming Yan</author><author>Huiping Zhang</author>
        <description><![CDATA[BackgroundNewborn screening (NBS) based on tandem mass spectrometry (MS/MS) is essential for the early identification of inherited metabolic disorders. However, physiological immaturity in preterm and low-birth-weight (LBW) infants frequently alters metabolite concentrations, thereby increasing the risk of false-positive results.ObjectiveThis study aimed to clarify the independent and interactive effects of gestational age (GA) and birth weight (BW) on neonatal amino acid and acylcarnitine profiles, with the goal of improving screening precision in vulnerable populations.MethodsWe conducted a retrospective analysis of 147,643 neonates screened in Hunan Province, China. The cohort was stratified into seven GA groups and five BW groups. One-way and two-way analyses of variance (ANOVA), together with principal component analysis (PCA), were used to characterize main effects, interaction effects, and global metabolic clustering.ResultsMetabolic profiles followed distinct developmental trajectories. Preterm infants (<37 weeks) showed significantly elevated amino acid concentrations (e.g., tyrosine and arginine) but relative attenuation of long-chain acylcarnitine levels, suggesting an altered balance between protein turnover and fatty acid oxidation. Importantly, significant GA × BW interactions were detected for multiple markers, indicating that the metabolic impact of birth weight varied according to gestational maturity.ConclusionNeonatal metabolic maturity is shaped by the synergistic interplay between intrauterine duration and fetal growth. The characteristic “high amino acid/low long-chain acylcarnitine” pattern observed in preterm infants, especially in those with lower birth weight, supports the need for individualized reference intervals in newborn screening.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1749724</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1749724</link>
        <title><![CDATA[Reactive lymphoid hyperplasia of the appendix in children: a descriptive analysis of accompanying neural and stromal features]]></title>
        <pubdate>2026-05-01T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Neslihan Gulcin</author><author>Ilkay Tosun</author><author>Ceyhan Sahin</author>
        <description><![CDATA[BackgroundReactive lymphoid hyperplasia (RLH) is frequently identified in pediatric appendectomy specimens performed for suspected acute appendicitis. However, its associated neural and stromal alterations remain incompletely characterized.MethodsThis retrospective descriptive study evaluated pediatric appendectomy specimens obtained between January 2019 and January 2024. RLH cases were identified based on histopathological criteria. Archived specimens were re-evaluated using hematoxylin and eosin staining, S-100 immunohistochemistry, and Masson's trichrome staining. Neural alterations were classified according to Höfler's criteria, and fibrosis was graded semiquantitatively.ResultsAmong 468 appendectomies, 100 cases fulfilled the criteria for RLH. The mean age was 11.34 ± 4.31 years, and 63% were male. Neural and stromal alterations, including S-100–positive nerve elements and varying degrees of fibrosis, were frequently observed. Höfler Type 1 and Type 3 patterns were the most common, and fibrosis was predominantly mild to moderate. Postoperative symptom resolution was observed in patients with available follow-up.ConclusionRLH in children is commonly associated with reactive neural and stromal alterations. However, these findings should be interpreted as nonspecific reactive changes rather than disease-specific features. Further studies are needed to clarify their clinical significance.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1814069</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1814069</link>
        <title><![CDATA[Telemedicine for new immigrant children in the US: a tool for equity or another layer of disparity?]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Niriksha Ravi</author><author>Michael Olaseni Bamgbose</author><author>Yousra Yehia Abdelkhalek</author><author>Saloni Parkar</author><author>Yossef Alnasser</author>
        <description><![CDATA[Telemedicine refers to the use of digital communication tools to deliver healthcare services. In pediatrics care in the United States (US), it has become an important approach to expand access to primary and subspecialty care while reducing travel demands and improving continuity of care, particularly for children in remote and underserved communities. Evidence consistently shows that telemedicine can supplement in-person visits while maintaining high levels of family satisfaction and clinical effectiveness among American families. This narrative review was developed to assess the applicability of telemedicine for new immigrant families in the US using a structured literature search across PubMed, Scopus, Google Scholar, and Cochrane of published English literature. Peer-reviewed studies were included if they were conducted in the last 50 years and focused on pediatric patients from birth to 21 years of age. Findings were synthesized to evaluate the acceptance, accessibility, feasibility, and applicability of telemedicine for new immigrant children in the US. Across the reviewed literature, telemedicine has meaningful potential in narrowing health disparities faced by new immigrant families such as transportation, specialist shortages, scheduling delays, limited English proficiency, and difficulty navigating the complex healthcare system. Furthermore, telemedicine can connect families with providers who share similar cultural and linguistic backgrounds, thereby strengthening cultural sensitivity and trust. Still, it comes with several obstacles limiting its use among new immigrant families. From digital divide, poor network coverage, low health literacy, privacy concerns, immigration-related concerns, to mistrust, the challenges are numerous. Studies during the COVID-19 pandemic found low acceptance and infeasibility of telemedicine for new immigrant families. However, telemedicine offers multiple opportunities and future directions to better serve immigrant children and their families. Expanding multilingual telehealth platforms and integrating telemedicine access points into schools, community centers, and immigrant resource hubs can enhance accessibility, usability, and acceptance. Pairing telemedicine with artificial intelligence can have huge future potential and might be a tool for inclusive care at lower cost. Furthermore, policy amendments, particularly broader Medicaid telemedicine coverage and mandates for interpreter integration into telemedicine workflows, are essential for promoting more equitable access with higher acceptance and more applicability for new immigrant children in the US.]]></description>
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