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Abstract Objective To analyze the structure, processes, and outcomes of different models of community-based palliative care of children, adolescents, and their families reported in the literature. Methods The authors conducted a systematic review of original, full-text studies in MEDLINE and Embase (January 2014-May 2024), following PRISMA. Two reviewers screened/extracted data; a third resolved disagreements. Study quality and reporting were appraised with the Newcastle-Ottawa Scale and, as applicable, STROBE, COREQ, and CARE. Narrative synthesis was organized with Donabedian’s framework. PROSPERO: CRD42018747214. Results Twenty-six high-quality studies (5 qualitative, 18 quantitative, 3 mixed-methods) described community PPC across home-based services, outpatient programs, community health and social support centers. Common structures included multidisciplinary teams with 24/7 availability, assistive devices/equipment, telemedicine, and screening/assessment tools (e.g., PedsQL, PedsQL-FIM, PIP, PaPaS). Core processes were home visits, caregiver education, symptom monitoring (including digital tools), advance care planning, interprofessional teamwork, and coordination with schools and social services. Reported outcomes most frequently included reduced hospital admissions and emergency use, improved symptom control and health-related quality of life, higher caregiver satisfaction, and lower parenting stress; however, measures and follow-up were heterogeneous. Conclusions Community-based PPC can improve children’s and families’ quality of life when medical, psychosocial, and social resources are integrated beyond the hospital. To advance the field, validated outcome measures, sustainable financing, workforce training, and stronger policy frameworks are urgently needed.

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Abstract Objective Evidence regarding total dietary protein intake remains inconsistent and limited for the US pediatric population. This study utilizes nationally representative data to examine the association between total dietary protein intake and asthma prevalence, thereby addressing this research gap. Method A cross-sectional study that involved 4825 people used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020. The relationship between total protein intake and asthma was investigated using multiple linear regression models. The linear relationship between the two was tested using a restricted cubic spline. Stratified analysis further confirms the stability of the findings. Results All eligible participants (N = 4,825; mean age 10.6 ± 2.9 years; 49.7% male) were analyzed. The fully-adjusted model revealed a positive association between total protein consumption and asthma after controlling for confounders. Compared to the lowest intake quartile Q1 (≤ 3.966 mg/day), adjusted odds ratios for asthma in Q2 (3.967-6.364 mg/day) and Q3 (≥ 6.365 mg/day) were 0.097 (95%CI:0.97-1.44, p = 0.097) and 0.036 (95%CI:1.01-1.55, p = 0.036), respectively. A dose-response relationship (p = 0.037) emerged between total protein consumption and asthma risk. Conclusion Total dietary protein intake demonstrated a positive association with asthma among US children and adolescents. These findings are statistically significant.

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Abstract Objective Early newborn care (ENC) is important for reducing neonatal mortality; however, the rate of receiving adequate newborn care is low in Somalia. Therefore, this study aimed to identify the individual, household, and community-level determinants and map the spatial patterns of ENC in Somalia to take the required actions and policies. Methods This study considered a weighted sample of 15,024 mother-newborn pairs extracted from a countrywide cross-sectional survey, the 2020 Somali Health and Demographic Survey (SHDS). Multilevel logistic regression was employed to identify factors associated with receiving adequate ENC within two days of birth. Global Moran’s I and Getis-Ord Gi* statistics were used for spatial analysis. Results The prevalence of adequate ENC was critically low (5.23%). Findings revealed that delivery in a health facility (vs. home: Adjusted Odds Ratio (AOR) = 0.22, 95% CI: 0.18-0.26), higher household wealth (richest vs. poorest: AOR = 2.02, 95% CI: 1.59-2.57), and higher birth order were influential predictors of receiving ENC. However, having multiple or a higher number of living children was associated with significantly lower odds of receiving ENC. Spatial analysis identified a statistically significant hot spot of higher ENC coverage in the northwestern regions and cold spots of extremely low coverage in the south. Conclusion In Somalia, early neonatal care is shockingly insufficient, and significant social and regional disparities. To achieve Sustainable Development Goal 3, interventions must be implemented based on identified cold spots, prioritizing the strengthening of access to skilled care at birth, and addressing the economic vulnerabilities of families.

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Abstract Objective To evaluate brown adipose tissue (BAT) and white adipose tissue using Infrared Thermography (IRT) in children with different nutritional statuses and correlate findings with anthropometric variables. Methods This cross-sectional observational study assessed body composition via bioelectrical impedance (BIA), skin temperature (supraclavicular and abdominal) through IRT, and anthropometric variables such as neck (NC), waist (WC), and hip (HC) circumferences. Calculations included waist-to-hip ratio (WHR) and conicity index (CI). Statistical analyses were performed in SPSS 20.0, with normality checked by the Shapiro-Wilk and homogeneity by Levene tests. Groups (eutrophic, overweight, obese) were compared using Pearson's Chi-square for categorical variables, Kruskal-Wallis, and ANOVA tests for quantitative data. Correlations were analyzed using Spearman's method. The significance level was set at p ≤ 0.05. Results Of 160 participants, 116 children were analyzed (eutrophic: N = 58; overweight: N = 26; obese: N = 32). Significant differences were noted between the eutrophic and obese groups. Supraclavicular temperature negatively correlated with BIA variables (total body water, fat-free mass, body fat percentage). Conclusions IRT demonstrated inverse correlations between BAT temperature and BMI, NC, WC, and HC, underscoring its potential in obesity risk analysis. IRT also offers quantitative assessments of BAT activity and may estimate body fat percentages, suggesting its relevance for monitoring adipose tissue function and metabolic effects of physical exercise.

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Abstract Objective There is increasing awareness of the benefits of early nutritional intervention in children with acute pancreatitis (AP). This study aims to compare oral feeding with NG feeding in mild to moderately severe AP patients. Methods A single-center, prospective, randomized controlled trial was conducted from September 2021 to August 2024. The participants were randomly assigned to the oral feeding group or the NG feeding group. The primary outcomes were the duration of AP-related pain, tolerance rate, and changes in weight. Results A total of 56 pediatric patients were enrolled, of whom 48 patients (24 in each group) were included in the final analysis. There were no significant differences in baseline characteristics or etiological analysis results between the two groups. The median duration of abdominal pain after admission was 3 days in both groups (p = 0.104); no difference was found in the tolerance rate between the 2 cohorts (p = 0.489). There were no significant differences in weight change between the two groups at discharge or at 1 week or 5 weeks after discharge (p = 0.658, 0.502, and 0.927, respectively), and both groups presented slight increases in weight at 5 weeks post-discharge. Four patients in the NG group developed complications, while no complications were observed in the ORAL group (p = 0.109). Conclusions Oral feeding is effective for nutritional therapy in children with mild to moderately severe AP, reducing the number of invasive procedures, without significant adverse effects.

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Abstract Objective To implement a systematic monitoring program for hyperbilirubinemia in the first week of life in newborns ≥ 35 weeks of gestational age. Methods A quality assessment study was conducted with an estimated sample size of 385 newborns using a phototherapy utilization rate of 10 %. All newborns with a gestational age of ≥ 35 weeks admitted to a secondary general hospital well-baby nursery were included. Transcutaneous bilirubin (TcB) was systematically measured, and total serum bilirubin (TsB) was measured as needed. Patients with TcB levels above the 75th percentile according to the nomogram by Bhutani et al. (2021) were followed up after discharge from a specific outpatient clinic. The rates of outpatient follow-up clinic utilization, incidence of total bilirubin ≥ 15 mg/dL at discharge, readmission for phototherapy, and exchange transfusion were evaluated. Results Of the 432 newborns analyzed, 53 (12.3 %) were referred for follow-up, with a return rate of 83 % (44). Twelve newborns (27.2 % of those who attended the return visit and 2.7 % of the total sample) were readmitted for phototherapy for a median duration of 36 (30-48) hours. Three infants had bilirubin values ≥ 15.0 mg/dL at discharge and did not require readmission. None of the patients required an exchange transfusion. Conclusions The outpatient follow-up program for jaundice demonstrated high adherence, safety, and effectiveness, and reduced the rate of phototherapy use threefold.

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Abstract Objective To evaluate the effects of hydrotherapy and hammock positioning, applied individually or in combination, on pain reduction in preterm neonates. Methods This randomized clinical trial included 45 preterm neonates under 37 weeks of gestation and weighing less than 2,500g, admitted to the neonatal intensive care unit or intermediate care unit at Santa Casa Hospital in Sobral, Brazil. Palliative interventions were performed during routine invasive and painful procedures, specifically heel lances and handling of the orogastric tube during feeding. Neonates were randomized into three groups: hydrotherapy, hammock positioning, or a combined intervention, with 15 participants per group. Interventions were applied once daily for 15 consecutive days. Pain was assessed using the Neonatal Facial Coding System before and after each session, totaling 1,350 evaluations. Continuous variables were analyzed using Student’s t-test, and categorical variables were analyzed using Fisher’s exact test. The study was registered in the Brazilian Registry of Clinical Trials. Results The sample consisted of 53.3% male neonates, with a mean gestational age of 32.4±2.1 weeks. Hydrotherapy significantly reduced pain scores and pain prevalence. Hammock positioning also produced significant reductions in pain scores and prevalence. The combined intervention resulted in the greatest reduction in pain scores and pain prevalence. All within-group comparisons showed statistically significant improvements. No statistically significant differences were observed when the three intervention groups were compared directly. Conclusion Hydrotherapy and hammock positioning, applied individually or in combination, are effective, safe, and feasible strategies for reducing pain in preterm neonates and may complement standard neonatal care in NICUs.

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Abstract Objective To determine whether the use of an electrocardiogram monitor in newborns receiving positive pressure ventilation (PPV) at birth affects the frequency of tracheal intubation in the delivery room. Methods Retrospective cohort of liveborn infants without congenital anomalies, with gestational age (GA) ≥ 23 weeks and birth weight ≥ 400 g who received PPV at birth, from 2014 to 2022. Newborns were stratified by GA (< 34 or ≥ 34 weeks) and by use or non-use of an electrocardiogram monitor during resuscitation. Logistic regression was used to assess the association between electrocardiogram monitoring and outcomes of interest for each GA group. Results Among 5622 live births, 516 met the inclusion criteria; 224 (43 %) were monitored, and 292 (57 %) were not. The frequency of tracheal intubation was similar between monitored and non-monitored groups: ≥ 34 weeks - 13 % vs. 14 %; < 34 weeks - 43 % vs. 43 %. Electrocardiogram monitoring increased the odds of initiating PPV with a face mask ≥ 60 seconds after birth by 2.45-fold (95 % CI: 1.08-5.54) for GA ≥ 34 weeks and by 2.72-fold (95 % CI: 1.13-6.59) for GA < 34 weeks, after adjustment for umbilical cord clamping time, year of birth, and birth weight. Conclusion Electrocardiogram monitor use did not reduce the frequency of tracheal intubation and was associated with delayed initiation of PPV with a face mask.

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Abstract Objective To evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), serum lactate, and Pediatric Trauma Score (PTS) for mortality in a large case series of critically ill pediatric trauma patients admitted to a specialized PICU in Brazil. Methods Retrospective case series conducted in the Pediatric Intensive Care Unit of a tertiary trauma hospital in Brazil. All trauma patients aged 1 month to 18 years admitted between March 2018 and March 2025 and hospitalized for >24 h were eligible (n = 1495). Demographic, clinical, and laboratory data were collected, including PIM2, initial lactate, and PTS. The primary outcome was all-cause PICU mortality. Results Death occurred in 1.5% of patients. ROC curve analysis was performed in 620 patients with complete data for the three markers. Areas under the curve (AUCs) were: PIM2, 0.93 (95% CI, 0.91-0.95); lactate, 0.86 (95% CI, 0.83-0.88); and PTS, 0.82 (95% CI, 0.79-0.85). In univariable logistic regression, all markers were independently associated with mortality. A 10-fold increase in PIM2 and lactate raised death odds by 36-fold and 226-fold, respectively, while each point increase in PTS reduced odds by 34.6%. In the multivariable model, PIM2 and lactate remained significant predictors. Conclusions PIM2 and lactate remained independently associated with mortality after mutual adjustment in pediatric trauma patients admitted to a specialized PICU. PTS, while valuable for prehospital triage, added little once intensive care was initiated.

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Abstract Objective This randomized controlled trial investigated the effectiveness of supervised lumbopelvic stabilization and urotherapy on factors associated with lower urinary tract symptoms in children with Duchenne Muscular Dystrophy and lower urinary tract dysfunction (LUTD). Method The study included 32 children aged 5-12 years, who were ambulatory and had a Dysfunctional Voiding and Incontinence Symptom Scale (DVISS) of 8.5 or higher. Lower urinary tract symptoms were assessed using the DVISS, a three-day bladder diary, and a nocturnal enuresis diary. Bowel symptoms were assessed with a seven-day bowel diary. Moreover, physical performance tests, the strength of pelvis-related muscle groups, and participation in activities of daily living were evaluated using validated measurement tools. Participants were randomized into two groups: the active control group (n:16, weight:25.81±9.53 kg, height:121.25±18.22 cm) received only urotherapy, while the treatment group (n:16, weight:25.88±9.67 kg, height: 122.69±16.63 cm) additionally performed lumbopelvic stabilization-based exercises for eight weeks under the supervision of a physiotherapist. Results Urotherapy significantly reduced LUTD severity (p < 0.001), enuresis frequency (p = 0.014), and the number of symptoms associated with LUTD (p = 0.001). However, adding lumbopelvic stabilization exercises conferred no superiority over urotherapy alone (p > 0.05). Supervised lumbopelvic stabilization improved functional mobility (p < 0.003), muscle strength (p < 0.05), and participation in activities of daily living (p < 0.049). However, neither urotherapy nor lumbopelvic stabilization training had a significant effect on Gower’s time or daytime voiding frequency (p > 0.05). Conclusion Both interventions were effective in improving bladder and bowel outcomes in children with Duchenne Muscular Dystrophy and LUTD, with no superiority observed on lower urinary tract symptoms.

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Abstract Objective The number of children with type 1 diabetes (CwD) is rising globally, increasing demand for school-based support. The primary objective was to assess parents’ perceptions of the current state of diabetes care in schools for CwD. The secondary objective was to gather feedback on a comprehensive educational program offered to participants. Methods Families of CwD attending an outpatient clinic completed a survey about diabetes care offered by schools. A comprehensive diabetes educational program was developed, comprising a mobile application, website, and printed diabetes management plan. The program was presented to the families to facilitate communication with school staff. Results A total of 107 families participated (mean age of students 10.7 ± 3.9 years; mean age at diagnosis 5.4 ± ± 3.3 years). Most were from the São Paulo metropolitan area (94.3%; 27 cities) and attended public schools (89.7%). Mean HbA1c was 8.8% ± 2.1 (75). Family members often provided in-school insulin support (25.2% overall; 55% of children < 6 years; p < 0.05). Nearly half of caregivers (45.8%) reduced working hours due to diabetes care (55.2% for children < 6 years; 0.05). Most families (73.8%) reported schools had little or no knowledge of diabetes, and 31.8% were dissatisfied with the care received. The possibility of having diabetes material specifically directed to schools was valued by the families and patients. Conclusion Families of CwD in the São Paulo metropolitan area face challenges in school settings. Providing educational materials in different formats is necessary, but strategies are needed to involve school staff in the management actively.

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Abstract Objective Neonatal mortality remains a significant global health challenge, particularly in low- and middle-income countries. This study aimed to analyze the trends and causes of neonatal mortality from 2000 to 2021. Methods Data on all-cause and cause-specific mortality were obtained from the Global Burden of Disease Study 2021. Joinpoint regressions were employed to calculate the annual percentage change and the average annual percentage change. Pearson's correlation was utilized to estimate the relationships between mortality rates and the Human Development Index. Results The global all-cause neonatal mortality rate has declined by an average of 2.1% per year since 2000, while the absolute number of neonatal deaths remained at 2.19 million globally in 2021. Neonatal disorders continued to be the leading cause of death among neonates in 2021, followed by congenital birth defects, lower respiratory infections, sexually transmitted infections excluding HIV, diarrheal diseases, and malaria. The neonatal mortality rate varied significantly across different countries and territories, ranging from 0.61 per 1000 livebirths in Andorra to 55.35 per 1000 livebirths in South Sudan. By 2021, 120 countries (58.8%) had achieved the Sustainable Development Goal 3.2 target. Additionally, strong negative correlations were found between mortality rates and Human Development Index (r = -0.867, P < 0.001). Conclusions Despite significant progress, regional disparities persist; only half of the countries achieved the Sustainable Development Goal 3.2 target by 2021. These findings emphasize prioritized interventions for neonatal disorders in low/middle-income countries and highlight socioeconomic development as critical to equitable mortality reduction within public health frameworks.

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Abstract Objective Although adenoid hypertrophy (AH) is associated with malocclusion, its age-specific impact on craniofacial development across different dentition stages remains unclear. This study aimed to assess AH-related craniofacial changes across distinct phases of dental development. Methods This retrospective study analyzed 180 children divided into three age groups: 3-5, 5-8, and 8-11 years. Lateral cephalometric radiographs were used to evaluate sagittal skeletal relationships (SNA, SNB, ANB), dentoalveolar position (NA-Apo), occlusal plane inclination (NPo-FH), jaw lengths (ANS-Ptm, Co-Gn), and overjet. Comparisons were made between the AH and control groups within each age cohort. Results In the 3-5 year group, no significant craniofacial differences were found between AH and control subjects. Between 5-8 years, AH was linked to a significantly lower SNB angle and higher NA-Apo angle (p < 0.05). By 8-11 years, AH patients showed significantly reduced SNA, SNB, and NPo-FH angles, along with increased ANB, NA-Apo, and overjet values compared to controls (p < 0.05). Conclusion AH was associated with age-dependent craniofacial changes—such as mandibular retrusion, dental protrusion, posterior occlusal tilt, and increased overjet—without altering jaw length. Early diagnosis and timely intervention during key growth stages are crucial to prevent long-term facial abnormalities. Given the retrospective, 2D cephalometric design, causality could not be inferred, and longitudinal or treatment effects could not be assessed.