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Most studies confirm the effectiveness of virtual reality (VR) in alleviating pain and fear during pediatric venipuncture, with limited evidence regarding physiological stress markers and dynamic assessment. This study aims to investigate the effects of VR technology on pain, fear, and physiological responses in children, as well as family satisfaction during intravenous cannulation. This single-blind randomized controlled trial was conducted in the Pediatrics Department of Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China. A total of 188 children requiring intravenous cannulation procedures and their families were allocated into: the control group (n&#x2009;=&#x2009;96), which received the conventional verbal comfort; and the experimental group (n&#x2009;=&#x2009;92), which wore VR headsets. The primary outcomes were dynamic fear/pain scores assessed by nurses and self-reported by patients, which were surveyed using the Children's Emotional Manifestation Scale (CEMS) and the Children's Fear Scale (CFS)/the Face, Legs, Activity, Crying, and Consolability scale (FLACC) and the Wong-Baker FACES Pain Rating Scale (Wong-Baker), respectively. The secondary outcomes were dynamic heart rate (HR) and peripheral oxygen saturation (SpO2) measurement, and family satisfaction levels. The pre-specified time points were pre-intervention, immediately post-intervention, at tourniquet application, at venipuncture, and one minute after venipuncture. Results were reported following the Consolidated Standards of Reporting Trials 2025 guidelines. VR significantly reduced children's fear at two pre-venipuncture time points (nurse-assessed CEMS and child-reported CFS; partial &#x3b7;2&#x2009;=&#x2009;0.072 and 0.053, both p&#x2009;<&#x2009;0.05). There were no significant group effects in nurse-assessed FLACC and child-reported Wong-Baker pain scores across three venipuncture time points. However, a significant time-by-group interaction was observed for nurse-assessed FLACC scores (partial &#x3b7;2&#x2009;=&#x2009;0.028, p&#x2009;=&#x2009;0.006). Notably, nurse-assessed FLACC scores were lower than child-reported Wong-Baker scores in both control and experimental groups (Mean Diff.=-1.04 to -2.10, all p&#x2009;<&#x2009;0.001). The dynamic changes in HR and SpO2 across five time points were lower within the experimental group (partial &#x3b7;2&#x2009;=&#x2009;0.106 and 0.045, both p&#x2009;<&#x2009;0.01). Partial correlation analysis revealed that family satisfaction responded to children's pain, fear, and physiological stress in a "process-sensitive" pattern in the control group but an "outcome-oriented" pattern in the experimental group. In this trial, VR distraction effectively reduced procedural fear (but not pain) during venipuncture. However, the nurse assessment appears to suggest that the effects of VR distraction and conventional intervention on pain experience may vary over time. These findings underscore the importance of multidimensional pain/fear assessment in pediatrics. Our study confirms that VR distraction can significantly reduce fear in children undergoing intravenous cannulation, though pain scores were not significantly lowered. Multidimensional assessment (including subjective fear measures) is therefore important. VR may improve the patient and family experience of painful procedures. We recommend further trials with larger samples to confirm these findings and refine VR interventions. Chinese Clinical Trial Registry, ChiCTR2500113849 (Registration Date: Dec. 3, 2025; Retrospectively registered).

Clerkship evaluations play a critical role in assessing medical student performance and informing residency selection. Prior studies suggest there are gender-related differences in narrative feedback and numerical evaluations of medical trainees; however, findings remain inconsistent across specialties and institutions. This study examined whether preceptor gender and student gender were associated with differences in clerkship evaluation scores. A retrospective analysis was conducted using 6,855 clerkship evaluations from students in the graduating classes of 2022-2024 at a U.S. Osteopathic medical school. Evaluations were completed by 2,425 preceptors across six required clerkships: Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Surgery. Associations between preceptor gender, student gender, and evaluation scores were analyzed using generalized linear mixed models, adjusting for academic year and clerkship rotation. Preceptor gender was significantly associated with evaluation scores, with female preceptors assigning modestly lower Total Average and Clinical Competence scores than male preceptors (P&#x2009;<&#x2009;0.0001). Student gender demonstrated smaller effects, with female students receiving slightly higher Total Average scores (P&#x2009;=&#x2009;0.0260) and Professionalism scores (P&#x2009;=&#x2009;0.0026). No significant interaction between preceptor and student gender was observed. Clerkship rotation was strongly associated with evaluation scores, with higher adjusted scores in Family Medicine and Pediatrics and lower in Surgery and Internal Medicine. Evaluator characteristics and specialty-specific grading cultures appear to influence numerical clerkship assessments. Although findings may be limited by the single-institution design, these results highlight the potential value of increased standardization and target preceptor development to promote equity and consistency in clinical evaluation.

Resource-limited school districts often lack athletic trainers and real-time medical support during sports events, placing student-athletes at risk for improper care. The Detroit Public School Health Corps (DPSHC), a medical student-led initiative, was developed to fill this need through supervised sideline coverage by trained medical students. This study evaluates the program's first full year of implementation. The authors analyzed injury encounters during the 2024-2025 academic year across 280 athletic events at 16 Detroit public high schools. Thirty-one medical student volunteers, known as Health Leaders (HLs), received 12&#xa0;h of standardized training in emergency triage, musculoskeletal assessment, concussion management, and Situation, Background, Assessment, and Recommendation (SBAR) communication. HLs were supported by attending physicians in pediatrics, sports medicine, and orthopedics, with real-time support available via phone for clinical decision-making. Post-event documentation captured injury characteristics, mechanism, anatomical location, clinical assessment findings, triage decisions, and athlete disposition. Descriptive statistics were used to summarize injury frequency, type, and clinical outcomes. A total of 89 injury encounters were documented, with lower extremity injuries being most common (56.2%), followed by head and neck injuries (23.6%). Over half (56.2%) of the injuries were fully managed on-site; 22.4% were referred for outpatient follow-up and 11.2% required emergency care. Only five athletes were transported by Emergency Medical Services. The DPSHC model demonstrates a feasible, cost-effective approach to expanding on-field sports medicine care in medically underserved school systems. The initiative provided timely care, enhanced safety, and offered meaningful clinical exposure for medical students. With appropriate training and oversight, medical students can help address systemic gaps in secondary school athletic healthcare. This model may be replicable in other resource-limited settings.

Neonatal respiratory distress syndrome (NRDS) is a major cause of significant morbidity and mortality among neonates, particularly in preterm infants. Existing studies have highlighted various microRNAs (miRNAs) implicated in NRDS, yet the precise molecular mechanisms, particularly regarding miR-18a-3p, remain incompletely understood. This research aimed to elucidate the role of miR-18a-3p as a potential biomarker for NRDS and to explore its functional mechanisms in alveolar type II epithelial cells. A total of 35 NRDS patients and 35 healthy controls were enrolled, with samples of amniotic fluid and neonatal blood collected for expression analysis of miR-18a-3p. Utilizing cell culture, transfection, qRT-PCR techniques, CCK-8 assay, and ELISA assay, the function of miR-18a-3p in alveolar epithelial type II cells (an immortalized cell line, IHPEC-II, and AEC2-like cells derived from human pluripotent stem cells) was investigated. The binding relationship between miR-18a-3p and surfactant pulmonary-associated protein C (SFTPC) was predicted and validated using a dual-luciferase reporter assay. Elevated levels of miR-18a-3p levels were observed in the serum of NRDS cases, with an area under the ROC curve (AUC) of 0.86 for distinguishing NRDS from healthy controls. Increased miR-18a-3p levels were also detected in amniotic fluid from these NRDS cases, yielding an ROC AUC of 0.82 for discriminating between NRDS cases and healthy controls. A positive correlation between serum miR-18a-3p levels and those in amniotic fluid was observed. Functional assays demonstrated that inhibition of miR-18a-3p significantly enhanced cell viability and increased SPC secretion in alveolar epithelial type II cells following surfactant stimulation. Dual-luciferase reporter assays confirmed that miR-18a-3p modulated SFTPC expression. MiR-18a-3p was increased in NRDS cases. MiR-18a-3p can inhibit alveolar epithelial type II cell function, suggesting its potential role in fetal lung development.

This study aimed to compare serum and cerebrospinal fluid (CSF) copeptin levels among children with febrile seizures, febrile illness without seizures, and meningitis; to investigate the relationship between serum and CSF copeptin levels; and to assess the potential diagnostic utility of these biomarkers. This study included children aged 1 month to 18 years who presented to the pediatric emergency department with fever or seizures and underwent lumbar puncture because of signs of meningeal irritation or the absence of an identifiable source of fever. The patients were classified into three groups: the Meningitis Group, the Febrile Illness Without Seizures Group, and the Febrile Seizure Group. In addition, a control group consisting of healthy children was included. Serum and CSF copeptin levels were measured in the patient groups, whereas only serum copeptin levels were measured in the control group. Serum copeptin levels were significantly higher in the Febrile Seizure Group than in both the Febrile Illness Without Seizures Group and the Control Group. Univariate linear regression analysis demonstrated a weak but statistically significant positive association between serum and CSF copeptin levels (p&#x2009;=&#x2009;0.040), indicating that CSF copeptin levels could be estimated from serum copeptin levels using the following formula: CSF copeptin level&#x2009;=&#x2009;2.02&#x2009;+&#x2009;0.05 &#xd7; serum copeptin level. In multivariable linear regression analysis, C-reactive protein (CRP) and CSF glucose levels were identified as independent predictors of CSF copeptin levels, irrespective of age and sex (p&#x2009;=&#x2009;0.009 and p&#x2009;=&#x2009;0.004, respectively). CSF copeptin measurement was not superior to serum copeptin measurement for distinguishing children with febrile seizures, or children with febrile seizures and/or meningitis, from those with febrile illness without seizures. Serum copeptin levels were higher in children with febrile seizures than in those with febrile illness without seizures and in healthy controls. However, because of the very small meningitis sample size, the meningitis-related findings should be considered exploratory and interpreted with caution. Larger prospective studies are required to determine whether copeptin has clinically meaningful utility in distinguishing febrile seizures from meningitis.

The favorable prognosis of pediatric AML1::ETO acute myeloid leukemia (AML) is well-established, yet the impact of co-occurring KIT mutations-particularly in exon 17-on clinical outcomes and chemosensitivity remains incompletely defined. We analyzed the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database comprising 957 pediatric AML patients to assess the clinical characteristics and prognosis of pediatric patients harboring AML1::ETO and KIT mutation using Kaplan-Meier survival analysis and Cox proportional hazards models. Subsequently, we performed experimental validation using bone marrow samples from 16 pediatric AML patients at Shenzhen Children's Hospital by high-throughput drug sensitivity (HDS) screening against therapeutic agents and whole transcriptome sequencing analysis of significant genes. Functional enrichment analysis of these differential expression genes was carried out by Gene Ontology. Analysis from the TARGET database revealed that while AML1::ETO AML generally carries a favorable prognosis, concomitant KIT exon 17 mutations significantly attenuate this survival advantage. Exploratory experimental validation in a limited cohort of AML1::ETO and KIT exon 17 mutation patients suggested a potential trend of broad drug resistance such as cytarabine and daunorubicin. Preliminary transcriptomic analysis identified upregulation of SOCS1, a negative regulator of the JAK-STAT pathway, as a potential feature of this resistant phenotype. Furthermore, elevated SOCS1 expression was associated with poor prognosis. We conclude that KIT mutations, especially exon 17, confer a high-risk phenotype in otherwise favorable pediatric AML1::ETO AML. Our exploratory data suggest this may be associated with a chemoresistant profile, potentially driven by SOCS1-associated JAK-STAT dysregulation. These findings highlight the necessity of refined risk stratification based on KIT exon profiling and support targeting the SOCS1/JAK-STAT axis to overcome therapy resistance.

Histopathological placental inflammation provides objective evidence of intrauterine inflammatory exposure in preterm birth, but placental histopathology is not immediately available after delivery. We aimed to determine whether placental inflammatory pathology is associated with cord blood and postnatal inflammatory biomarkers in preterm infants. In this prospective cohort study, 87 preterm infants with birth weight&#x2009;<&#x2009;2500&#xa0;g were enrolled. Cord blood collected at birth was analyzed for procalcitonin (PCT), presepsin (P-SEP), and high-sensitivity C-reactive protein (hs-CRP). Placentas were categorized as no pathological findings, inflammatory placental pathology, or other placental pathology. Exploratory lesion-specific analyses further classified inflammatory lesions as maternal inflammatory response only (MIR-only) or fetal inflammatory response present (FIR-present). Multiple linear regression models with log-transformed outcomes were used to examine associations between inflammatory placental pathology and cord blood PCT and postnatal CRP after adjustment for perinatal covariates. Fifteen infants (17%) had inflammatory placental pathology. Cord blood PCT differed significantly between the primary placental pathology groups and was highest in infants with inflammatory placental pathology (P&#x2009;=&#x2009;0.001), whereas cord blood P-SEP and hs-CRP did not differ significantly. Postnatal CRP was also higher in infants with inflammatory placental pathology (P&#x2009;=&#x2009;0.004). In adjusted binary models, inflammatory placental pathology remained associated with higher cord blood PCT (adjusted fold change 2.31, 95% CI 1.50-3.55; P&#x2009;<&#x2009;0.001) and higher postnatal CRP (adjusted fold change 4.66, 95% CI 2.23-9.76; P&#x2009;<&#x2009;0.001). Exploratory lesion-specific analyses showed stepwise increases in cord blood PCT and postnatal CRP from no inflammatory lesion to MIR-only and the highest values in FIR-present cases (overall P&#x2009;=&#x2009;0.003 and P&#x2009;=&#x2009;0.002, respectively). Culture-confirmed or clinically diagnosed EOS and microbiological positivity were more frequent in infants with inflammatory placental pathology. Histopathological placental inflammation in preterm infants was associated with higher umbilical cord PCT and higher postnatal CRP. Cord blood PCT showed the most consistent association with inflammatory placental pathology, including in exploratory analyses of fetal inflammatory response lesions. These findings support the potential clinical relevance of clinically available inflammatory biomarkers in relation to placental inflammatory pathology, but larger studies are needed to confirm lesion-specific associations and clarify their clinical utility.

Comprehensive genomic analyses are increasingly accessible to children, adolescents and young adults (AYAs) with poor prognosis cancers. Challenges and successes of pediatric precision oncology studies from the perspectives of AYA patients, parents and healthcare providers (HCPs) are poorly described. Between March 2021 and May 2023, we interviewed AYA patients (12-21&#xa0;years), parents and HCPs who participated in pediatric precision oncology studies for poor prognosis cancers in British Columbia. Interviews followed an investigator-developed semi-structured topic guide. Data were coded inductively and deductively by one qualitative researcher and one trainee, supported by two additional team members. Analytic themes were established using qualitative thematic analysis. We interviewed 9 AYAs, 10 parents, and 17 HCPs. We identified five analytic themes: importance of clear communication of study information between patients, families and multidisciplinary HCPs; a need to support disclosure, understanding and clinical integration of research results; barriers to accessing innovative therapy and mitigation strategies; approaches to managing parent, patient and HCP hopes and expectations; personal challenges and stressors related to participation. We highlight unmet needs and offer practical considerations for integrating precision oncology into clinical practice. Considerations include educating and supporting oncologists through genomics results disclosure, increasing engagement with multidisciplinary HCPs, streamlining access to study information and results, coordinating efforts to clinically validate results and access therapies, and establishing real-world outcome data to inform clinical decision-making. Implementation of these strategies will optimize care for patients and families who are navigating poor prognosis cancers.

Evidence suggests that Ureaplasma urealyticum (UU) colonization is associated with the onset and progression of bronchopulmonary dysplasia (BPD) in very preterm infants. However, clinically practical tools for early postnatal risk stratification in very preterm infants with positive respiratory tract UU results remain lacking. This study aimed to develop a 72-h early postnatal prediction model for BPD in very preterm infants with positive respiratory tract UU results using variables available by the end of the first 72&#xa0;h after birth. This retrospective study included very preterm infants (gestational age&#x2009;<&#x2009;32&#x2009;+&#x2009;0&#xa0;weeks) with a positive UU result from respiratory tract sampling within 48&#xa0;h after admission at Qilu Hospital, Shandong University, between January 2020 and December 2024. Candidate predictors were restricted to perinatal and early postnatal variables available by the end of the first 72&#xa0;h after birth; therefore, the model was intended for early postnatal risk stratification rather than delivery-room or immediate-at-birth prediction. LASSO regression with tenfold cross-validation was used for variable selection. Variables with non-zero coefficients at &#x3bb;1se were entered into a full multivariable logistic regression model, and a parsimonious four-variable logistic regression model was refitted for nomogram construction. Internal validation of the final four-variable model was performed using bootstrap resampling (B&#x2009;=&#x2009;500). Of 270 infants assessed for eligibility, 260 were included in the final analysis, including 90 infants with BPD and 170 without BPD. Gestational age, endotracheal intubation, neutrophil count, and lymphocyte count were retained in the final model and incorporated into a nomogram. The model showed high apparent discrimination in the derivation cohort, with an apparent C-index of 0.950 (95% CI, 0.925-0.975) and an apparent Brier score of 0.084. Bootstrap internal validation yielded an optimism-corrected C-index of 0.945, an optimism-corrected calibration intercept of 0.010, and an optimism-corrected calibration slope of 0.875. These findings indicate good internal performance but should be interpreted cautiously because the model was developed in a single-center cohort and lacks external validation. We developed a 72-h early postnatal prediction model for BPD risk stratification in very preterm infants with positive respiratory tract UU results. The model should be interpreted as a 72-h early postnatal risk-stratification tool rather than a delivery-room prediction model. The model showed promising internal performance in this single-center cohort, but external validation is required before clinical implementation.

Due to immunosuppression, mucosal barrier injury, and prolonged neutropenia resulting from both the disease and chemotherapy, along with the frequent use of broad-spectrum antibiotics and glucocorticoids, children with leukemia are at a high risk of invasive fungal disease (IFD). The present study aimed to develop an effective machine learning model to predict fungal infections in children with leukemia. A total of 247 pediatric patients diagnosed with leukemia and concurrent infections were evaluated. Five distinct ML classifiers-Random Forest, Logistic Regression, Support Vector Machine (SVM), Na&#xef;ve Bayes, and K-Nearest Neighbors-were employed to construct predictive classification models. These models were trained using three distinct feature sets: (1) clinical features exclusively, (2) imaging features exclusively, and (3) an integrated feature set comprising both clinical and imaging data. The predictive model was validated prospectively in an independent cohort of 61 patients. Model performance was evaluated through cross-validation techniques to ensure robustness and generalizability. To validate the clinical applicability of the ML models, their diagnostic performance was systematically compared against that of three radiologists with varying experience levels: Reader A (3 years), Reader B (6 years), and Reader C (11 years). Among the five classifiers evaluated, models using both clinical and imaging features consistently outperformed those relying solely on either clinical or imaging features. Notably, the SVM algorithm exhibited the highest overall predictive performance. Within the SVM algorithm, the validation set achieved the mean area under the curve (AUC) values of 0.825 with clinical features alone, 0.852 with imaging features alone, and 0.947 when both clinical and imaging features were combined. The corresponding mean AUC values for the test set were 0.777, 0.797, and 0.879. Furthermore, a comparative analysis between the classification results of the SVM model and the diagnostic assessments provided by three radiologists demonstrated that the SVM consistently outperformed the radiologists across key performance metrics. The SVM algorithm demonstrates robust efficacy in predicting fungal infections among pediatric patients diagnosed with leukemia. Within the predictive model, the variables that exhibited the greatest influence included pleural thickening, neutropenia, hormone therapy, CRP level, mediastinal lymphadenopathy, and the presence of pleural effusion.

Apart from cholangitis, studies focusing on other postoperative infections after the Kasai procedure (KP) in children with biliary atresia (BA) remain limited.This study aimed to investigate the association between post-KP infection and prognosis. This retrospective study included children with BA who underwent KP. Postoperative infection was the primary exposure variable of interest in this cohort. The primary outcome measure was post-operative native liver survival, while the secondary outcome measure was mortality attributed to infection. A time-dependent Cox regression model was used to account for the timing of postoperative infection as a time-varying covariate. One. A total of 404 cases included in the study. There were no significant differences in gender, age at operation, or gestational age between the two groups (P&#x2009;>&#x2009;0.05). Two. Early-onset infection is primarily associated with delayed bilirubin clearance (P&#x2009;<&#x2009;0.01).Time-dependent Cox regression showed that later onset of infection was associated with better native liver survival (HR&#x2009;=&#x2009;0.777, 95% CI: 0.719-0.839, P&#x2009;<&#x2009;0.001). After accounting for measured confounders, each one-month later infection onset corresponded to a 22.3% lower hazard of death or liver transplantation. These findings should be interpreted as associations, not causal effects. Postoperative infection in biliary atresia is associated with delayed bilirubin clearance and poorer native liver survival. The timing of infection onset is an important factor associated with native liver survival outcomes. Given the observational design, causality cannot be inferred.

The diagnosis and management of pediatric sepsis remain challenging and time-sensitive. Early biological markers that may identify patients at risk of progression to septic shock are needed. Base deficit (BD) has been associated with adverse outcomes in adult sepsis, while alactic base excess (ABE) reflects non-lactate metabolic acidosis. This study aimed to evaluate the performance of BD and ABE compared with lactate in pediatric sepsis and to assess their association with time to progression to septic shock. This retrospective single-center cohort study included pediatric patients with sepsis between January 1, 2020, and September 1, 2024. Biomarkers were obtained at initial presentation prior to resuscitation. BD and ABE were categorized into normal, abnormal, and extremely abnormal groups based on distribution thresholds, while lactate was classified as normal (&#x2264;2.2 mmol/L) or abnormal (>2.2 mmol/L). Diagnostic performance was assessed using ROC curve analysis. Time-to-event analyses were performed using Kaplan-Meier curves and multivariable Cox regression models adjusted for BMI, CRP, albumin, and Phoenix Sepsis Score. A total of 44 patients were included, of whom 30 (68.18%) developed septic shock. Lactate demonstrated lower discriminative performance (AUC 0.624, 95% CI 0.447-0.800) compared with BD (AUC 0.940, 95% CI 0.875-0.999) and ABE (AUC 0.905, 95% CI 0.813-0.997). Both BD and ABE showed higher sensitivity and specificity for identifying patients who progressed to septic shock. In adjusted analyses, abnormal and extremely abnormal ABE and BD were associated with an increased hazard of progression to septic shock. Median time to shock was shortest in patients with extremely abnormal BD and ABE (approximately 8-9 hours), followed by abnormal lactate (13 hours), abnormal ABE (17 hours), and abnormal BD (18 hours). BD and ABE were associated with progression to septic shock in pediatric sepsis and may provide clinically relevant information for early risk stratification. In this cohort, these markers demonstrated stronger discriminative performance than lactate and may reflect metabolic disturbances present earlier in the disease course. However, these findings should be interpreted cautiously given the retrospective design and require prospective multicenter validation before clinical implementation.

Human herpesvirus 6 (HHV-6), the causative agent of exanthema subitum (ES), is a major viral cause of acute encephalopathy in Japan. Serum procalcitonin (PCT) is widely used as a biomarker of severe bacterial infections and has also been proposed as an early predictor of encephalopathy. However, elevated PCT levels are occasionally observed in ES without bacterial co-infection or encephalopathy, potentially complicating interpretation of PCT levels in febrile children. The association between primary HHV-6 infection and PCT elevation remains unclear. We therefore investigated clinical and laboratory factors associated with serum PCT levels in young children with primary HHV-6 infection. We conducted a retrospective cohort study of 188 febrile children aged&#x2009;<&#x2009;60 months who underwent serum PCT measurement between April 2021 and May 2024. Thirty children with clinically diagnosed ES and laboratory-confirmed primary HHV-6 infection were compared with 53 children with other virologically confirmed febrile illnesses. In exploratory analyses, multivariable logistic regression identified factors associated with ES, and multivariable linear regression explored factors associated with serum PCT levels in the ES group. Median serum PCT levels were significantly higher in the ES group than in controls (0.28 [interquartile range (IQR) 0.10-0.61] vs. 0.10 [IQR 0.10-0.31] ng/mL; P&#x2009;=&#x2009;0.018). The PCT/C-reactive protein ratio was also higher in ES (P&#x2009;=&#x2009;0.018). ES patients had lower white blood cell, neutrophil, and platelet counts, and higher aspartate aminotransferase and lactate dehydrogenase levels. In exploratory multivariable analysis, younger age (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.87-0.98; P&#x2009;=&#x2009;0.006), lower platelet count (OR 0.88; 95% CI 0.82-0.94; P&#x2009;<&#x2009;0.001), and higher PCT level (OR 1.74; 95% CI 1.02-2.95; P&#x2009;=&#x2009;0.042) were associated with ES. Among patients with ES, lower lymphocyte count and absence of febrile seizures were associated with higher PCT levels. All ES patients had a self-limited clinical course without encephalopathy. Among febrile children undergoing clinically indicated PCT testing, primary HHV-6 infection was associated with modest PCT elevation. These elevations may reflect HHV-6-associated hematologic alterations rather than bacterial co-infection or disease severity, highlighting the need for cautious interpretation of PCT in ES.

The Indiana Complex Care Coordination Collaborative (IC4) is a statewide model of care coordination design to enhance the quality of medical care for children with medical complexity (CMC) by training and embedding nurse care coordinators in primary care practices. This study examines the impact of IC4 care coordinators on caregivers' and patients' quality of medical care, access to medical and community resources, care workload, and the quality of life of caregivers and CMC. Caregivers of CMC (n = 13) completed one-hour semi-structured interviews focused on met/unmet needs, quality of medical care, co-developed shared plan of care, caregiver/patient quality of life, caregiver workload, and medical home experience. Using NVIVO, researchers used a codebook to conduct an inductive thematic analysis of the interview transcripts. The thematic analysis was revealed five overarching themes: (1) central role of the care coordinator, (2) proactive and personalized support, (3) care across the lifespan, (4) emotional support, and (5) navigating healthcare systems. Caregivers reported that they considered their care coordinator a trusted health professional who can advocate for them with other health professionals.&#xa0;Families appreciated that the shared plan of care created with the care coordinator can be easily&#xa0;disseminated to other healthcare and service professionals, as well as other family members,&#xa0;and helps the patients and families be seen as individuals, not just as a medical record. Care coordination can address unmet needs and greatly improve the quality of and access to care received by CMCs and their families. Unanimously, caregivers report the substantial instrumental, informational, and emotional support care coordinators (CCs) provide to access medical systems, resources, planning, and reduce patient care workload. Additionally, several caregivers reported substantial social support from the CC. However, several caregivers still reported feelings of loneliness and difficulties engaging with families without CMC.

Globally, jaundice affects about 6 in 10 term babies and 8 in 10 preterm newborns in their first week of life; West Africa, has the highest cases of neonatal jaundice, and it remains the leading cause of severe illnesses such as mental handicap, brain damage, physical disabilities and even early deaths among newborns in the region. A hospital-based retrospective study design was conducted from perinatal data collected over 10 years in tertiary hospitals in Ondo State, Nigeria. A structured data extraction form was used to collect retrospective data from records of neonates and their respective mothers from the selected health facilities from 2015 to 2024. Statistical analysis was performed using SPSS version 23. The prevalence of jaundice was presented using a line graph. Participants' socio-demographic and obstetric characteristics were assessed using frequency and percentage. Chi-square analysis was used to ascertain the relationship between the incidence of jaundice and socio-demographic and obstetric characteristics. P-value was set at 5% for significance. Among the 10,182 mother-neonates pairs analyzed, 8% were preterm and 92% were full-term neonates. The prevalence of jaundice among preterm and high-risk full-term between the year 2015-2024 were 37.4% and 5.7% respectively. Among pre-term neonates, jaundice was significantly more prevalent in babies aged 0-4 days, likewise among high-risk full-term neonates with 90.1% of jaundiced cases falling into this group. Neonatal jaundice exhibits a pronounced disparity in Ondo State, with preterms dramatically more affected than high-risk full-terms. Low birth weight, prematurity, and structural disadvantages like low maternal education, unemployment, and rural residence were consistent risk amplifiers.

Sub-Saharan Africa continues to face significant challenges with low birth weight (LBW). Factors such as antenatal care (ANC) utilization and socioeconomic status play critical roles in birth outcomes. It is therefore imperative to understand these relationships, which are crucial to developing tailored, workable interventions to improve maternal and child health outcomes in Ghana. This study aimed to examine the association between ANC utilization patterns, socioeconomic disparities, and low birth weight outcomes among women in Ghana. The study included 6,965 observations, with 4,056 complete cases. Due to substantial missingness in key variables (LBW, adequate ANC), a monotone missing data pattern consistent with Missing at Random (MAR) was observed. Multiple Imputation by Chained Equations (MICE) was employed using Fully Conditional Specification across 20 imputed datasets. Survey-weighted logistic regression was performed on each imputed dataset, with estimates pooled via Rubin's Rules. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test. The slope index of inequality was calculated to examine socioeconomic disparities. The prevalence of LBW was 10.0% in complete cases and 19.2% in imputed data. Socioeconomic inequality analyses revealed significant pro-rich gradients in ANC utilization. The disparities were more pronounced for optimal ANC (8&#x2009;+&#x2009;visits; SII: 0.431; RII: 1.538) than adequate ANC (4&#x2009;+&#x2009;visits; SII: 0.203; RII: 1.224). LBW was disproportionately concentrated among women of lower socioeconomic status (SII: -0.159; RII: 1.172). The adjusted multivariable model showed inadequate ANC (aOR: 1.97; 95% CI: 1.34-2.90), suboptimal ANC (aOR: 1.73; 95% CI: 1.27-2.36), and poor wealth status (aOR: 1.79; 95% CI: 1.18-2.72) were independently associated with higher odds of LBW. ANC visit frequency and household wealth are independently associated with LBW among Ghanaian women. These findings underscore the need for targeted interventions to improve ANC attendance and address socioeconomic disparities to reduce the burden of LBW in Ghana.

There remains controversy regarding the risk factors for failed hydrostatic enema reduction; therefore, we aimed to identify additional factors associated with unsuccessful hydrostatic enema reduction in children with ileocolic intussusception. This study was conducted retrospectively in two tertiary centers. Data were collected from patient charts or electronic medical records and consisted of pediatric intussusception cases treated with hydrostatic reduction during January 2021 and January 2025. Univariate and multivariate analyses, incorporating stepwise logistic regression, were conducted. Two hundred thirty-one patients with ileocolic-type intussusception were included and treated by ultrasound-guided hydrostatic reduction at two different institutions. Hydrostatic reduction was successful in 199 patients (86.2%), failed in 32 (13.8%). All patients were successfully discharged with uneventful recoveries. On multivariate analysis, under 12-month-old(OR&#x2009;=&#x2009;58.106,P&#x2009;<&#x2009;0.001 95%CI,14.166-238.338),an Onset of symptoms>48&#xa0;h (OR&#x2009;=&#x2009;7.070,P&#x2009;=&#x2009;0.014 95%CI,1.491-33.517), previous history of intussusception (OR&#x2009;=&#x2009;42.721, P&#x2009;<&#x2009;0.001 95%CI,5.729-318.572), constipation (OR&#x2009;=&#x2009;31.488, P&#x2009;<&#x2009;0.001 95%CI,5.597-177.137), and bowel Wall Thickening on US(OR&#x2009;=&#x2009;8.177, P&#x2009;=&#x2009;0.015 95%CI,1.513-43.553) were significantly associated with failed hydrostatic enema reduction. An age of under 1 year, previous history of intussusception, onset of symptoms, constipation, and bowel wall thickening on US were risk factors for failed hydrostatic reduction of ileocolic intussusception. Older children with long-term recurrent intussusception are at high risk of pathological leading points(PLPs) and hydrostatic reduction failure, requiring close pediatric surgical attention. Patients with these findings warrant early surgical consultation or transfer to a facility with pediatric surgical capabilities.

Cytomegalovirus (CMV) can be transmitted from the mother to the fetus during pregnancy, leading to a congenital CMV (cCMV), the most common congenital infection worldwide and may lead to severe neurological sequelae. Therefore, it is essential to evaluate the awareness of CMV infection and cCMV in childbearing women in high CMV prevalence countries, such as Jordan. A cross-sectional study was conducted to assess Jordanian women's knowledge and awareness of CMV and cCMV infection, attitudes toward prenatal and neonatal screening for CMV, and the frequency of behaviors that may increase the risk of CMV transmission. Data were collected over two months using a structured questionnaire administered face-to-face in private settings at public community centers and the University of Jordan Hospital clinics. The questionnaire included demographic variables, CMV-related knowledge, attitudes toward screening, and behaviors potentially associated with CMV transmission risk. Data were recorded electronically by interviewers. Out of 589 eligible women, only 16.3% of women had heard of CMV, and among those, 67% were aware of cCMV. Never-pregnant women were more likely to report awareness of cCMV than recently-pregnant women. After receiving educational information about CMV, 91.7% and 94.9% of women believed that CMV screening for pregnant women and newborns, respectively, should be offered. Additionally, 71.3% indicated they would choose prenatal screening in a future pregnancy. Childcare&#x2011;related behaviors that may increase CMV transmission-such as kissing children on the lips or sharing cups and food-were commonly reported, highlighting important knowledge gaps. This study demonstrates a substantial lack of awareness of CMV and cCMV among Jordanian women of childbearing age, regardless of pregnancy history. However, brief education markedly improved support for both prenatal and newborn CMV screening. These findings underscore the urgent need for comprehensive CMV education, increased public health messaging on CMV transmission, and consideration of policy measures to reduce cCMV risk in high&#x2011;prevalence populations.

To investigate the predictive value of interleukin-25 (IL-25), interleukin-33 (IL-33), and thymic stromal lymphopoietin (TSLP) levels in bronchoalveolar lavage fluid (BALF) for the development of asthma in children under 6 years of age with recurrent wheezing. A prospective cohort study was conducted from May 1 to September 30, 2024. Fifty children under 6 years of age with recurrent wheezing were enrolled as the wheezing group from the Department of Respiratory Medicine at Children's Hospital of Chongqing Medical University, while 51 age-matched children with bronchial foreign bodies were recruited as controls during the same period. Levels of IL-25, IL-33, and TSLP in BALF were measured by enzyme-linked immunosorbent assay (ELISA). Children in the wheezing group were followed for one year and were subsequently categorized into an asthma group or a non-asthma group based on the follow-up outcomes. Integrating these clinical data with BALF cytokine levels, we constructed a predictive model for asthma development using receiver operating characteristic (ROC) curve analysis. Univariate analysis revealed significant differences between the wheezing group and the control group in terms of clinical characteristics (the number of wheezing episodes, age, history of allergy, breastfeeding), peripheral blood eosinophil count, BALF parameters (nucleated cells, red blood cells, neutrophils, macrophages), and cytokine levels (IL-25, IL-33, TSLP) (P&#x2009;<&#x2009;0.05). Of the 47 children in the wheezing group who completed the follow-up, 17 were diagnosed with asthma (asthma group) and 30 did not develop asthma (non-asthma group). Univariable analysis revealed significant differences between these two groups in terms of age, the number of wheezing episodes, levels of IL-25, IL-33, and TSLP in BALF (P&#x2009;<&#x2009;0.05). Logistic regression analysis confirmed that these factors were significant predictors for the progression to asthma in children with recurrent wheezing (P&#x2009;<&#x2009;0.05).ROC curve analysis demonstrated that the combination of the number of wheezing episodes with IL-25, IL-33, or TSLP levels yielded higher predictive values, with area under the curve (AUC) values of 0.90 (95% CI: 0.788-1.000), 0.946 (95% CI: 0.855-1.000), and 0.86 (95% CI: 0.698-1.000), respectively. These were superior to predictions based on wheezing episodes alone (AUC: 0.705) or individual cytokine levels (IL-25 AUC: 0.779; IL-33 AUC: 0.857; TSLP AUC: 0.841). In children under 6 years with recurrent wheezing, the levels of IL-25, IL-33, and TSLP in BALF are elevated and hold predictive value for the subsequent development of asthma, providing a reference for the early clinical identification of at-risk children.