Oral motor intervention plays a critical role in facilitating nutritional intake and supporting neurodevelopmental outcomes in preterm infants. The Premature Infant Oral Motor Intervention (PIOMI) is a standardized, five-minute, eight-step manual protocol designed to enhance oral-motor skills and sucking performance in very preterm infants. To translate, culturally adapt, and preliminarily validate the PIOMI for neonatal nurses in mainland China, and to pilot-test its clinical feasibility and preliminary efficacy on oral sucking performance in very-preterm infants. This study employed a two-phase translation and testing approach. Phase 1 comprised Brislin's six-step translation, a two-round electronic Delphi (e-Delphi) process, and assessment of content validity and implementation consistency. Phase 2 involved a parallel-group pilot randomized controlled trial. This study cross-culturally adapted the Premature Infant Oral Motor Intervention (PIOMI) into Chinese using Brislin's framework, finalized the mainland Chinese version (CMV-PIOMI) via a two-round e-Delphi expert consensus (n = 21), assessed its implementation consistency (n = 117), and evaluated its efficacy on preterm infants' oral sucking ability through a randomized controlled trial (n = 76). The Delphi response rate was 85.71% (n = 18), I-CVI ranged from 0.88 to 1.00, and S-CVI/Ave was 0.96, with six amendments incorporated. Among the 117 NICU nurses, the Pearson correlation coefficient for implementation consistency was 0.68 (p < 0.001), and paired CMV-PIOMI operational scores did not differ systematically (27.95 ± 0.48 vs. 27.99 ± 0.45, p = 0.266). In the pilot RCT (n = 76), baseline characteristics were comparable, and the proportion of preterm infants with normal sucking patterns was higher in the intervention group (50.0%) than in the control group (21.1%) (95% CI: 7.0% to 47.2%; p = 0.008). The Chinese PIOMI shows satisfactory content validity and acceptable implementation consistency and is feasible for delivery by bedside nurses. Preliminary evidence suggests improved oral sucking performance in very preterm infants, but larger, fully powered multicenter trials are needed to confirm these initial findings.Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR) ID: ChiCTR2300070320.
For children with asthma, access to and use of quick-relief inhalers can be life-saving. Children must have access and ability to use inhalers across home, school, and community settings. This study aimed to examine how children store and use inhalers across settings and evaluated the relationship to asthma control and exacerbations. This cross-sectional study recruited participants 10-17 years with asthma from clinics affiliated with one urban academic medical center. Children completed a questionnaire with questions about quick-relief inhaler storage and use within home, school, and community settings as well as asthma control and exacerbations. Responses were categorized by whether storage or use were independent or not independent. Kendall's Tau was calculated to assess correlation between children's independence of inhaler storage and use across settings. Chi-squared and Fisher's exact tests examined their association with asthma control and exacerbations. Among 90 enrolled children, 53% (N = 48) were male and 67% (N = 60) were non-Hispanic Black. Mean age was 13.1 years (SD = 2.2). At home, 52% (N = 47) of children reported independently storing quick-relief inhalers and 54% (N = 48) independently used inhalers. At school, 60% (N = 54) of children indicated they independently stored inhalers while 82% (N = 74) independently used inhalers. In the community, 90% (N = 81) of children reported independently storing inhalers. Within settings, there was moderate correlation between independent inhaler storage and use. Across settings, independent inhaler use was moderately correlated between home and school; however, independent storage of inhalers was not correlated. Also, inhaler storage and use was not associated with asthma control or exacerbations. This observational study is among the first to describe quick-relief inhaler storage and use by children across settings, showing variation in practices. Although we found storing and using quick-relief inhalers independently were correlated at home and school, they were not associated with asthma control or exacerbations. These findings help identify patterns related to asthma self-management and highlight opportunities for collaboration between clinicians, caregivers, and children to support developmentally-appropriate asthma care across settings.
Arterial hypotension in critically ill children is a frequent and high-risk clinical finding, yet universally accepted definitions, thresholds, and management strategies remain lacking. Blood pressure is an accessible but imperfect surrogate for circulatory adequacy, and uncertainty persists regarding when and how aggressively hypotension should be treated. This narrative review aims to synthesize current evidence on the assessment and management of arterial hypotension in critically ill infants and children (beyond the neonatal period) and to translate these concepts into a structured, clinically applicable framework. This publication synthesizes current international guidelines, recent clinical studies, and expert consensus on pediatric hemodynamic monitoring and shock management. Particular emphasis is placed on the interpretation of blood pressure in context, age-dependent mean arterial pressure (MAP) targets, and the integration of clinical examination, laboratory parameters, and point-of-care echocardiography. Arterial hypotension is typically a late sign of decompensated shock and is associated with increased mortality and adverse neurologic outcomes across multiple clinical scenarios, including septic shock, traumatic brain injury, and post-resuscitation care. MAP is the preferred parameter for assessment and therapeutic guidance. A pragmatic target of at least the 10th percentile for age appears reasonable in most critically ill children, balancing the risks of hypoperfusion and overtreatment. Early, repeated assessment using multimodal parameters-including cardiac point-of-care ultrasound-is essential. Initial management should prioritize rapid differentiation of shock etiology, judicious fluid resuscitation with balanced crystalloids, and early initiation of vasoactive therapy to avoid fluid overload. Emerging evidence supports norepinephrine as a first-line agent in distributive shock, with therapy tailored to underlying physiology. This review provides a pragmatic synthesis of current knowledge and presents a structured, evidence-based framework to support the bedside assessment and management of arterial hypotension in critically ill children. The inclusion of schematic approaches is intended to enhance clinical applicability by organizing existing evidence into an accessible format, while not representing original or unpublished data.
Understanding temporal and epidemiological patterns of pediatric infectious diseases is essential for developing targeted prevention strategies. This study investigated long-term incidence trends and epidemiological characteristics of notifiable infectious diseases among children in Xuhui District, Shanghai, from 2015 to 2023. Surveillance data for children aged 0-17 years were obtained from the National Notifiable Disease Reporting System (NNDRS). Joinpoint regression was applied to identify temporal trends and significant inflection points. Age-specific distributions were analyzed and seasonal patterns were visualized using radar charts. From 2015 to 2023, a total of 27,940 pediatric cases involving 23 notifiable infectious diseases were reported, corresponding to an average annual incidence of 2,421.68 per 100,000 children. Joinpoint regression identified a significant inflection point in 2021. Overall incidence declined during 2015-2021 (APC = -11.71%, 95% CI: -30.10 to -1.50, P = 0.029) and increased sharply thereafter (APC = 141.05%, 95% CI: 34.40-244.50, P < 0.001). When COVID-19 cases were excluded, no significant long-term trend was observed (APC = -4.2%, 95% CI: -23.60 -20.80, P = 0.71), indicating that the apparent post-2021 increase was driven primarily by COVID-19 notifications rather than a generalized resurgence of other pediatric infections. Disease-specific trajectories varied: influenza showed a pronounced post-pandemic surge, despite the absence of a significant long-term monotonic trend, whereas varicella, mumps, and scarlet fever continued to decline; in contrast, other infectious diarrhea showed a sustained upward trend (APC = 8.00%, 95% CI: 2.60-13.70, P = 0.003). Over time, the age distribution shifted toward school-aged children, with a significantly increasing proportion of cases occurring among those aged ≥4 years (χ 2 trend = 1475.594, P < 0.01). Pediatric infectious disease epidemiology in Xuhui District underwent substantial changes across the pre-pandemic and post-pandemic periods. The sharp rise after 2021 was largely attributable to COVID-19, rather than a uniform rebound of all infectious diseases. Distinct temporal patterns across respiratory, enteric, and other infections underscore the importance of pathogen-specific transmission characteristics and age-related exposure in shaping long-term trends. These findings highlight the need for targeted, age-appropriate prevention strategies and sustained surveillance in the post-pandemic era.
Necrotizing enterocolitis (NEC) is s a life-threatening inflammatory intestinal disorder primarily affecting preterm infants, though rare in full-term neonates. NLR-family CARD domain-containing protein 4 (NLRC4), a cytosolic inflammasome component driving IL-1β-mediated inflammation, is linked to autoinflammatory syndromes via germline gain-of-function mutations, though its role in term infant NEC remains underexplored. A full-term male infant developed NEC shortly after birth, requiring emergency surgical interventions including ileostomy and intestinal resection. Intraoperative findings revealed multifocal necrosis in the small intestine (80 cm total length) and colon. Genetic testing identified a heterozygous NLRC4 variant (c.1357C > T, p. Arg 453*), inherited from an asymptomatic father. Sanger sequencing confirmed the mutation's de novo origin. Pathological analysis demonstrated transmural inflammation without evidence of Hirschsprung disease. This report identifies a novel truncating variant in the NLRC4 gene associated with severe autoinflammatory enterocolitis presenting as NEC in a term neonate. Early NLRC4 screening may guide targeted therapies and improve outcomes in severe intestinal inflammation.
In children and infants, thoracic empyema most often develops as a complication of parapneumonic pleural effusions progressing to purulent collections. With an estimated incidence of approximately 0.6% among pediatric pneumonia cases, empyema remains associated with significant morbidity. This study aimed to characterize pediatric parapneumonic empyema by analyzing clinical, biochemical, and radiological parameters and their relationship with treatment decisions and outcomes. We conducted a retrospective, single-center study including children diagnosed with parapneumonic pleural empyema and treated in the Pulmonology Department of the "Grigore Alexandrescu" Emergency Hospital for Children between January 2021 and December 2024. Only patients managed surgically-either by chest-tube drainage or video-assisted thoracic surgery (VATS)-were included. Fibrinolytic therapy was not used due to limited institutional experience, with VATS preferred in complicated cases. Patients were stratified according to initial intervention. Clinical, laboratory, and imaging data were extracted from medical records. A total of 33 patients were included, with a median age of 4 [3-8] years. The median time to initial intervention was 2 [1-5] days. Fourteen patients (42.4%) underwent primary VATS after a median of 4.5 [2-6.3] days, while 19 received initial chest-tube drainage after 1 [0-3] days, with a mean drainage duration of 21.2 ± 11.5 days. Median hospital stay for the cohort was 27 [21-38.5] days. Loculations and septations were significant predictors of hospitalization length. Drainage duration was significantly shorter in the primary VATS group compared with the chest-tube group (9.5 [7.8-12.5] vs. 19 [11-30] days; p = 0.011). Dyspnea strongly predicted selection of VATS as initial treatment (OR 18.0, 95% CI 1.86-174.21; p = 0.013). Imaging findings on thoracic ultrasound did not significantly influence the choice of initial intervention. Computed tomography, performed in 45.5% of cases, identified complications such as bronchopleural fistula, empyema necessitans, and pyopneumothorax, and was associated with prolonged hospitalization. Chest-tube drainage was the most frequent initial treatment, with escalation decisions driven primarily by clinical presentation rather than imaging or biochemical markers. Thoracic ultrasound was valuable for assessing effusion complexity but had limited prognostic utility. The lack of fibrinolytic therapy resulted in a high rate of VATS, highlighting the need for standardized, symptom-driven management algorithms integrating clinical, laboratory, and imaging data.
To explore the efficacy and safety of ruxolitinib in children with systemic juvenile idiopathic arthritis complicated by macrophage activation syndrome (sJIA-MAS), particularly in those with refractory disease. The clinical courses of two children with refractory sJIA-MAS treated with ruxolitinib at our center were retrospectively reviewed. In addition, Chinese and English databases were searched to summarize the clinical features, therapeutic outcomes, and safety of ruxolitinib in pediatric sJIA-MAS. In both patients from our center, systemic hyperinflammation improved markedly during combined therapy that included ruxolitinib, allowing glucocorticoids to be gradually tapered and discontinued without relapse. Case 1 was a 19-month-old boy diagnosed with refractory sJIA-MAS complicated by respiratory failure. Despite methylprednisolone pulse therapy, low-grade fever and rash persisted. After starting ruxolitinib, body temperature stabilized and clinical symptoms improved rapidly. Glucocorticoids were discontinued within three months, and tocilizumab was stopped after one year. Case 2 was a 4-year-old girl diagnosed with refractory sJIA-MAS complicated by acute respiratory distress syndrome and thrombocytopenia. She received methylprednisolone pulse therapy and ruxolitinib combined with plasma exchange (three sessions). Body temperature normalized on the second day after ruxolitinib initiation. Dyspnea resolved, and ferritin levels normalized within 10 days. Glucocorticoids were discontinued within six months. No ruxolitinib-related adverse events were observed. In addition, five previously reported pediatric cases were identified. A total of seven children (three males and four females; age range 1-11 years) were analyzed. Of the seven patients reviewed, five met criteria for refractory sJIA-MAS, while two were not strictly refractory but received ruxolitinib due to incomplete response or intolerance to standard therapy. Five achieved complete remission and two achieved partial remission. Two patients experienced relapse during glucocorticoid tapering and achieved complete remission after the addition of canakinumab. No deaths were reported. One patient developed Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis and neutropenia after ruxolitinib treatment, which resolved after drug discontinuation and plasma exchange. Ruxolitinib may serve as a potential rescue or bridging therapy for patients with sJIA-MAS, especially those with refractory disease unresponsive to first-line therapy. Close monitoring for cytopenia and viral infections is recommended during treatment.
This study aims to evaluate the clinical value of combined blood acylcarnitine (BA) and amino acid profiling in differentiating the etiologies of neonatal cholestasis (NC) and to provide a novel approach for the early and accurate identification of biliary atresia and non-biliary atresia forms of NC. Clinical data were retrospectively collected from 180 newborns with NC who were admitted to this hospital between January 2023 and January 2026. The patients were divided into a biliary atresia group and a non-biliary atresia group based on whether they ultimately developed BA. Baseline characteristics and laboratory test results were obtained for all participants. Plasma acylcarnitine levels were detected by tandem mass spectrometry, and serum amino acid concentrations were determined using high-performance liquid chromatography/tandem mass spectrometry. Acylcarnitine and amino acid concentrations were then compared between the two groups. The diagnostic ability of individual metabolites was assessed by calculating the area under the curve (AUC). A composite detection model was established by performing binary classification analysis, and its predictive accuracy was evaluated. Compared with the non-biliary atresia group, patients in the biliary atresia group showed significantly higher levels of direct bilirubin/total bilirubin ratio, γ-glutamyl transpeptidase, alkaline phosphatase, C2, C8, C12, C18, leucine (Leu), valine (Val), proline, phenylalanine, alanine (Ala), glycine, and the (Leu + Val)/tyrosine ratio (all P's < 0.05). Receiver operating characteristic curves of the individual markers showed that Leu had the highest discrimination index (AUC = 0.805), whereas C2 and Ala were less effective. The integrated detection system obtained an AUC of 0.963, with sensitivity exceeding 89.86% and specificity exceeding 86.24%. Overall, the combined evaluation of plasma acylcarnitine and amino acid profiles provides a more accurate approach for identifying the causes of neonatal cholestasis, such as biliary atresia, through multiple factors. This method provides necessary non-invasive reference for diagnosing neonatal cholestasis and should be widely promoted for clinical use.
Neonatal esophageal perforation (EP) is a rare but potentially life-threatening complication, particularly in extremely low birth weight (ELBW) infants exposed to repeated invasive procedures. Although conservative management has progressively improved survival rates, mortality remains significant among the most vulnerable neonates. Literature studies predominantly describe favorable outcomes, possibly underrepresenting early lethal cases and overlooking the ethical implications of iatrogenic injury in infants at the threshold of viability. We report a fatal case of iatrogenic EP in an ELBW preterm infant and discuss diagnostic challenges, management strategies, and ethical considerations. A male infant was born at 27 weeks' gestation with severe intrauterine growth restriction and birth weight of 480 g. His clinical course was complicated by respiratory distress syndrome requiring prolonged mechanical ventilation, sepsis, patent ductus arteriosus, evolving bronchopulmonary dysplasia, pulmonary hypertension, hypertrophic cardiomyopathy, and periventricular leukomalacia. On day 24 of life, acute abdominal distension and clinical deterioration prompted radiographic and ultrasonographic evaluation. Imaging demonstrated malposition of the orogastric tube and right-sided pneumothorax, and subsequent mediastinal emphysema, confirming esophageal perforation. Conservative management was initiated, consisting of tube removal, nil per os, parenteral nutrition, broad-spectrum antibiotics, antifungal prophylaxis, respiratory and hemodynamic support, and pleural drainage. Despite timely recognition and adherence to recommended management strategies, the infant progressed to refractory multiorgan failure and died at one month of age. This case highlights the potentially fatal impact of EP in ELBW infants, in whom outcomes may be driven more by extreme prematurity and systemic instability than by the perforation itself. Bedside ultrasonography proved valuable for early detection and monitoring while limiting radiation exposure. Beyond clinical management, EP in critically ill preterm neonates raises complex ethical issues regarding proportionality of care, risk-benefit balance of invasive procedures, and transparent communication with families. Reporting severe and fatal cases is essential to improve awareness, refine preventive strategies, and foster ethically grounded decision-making in neonatal intensive care.
Preterm infants are frequently exposed to painful procedures during neonatal intensive care, yet their physiological capacity to respond to pain and the reliability of related biomarkers remain incompletely understood. This meta-analysis aimed to synthesize evidence on physiological correlates of pain in preterm infants to identify consistent objective indicators of pain. A systematic search of PubMed, Scopus, Web of Science, Embase, and CINAHL was conducted for studies published between January 2017 and December 2025. Randomized controlled trials, cohort, and observational studies assessing physiological responses to procedural pain in preterm infants were included. Data were analyzed using random-effects models, and heterogeneity was assessed with the I² statistic. Fifteen studies involving 1,273 preterm infants met the inclusion criteria. Painful procedures induced significant increases in heart rate (mean difference +12.6 bpm, p < 0.001) and cortisol levels (SMD =  + 0.68, p < 0.01), alongside decreases in heart rate variability (SMD = -0.81, p < 0.001), oxygen saturation (-4.3%, p < 0.01), melatonin (SMD = -0.54, p < 0.05), and cerebral oxygenation (-8.5%, p < 0.001). Subgroup analyses showed the strongest effects in cardiorespiratory parameters (SMD = 0.91). No significant publication bias was detected. Procedural pain in preterm infants elicits robust physiological responses across autonomic, endocrine, and neurophysiological domains. Integrating these objective indicators into neonatal pain assessment may enhance early recognition and improve pain management practices, ultimately supporting better neurodevelopmental outcomes.
Unexpected distal airway obstruction is a critical challenge during neonatal resuscitation. Aspiration of intrauterine tissue is an uncommon cause that may not respond to standard algorithms. Through comparative analysis with three previously documented cases, this report aims to clarify the clinical features, diagnostic pitfalls, and key outcomes for this entity, emphasizing the need for heightened clinical awareness and technological advances. A male infant was born at 30⁺⁵ weeks via vaginal breech delivery due to spontaneous preterm labor. The mother completed antenatal corticosteroids for lung maturation 4 days prior. The infant exhibited apnea and bradycardia. Standard neonatal resuscitation failed. A DOPE assessment revealed no correctable problems; a suction catheter passed easily, creating a deceptive "False-Patency" sign. Deeper suctioning yielded only scant secretions. Chest compressions began at 18 min after birth. Simultaneously, intravenous epinephrine (1:10,000) was administered every three minutes, and a resuscitation bag delivered positive-pressure ventilation. These measures continued for 42 min (until one hour of life). Approximately 60 min after delivery, with chest compressions and ventilation still in progress, two bean-sized tissue fragments were pushed out of the trachea. After removal via endotracheal tube exchange, the infant achieved return of spontaneous circulation (ROSC). Within two minutes, heart rate rose to 140 beats/minute, and SpO₂ reached 93%. Chest compressions were then halted. Histopathology confirmed decidual tissue. Despite maximal support, the infant died from irreversible multi-organ failure. This case illustrates that aspiration of intrauterine decidual tissue is a rare but devastating cause of unexpected distal airway obstruction in preterm infants. Findings from all four reported cases indicate that standard algorithms (MRSOPA/DOPE) are ineffective. The "False-Patency" sign-easy passage of a suction catheter despite absent chest rise and breath sounds-is a major diagnostic trap, delaying identification of a solid, peripherally impacted foreign body. A strong suspicion for this condition is critical. While specialized airway visualization instruments for preterm neonates remain a long-term goal, the primary solution lies in cognitive vigilance-specifically, recognizing this unusual condition and its misleading "False-Patency" indicator.
This paper aims to review and summarize the existing research findings on Family-Centered Care (FCC) and Family-Integrated Care (FICare) in Neonatal Intensive Care Units (NICUs), evaluate their impacts on infants and their families, explore the facilitators and barriers during implementation, and discuss the applicability of these care models. We formulated strict inclusion and exclusion criteria for literature search and screening. Eligible studies were selected and collated in accordance with these criteria. Meanwhile, the measurement tools and research methods applied in the included literature were systematically sorted out, and a complete research framework was established. Literature was initially retrieved through databases and supplemented by snowball sampling. After removing duplicates, the remaining literature was screened by title and abstract, followed by full-text evaluation. A total of 33 methodological studies were finally included for analysis, covering randomized controlled trials, cohort studies, qualitative studies and other research types. FCC takes the family as the core and builds a collaborative partnership between healthcare providers and families. Family-Integrated Care has formed a more standardized implementation framework. Research evidence shows that FCC and FICare can accelerate infants' clinical growth rate, shorten hospital length of stay and improve breastfeeding rate, while reducing parental stress and effectively alleviating parental mental health problems. This review further identified the core facilitators for the implementation of these care models and summarized the major implementation barriers. Relevant studies confirm that the models have good applicability in countries such as China and India, although family financial burden affects their long-term implementation. FCC and FICare can significantly improve the clinical and developmental outcomes of NICU infants, enhance the efficiency of infant recovery and the mental health of parents. The promotion of this model requires strengthened training for medical staff, optimized diagnosis and treatment environments, as well as relevant adjustments based on regional culture and economic levels. Despite certain implementation challenges, they remain high-quality care models that meet the holistic needs of neonates and their families. In the future, digital technology will be used to explore their impact on long-term neurodevelopment of neonates, and a standardized evaluation system will be established to facilitate clinical application.
To investigate the effects of red blood cell transfusions and transfusion strategies on clinical outcomes in extremely low gestational age neonates (ELGANs). This retrospective cohort study enrolled 545 ELGANs with gestational age <28 weeks admitted between 2012 and 2024. Infants were divided into transfusion and non-transfusion groups. Tra nsfused infants were further classified into restrictive, liberal, and relatively liberal transfusion groups according to transfusion thresholds, and intergroup differences in clinical outcomes were analyzed. Multivariate logistic regression was performed to analyze the independent association between transfusion and outcomes, adjusted for treatment era (2012-2019 vs. 2020-2024), perinatal factors, postnatal illness severity, and treatment-related variables. Primary outcomes were bronchopulmonary dysplasia (BPD) and survival without severe complications. Secondary outcomes included severe retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), severe brain injury, and death. A total of 545 ELGANs were included, with a median gestational age of 26.5 (IQR 25.6-27.2) weeks. Among them, 346 infants (63.5%) received at least one transfusion, with a total of 798 transfusion episodes and a median number of transfusions of 2 (IQR 1-3). Of the transfused infants, 82 (25.0%) were in the restrictive transfusion group, 138 (39.9%) in the liberal transfusion group, and 92 (26.6%) in the relatively liberal transfusion group. An increased number of transfusions was an independent risk factor for BPD (adjusted OR = 1.88, 95% CI: 1.48-2.40, p < 0.001) and was independently associated with a lower rate of survival without severe complications (adjusted OR = 0.75, 95% CI: 0.63-0.91, p = 0.003). Meanwhile, a higher transfusion number was independently associated with lower risks of severe brain injury (adjusted OR = 0.62, 95% CI: 0.46-0.84, p = 0.002) and mortality (adjusted OR = 0.66, 95% CI: 0.53-0.83, p < 0.001). Transfusion number was not independently associated with severe ROP or NEC. The restrictive transfusion group had significantly fewer transfusions than the relatively liberal transfusion group, with no significant differences in BPD, survival without severe complications, or other adverse outcomes compared with the other two groups. In ELGANs, an increased number of transfusions is independently associated with a higher risk of BPD and lower survival without severe complications. A restrictive transfusion strategy safely reduces transfusion exposure without increasing the risk of major adverse outcomes and is recommended in clinical practice.
Acute rheumatic fever (ARF) remains a major cause of acquired heart disease in children, particularly in low- and middle-income countries. Cardiac involvement is the main determinant of long-term morbidity and mortality; however, early evaluation relies heavily on echocardiography, which may not always be readily accessible. Therefore, there is a need for adjunctive biomarkers to support clinical assessment and risk stratification. This case-control study included 38 pediatric patients diagnosed with ARF and 38 age- and sex-matched healthy controls. Serum levels of soluble suppression of tumorigenicity-2 (sST2) and mid-regional pro-adrenomedullin (MR-ProADM) were measured using enzyme-linked immunosorbent assay. Cardiac involvement was assessed by echocardiography and further categorized as mild or no involvement vs. moderate-to-severe involvement. Nonparametric tests, receiver operating characteristic (ROC) analysis, and multivariate logistic regression were performed. Both sST2 and MR-ProADM levels were significantly higher in patients with ARF compared to controls (p < 0.001 and p = 0.046, respectively). sST2 demonstrated good discriminative performance for distinguishing ARF from controls (AUC: 0.81), whereas MR-ProADM showed moderate performance (AUC: 0.67). When evaluating clinically relevant cardiac involvement, both biomarkers showed acceptable discriminative ability (AUC: 0.732 for sST2 and 0.707 for MR-ProADM). In multivariate analysis, sST2 was independently associated with moderate-to-severe cardiac involvement (OR: 1.02, 95% CI: 1.002-1.042, p = 0.033), while MR-ProADM showed a borderline association. sST2 and MR-ProADM are elevated in pediatric ARF and reflect systemic inflammatory and cardiovascular processes. While they are not substitutes for echocardiographic evaluation, sST2 in particular may provide additional information in identifying patients with more clinically significant cardiac involvement. These biomarkers may serve as supportive tools for clinical assessment and early risk stratification, especially in resource-limited settings.
Restraint use in pediatric intensive care units (PICUs), while essential for preventing unplanned extubation, presents ethical and practical challenges. Nurses, as primary implementers, often face psychological tensions arising from their dual role as caregivers and enforcers of safety. Yet, their subjective experiences remain underexplored. A descriptive phenomenological design was employed. Purposive sampling recruited 16 PICU nurses from a tertiary children's hospital in Jiangsu, China, between March and June 2025. Semi-structured, face-to-face interviews (30-60 min) were conducted and analyzed using Colaizzi's method. Ethical approval was obtained, and triangulation ensured rigor. Sample size was determined by data saturation. Sixteen PICU nurses participated. Five core themes emerged: (1) ethical tensions in balancing patient safety with respect for autonomy; (2) practical difficulties due to ill-fitting restraint tools and technical demands; (3) nurse-family communication breakdowns from emotional resistance and information asymmetry; (4) cumulative psychological strain, including vicarious trauma and diminished professional identity; (5) institutional needs for clear protocols, targeted training, and staffing support. Practice gaps included inconsistent emergency assessments, incomplete family consent, poor site-monitoring compliance, and lack of pediatric-specific tools. PICU nurses face multifaceted challenges in restraint care. Improvements require standardized pediatric guidelines, communication-focused training, non-restraint alternatives, and enhanced institutional support.
Pediatric arrhythmias are heterogeneous and differ from adult disease in presentation and management; evidence from geographically vast, resource-variable regions of northwestern China remains limited, particularly in settings where access to pediatric electrophysiology services and prolonged rhythm monitoring is uneven. To describe the clinical spectrum of pediatric arrhythmias, identify independent risk factors, and assess treatment effectiveness and safety in a multicenter cohort from Xinjiang. This retrospective multicenter study included children (≤18 years) diagnosed with arrhythmia by ECG and/or 24-hour Holter monitoring in six prefecture-level hospitals in Xinjiang (January 2019 to December 2024). A 1:1 age- and sex-matched healthy cohort served as controls. Candidate factors were screened by univariable chi-square tests and entered into multivariable binary logistic regression; results are reported as ORs with 95% CIs. Management was categorized as regular follow-up, pharmacotherapy, or radiofrequency catheter ablation, with effectiveness assessed using standardized follow-up criteria. We enrolled 232 children with arrhythmia (50.9% male), aged 1.2-18.0 years (mean 11.5 ± 3.6); 68.9% were ≥6 years. Supraventricular arrhythmias were most common (49.1%), and PSVT accounted for 35.3%. In multivariable analysis, congenital heart disease (OR 7.265, 95% CI 4.012-13.298), recent infection exposure (OR 6.452, 95% CI 3.605-11.521), and recurrent arrhythmia history (OR 8.216, 95% CI 4.458-15.169) were independent risk factors (all P < 0.05), while age ≥6 years was not. Management included follow-up (65.5%), pharmacotherapy (25.0%), and ablation (9.5%). Ablation in 22 PSVT patients achieved 100% acute success with no recurrence over 6-12 months. Among 102 patients with complete effectiveness evaluation, the overall response rate was 88.2%; four mild adverse drug reactions were observed. This Xinjiang multicenter cohort reveals region-specific divergences from published data: higher PSVT (35.3%) and ventricular arrhythmia (24.1%) proportions, and markedly lower ablation utilization (9.5%) vs. tertiary centers in eastern China and internationally. Congenital heart disease, infection exposure, and recurrence history were independent risk factors (ORs 6.5-8.2). Key actionable findings: (1) targeted ECG screening for high-risk children; (2) maintenance of school-based screening for subclinical detection; and (3) effective stratified management with pharmacotherapy and selective ablation, with regional capacity building needed to close the interventional care gap.
To evaluate factors associated with death before 36 weeks' postmenstrual age (PMA) or moderate-to-severe bronchopulmonary dysplasia (BPD) in very preterm infants while accounting for survivor bias. This retrospective cohort study included infants born at <32 weeks' gestation and admitted to a tertiary neonatal intensive care unit between January 2017 and December 2025. The primary outcome was death before 36 weeks' PMA or moderate-to-severe BPD. Baseline characteristics, neonatal morbidities, and respiratory support variables were examined. Multivariable logistic regression was performed using a sequential modelling approach incorporating early clinical variables and subsequent respiratory-course variables. Among 1,259 infants, 1,253 had complete outcome data and were included in the analysis; the composite outcome occurred in 27.1%. Risk decreased progressively with advancing gestational age, from 80.2% in infants born at <26 weeks to 11.7% at 30-31 weeks (p < 0.001). Each additional week of gestation was associated with lower odds of the composite outcome (aOR: 0.85, 95% CI: 0.77-0.94). In the fully adjusted model, cumulative duration of invasive ventilation (aOR: 1.29 per 7 days, 95% CI: 1.14-1.45) and HFOV exposure (aOR: 1.79, 95% CI: 1.15-2.79) were associated with the composite outcome, although the association with HFOV likely reflected greater underlying respiratory illness severity and escalation of support. Associations involving infection-related variables were attenuated after inclusion of respiratory-course variables. Model discrimination improved from 0.807 to 0.841. In very preterm infants, lower gestational age and prolonged invasive ventilation were the principal factors associated with death or moderate-to-severe BPD. Associations involving respiratory escalation therapies likely reflected greater underlying illness severity and evolving respiratory trajectory.
To characterize the epidemiological patterns of childhood infectious diseases during and after the COVID-19 pandemic and to inform optimization of pediatric prevention and control strategies. A descriptive epidemiological analysis was conducted on reported infectious disease cases among children aged ≤14 years at Qingyang Maternal and Child Health Care Hospital. The pandemic period was defined as 2020-2022, and the post-pandemic period as 2023-2025. Proportions were compared using the chi-square test. From 2020 to 2025, a total of 2,559 cases were reported, yielding an overall reporting rate of 5.28 per 1,000 outpatient visits. Only 53 cases (0.42‰) occurred during the pandemic period, whereas 2,506 cases (6.98‰) occurred post-pandemic. The annual reporting rate ranged from 0.37‰ in 2022 to 10.32‰ in 2025. The male-to-female ratio was 1.30:1. The proportion of cases aged ≤2 years increased from 33.96% during the pandemic to 46.89% post-pandemic, while the 7-14 year age group declined from 28.30% to 15.96%. Nearly all cases (98.94%) resided in Qingyang City. The disease spectrum shifted markedly: varicella (45.28%), pertussis (22.64%), and mumps (11.32%) predominated during the pandemic, whereas influenza (48.72%), other infectious diarrheal diseases (26.94%), and hand-foot-mouth disease (12.01%) dominated the post-pandemic period. Case counts for pertussis, diarrheal diseases, hand-foot-mouth disease, and varicella increased significantly across multiple age strata post-pandemic. Total medical expenditures reached ¥5,623,550.62, with 98.70% incurred post-pandemic; influenza [¥2,746,750.98 (RMB)] and other infectious diarrheal [¥2,455,076.20 (RMB)] constitute the primary economic burden. The pediatric infectious disease spectrum underwent a substantial post-pandemic transformation, with influenza, diarrheal diseases, and hand-foot-mouth disease replacing varicella and pertussis as dominant conditions. Children aged ≤6 years emerged as the primary affected population. The high caseload and economic burden of influenza and diarrheal diseases underscore the need for strengthened surveillance, prioritized protection of younger children, optimized resource allocation, and refined vaccination strategies in the evolving epidemiological landscape.
Suicide is the second leading cause of death among children and adolescents, with rates of pediatric suicidal behavior rising substantially over the past two decades. The neurobiology of suicide has been extensively studied in adults, yet pediatric-specific evidence remains limited and the extent to which adult findings can be extrapolated to youth is unclear. This review synthesizes current evidence on the neurobiological correlates of suicidal ideation, suicide attempt, and death by suicide in pediatric and adolescent populations across neurological, genetic, epigenetic, inflammatory, metabolic, and endocrine domains. A literature search was conducted in PubMed, Embase, PsycINFO, and Google Scholar for peer-reviewed, English-language human studies. Priority was given to pediatric and adolescent samples, with adult data included where pediatric evidence was lacking. Studies were grouped by biological domain and by suicidal phenotype. Suicidal ideation, suicide attempt, and death by suicide showed partially distinct biological signatures rather than lying on a single continuum of severity. Different markers, most notably cortisol regulation and stress-related DNA methylation, differed in direction between pediatric and adult cohorts, indicating that adult biomarker data cannot be directly extrapolated to youth. Findings converged on a developmental cascade in which genetic liability and early-life adversity influence the hypothalamic-pituitary-adrenal axis, with downstream effects on epigenetic regulation, neuroinflammation, neurochemistry, and frontolimbic circuitry. Pediatric suicidal behavior reflects developmentally distinct biological processes that cannot be inferred from adult findings. Advancing the field will require longitudinal, multimodal pediatric studies that disaggregate suicidal phenotypes, span the pubertal transition, and apply age-stratified reference ranges, supporting biologically informed stratification and mechanism-targeted intervention.
Patent ductus arteriosus (PDA) results in pulmonary overcirculation and, depending on ductal size and patient age, may lead to symptoms of congestive heart failure and the development of pulmonary hypertension, among other complications. Percutaneous closure is currently considered the first-line option in most patients, depending on clinical and anatomical characteristics. Approved PDA occlusion devices are tailored to specific ductal morphologies; therefore, off-label devices such as muscular ventricular septal defect occluders, vascular plug II, or atrial septal defect occluders have been used in selected patients. With the advent of newer devices, and particularly the KONAR-MF™, a broad range of PDA morphologies can be treated, including in patients weighing <6 kg. To evaluate the clinical and epidemiological characteristics of patients in whom PDA was closed using the off-label KONAR-MF™ device and to report outcomes at 6 months postprocedure. This was a retrospective, single-center, descriptive observational case-series study with a 6-month follow-up. All patients who used the KONAR-MF™ device between 2024 and 2025 and met the inclusion and exclusion criteria were included in this study. Seventeen patients were analyzed. The median age was 1 year and the median weight was 11 kg. Female sex accounted for 58.8% of cases. Functional class III was present in 58.8% of patients. Severe pneumonia was the reason for admission in 23.5% of patients. Down syndrome was recorded in 17.6% of patients. According to the Krichenko classification, 47.1% of PDAs were type C, and 11.7% were associated with a ventricular septal defect. The median minimum ductal diameter was 5 mm and the median ductal length was 8 mm. The median pulmonary artery pressure was 25 mmHg, median fluoroscopy time was 9.7 min, and median radiation dose was 46 mGy/cm2. Transthoracic echocardiography combined with fluoroscopy was used in 11.8% of patients. The antegrade approach was used in 64.7% of procedures. The most frequently used device sizes were 6/4 and 12/10. On serial echocardiography, a residual shunt was detected in 23.5% of patients, and it had resolved in all of them by 6 months. Despite the small sample size of this study, the findings suggest that the KONAR-MF™ device, when used off-label, may be a valid alternative in complex anatomies or in underweight patients.