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The intergenerational transmission of obesity-related traits could propagate an accelerating cycle of obesity, if parental adiposity causally influences offspring adiposity. The extent to which intergenerational obesity associations are due to such causal effects, as opposed to genetic confounding (inheritance), is unclear. We aimed to establish whether associations between parental peri-pregnancy body mass index (BMI) and offspring birth weight (BW), BMI until 8 years of age, and 8-year-old eating behaviour are due to genetic confounding. Data were from the Norwegian Mother, Father and Child Cohort Study, a prospective population-based birth cohort born between 1999 and 2009 at 50 out of 52 hospital maternity units in Norway. We compared the strength of the associations of maternal pre-pregnancy BMI versus paternal BMI during pregnancy, with offspring outcomes including birth weight and BMI assessed between age 6 months and 8 years of age, and appetite-related eating behaviour traits assessed at age 8 years via the Child Eating Behaviour Questionnaire (CEBQ), adjusting for potential confounders including parity, parental/grandparental language group and parental age, smoking, education and income). We then used an extended children of twins structural equation model (SEM) to quantify the extent to which associations were due to genetic confounding. Up to 85,866 children (51.3% male) were included in linear regression models, whereas SEM models included up to 50,999 children. Maternal BMI was more strongly associated than paternal BMI with offspring BW, but the maternal-paternal difference decreased for offspring BMI after birth. Greater parental BMI was associated with obesity-related offspring eating behaviours. SEM results indicated that genetic confounding did not explain the association between parental BMI and offspring BW, but explained the majority of the association with offspring BMI from 6 months onwards. For 8-year BMI, genetic confounding explained 79% (95% CI [62, 95]; p = 1.9 × 10-12) of the covariance with maternal BMI and 94% (95% CI [72, 113]; p = 2.7 × 10-14) of the covariance with paternal BMI. Limitations of this study include selective recruitment and attrition, potential bias due to parental assortative mating, and that findings may not generalise beyond high-income country settings with high obesity prevalence. We found strong evidence that parent-child BMI associations may primarily be due to genetic confounding. When considered alongside prior evidence, this finding may argue against a strong causal effect of maternal or paternal adiposity on childhood adiposity via intrauterine or periconceptional mechanisms.

The overall aim of this exploratory study was to evaluate personal narrative coherence in groups of children representing a range of cultural and/or linguistic backgrounds. Based on previous research, we expected to find effects based on culture/language participant group and the emotional valence of the prompt (positive, negative, neutral). We also anticipated potential interactions between culture/language participant group and prompt type. Four hundred seventeen 10-year-old children from 21 culture/language participant groups took part in this cross-sectional study. The children were from 19 countries or regions, speaking 18 different languages or dialects. All children were seen individually, either face-to-face or online, and asked to produce personal narratives in response to the Global Talking About Lived Experiences in Stories (TALES) protocol. Three of their narratives, each representing a different emotional valence-happy, angry, and a problem situation-were included in the current study. All narratives were coded for coherence using the multidimensional Narrative Coherence Coding Scheme (NaCCS), which yields a total coherence score and three coherence dimension subscores: context, chronology, and theme. Linear mixed models were used to identify differences in narrative coherence between culture/language participant groups and narrative prompt types. We found significant main effects for both participant group and narrative prompt type on total coherence scores, as well as a significant interaction effect. Overall, the problem prompt elicited more coherent narratives than the angry prompt. Performance varied notably across culture/language participant groups, with no consistent pattern of strength linked to prompt type. Additionally, some culture/language participant groups scored significantly lower on total coherence than others. Significant participant group effects were also observed across all three coherence dimension subscores, with the theme dimension showing the greatest number of between-groups differences. In an increasingly multicultural and plurilingual world, the need for ecologically valid tools to assess children's spoken language skills is more critical than ever. Findings from this exploratory study offer further support for the use of the Global TALES protocol for eliciting personal narratives in children from diverse cultural and/or linguistic backgrounds. Furthermore, results indicated that the NaCCS is a viable method for describing differences and similarities in personal narrative coherence among these diverse groups of children. Our next steps involve refining the coding framework and expanding our participant pool to include larger, more age- and ability-representative samples-with the ultimate aim of integrating personal narrative assessment and analysis into routine clinical practice worldwide. https://doi.org/10.23641/asha.32653314.

Fixed hemoglobin cutoffs are commonly used to define anemia, yet hemoglobin concentration varies physiologically with age. Rigid thresholds may therefore misclassify individuals, particularly in early childhood. This study proposes a dynamic, continuous model based on empirical hemoglobin-age relationships to address limitations of fixed anemia cutoffs. This secondary data analysis used nationally representative data from the Lebanon Integrated Micronutrient, Anthropometry and Child Development Survey 2023 (LIMA-2023) survey conducted in Lebanon. Venous blood samples were collected, and complete blood counts were analyzed on the same day in a centralized laboratory. The analysis included 1448 children, 6 to 59 months of age and 4353 girls and non-pregnant women, 10 to 50 years of age. Polynomial regression was applied to hemoglobin distributions within a healthy reference population to derive continuous, age-specific thresholds for anemia severity (mild, moderate, or severe). Anemia prevalence under the dynamic model was compared with WHO 2024 fixed cutoffs. Misclassification patterns and age-related trends in hematological parameters (red blood cell count [RBC], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC], soluble transferrin receptor [sTfR]) were explored. The dynamic model identified a higher prevalence of anemia among children, 6 to 59 months of age, than WHO 2024 criteria, particularly for mild and severe anemia. Estimates in older children and women were largely comparable. The continuous model captured age-dependent physiological trends and reduced misclassification linked to fixed thresholds. Fixed hemoglobin cutoffs may not adequately reflect age-related physiology. A dynamic, continuous model offers a refined alternative that improves anemia classification, especially in early childhood, and may inform more accurate epidemiological and public health responses.

This study examined associations between single-versus dual-parental depressive and anxiety symptoms during the antenatal and postpartum period with child socioemotional problems from 12 to 24 months of age. In this nationwide Canadian longitudinal cohort study of women and their cohabitating partners, generalized estimating equations were used to examine associations between antenatal maternal and paternal depressive (Edinburgh Postnatal Depression Scale) and anxiety (State-Trait Anxiety Inventory) symptoms measured retrospectively within 3 weeks postpartum, and postnatal symptoms measured prospectively at 3, 6, 9, 12, and 18 months postpartum and their children's socioemotional development (Brief Infant-toddler Social and Emotional Assessment) from 12 to 24 months of age. The study included 3217 cohabitating couples. Adjusting for covariates, mother-only (range of ORs = 1.50 [95% CI, 1.08-2.10] for antenatal anxiety symptoms to 2.03 [95% CI, 1.13-3.65] for antenatal comorbid symptoms), father-only (range of ORs = 1.57 [95% CI, 1.18-2.09] for postpartum anxiety symptoms to 2.44 [95% CI, 1.33-4.47] for antenatal comorbid symptoms), and dual-parental (range of ORs = 1.78 [95% CI, 1.00-3.15] for antenatal anxiety symptoms to 4.34 [95% CI, 1.83-10.29] for antenatal depressive symptoms) depressive and anxiety symptoms in both the antenatal and postpartum periods were associated with increased child socioemotional problems. Maternal and paternal depressive and anxiety symptoms during the antenatal and postpartum periods are associated with increased child socioemotional problems in early childhood, with roughly equal magnitude. Dual-parental mental health conditions and comorbid conditions have the strongest associations with socioemotional problems. Findings underscore the importance of considering the well-being of mothers and fathers in promoting healthy socioemotional development.

Malnutrition accounts for nearly one-third of child deaths globally and continues to be a major concern in India. Despite economic progress, undernutrition remains prevalent, with one-third of children underweight and over two-thirds anemic. Within India, marginalized groups such as the Koraga tribe face greater risks due to poverty, limited healthcare access and cultural barriers that compound child health challenges. Understanding maternal perceptions is crucial to effectively address these challenges. In-depth interviews were conducted with Koraga tribal mothers of children aged 5-10 years. Participants were selected using criterion-based purposive sampling to ensure representation across different age groups and household contexts. Interviews were audio-recorded in local languages (Tulu and Kannada), transcribed verbatim, translated into English and analysed inductively using thematic analysis with NVivo software (version 14). Twenty Koraga tribal mothers were interviewed between October 2023- March 2024. Thematic analysis revealed five major themes: evolving perceptions of health and wellbeing; nutrition beliefs and practices; hygiene and health promotion; traditional healing with modern care and barriers and community solutions. These findings highlighted key challenges such as limited healthcare access, poverty and educational constraints, while also capturing community-driven strategies including reliance on health workers and government food-schemes. Maternal perceptions, shaped by cultural norms and socioeconomic constraints, play a critical role in influencing health and child nutrition in the Koraga community. The findings highlight the need for policy measures that integrate culturally informed nutrition education with strengthened frontline health services, alongside community-based programs involving women's self-help groups to improve health outcomes in marginalised tribal populations.

Child abuse is an important issue that threatens child development. The COVID-19 pandemic had psychological, social, and economic effects, and concerns were raised about a possible increase in child maltreatment. This study aimed to describe online search trends on child abuse in Japan during the COVID-19 pandemic. We conducted a retrospective observational study on the online search volume of terms related to abuse, such as "abuse," "psychological abuse," "physical abuse," "neglect," "sexual abuse," "I might become abusive," "I am scared I might become abusive," and "I cannot stop abusing," in Yahoo! Japan. Search volumes were compared with trends in the number of reported cases of COVID-19. The number of searches for "neglect" increased during periods of social change caused by the COVID-19 pandemic and when waves of the pandemic coincided with the summer vacation period. Searches for terms suggesting abuse, such as "I might become abusive" and "I am scared I might become abusive," increased in 2020 followed by a decrease from 2021 onward. Most of the searches were conducted by women aged 20 to 49 years. Online searches related to "neglect" increased during periods of major social change during the COVID-19 pandemic. Searches suggestive of concern about perpetrating abuse were conducted predominantly by women aged 20 to 49 years. Online search data may serve as a useful tool for identifying trends in child abuse-related search interest.

Maternal perinatal depression is a well-established risk factor for adverse child developmental outcomes; however, its long-term association with academic achievement remains unclear. This study examined its association with children's academic performance across multiple stages of schooling. Data were drawn from the New South Wales Perinatal Data Collection, linked with the New South Wales Admitted Patient Data Collection and the New South Wales National Assessment Program - Literacy and Numeracy. Maternal perinatal depressive disorders were identified from hospital admission records using the International Classification of Diseases, 10th Revision, Australian Modification codes. Academic performance was assessed using the National Assessment Program - Literacy and Numeracy results in Grades 3, 5 and 7. Outcomes were classified as meeting or not meeting the national minimum standards in reading, spelling, writing, grammar and numeracy. Generalised estimating equations and propensity score matching were applied to examine associations. After adjustment and matching, maternal perinatal depressive disorders were associated with increased odds of children not meeting the national minimum standards in reading (odds ratio = 1.24, 95% confidence interval = [1.10, 1.41]), spelling (odds ratio = 1.28, 95% confidence interval = [1.13, 1.46]), writing (odds ratio = 1.32, 95% confidence interval = [1.19, 1.47]) and grammar (odds ratio = 1.18, 95% confidence interval = [1.06, 1.33]), but not numeracy (odds ratio = 1.10, 95% confidence interval = [0.96, 1.27]). Associations were more consistent for antenatal depression, while postnatal depression was associated with reading and writing only. Children of mothers with perinatal depressive disorders showed an association with suboptimal academic performance, particularly in literacy-related domains. The stronger associations observed for antenatal depression suggest that early gestational exposure may affect foundational cognitive and socio-emotional development, highlighting the importance of timely identification and treatment of maternal depression during pregnancy to support long-term educational outcomes.

The evidence base for parent support groups in child welfare systems is limited but growing. Evaluation of such programs requires flexible and context-specific designs that capture both outcomes and mechanisms of change. This exploratory mixed-methods evaluation examined a peer-led support group program for parents who experienced child removal in a large Florida county to better understand how these programs operate and benefit parents working toward reunification. A total of 22 parents participated in weekly sessions facilitated by peer specialists with prior child welfare involvement. Quantitative assessments measured changes in psychosocial functioning and engagement in child welfare services, while semi-structured interviews (n = 8) explored participant perceptions of group processes and benefits. Significant decreases were observed in depression, trauma, and loneliness, alongside increases in perceived emotional support. Thematic analysis identified four interrelated themes that informed an empirically grounded conceptual framework describing the functions and benefits of support groups.This evaluation study demonstrates how mixed-methods approaches can yield actionable evidence from small scale community-based interventions and offers insight into the mechanisms that may inform future implementation and evaluation of peer-led models.

Socioemotional skills emerge from coordinated behavioral, autonomic, and neural processes that continue to reorganize across development, yet how these systems jointly support emotion processing and mental health remains unclear. Using a naturalistic movie-watching paradigm, we integrated behavioral, cardiac, and fMRI measures in children (6-14 years) and adults (18-29 years), alongside independent ratings of experienced valence and arousal. Across age groups, positive and negative emotional content elicited changes in subjective experience, heart rate, and corticolimbic activity, including the amygdala, hippocampus, and prefrontal cortex. Despite these shared patterns, group differences emerged. Children reported more positive affect, showed larger heart-rate deceleration, and exhibited stronger recruitment of thalamic and lateral prefrontal regions, areas previously linked to sensory integration and cognitive control. Adults, in contrast, showed greater activation in hippocampal and posterior midline regions, which have previously been associated with memory and self-referential appraisal. During negative emotional content specifically, children preferentially engaged medial prefrontal regions, whereas adults engaged lateral prefrontal regions. Importantly, in adults but not children, models combining behavioral, cardiac, and neural indices explained substantially more variance in internalizing symptoms than any single modality alone. Together, these findings demonstrate that socioemotional experiences evoke coordinated behavioral, autonomic, and neural responses across development, while also revealing age-group differences in their organization and associations with mental well-being.

Pneumonia is preventable and treatable, yet it remains the leading infectious cause of illness and death among under-five children. Bubble continuous positive airway pressure (bCPAP) offers a promising option for oxygen therapy combined with appropriate antibiotics and other supportive care. However, the cost-effectiveness of bCPAP in resource-limited settings such as Ethiopia is not documented. We aimed to evaluate the cost-effectiveness of bCPAP in treating severe pneumonia and hypoxaemia in under-five children in Ethiopia. We developed a decision-analytical model (decision tree) to determine the cost-effectiveness of a locally made bCPAP compared with the standard of care (WHO-recommended low-flow oxygen therapy) in general hospitals. Effectiveness was measured as the number of child deaths and disability adjusted life years (DALYs) averted. Cost data were extracted from published literature and local markets. The incremental cost-effectiveness ratio (ICER) was calculated and evaluated against the willingness-to-pay (WTP) thresholds set at multiples (0.34, 1, and 3) of Ethiopia's GDP per capita. Sensitivity analyses were performed to test the robustness of the results. For every 10,000 children with severe pneumonia and hypoxaemia, providing oxygen using locally made bCPAP will save an additional 31 children compared to the standard of care. A locally made bCPAP has an ICER of 139.5 USD per DALY averted. These results were robust in the sensitivity analysis performed, showing a 100% probability of being cost-effective at one times the GDP per capita of Ethiopia. A locally made bCPAP is a highly cost-effective intervention for treating severe pneumonia and hypoxaemia in under-five children in Ethiopian general hospitals. These findings provide critical evidence for decision-makers to support and scale-up use of bCPAP in Ethiopia and other similar low and middle income countries.

Use of automated insulin delivery (AID) systems has increased in people with type 1 diabetes (T1D); however, real-world data in preschool-age children remain limited. In this multicenter analysis, we assess real-world glycemic outcomes in preschool-age children using AID systems compared with those using multiple daily injections (MDIs). This retrospective, multicenter, cross-sectional analysis assessed current usage of AID systems and glycemic outcomes in preschool-age children &#x2264;6 years across 37 pediatric sites in the T1D Exchange Quality Improvement Collaborative (T1DX-QI). Differences in AID use and HbA1c were evaluated using t tests and &#x3c7;&#xb2; tests, with multivariable logistic and linear regression models adjusting for age, race/ethnicity, diabetes duration and insurance type to assess associations between AID use and glycemic outcomes. In this cohort of 3521 youth &#x2264;6 years, the mean age was 4.6 (1.4), 47% female, 53% non-Hispanic white, 12% non-Hispanic black, and 14% Hispanic, and 31% with public insurance. Of these, 48% were using AID for insulin management with a mean HbA1c of 7.9% (1.7), compared with 52% using MDI with a mean HbA1c of 8.8% (2.2), P < .0001. In this cohort, 25% had an HbA1c <7%. AID use was associated with a greater odds of achieving HbA1c <7% (OR 1.91, 95% CI 1.57 to 2.33, P < .001). Real-world use of AID systems in preschool-age children (&#x2264;6 years of age) is associated with lower A1c levels and greater potential to achieve the American Diabetes Association (ADA) A1c target range of <7%.

Femoral shaft fractures in children aged 4 to 6 years represent a clinical gray zone between closed reduction with casting and operative treatment. Traditional guidance favors closed treatment under age 6, yet recent reports suggest increasing use of operative treatment despite limited evidence. This study characterized national treatment rates from 2013 to 2024 and compared health care utilization outcomes. This retrospective cohort study used the TriNetX Research Network, a federated platform containing nationwide deidentified health records. Patients from 2013 to 2024 with femoral shaft fractures were identified through ICD codes. Data on closed versus operative treatment (defined by CPT codes), sex, race, and ethnicity were extracted. Annual treatment rates, both total and age-stratified, were calculated. Logistic regression and Rao & Scott adjusted &#x3c7;2 testing with Bonferroni correction were performed. Propensity score matching was performed for the combined 4- to 6-year cohort; age-stratified analyses were unmatched. A total of 2486 children aged 4 to 6 years with femoral shaft fractures were identified; 47.3% underwent operative treatment. The proportion treated with closed reduction and spica casting decreased overall, most notably among children aged 5 years (64.3% to 30.6%) and 6 years (51.4% to 23.7%), while rates remained stable at age 4 (67.4% to 77.8%). In the matched combined cohort, operative treatment was associated with fewer early emergency department visits (RR: 0.64; 95% CI: 0.42-0.97), more late postreduction procedures (RR: 4.20; 95% CI: 2.77-6.37), and more routine healing visits (RR: 1.76; 95% CI: 1.45-2.13). Differences were most pronounced at age 6 in unmatched analyses (early ED visits-OR: 0.32; 95% CI: 0.19-0.51; early postreduction procedures-OR: 0.23; 95% CI: 0.12-0.42). The rate of operative management of femoral shaft fractures increased by 94% at age 5 and by 61% at age 6 during the study period, despite limited age-specific evidence supporting this shift. This change likely reflects multiple factors, including growing surgeon familiarity with minimally invasive fixation, family-centered considerations, and age-dependent challenges of spica casting, rather than evidence of clinical superiority. Level III-therapeutic study (retrospective comparative study).

HIV infection among children is predominantly due to perinatal transmission. The timing of HIV-related symptoms in perinatally infected children reveals how quickly the disease progresses and helps predict prognosis. This study used case-based surveillance to examine treatment outcomes and disease progression among HIV-infected, HIV-exposed infants in Plateau State, Nigeria. This is a retrospective cohort study using a case-based surveillance approach. The data of HIV-exposed infants enrolled between 1st October 2018 and 30th September 2022, who had confirmed positive DNA PCR results and commenced antiretroviral therapy (ART), were sampled via a cluster sampling method. Participants were followed up for 6 months to 5 years post-ART initiation. Disease progression, treatment mortality, and loss outcomes were assessed with respect to age at follow-up. A total of 57 infants were included in the study, drawn from 15 health facilities across the three senatorial districts of Plateau State, Nigeria. The female-to-male ratio was approximately 1:1 (29:28), with a mean age of 0.7 years (8.9 months) &#xb1; 0.7 years at ART initiation. By the end of the follow-up period, 70% (40/57) of the infants had favorable treatment outcomes, with 87.5% achieving viral suppression. The remaining 29.8% (17/57) experienced treatment mortality or losses (TX_ML): 47.1% (8/17) died, 29.4% (5/17) transferred out, 17.6% (3/17) discontinued treatment, and 5.9% (1/17) interrupted treatment. Among those with mortality outcomes, 75% died before the age of two years, while 25% survived beyond two years, with some reaching up to their fourth birthday. Mortality was unevenly distributed across local government areas (LGAs), with the highest rates recorded in Mangu LGA (37.5%), followed by Shendam LGA (25%), and the remaining 37.5% shared equally among Pankshin, Langtang North, and Jos North. This study revealed disparities in TX_ML outcomes across senatorial districts, with higher treatment mortality in the Southern and Central districts compared to the Northern district. These findings highlight the need to design targeted, context-specific interventions to improve survival and treatment outcomes among perinatally HIV-infected children and further research to identify the contributing factors.

To evaluate the field accuracy of a malaria diagnostic algorithm combining sequential interpretation of two-step malaria RDT detecting PfHRP2 and pLDH with information on previous antimalarial treatments within the past four weeks for the diagnosis of malaria in febrile children under 5 years compared to standard diagnosis using a PfHRP2 only based RDT. Febrile children aged 6-59 months attending outpatient clinics were randomized to either the control group, which received the standard RDT (PfHRP2 only), or the intervention groups (an e-algorithm or a decisional algorithm), which was subjected to the diagnostic algorithm combining an RDT detecting PfHRP2 and pLDH with information on previous antimalarial treatment. Malaria diagnosis with PfHRP2-based RDT was reported as positive or negative. The sequential interpretation was reported as (i) positive when the pLDH line appeared, regardless of the PfHRP2 results, (ii) negative when both lines did not appear and (iii) undetermined when only the PfHRP2 line appeared, and information on previous antimalarial treatment within the past 4 weeks was used as a decision-support tool to classify active malaria from past infection. Blood samples were also collected for expert microscopy as the gold standard, and for qPCR to further evaluate undeterminate results and potential false-positive RDT outcomes. In total 1176 children were included, with 66.7% (784/1176) assigned to the intervention arms and 33.3% (392/1176) to the control arm. In patients assigned to the sequential algorithm, the number of undetermined cases was 12.7% (100/784). Considering microscopy as the gold standard, PfHRP2-based RDT reported a sensitivity of 96.5% and a of specificity 79.1%, with positive and negative predictive values of 78.3% and 96.7%, respectively. For the sequential algorithm, the sensitivity, specificity, positive and negative predictive values of the conclusive-only results (i.e., PfHRP2&#xb1;/pLDH+ and PfHRP2-/pLDH-) were 97.4%, 98.4%, 98.0% and 97.9%. However, when undetermined result were combined with conclusive results, the sensitivity, specificity, positive and negative predictive values were 89.7%, 96.8%, 95.6% and 92.4% respectively. Among recently antimalarial treated participants in sequential algorithm arm, 59.5% (50/84) were qPCR-positive, compared to 68.7% (11/16) qPCR-positivity in those without recent treatment. The sequential diagnostic approach improves the diagnosis of malaria in a real world setting, compared to the use of PfHRP2-(only) based RDT. However, relying only on history of antimalarial treatment in undetermined cases may decrease algorithm's sensitivity, which could result in missing active or recurrent malaria infections.

Postoperative urinary tract infection (UTI) following pyeloplasty remains a significant complication and continues to pose challenges in pediatric urological care. This study aimed to develop a simplified predictive model to identify risk factors for postoperative UTI after unilateral pyeloplasty and to support clinicians in implementing preventive strategies targeting modifiable risk factors. Clinical data from children who underwent unilateral pyeloplasty at the Children's Hospital of Capital Institute of Pediatrics (Beijing, China) between January 2012 and January 2022 were retrospectively analyzed. Variables including sex, age, body mass index (BMI), surgical modality, drainage tube type, and parameters from blood and urine tests were evaluated. Statistical analyses, including least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and random forest modeling, were performed to identify significant predictive factors. Variables with the greatest predictive importance were used to develop a nomogram, and its clinical utility was evaluated using decision curve analysis (DCA). Among 764 patients, 265 (35%) developed postoperative UTI. Key risk factors included surgical modality, laterality of ureteropelvic junction obstruction (UPJO), drainage tube type, blood urea nitrogen (BUN) level, and patient height. LASSO regression identified 14 predictive variables, while logistic regression determined independent risk and protective factors. Ultimately, 8 variables (e.g., sex, operative time, drainage tube type, history of infection, history of fistula, age, BUN level, and renal cortical thickness) were selected for development of the nomogram predicting postoperative UTI risk after unilateral pyeloplasty. This study identified 8 factors associated with postoperative UTI following unilateral pyeloplasty in children. The developed predictive model may assist clinicians in identifying high-risk patients, thereby supporting improved perioperative planning and postoperative management.

Omalizumab is an effective therapy for H1-antihistamine-refractory chronic spontaneous urticaria (CSU). However, predictive biomarkers for treatment success in the pediatric population remain poorly defined. This study aimed to identify clinical and laboratory factors predicting complete disease control in children receiving omalizumab. We conducted a retrospective cohort study of 44 pediatric patients (aged 12-18 years) with CSU treated with omalizumab (300 mg/4 weeks). Disease activity and control were assessed using Urticaria Activity Score (UAS7), Urticaria Control Test (UCT), and Chronic Urticaria Quality of Life Questionnaire at baseline and months 1, 3, and 6. Complete control was defined as UAS7=0 and UCT=16 at month 6. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Complete control was achieved in 40.9% (n=18) of patients at month 6. In multivariate analysis, shorter symptom duration prior to omalizumab (OR: 0.46; 95% CI: 0.25-0.88) and higher baseline absolute eosinophil count (OR: 1.04; 95% CI: 1.00-1.06) were identified as independent predictors of complete control. In addition, early clinical response at month 1 was significantly associated with subsequent treatment success and may serve as an early on-treatment prognostic marker. Early initiation of omalizumab and higher baseline eosinophil counts are strong predictors of complete disease control in pediatric CSU. These findings support a biomarker-guided and timely intervention strategy to optimize clinical outcomes in children.

Pediatric postoperative opioid prescribing remains a modifiable source of harm, but procedure-specific national prescribing patterns, inter-hospital variability, and high-yield stewardship targets are not well defined. This retrospective cohort study used January-December 2023 data from NSQIP-Ped and PHIS for non-neonate children aged 0-17 years undergoing surgery. Procedure groups were defined by CPT code. Outcomes were Opioid Prescription Proportion (OPP), Prescribing Practice Variability (PPV; interquartile range of hospital-level OPP), and Contribution to Total Opioid Prescriptions (CTOP). PHIS volumes from 45 hospitals also participating in NSQIP-Ped were used to estimate procedure-group case volumes and CTOP. Among 142,748 NSQIP-Ped cases from 157 hospitals, 31% (44,110/142,748) had an opioid prescription at discharge. After PHIS case-volume adjustment, this corresponded to 27% (38,102/142,748) of cases. The top 20 procedure groups accounted for 95% (36,241/38,102) of estimated opioid prescriptions at discharge. Highest OPPs were observed for chest wall procedures at 82% (1,839/2,242), lower extremity procedures at 78% (5,949/7,658), and spine procedures at 77% (7,724/10,047). Highest PPV was observed for craniofacial procedures (IQR 0.7), cleft lip-palate procedures (IQR 0.6), and fracture repair (IQR 0.6). Highest CTOPs were fracture repair at 16% (5,904/38,102), spine procedures at 13% (5,032/38,102), and lower extremity procedures at 13% (4,913/38,102). Pediatric postoperative opioid prescribing is concentrated within a limited number of procedure groups, with substantial variation across hospitals for selected procedures. These data identify procedure-specific opportunities for opioid stewardship initiatives in children's surgery.