Frontiers in Pediatrics最新文献

{"title":"Indications, findings, and clinical impact of invasive pediatric urodynamic studies in Iraqi children.","authors":"Hawkar Khayyat","doi":"10.3389/fped.2026.1885576","DOIUrl":"https://doi.org/10.3389/fped.2026.1885576","url":null,"abstract":"<p><strong>Background: </strong>Pediatric urodynamic study (UDS) provides an objective functional assessment of lower urinary tract dysfunction and assists in identifying high-risk bladder abnormalities associated with renal deterioration in children. However, regional evidence regarding pediatric UDS findings and their clinical implications remains limited in the Kurdistan Region of Iraq.</p><p><strong>Objective: </strong>To evaluate the clinical indications, urodynamic findings, and impact of pediatric UDS on patient management among children undergoing evaluation at a tertiary pediatric referral centre in Erbil, Iraq.</p><p><strong>Methods: </strong>This retrospective observational study included pediatric patients who underwent invasive UDS between January 2019 and December 2025 at a tertiary pediatric hospital in the Kurdistan Region of Iraq. Demographic characteristics, clinical indications, urodynamic findings, and treatment modifications following UDS were retrospectively collected from archived medical records and urodynamic reports. Associations between selected urodynamic abnormalities and treatment adjustment were evaluated using Fisher's exact test.</p><p><strong>Results: </strong>A total of 47 children were included, with a median age of 3.0 years (IQR, 7.0), and 78.7% were male. Vesicoureteral reflux (25.5%), posterior urethral valve (19.1%), and functional urinary incontinence (14.9%) were the most common indications for UDS. Abnormal urodynamic findings were identified in 59.6% of patients, with detrusor overactivity (21.3%), obstructive voiding (19.1%), underactive bladder (17.0%), reduced bladder compliance (19.1%), elevated detrusor leak point pressure (DLPP >40 cmH₂O; 12.8%), and abnormal sphincteric activity (10.6%) being the most frequent abnormalities. Treatment modification following UDS occurred in 48.9% of patients. Reduced bladder compliance was significantly associated with treatment adjustment (<i>p</i> = 0.001), whereas elevated DLPP and abnormal sphincteric activity were not significantly associated with management modification.</p><p><strong>Conclusion: </strong>Pediatric UDS provided clinically valuable functional information and influenced individualized management decisions in children with complex lower urinary tract disorders in the Kurdistan Region of Iraq. Reduced bladder compliance was associated with treatment modification following UDS, highlighting its clinical importance in guiding therapeutic decision-making. These findings provide one of the first regional datasets describing the indications, urodynamic findings, and management implications of pediatric UDS in Iraq.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1885576"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Turkish cultural adaptation and psychometric evaluation of the children activity scales-parent and teacher forms (ChAS-P/T).","authors":"Duygu Demirbas, Merve Cebi, Teresa A May-Benson, Aymen Balikci","doi":"10.3389/fped.2026.1906645","DOIUrl":"https://doi.org/10.3389/fped.2026.1906645","url":null,"abstract":"<p><strong>Background: </strong>Developmental Coordination Disorder (DCD) is a prevalent neurodevelopmental condition that negatively affects children's participation in daily activities at home and school. Screening tools based on parent and teacher reports are particularly valuable for early identification, as they capture functional performance in natural contexts. The Children Activity Scales-Parent and Teacher Forms (ChAS-P/T) were developed for this purpose; however, a Turkish version for Turkish children has not previously been available.</p><p><strong>Objective: </strong>This study aimed to translate and culturally adapt the ChAS-P/T into Turkish and to examine its reliability and validity in children aged 4-8 years.</p><p><strong>Methods: </strong>The study followed internationally recommended guidelines for cross-cultural adaptation and psychometric validation. The ChAS-P/T was translated, culturally adapted, and pre-tested before psychometric evaluation. Parents and teachers of 340 Turkish children aged 4-8 years, including typically developing children and 34 children diagnosed with DCD, participated. The psychometric evaluation assessed the reliability, construct validity, discriminant validity, and criterion-related validity of the Turkish version.</p><p><strong>Results: </strong>The Turkish ChAS-P and ChAS-T demonstrated excellent internal consistency and strong test-retest reliability. Confirmatory factor analyses supported the original four-factor structure of the parent form and three-factor structure of the teacher form. Significant group differences supported discriminant validity. ROC analyses indicated good to excellent criterion-related validity, with optimal cut-off scores yielding high sensitivity and specificity. Strong correlations between parent and teacher reports further supported convergent validity across informants.</p><p><strong>Conclusions: </strong>The Turkish versions of the ChAS-P and ChAS-T are reliable and valid screening instruments for identifying children aged 4-8 years at risk for DCD. Their robust psychometric properties and multi-informant structure support their use in clinical and educational settings to facilitate early identification and referral.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1906645"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Juvenile dermatomyositis in Latvia: clinical, radiologic, laboratory, and therapeutic findings from 2010 to 2025.","authors":"Lilija Banceviča, Zane Dāvidsone, Kristīna Budarina, Kristīne Rasa","doi":"10.3389/fped.2026.1880638","DOIUrl":"https://doi.org/10.3389/fped.2026.1880638","url":null,"abstract":"<p><strong>Background: </strong>Juvenile dermatomyositis (JDM) is a rare autoimmune inflammatory myopathy characterized by inflammation of skeletal muscle and skin, with potential multisystem involvement. Long-term population-based data remain limited, particularly in small countries such as Latvia. This retrospective analysis (2010-2025) describes epidemiological, clinical, laboratory, and imaging findings among children with JDM in Latvia.</p><p><strong>Materials and methods: </strong>We conducted a single-center retrospective case series of all children diagnosed with JDM at the Children's Clinical University Hospital, Riga, between 2010 and 2025. Diagnosis was established according to the 2017 EULAR/ACR classification criteria. Clinical features, laboratory parameters, imaging findings, treatment strategies, and outcomes were analyzed.</p><p><strong>Results: </strong>Seventeen children were identified (58.8% female), with a median age at diagnosis of 6 years (range, 2-16 years). The mean annual incidence was 0.32 per 100,000 children. Disease was most frequently diagnosed in winter (52.9%). The median time from symptom onset to diagnosis was 90 days. The most common clinical features were symmetric proximal muscle weakness (70.6%), generalized weakness (70.6%), and characteristic skin manifestations (58.8%), including heliotrope rash and Gottron's papules. Elevated lactate dehydrogenase (LDH) and erythrocyte sedimentation rate (ESR) were observed in 94% of children, whereas creatine phosphokinase (CPK) elevation occurred in 35%. Muscle magnetic resonance imaging demonstrated inflammatory changes consistent with myositis when clinically indicated. One child with JDM developed interstitial lung disease, one had gastrointestinal vasculitis, and one had clinically amyopathic JDM. All children received pharmacological treatment, most commonly glucocorticosteroids and non-steroidal anti-inflammatory drugs, with methotrexate used as the principal steroid-sparing agent. Remission within the first year was achieved in 70.6% of children using conventional therapy alone. Two children received biologic therapy. No mortality or macrophage activation syndrome was observed.</p><p><strong>Conclusions: </strong>This retrospective study covering 2010-2025 shows that JDM in Latvia generally presents similarly to that described in other cohorts of children. Proximal muscle weakness and characteristic skin findings were common, while CPK elevation was observed in only a subset of children. Most children responded well to treatment with glucocorticosteroids and methotrexate, with remission achieved in the majority within the first year and only rare need for biologic therapy. Muscle MRI was particularly helpful in selected cases when laboratory findings were inconclusive. Overall outcomes were favorable, with few severe complications and no mortality.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1880638"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrepancy in applied tidal volumes between t-piece and lung level during delivery room stabilization - a case report.","authors":"Alexia Zanghi, Maria Wall, David G Tingay, Andreas W Flemmer, Vincent D Gaertner","doi":"10.3389/fped.2026.1918821","DOIUrl":"https://doi.org/10.3389/fped.2026.1918821","url":null,"abstract":"<p><p>We present data of a preterm infant at 28 4/7 weeks gestation with inadequate response to non-invasive ventilation after birth who was intubated five minutes after delivery. During non-invasive stabilization, we noted a discrepancy between the displayed tidal volumes on the respiratory function monitor (RFM) and the real-time electrical impedance tomography (EIT) measurements. While expiratory tidal volumes on the RFM were in the recommended target of 4-6 mL/kg, EIT showed only minimal tidal volumes (corresponding to approximately 1-3 mL/kg), which was more consistent with the clinical impression of the neonate. After intubation, tidal volumes shown on RFM and EIT were similar, suggesting that RFM may be unreliable during non-invasive ventilation, possibly due to the large compliance of the nasopharyngeal space. EIT may be a helpful additional clinical tool in selective cases in the delivery room.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1918821"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose (0.15 mg/kg) versus high-dose (0.6 mg/kg) dexamethasone for pediatric croup: a meta-analysis with trial sequential analysis of RCTs.","authors":"Ayesha Khalid, Susan Flesher, Thaís S Martins Shehan","doi":"10.3389/fped.2026.1925971","DOIUrl":"https://doi.org/10.3389/fped.2026.1925971","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic glucocorticoids are the standard treatment for croup. Although dexamethasone 0.6 mg/kg is widely recommended, lower doses may provide similar benefit. To compare oral dexamethasone low dose (0.15 mg/kg) to high dose (0.6 mg/kg) in children with croup.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Cochrane Library from inception to November 25, 2025. We restricted our analysis to randomized controlled trials (RCTs) directly comparing low-dose vs high-dose oral dexamethasone in children with croup. Risk ratios (RRs) were calculated for binary outcomes and mean differences (MDs) for continuous outcomes, with 95% confidence intervals (CIs). We performed a random-effect meta-analysis for all outcomes using R software (version 2025.09.2+418).</p><p><strong>Results: </strong>Five RCTs were included, encompassing 1,058 patients, of whom 50% received low-dose dexamethasone and 50% received standard dose. We found no significant difference between doses for croup severity scores at 1hr, 3hr and 4hr (MD -0.05 points; 95% CI -0.37 to 0.27), (MD 0.00 points; 95% CI -0.42 to 0.42) and (MD -0.03 points; 95% CI -0.19 to 0.12) respectively, hospital admission (RR 1.06; 95% CI 0.58 to 1.94), return to healthcare (RR 1.05; 95% CI 0.67 to 1.64), and need for additional racemic epinephrine (RE) (RR 1.58; 95% CI 0.77 to 3.25).</p><p><strong>Discussion: </strong>In this meta-analysis, low-dose oral dexamethasone (0.15 mg/kg) was comparable to the traditional 0.6 mg/kg dose in children with mild to moderate croup, with similar clinical outcomes in croup severity scores at 4 hours, hospital admission, return to healthcare, and need for additional RE. However, trial sequential analysis suggests that the current evidence remains underpowered and inconclusive, as the required information size was not reached for key outcomes. The small number of available RCTs limited statistical power to detect modest differences in effect size. Although we sought to evaluate dose equivalence in children with more severe croup (baseline croup score >5), only three trials included this population, and outcome reporting was insufficiently standardized to allow a meaningful subgroup synthesis. These findings should not be extrapolated to children with severe croup, and adequately powered randomized trials are needed before definitive dosing recommendations can be made.</p><p><strong>Systematic review registration: </strong>identifier CRD420251238877.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1925971"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune dysregulation and pathogen prevalence in Mycoplasma pneumoniae pneumonia: a retrospective insight in children.","authors":"Yuzuo Geng, Jiang Yang, Yuanyuan Wang, Guiling Wang, Qiaowen Xu, Wenmiao Zhong, Xianzhi Ren","doi":"10.3389/fped.2026.1858160","DOIUrl":"https://doi.org/10.3389/fped.2026.1858160","url":null,"abstract":"<p><strong>Objective: </strong>To explore the etiological characteristics and lymphocyte subtype features of pediatric mycoplasma pneumonia complicated with pleural effusion, clarify the influencing factors and predictive indicators of its occurrence, and analyze the manifestations of immune dysregulation in the children.</p><p><strong>Methods: </strong>This study retrospectively selected 104 children diagnosed with mycoplasma pneumonia in the pediatric department of our hospital from February 2023 to February 2025. The age range was 1-13 years old. They were divided into the mycoplasma pneumonia with pleural effusion group (46 cases) and the non-pleural effusion group (58 cases) based on chest ultrasound examination. Pathogenic identification was performed by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry, and qRT-PCR. Peripheral blood lymphocyte subsets (CD3⁺T, CD4⁺T, CD8⁺T, CD19⁺B, CD56⁺NK) were analyzed by flow cytometry. Risk factors were identified using multivariate logistic regression, and their predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Among the 104 children with Mycoplasma pneumoniae, the incidence of pleural effusion was 44.23% (46/104). A total of 59 pathogens were detected in the respiratory specimens of the aforementioned children. Among them, viruses accounted for the highest proportion (44.07%), followed by Mycoplasma pneumoniae (32.20%) and bacteria (23.73%). Mixed infections accounted for 66.10%, while single infections accounted for 33.90%. Compared with the non-effusion group, the levels of CD3 ⁺ T, CD4 ⁺ T, and CD8 ⁺ T were reduced in the complicated group, while the levels of CD19 ⁺B and CD56 ⁺NK were significantly increased (<i>P</i> < 0.05). α1-AG, CRP, and GAG were independent risk factors for pleural effusion, with OR values of 2.277 (95% CI: 1.365-3.800), 1.982 (95% CI: 1.245-3.155), and 2.502 (95% CI: 1.480-4.229), respectively (<i>P</i> < 0.05). The combined detection of α1-AG, CRP, and GAG achieved an AUC of 0.924, with sensitivity of 89.13% and specificity of 87.93%, significantly outperforming any single marker.</p><p><strong>Conclusion: </strong>Among the 104 children diagnosed with mycoplasma pneumonia, viral pathogens were the most frequently detected in the respiratory tract, and the proportion of mixed infections was relatively high. Children with pleural effusion showed more significant immune dysfunction. The combined prediction model of these three indicators has a high diagnostic value (AUC = 0.924), providing a reference for early clinical warning.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1858160"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic profile of neonatal fungal sepsis with insights into the disease spectrum: a retrospective study.","authors":"Arshdeep Kaur, Priyadarshini Virupaxi Chougula, Nandini Malshe, Pari Singh, Pradeep Suryawanshi","doi":"10.3389/fped.2026.1905411","DOIUrl":"https://doi.org/10.3389/fped.2026.1905411","url":null,"abstract":"<p><strong>Background: </strong>Neonatal fungal sepsis is a significant contributor to late-onset sepsis in neonatal intensive care units, particularly among preterm and low-birth-weight infants. While its epidemiology and microbiology are well described, the hemodynamic profile remains poorly characterized. This study aimed to evaluate the clinical spectrum with a focused assessment of cardiovascular alterations using functional echocardiography.</p><p><strong>Methods: </strong>Data for this retrospective observational study were collected from a tertiary care neonatal intensive care unit over a three-year period. Neonates with culture-proven fungal sepsis were included. Demographic, clinical, microbiological and outcome data were analyzed. Functional echocardiography was performed during active infection and repeated after microbiological clearance according to unit protocol. Paired hemodynamic comparisons were performed among survivors.</p><p><strong>Results: </strong>Twenty-six neonates with fungal sepsis were included, of whom 73.1% were preterm and predominantly low birth weight. Non-<i>Candida albicans</i> species were the predominant isolates. Respiratory deterioration, feed intolerance and thrombocytopenia were common clinical manifestations, with frequent exposure to prolonged antibiotics, parenteral nutrition and central venous access. Functional echocardiography demonstrated significant cardiovascular involvement during active infection. Survivors showed reduced tricuspid annular plane systolic excursion (6.4 ± 1.2 vs. 7.8 ± 2.4 mm), elevated pulmonary artery systolic pressure (28.5 ± 17.3 vs. 12.8 ± 4.2 mmHg), and increased right ventricular output (315.0 ± 49.4 vs. 246.0 ± 27.1 mL/kg/min), suggesting right ventricular dysfunction with pulmonary vascular involvement and a hyperdynamic circulatory state. Diastolic dysfunction was reflected by lower tricuspid and mitral E/A ratios. Hemodynamic parameters improved following antifungal therapy and microbiological clearance, while left ventricular systolic function remained relatively preserved. Mortality was 19.2%.</p><p><strong>Conclusion: </strong>In this cohort, neonatal fungal sepsis was associated with reversible hemodynamic alterations, predominantly involving right ventricular function and the pulmonary circulation. Functional echocardiography may provide valuable physiological insights and assist targeted hemodynamic management. Although our study did not include a bacterial sepsis comparator cohort, the observed cardiovascular alterations are broadly consistent with those reported in published neonatal bacterial sepsis studies.</p><p><strong>Clinical trial registration: </strong>This study was registered with the Clinical Trials Registry of India (CTRI/2025/03/083270) on 23rd march 2025. Trial details are publicly accessible at https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=127824.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1905411"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coagulation dysfunction in term neonatal sepsis: a prospective cohort study.","authors":"Dang Thi Thu Thuy, Ta Anh Tuan, Nguyen Thi Duyen, Le Thi Ha, Tran Huu Dat, Nguyen Thi Quynh Nga","doi":"10.3389/fped.2026.1859012","DOIUrl":"10.3389/fped.2026.1859012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize clinical features, conventional coagulation profiles, and rotational thromboelastometry (ROTEM) parameters in term neonates with sepsis, and to evaluate their associations with all-cause mortality within 28 days after sepsis diagnosis, with particular emphasis on whether a fibrin-based ROTEM parameter provides incremental prognostic information beyond organ dysfunction severity and conventional coagulation testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective hospital-based cohort study was conducted at the Neonatal Center of Vietnam National Children's Hospital between June 2024 and December 2025. Term neonates (gestational age 37-42 weeks) diagnosed with neonatal sepsis according to the European Medicines Agency 2010 criteria were enrolled. Clinical severity was assessed using the neonatal Sequential Organ Failure Assessment (nSOFA) score. Conventional coagulation tests included platelet count, prothrombin time/international normalized ratio (INR), aPTT ratio, fibrinogen, D-dimer, and selected natural anticoagulants. Viscoelastic coagulation was evaluated using ROTEM (INTEM, EXTEM, and FIBTEM assays). The primary outcome was all-cause mortality within 28 days after sepsis diagnosis. Associations between clinical, laboratory, and ROTEM parameters and mortality were examined using univariable analyses and prespecified multivariable logistic regression models. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 168 term neonates with sepsis were included, of whom 23 died within 28 days (mortality rate, 13.7%). Non-survivors had significantly higher nSOFA scores at diagnosis than survivors (median 12 vs. 6; &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and universally presented with septic shock and required mechanical ventilation. Conventional coagulation testing demonstrated a hypocoagulable profile among non-survivors, characterized by lower platelet counts, prolonged PT/INR and aPTT ratio, lower fibrinogen levels, and reduced protein S and antithrombin III activities. ROTEM analyses revealed reduced clot strength (lower A5, A10, and maximum clot firmness) and impaired clot propagation (prolonged clot formation time and reduced alpha angle) across INTEM, EXTEM, and FIBTEM assays. In multivariable logistic regression using complete-case data (&lt;i&gt;n&lt;/i&gt; = 161; deaths=20), the nSOFA score remained independently associated with mortality (OR per 1-point increase, 1.53; 95% CI, 1.25-1.87), whereas INR was not. Addition of FIBTEM maximum clot firmness (per 10-mm increase) showed a protective direction of association with mortality (OR, 0.43; 95% CI, 0.17-1.09) but resulted in only a modest, non-significant improvement in discrimination (AUC 0.862 vs. 0.878; DeLong &lt;i&gt;P&lt;/i&gt; = 0.455).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Among term neonates with sepsis, early organ dysfunction severity assessed by nSOFA was the strongest determinant of sh","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1859012"},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Wolman disease caused by LIPA variants in two Chinese infants and a focused literature synthesis.","authors":"Leping Zhang, Qiong Yu, Xinjing Ge, Xinbao Xie","doi":"10.3389/fped.2026.1933873","DOIUrl":"10.3389/fped.2026.1933873","url":null,"abstract":"<p><strong>Background: </strong>Wolman disease is the severe infantile form of lysosomal acid lipase deficiency, caused by biallelic pathogenic variants in the Lysosomal Acid Lipase (LIPA) gene. It is rapidly progressive and often fatal within the first year of life without disease-specific therapy. Because early manifestations are non-specific, timely diagnosis remains challenging.</p><p><strong>Case presentation: </strong>We report the cases of two Chinese male infants with genetically confirmed Wolman disease. Case 1 involved an 8-week-old infant-born to consanguineous parents-who presented with persistent diarrhea, recurrent low-grade fever, abdominal distension, hepatosplenomegaly, ascites, bilateral adrenal involvement, anemia, thrombocytopenia, hypoproteinemia, dyslipidemia, coagulopathy, and electrolyte disturbances. Liver biopsy showed diffuse hepatocyte vacuolization. Genetic testing identified a novel homozygous LIPA variant-c.285G > T/p.Trp95Cys-inherited from heterozygous carrier parents. Lysosomal acid lipase activity was markedly reduced to 0.62% of the normal control level. Case 2 involved an 11-week-old infant who presented with failure to thrive, poor feeding, abdominal distension, cough, progressive hepatosplenomegaly, ascites, bilateral adrenal calcifications, hepatic dysfunction, systemic inflammation, coagulopathy, anemia, and thrombocytopenia. He carried compound heterozygous LIPA non-sense variants, c.796G > T/p.Gly266* and c. 193C > T/p.Arg65*, inherited from his mother and father, respectively. Despite supportive care, both infants developed progressive multiorgan failure and died.</p><p><strong>Conclusion: </strong>These cases expand the clinical and molecular spectrum of Wolman disease in Chinese infants and highlight important diagnostic challenges, including non-specific early manifestations and inflammatory presentations mimicking hematologic disorders. Recognition of the characteristic combination of hepatosplenomegaly, failure to thrive, dyslipidemia, adrenal calcification, reduced lysosomal acid lipase activity, and LIPA variants may facilitate early diagnosis. Timely identification is essential because early enzyme replacement therapy may alter the otherwise fatal natural course of this rapidly progressive disease.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1933873"},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and epidemiological profiles of six respiratory pathogens in hospitalized children in Lixin County, Anhui, China (2024-2025).","authors":"Tong Xu, Xiaolei Wu, Fang Lin","doi":"10.3389/fped.2026.1918213","DOIUrl":"10.3389/fped.2026.1918213","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory infections are caused by a diverse range of pathogens. This study aimed to investigate the epidemiological profiles and clinical features of major respiratory pathogens by analyzing their detection rates in hospitalized pediatric patients.</p><p><strong>Methods: </strong>Nasopharyngeal swab specimens were retrospectively enrolled from pediatric inpatients diagnosed with acute respiratory infections at the Department of Pediatrics, Lixin County People's Hospital, between February 2024 and August 2025. All specimens were subjected to polymerase chain reaction (PCR) assays targeting six major respiratory pathogens, namely adenovirus, respiratory syncytial virus, influenza A virus, influenza B virus, parainfluenza virus, and <i>Mycoplasma pneumoniae</i>. Based on the PCR results, we further delineated the epidemiological trends, age-stratified distribution, and corresponding clinical profiles associated with each identified pathogen.</p><p><strong>Results: </strong>The epidemiological and clinical profiles of the six detected respiratory pathogens are summarized below. In brief, the overall positivity rate of pathogens exhibited winter-spring predominance, with adenovirus and RSV showing the broadest outbreak windows (November-July and November-May, respectively), while influenza A was more restricted (December-March). <i>Mycoplasma pneumoniae</i> displayed a sporadic annual pattern without a statistically significant seasonal peak. Age distribution varied substantially: RSV targeted children < 3 years, M. pneumoniae affected those > 1 year, and influenza A showed a slight infant-toddler predominance. Clinically, while fever and cough were universal, RSV was distinguished by a significantly elevated wheezing rate (27.57% vs. 3.97%-9.52% for others), Febrile seizures were most frequently observed in influenza A virus infections (6.29%), followed by adenovirus (3.57%). Dyspnea or cyanosis was uniformly rare across all pathogens (≤ 0.45%).</p><p><strong>Conclusion: </strong>During the winter season, multiple respiratory pathogens tend to circulate actively. Acute respiratory infections caused by different pathogens exhibit distinct age distributions and clinical manifestations. These features, when combined with local epidemiological data, may assist clinicians in promptly identifying the likely causative pathogen.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1918213"},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}