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Abstract Objective: This study aimed to determine the epidemiology and clinical characteristics of EV-D68-associated respiratory diseases among Asian children. Sources: The PubMed, Embase, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), VIP, WanFang, and SinoMed electronic databases were searched from inception to February 28, 2025, to identify relevant articles. Studies reporting the detection rate of enterovirus D68 (EV-D68) in pediatric patients with respiratory tract infections were included. The methodological quality regarding the risk of bias was assessed according to the approach proposed by the Joanna Briggs Institute. Summary of the findings: Twenty studies involving 47,451 participants were included; additionally, 450 participants were positive for EV-D68 infection. The detection rate of EV-D68 ranged from 0.23 % to 10.56 %, with a pooled prevalence of 1.29 % (95 % CI 0.88-1.78 %), but significant heterogeneity (I2 = 94.20 %, p < 0.001) indicated that this estimate was context-dependent. Subgroup analyses revealed that detection rates varied substantially by country, study period, and income level. Pneumonia is the most common respiratory disease presentation. EV-D68 is most prevalent during the summer and autumn. Conclusion: This is the first review to focus specifically on Asian children, which suggests that EV-D68 detection rates vary significantly across Asian populations and are especially influenced by geographic location and surveillance timing. EV-D68 infection in children is most frequently associated with pneumonia. These findings support targeted regional surveillance networks during the summer-autumn seasons to improve clinical diagnostics and public health responses.

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Abstract Objective: Given the increasing incidence of dry eye in children and the established role of sleep as a key health determinant, this study aimed to examine the prevalence of dry eye in children and its association with sleep, adjusting for confounders. Methods: This study included 169,080 children aged 6–12 years. Dry eye syndromes (DEs) were assessed using the 5-Item Dry Eye Questionnaire, whereas sleep quality was evaluated using the Children’s Sleep Habits Questionnaire. Logistic and linear regression analyses were performed. Results: Overall, 13.12% of the children exhibited DEs, and 66.25% experienced poor sleep. Children with poor sleep quality had a significantly higher prevalence of DEs (15.97%, 17,889/112,018) than those with normal sleep quality (7.53%, 4296/57,062) (P < 0.001). The prevalence of poor sleep was 80.64% (17,889/22,185) in children with DEs, compared to 64.08% (94,129/146,895) in those without DEs (P < 0.001). After adjusting for age, sex, body mass index, and other risk factors, poor sleepers had a higher risk of developing DEs than good sleepers (odds ratio [OR] = 2.005; 95% confidence interval [CI]: 1.933–2.080). Children who slept for < 10 h were more likely to have DEs (OR = 1.236l; 95% CI: 1.167–1.310). In logistic regression analyses stratified by age and sex, poor sleepers showed a high risk of DEs. Moreover, the three dry eye symptoms and sleep were related (P < 0.001). Conclusion: This large-scale study revealed that all domains of sleep were significantly poorer in participants with DEs in children, and these associations remained significant after adjusting for comorbidities.

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Abstract Objective: To explore the application of machine learning methods for screening risk factors for long-term adverse prognosis in neonatal bacterial meningitis, determine the final prediction model, and evaluate its predictive value. Methods: This study included 139 full-term neonates diagnosed with neonatal bacterial meningitis in the capital institute of pediatrics between January 2019 and December 2023. Based on follow-up outcomes, they were divided into a poor prognosis group (n = 45) and a good prognosis group (n = 94). Thirty-three clinical variables were collected. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator, Boruta, and Recursive Feature Elimination. Seven machine learning models were constructed. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve, accuracy, and sensitivity. The Shapley Additive explanation method was used to interpret the models. Results: Among the seven models, The Random Forest model demonstrates the best overall predictive performance, although Logistic Regression achieved the highest discriminative ability (AUC: 0.903), Random Forest was more suitable for clinical application due to its superior accuracy (0.881), better calibration (Brier score: 0.123), and balanced sensitivity (0.887) and specificity (0.878). Shapley Additive explanation interpretability analysis further revealed that the top three important features were cerebrospinal fluid white blood cell count, cerebrospinal fluid protein levels, and seizures. Conclusion: Machine learning models, particularly the superior-performing Random Forest, are proven to reliably predict long-term adverse outcomes in NBM patients, aiding in the identification of high-risk individuals. Further validation in broader cohorts is warranted to enhance generalizability and clinical applicability.

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Abstract Objective: To describe the demographic and clinical characteristics of pediatric cancer patients receiving continuous renal replacement therapy (CRRT) and to analyze its effect on biochemical markers. Methods: The authors conducted a cohort study of patients with multiple organ dysfunction syndrome (MODS) who received CRRT in a pediatric oncology intensive care unit. Biochemical measurements were compared at CRRT initiation (D0), after 72 h (D3), and during the final 72 h of therapy. Results: Fifty-nine cases were analyzed. Hospital mortality was 67.7 %, and the median duration of CRRT was 9 days. Fluid overload was present in 51 % of patients; the mean KDIGO score was 2 (SD: 1). Mechanical ventilation was required in 79.7%. Among survivors, significant improvements were observed in pH (mean 7.34 on D0 vs. 7.41 on D3; p = 0.012; effect size: 0.72) and bicarbonate (mean 22.17 on D0 vs. 27.1 on D3; p = 0.003; effect size: 0.77). In non-survivors, lactate levels increased over time (mean 2.3 on D0 vs. 5.37 on the last day; p = 0.03; effect size: 0.49). Generalized estimating equation models identified bicarbonate(OR:0.05),pH(OR:0.92),PCO2 (OR: 176), and lactate (OR: 9.8) as significant predictors of in-hospital death. Logistic regression showed that mechanical ventilation (OR: 8.48) and fluid overload in the final 72 h (OR: 1.15) were associated with mortality. Conclusion: While CRRT’s impact on mortality in MODS remains uncertain, it improved biochemical markers. The findings suggest that metabolic and lactic acidosis, fluid overload, and mechanical ventilation may be modifiable targets to reduce mortality.

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Abstract Objective: Avoiding early-life exposure to environmental endocrine disruptors (EDCs) is critical for neonatal growth and long-term health. However, exposure to Di-(2-ethylhexyl) phthalate (DEHP), a typical EDC and plasticizer, is unavoidable in neonatal intensive care units due to contact with polyvinyl chloride medical devices. Methods: This study examined the impact of DEHP exposure through blood transfusion on gut microbiota development in preterm infants. To address this aim, the authors conducted a prospective cohort study, enrolling preterm infants between May 1, 2016, and March 30, 2021, who had not received blood transfusions or antibiotic treatment for at least seven consecutive days prior to enrollment. Fecal samples collected before and after transfusion underwent 16S ribosomal RNA gene-based next-generation sequencing analysis, while DEHP levels were measured in post-transfusion blood products. The average DEHP level in these products was 0.072 ± 0.03 mg/mL. Results: Initial analysis of 23 preterm infants (including five recruited twice) indicated that blood transfusion did not significantly alter bacterial composition and diversity. However, when examining recruitment events by postmenstrual age (PMA) or days of life (DOL), a significant increase in Enterococcus abundance was observed in both the lower PMA and younger DOL groups. Conclusion: These findings suggest a possible association between early-life DEHP exposure via blood transfusion and altered gut microbiota. Further studies are needed to clarify causality and long-term health implications.

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Abstract Objective: Central precocious puberty (CPP) may lead to premature pubertal onset. While the GnRH stimulation test remains the gold standard, its invasive nature and prolonged procedure limit clinical utility, particularly in pediatric populations. Emerging biomarkers, including luteinizing hormone, estradiol, kisspeptin, and vitamin D, have shown promise in distinguishing CPP from normal puberty. This study systematically evaluated the diagnostic utility of these bio-markers both individually and in novel combinatorial models, with the aim of establishing a non-invasive and more accessible diagnostic alternative for CPP. Methods: This retrospective study included 129 girls with CPP and 116 age-matched controls. Clinical characteristics, including height, weight, body mass index, and bone age, were recorded. Serum levels of luteinizing hormone, estradiol, kisspeptin, vitamin D, progesterone, and prolactin were measured. The diagnostic performance of individual biomarkers and three combined bio-marker models was assessed using receiver operating characteristic curve analysis. Results: Model 1 included luteinizing hormone and kisspeptin, Model 2 incorporated vitamin D, and Model 3 added estradiol. CPP patients exhibited significantly higher levels of luteinizing hormone (2.51 vs. 0.23 mIU/mL), kisspeptin (1.59 vs. 0.96 μg/L), and estradiol (25.86 vs. 13.41 pg/mL) and lower vitamin D levels (20.13 vs. 25.90 ng/mL) compared to controls (all p < 0.001). Model 3 demonstrated the highest diagnostic accuracy with an AUC of 0.939 (95 % CI: 0.910–0.968), sensitivity of 89.06 %, and specificity of 87.93 %, outperforming individual biomarkers and other models. Conclusion: This study highlights the potential of combining luteinizing hormone, kisspeptin, vitamin D, and estradiol into a single diagnostic model for CPP.

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Abstract Objective: Respiratory mechanic instability (RMI) is characterized by irregular chest and abdominal movements due to upper airway collapse or obstruction, frequently observed during obstructive apnea or hypopnea events. This study aims to explore the potential of RMI as a determinant of adenotonsillectomy’s success in treating pediatric obstructive sleep apnea (OSA). Methods: Medical records of pediatric patients diagnosed with OSA via standard polysomnography who underwent adenotonsillectomy with subsequent follow-up evaluations were retrospectively analyzed. RMI parameters were automatically discerned during polysomnography, and comparisons of sleep scoring data, respiratory events, and RMI metrics (events, index, duration, and % of stage duration) were made pre- and post-surgery. Results: A total of 42 consecutive pediatric patients with OSA (26 boys, 16 girls) were included in the study. Post-adenotonsillectomy, marked improvements were noted in RMI parameters (events [95.6 ± 43.7 vs 58.9 ± 34.7; p < 0.001], index [14.5 ± 7.0 vs 8.5 ± 4.5; p < 0.001], duration [81.2 ± 56.3 vs 42.1 ± 52.0; p = 0.003], and % of stage duration [20.5 ± 13.9 vs 7.6 ± 6.8; p < 0.001]), along with significant improvements in polysomnographic parameters such as arousal index, AHI, RDI, ODI3, mean oxygen saturation, and snoring duration. Significant correlations were observed between respiratory events (AHI, RDI, ODI3) and RMI metrics such as event counts and index, both before and after the procedure. Conclusion: This study highlights the effectiveness of adenotonsillectomy in improving sleep quality and respiratory stability in pediatric patients with OSA, underscoring the utility of RMI as a promising additional marker in conjunction with conventional polysomnographic measures.

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Abstract Objective: To describe the clinical characteristics of tracheostomized children in Northeastern Brazil and to identify existing gaps in the indication and implementation of palliative care. Methods: This retrospective descriptive study reviewed medical records of children under 15 years who underwent tracheostomy between 2008 and 2019 at a quaternary referral center. Results: Sixty-five tracheostomized patients with indications for palliative care were analyzed. The main reasons for palliative classification were acute life-threatening conditions (50.7 %) and chronic life-threatening conditions (20 %). The most frequent tracheostomy indications were prolonged invasive mechanical ventilation (46.1 %) and severe upper airway obstruction (23 %). The mortality rate was 30.7 %, higher among infants, severely malnourished children, those with Lansky scores below 40 % before tracheostomy, congenital heart disease, bronchopulmonary dysplasia, and multiple comorbidities. Only 10.8 % received palliative care consultations during hospitalization, all in the end-of-life care phase. Conclusion: The results highlight a critical gap in the provision of palliative care to tracheos-tomized children. Early involvement of a multidisciplinary palliative care team is crucial to support clinical decision-making, family-centered care, and ensure quality of life. The proposed framework may facilitate timely referral and airway planning in the Intensive therapy, although further validation and qualitative research in various healthcare settings are needed.

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Abstract Objective: To investigate the association between maternal hypertensive disorders of pregnancy (HDP) and blood pressure (BP) in preterm children born with very low birth weight (VLBW, < 1500 g). Methods: Longitudinal cohort study of VLBW preterm infants from birth to early childhood. Systolic and diastolic blood pressure (SBP and DBP), and their age-, height- and sex-adjusted percentiles (SBP%, DBP%), were assessed at multiple time points. Linear quantile mixed models estimated BP trajectories across the 25th, 50th, and 75th quantiles, stratified by maternal HDP exposure. Results: Among 277 infants, 121 (43.6 %) were exposed to HDP. Median gestational age was 30 weeks (IQR: 28 - 32), and median birth weight was 1180 g (IQR: 985, 1340), 128 (46.2 %) were male. Maternal HDP was not significantly associated with SBP or DBP at any quantile. BP increased modestly with age across all quantiles. SBP increased by 0.06, 1.55, and 2.58 mmHg; DBP by 1.77, 1.80, and 3.06 mmHg at the 25th, 50th, and 75th quantiles, respectively. Conversely, SBP% and DBP% declined with age, indicating a relative downward shift in BP percentiles over time. This decline was more pronounced for DBP%, especially in the lower quantiles. Conclusion: In this cohort of VLBW preterm children, maternal HDP was associated with modest differences in blood pressure, though not statistically significant. These findings suggest that the cardiovascular effects of prenatal hypertensive exposure may be delayed, subtle, or modulated by postnatal factors. Long-term follow-up is essential to clarify these trajectories and guide early prevention efforts.

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Abstract Objective: Describe the occurrence of warning signs of gastroesophageal reflux disease (GERD) and esophagitis in children with eating behavior (EB) alterations associated with autism spectrum disorder (ASD). Methods: Descriptive study of 115 children aged 3 to 12 years, followed at a tertiary hospital and previously diagnosed with ASD. The BRCA-TEA instrument was applied to identify children with EB alterations, and the 17-ATN-GISSI instrument was applied to identify those with warning signs of GERD. The selected children were invited for a medical consultation to identify those with suspected esophagitis and an indication for upper gastrointestinal (GI) endoscopy with biopsies. Results: Sixty-nine children (60 %) were classified with alterations in the EB and, among these, 62 (89.8 %) presented warning signs of GERD. Eighteen children had suspected esophagitis and an indication for upper GI endoscopy. Among the 8 children who underwent the exam, 1 child had grade A erosive esophagitis, 1 child had grade B erosive esophagitis, and 1 child had eosinophilic esophagitis. Conclusion: A high frequency of EB alterations was found in children with ASD. The high frequency of GERD warning signs may be related to EB alterations in this group. Cases of esophagitis highlight the possibility of an organic disease. In these cases, performing upper GI endoscopy with biopsies is essential for diagnosis.

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Abstract Objective: To describe the quality of the diet and its relationship with lung function and nutritional status in adolescents with cystic fibrosis (CF). Methods: A questionnaire was applied to 47 adolescents (12–19 years old) followed at a university reference center. Lung function impairment was classified as mild (FEV1pp ≥ 60%), moderate (FEV1pp 41–59%), or severe (FEV1pp < 40%) using spirometry. Food consumption frequency was classified as rarely, 1-2 times/week, 3-4 times/week, or ≥ 5 times/week. Linear regression analysis was used to model the relationship between lung function, BMI/age Z-score, and food frequency. Principal component analysis (PCA) was performed to identify patterns of diet quality. Results: The mean BMI/age Z-score was −0.62. Approximately 60% of adolescents had FEV1 ≥ 60%, and 21% had severe impairment (FEV1 < 40%). Better BMI/age Z-score was observed in groups with higher consumption frequencies of vegetables and fruit (≥ 5/week), white meat (> 3-4/week), and oil (> 3-4/week). Linear regression models identified significant relationships: BMI/age Z-Score = −3.25+ 0.8182*meat_b+0.5082*vegetables_fruit (p < 0.001): Increased white meat, fruit, and vegetable consumption positively influenced the BMI/age Z-Score; lung function = 0.6927 + 0.3356*vegetables-0.2406*fruit_vegetables-0.4550*fast_food (p < 0.001): Lower consumption of fruit and vegetables and higher fast-food intake were associated with more severe lung function; and lung function = 0.39376 −0.32345 *ZSCORE (p < 0.0001): The BMI/age Z-Score positively influenced lung function. PCA confirmed the positive relationship between fruit, vegetables, and white meat consumption and BMI/age Z-score. Conclusion: Higher consumption of fruit, vegetables, and meat has a positive influence on the BMI/age Z-score and lung function among adolescents with CF.

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Abstract Objective: The lower hemoglobin to red blood cell distribution width ratio (HRR) is associated with an increased risk of mortality in adult patients, but its relationship with clinical progress in the Pediatric Intensive Care Unit (PICU) is unclear. The authors aimed to investigate the association between HRR and all-cause mortality among pediatric patients. Methods: The authors conducted a retrospective cohort study by analyzing the PIC database from 2010 to 2018.HRR was calculated based on laboratory tests conducted within the first 24 hours of PICU admission. The primary outcome was 28-day in-hospital all-cause mortality. Multivariable logistic regression models, restricted cubic spline, and threshold effects analysis were applied to assess the relationship between HRR and mortality in this cohort. Results: A total of 8015 patients with an average age of the participants was1.5 (0.4, 4.8) years, and 3547 (44.3%) individuals were female. The 28-day in-hospital all-cause mortality was 4.1% (330/8015). The relationship between HRR and mortality was U-shaped, which had a threshold of around 8.91. The effect size on the left and right sides of the inflection point, was 0.803 (95% CI 0.742-0.869, p < 0.001) and 1.421 (95% C11.159-1.743, p < 0.001), respectively. No significant interactions were observed between HRR and all-cause mortality, except in patients with high lactate (p for interaction > 0.05). The results of the sensitivity analysis remained stable. Conclusion: There is a U-shaped relationship between HRR and 28-day in-hospital all-cause mortality in critically ill pediatric. With a lower mortality risk at an HRR of 8.91.

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Abstract Objective: To describe the caregiver adherence to the various interventions proposed by the Ministry of Health in the follow-up of children infected with or exposed to Treponema pallidum during pregnancy. Methods: This is a prospective cohort study that included 256 children treated for congenital syphilis during the neonatal period. The children were referred from maternity to a reference outpatient clinic in the state of Rio de Janeiro between 2016 and 2021. Adherence was used as the outcome variable. It was assessed in two components: clinical-laboratory adherence (basic adherence) and adherence to specialist consultations (final adherence). Factors associated with adherence were investigated using logistic regression. Results: It was observed that 41 % of the children were followed for at least 18 months, and 68 % had two consecutive non-reactive VDRL tests. Basic adherence was 32 %, while final adherence (including specialist consultations and clinical-laboratory follow-up) was only 16 %. Additionally, 36 children presented permanent sequelae during follow-up. Factors such as higher maternal age (OR = 1.10; 95 % CI:1.03–1.20) and the presence of permanent sequelae in the children (OR = 4.87; 95 % CI: 2.29–10.35) were predictors of adherence. Loss to follow-up occurred in 68 % (173/256) of the cases. Conclusion: This study highlights a very low level of caregiver adherence to the congenital syphilis management protocol recommended by the Brazilian Ministry of Health. The presence of sequelae in children and higher maternal age were associated with improved adherence.

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Abstract Objective: a) To verify the applicability of anthropometric indicators to evaluate physical fitness in school children and b) Propose physical fitness reference values for Peruvian children living at high altitudes in Peru. Methods: A cross-sectional study was carried out in children aged 6 to 12 years living at high altitude in Peru. A total of 1372 primary school children (785 males and 587 females) were evaluated. Weight, height and four physical tests [Hand grip strength (right and left HGS)], Horizontal jump (HJ), Round trip (5 × 10 repetitions), and the 6-minute walk test (6MWT)] were evaluated. Body Surface Area (BSA), Body Mass Index (BMI), and Triponderal Index (TPI) were calculated. Results: The BSA presented a better comparative structure in relation to BMI and TPI with all physical tests. In males, HGS was related between r = 0.64 and 0.66; HJ (r = 0.26), agility (r = −0.31) and 6MWT (r = 0.30). In females, HGS was related between r = 0.63 and 0.64; HJ (r = 0.36), agility (r = −0.36), and 6MWT (r = 0.21). The predictive power in the four physical tests ranged from R2 = 9% to 43% in males, and from 5% to 41% in females. Percentiles by age and sex were proposed for BSA, HGS (right and left), HJ, agility, and 6MWT. Conclusion: BSA is the best predictor of physical fitness in schoolchildren from high altitude areas in Peru, surpassing BMI and TPI. In addition, reference values were proposed to evaluate physical fitness in these children.