Frontiers in Pediatrics最新文献

{"title":"Feasibility of exercise training to address corticosteroid-induced changes in adolescents aged 10+ with lymphoma or leukemia during the first eight weeks of treatment: a pilot study.","authors":"Vera Blümer, Sarah Erhard, Nicola Schanda, Aleksandar Tomaskovic, Mirjam Dieckelmann","doi":"10.3389/fped.2026.1819451","DOIUrl":"10.3389/fped.2026.1819451","url":null,"abstract":"<p><strong>Introduction: </strong>Children and adolescents with hematological malignancies are at risk of adverse side effects from high-dose corticosteroid treatment during induction therapy. In this context, exercise and nutrition interventions are promising, physiologically grounded approaches but their feasibility and practical delivery during early intensive therapy remain unclear. Therefore, this prospective pilot randomized controlled trial was designed to evaluate the feasibility and preliminary effects of an exercise intervention and nutrition consultation in newly diagnosed patients.</p><p><strong>Methods: </strong>Participants with leukemia or lymphoma, aged 10-17 years, were allocated to an 8-week exercise or sham control intervention (stratified randomization, 1:1 ratio, parallel groups) plus one-time nutrition counseling. Feasibility outcomes included recruitment, retention, adherence, safety, completion of assessments, and subjective feedback from patients and personnel involved in the study. Furthermore, repeated measures of physical performance, functional capacity, metabolic health, and body composition were used to explore baseline status and changes over time, after four and eight weeks of therapy.</p><p><strong>Results: </strong>Six participants, two of which were allocated to the intervention group, completed the trial. Overall rates of consent (67%), training adherence (51%) and complete measures (70%) did not attain prespecified criteria (≥80%). Despite considerable variability, pilot data indicated reduced physical capacity and functioning inferior to healthy norms at baseline and over the course of the intervention including hand grip strength (Δ<i>Z</i> ± SD = -1.5 ± 1.4), cardiorespiratory fitness (steep ramp cycle ergometry peak power; Δ<i>Z</i> ± SD = -3.8 ± 1.2), and lower extremity muscle strength (5-times sit-to-stand test; Δ<i>Z</i> ± SD = 2.3 ± 2.0), while having mostly normal quadriceps muscle and abdominal fat thickness and erratic unfavorable metabolic states. No formal exploration of intervention effects was performed.</p><p><strong>Discussion: </strong>Limited feasibility opposed continuation to a definite trial. Respective challenges observed may reflect particularities of early treatment, thus, substantial changes are advised for future protocols (e.g., towards a more adaptive trial design). Besides their limited generalizability and variability, pilot data suggests that adolescents undergoing induction therapy can experience intermittent deconditioning, while other outcomes were inconclusive. Thus, future exercise interventions should account for various objections to exercise participation, heterogeneous medical conditions, and potentially impaired physical capacity and functioning, especially during early therapy.</p><p><strong>Clinical trial registration: </strong>https://drks.de/search/de/trial/DRKS00032259, identifier DRKS00032259.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1819451"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238096","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":"Experiences of telehealth-delivered occupational performance coaching among Palestinian mothers of autistic children: a qualitative study.","authors":"Mohammad Hassan Salahat, Hassan Izzeddin Sarsak, Hatem Ahmad Al Adam","doi":"10.3389/fped.2026.1974022","DOIUrl":"10.3389/fped.2026.1974022","url":null,"abstract":"<p><strong>Background: </strong>Families of autistic children in Palestine face substantial barriers to sustained, family-centred rehabilitation, including travel demands, fragmented services, financial pressures, digital inequalities, and recurrent movement restrictions. Occupational Performance Coaching (OPC) is a collaborative, occupation-focused approach that supports caregivers to analyse everyday participation challenges, identify priorities, generate contextually relevant strategies, and evaluate change. This study explored how Palestinian mothers experienced an eight-session OPC telecoaching intervention and how they perceived its acceptability, benefits, challenges, and contextual fit.</p><p><strong>Methods: </strong>A qualitative descriptive study was embedded within an explanatory sequential mixed-methods external pilot trial. All 12 mothers who completed OPC participated in a post-intervention semi-structured interview in Arabic via Zoom. The interview guide was informed by the Theoretical Framework of Acceptability (TFA) and included broader questions about intervention processes, perceived change, and contextual experience. Analysis of the complete Arabic interview dataset used reflexive thematic analysis. TFA provided deductive sensitizing concepts, while coding and theme development remained open to meanings arising from participants' accounts. Reflexive notes, cross-case comparison, attention to divergent accounts, peer debriefing, and an audit trail supported analytic reflexivity and transparency. COREQ guided reporting.</p><p><strong>Results: </strong>Five interrelated themes were developed: (1) from receiving advice to becoming a reflective problem-solver; (2) coaching in the context of everyday life; (3) taking responsibility: empowering, but demanding; (4) context-responsive access with conditional digital and cultural fit; and (5) meaningful progress as partial, variable, and still unfolding. Mothers valued collaborative reasoning, individualized goals, and the ability to work within real family routines. Remote delivery reduced some travel, scheduling, cost, and safety burdens, but connectivity, time, caregiving demands, and wider structural conditions remained important constraints. Increased parental responsibility could be experienced as both meaningful and demanding, and perceived changes were not uniform across goals or families.</p><p><strong>Conclusion: </strong>Mothers valued OPC telecoaching not only as a means of remote access, but as a way of working collaboratively on occupational challenges within everyday family life. Telehealth reduced selected access burdens in the Palestinian context but did not remove digital, caregiving, or structural constraints. The findings support further evaluation of culturally and contextually responsive, participation-focused telecoaching within pediatric occupational therapy.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1974022"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237953","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":"Respiratory function monitoring during neonatal resuscitation: a crossover study of high-fidelity simulated bronchopulmonary dysplasia.","authors":"Allan Jenkinson, Kerstin Jost, Janneke Dekker, Emma Williams, Almudena Alonso-Ojembarrena, Anna Lavizzari, Benjamin Stoecklin, Olivier Danhaive, Theodore Dassios","doi":"10.3389/fped.2026.1940755","DOIUrl":"10.3389/fped.2026.1940755","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to test the hypothesis that respiratory function monitoring (RFM) during neonatal resuscitation can reduce mask leak and the delivery of inadvertently high tidal volumes.</p><p><strong>Methods: </strong>We used a high fidelity neonatal manikin mimicking the lung mechanics of bronchopulmonary dysplasia. Neonatal clinicians provided positive pressure ventilation with a bag-valve and mask while blinded and while unblinded to the RFM, displaying the leak and the tidal volume.</p><p><strong>Results: </strong>The median (IQR) inspiratory tidal volume when blinded to the RFM [8.3 (7.1-10.6) ml/kg] was significantly higher compared to when unblinded to the RFM [6.7 (5.8-8.3) ml/kg, <i>p</i> = 0.002]. The expiratory tidal volume when blinded to the RFM [6.5 (5.8-7.8) ml/kg] was significantly higher compared to when unblinded to the RFM [5.7 (5.1-6.9) ml/kg, <i>p</i> = 0.021]. The percentage of leak was not different when blinded to the RFM compared to when unblinded. The peak inflation pressure was not different when blinded to the RFM compared to when unblinded.</p><p><strong>Conclusion: </strong>During simulated resuscitation of bronchopulmonary dysplasia, participants were more likely to achieve a tidal volume within the intended range and a higher respiratory rate when they had real-time RFM feedback compared to when such feedback was not available.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1940755"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238023","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":"A predictive model for cytarabine syndrome-associated febrile episodes in children with acute lymphoblastic leukemia.","authors":"Zheng Wu, Lixiang Zhu, Yi Liu, Fangyuan Lai, Zebin Chen, Feiqiu Wen, Huirong Mai, Xuejuan Li","doi":"10.3389/fped.2026.1957986","DOIUrl":"10.3389/fped.2026.1957986","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to develop a predictive model for cytarabine syndrome (CS)-related fever in pediatric patients with acute lymphoblastic leukemia (ALL). By integrating clinical features and laboratory indicators, we seek to establish an evidence-based diagnostic tool to assist clinicians in decision-making and optimize the use of antimicrobial agents.</p><p><strong>Methods: </strong>Study Design: A retrospective case-control study was conducted involving 72 ALL children (32 in the CS group vs. 40 in the infection group) who developed fever (≥37.5 °C) following cytarabine treatment. Model Development: Multivariate logistic regression was used to identify independent predictors. A nomogram was constructed. The model's discriminative ability was evaluated using the receiver operating characteristic (ROC) curve, calibration was assessed via the Hosmer-Lemeshow test, and clinical utility was validated using decision curve analysis (DCA).</p><p><strong>Results: </strong>Key Predictors: Multivariate analysis revealed that BSA (OR = 0.01, 95% CI: 0.00-0.17) and hs-CRP (OR = 0.84, 95% CI: 0.72-0.97) were the most significant predictors of CS. Model Performance: The ROC analysis demonstrated an AUC of 0.785, with internal validation via 1000 bootstrap resamples yielding a 95% confidence interval of 0.675-0.882. The calibration curve demonstrated excellent agreement between predicted and observed outcomes (MAE = 0.039). Decision curve analysis indicated that the model provided superior net benefits across most threshold probabilities (0.2-0.8) compared to strategies of universal antibiotic use or no intervention.</p><p><strong>Conclusion: </strong>The developed predictive model demonstrates high discriminative performance and robust clinical applicability, functioning as an effective quantitative instrument for early identification of cytarabine syndrome (CS) and facilitating evidence-based antibiotic stewardship.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1957986"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238019","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":"Patterns and predictors of surgical management in pediatric chronic idiopathic constipation.","authors":"Prisca C Obidike, Katlyn A Droke, Grant F Williams, Cecily A Wainstein, Trevor C Jones, Zoë Hemmer, Alison Jung, Bea B Jeon, Kristy L Rialon, Lily S Cheng","doi":"10.3389/fped.2026.1955197","DOIUrl":"10.3389/fped.2026.1955197","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic idiopathic constipation (CIC) is a common childhood gastrointestinal disorder that substantially affects quality of life and healthcare utilization. Most children are managed successfully with dietary modification, behavioral interventions, and medical therapies. However, many patients experience severe or refractory symptoms that necessitate surgical intervention. We sought to identify patient factors associated with progression to surgical intervention.</p><p><strong>Methods: </strong>A retrospective multi-institutional cohort study was performed of children (<18 years of age) who presented to a pediatric surgeon for chief complaint of CIC between 2017 and 2022. The primary outcome was major surgical intervention for the management of CIC. Patient characteristics, including demographic characteristics and clinical variables, were queried, and multivariable logistic regression was used to assess the association between patient factors and surgical intervention.</p><p><strong>Results: </strong>A total of 188 patients were included. Forty patients (21.3%) had a major operation for CIC, including antegrade continence enema (ACE) procedures, intestinal resection, and intestinal diversion. Patients who underwent surgery were older at the time of first visit (mean 9.12 vs. 4.64 years; <i>p</i> < 0.001). In multivariable logistic regression, older age at first pediatric surgery visit was independently associated with surgical intervention. Each additional year of age was associated with approximately 30% higher adjusted odds of surgical intervention (adjusted OR 1.29, 95% CI 1.14-1.48; <i>p</i> < 0.001). Sex, race, ethnicity, insurance type, and neurodiversity were not significantly associated with surgery.</p><p><strong>Conclusion: </strong>Approximately one in five patients referred to a pediatric surgeon for refractory constipation undergo surgical intervention to treat constipation. Older age at presentation was associated with surgical treatment.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1955197"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238077","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":"Retrospective evaluation of sirolimus (mTOR blocker) for lymphatic malformations presenting in the neonatal period: a single-center experience.","authors":"Alexey Podkamenev, Arina Syrtsova, Gleb Kondratiev, Victor Nabokov, Roman Ti, Svetlana Kuzminykh, Vladislav Dvoretsky, Ani Ajamoghlian, Alexander Kostylev, Irina Myznikova","doi":"10.3389/fped.2026.1900903","DOIUrl":"10.3389/fped.2026.1900903","url":null,"abstract":"<p><strong>Background: </strong>Lymphatic malformations are rare vascular anomalies. Currently, there is no uniform approach to the treatment of these patients. Neonates with extensive disease often suffer from multiple complications, organ dysfunction, and various tissue lesions, which may be life-threatening and lead to aesthetic deformity. Treatment with sirolimus has the potential to improve symptoms and downsize the lesion, up to complete regression. This retrospective single-center study presents our experience with oral sirolimus in the treatment of newborns with lymphatic malformations, evaluating its efficacy and safety.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 23 patients in the neonatal period and early infancy with lymphatic malformations, treated at the St. Petersburg State Pediatric Medical University between 2021 and 2025. Seven patients underwent primary radical surgical treatment and were not included in the analysis. The final study cohort consisted of 16 patients who received primary conservative therapy with sirolimus. Fifteen out of 16 patients started receiving oral sirolimus before the age of 28 days of life. The median age at the commencement of treatment was 15 days after birth. After instrumental and laboratory examination, sirolimus was administered at a starting reduced dose of 0.5 mg/m²/day divided into two daily doses, followed by a gradual increase under clinical and laboratory monitoring. The therapeutic concentration of sirolimus in the blood (5-15 ng/mL) was monitored once a week.</p><p><strong>Results: </strong>Disease stabilization or regression was achieved in all 16 patients (100%), with a partial or complete radiological response (≥50% volume reduction) in 13 patients (81.25%) and complete regression (>90% volume reduction) in 10 patients (62.5%) at the 6-month assessment. No treatment-related serious adverse events requiring permanent discontinuation were observed. Recorded adverse events included transient respiratory infections (<i>n</i> = 2), diarrhea (<i>n</i> = 2), aphthous stomatitis (<i>n</i> = 1), and mild anemia (<i>n</i> = 1), all of which resolved with supportive care or temporary dose adjustment.</p><p><strong>Conclusion: </strong>In this selected cohort, sirolimus demonstrated an acceptable safety and efficacy profile, supporting its feasibility as a conservative first-line strategy in neonates with extensive or unresectable lymphatic malformations. However, larger prospective studies are needed to confirm these findings.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1900903"},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238171","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":"LncRNA ZFPM2 silencing alleviates lung epithelial injury by inducing M2 macrophage polarization: possible implication in bronchopulmonary dysplasia.","authors":"Hanzhou Guan, Huaiqing Yin","doi":"10.3389/fped.2026.1921479","DOIUrl":"https://doi.org/10.3389/fped.2026.1921479","url":null,"abstract":"<p><strong>Background: </strong>To screen the key long-chain non-coding RNA (LncRNA) closely related to the occurrence and development of Bronchopulmonary dysplasia (BPD), and explore its mechanism of affecting lung epithelial cell injury.</p><p><strong>Methods: </strong>Based on the BPD mouse model induced by lipopolysaccharide (LPS), LncRNA high-throughput sequencing was used to screen differentially expressed LncRNAs. GO and KEGG functional enrichment analysis were performed on differentially expressed target genes. The expressions of key LncRNA in LPS-induced MLE-12 and MH-S cells were verified. ZFPM2 specific siRNA (si-ZFPM2) and negative control (si-NC) plasmids were transfected into LPS-induced cells. Cells were divided into control group, LPS group, LPS + si-NC group, and LPS + si-ZFPM2 group. Cell vitality was measured by CCK-8 method, pro-inflammatory cytokines (IL-1β, TNF-α) and anti-inflammatory cytokines (IL-10, IL-4) were quantified, and M1 (iNOS, CD86) and M2 (CD206, Arg1) markers were detected. In MLE-12 cells, cell apoptosis rate was further detected, and the protein expressions of NLRP3 and caspase-1 were analysed. A Transwell co-culture system was established with MH-S cells in the upper chamber (treated as above) and MLE-12 cells in the lower chamber; the latter were harvested to assess viability, apoptosis, NLRP3/caspase-1 expression, and inflammatory cytokine levels.</p><p><strong>Results: </strong>A total of 1,290 differentially expressed LncRNAs and 4,084 differentially expressed mRNAs were screened by LncRNA sequencing. Functional enrichment analysis showed that these differential genes were closely related to the development of lung epithelial cells and macrophage polarization. The expression of ZFPM2 was markedly upregulated in BPD mouse lung tissue and in LPS-stimulated cells. In MH-S cells, silencing ZFPM2 significantly increased cell viability, decreased M1 markers (iNOS, CD86) and pro-inflammatory cytokines (TNF-α, IL-6, IL-1β), and increased M2 markers (CD206, Arg1) and anti-inflammatory cytokines (IL-4, IL-10). In MLE-12 cells, silencing ZFPM2 significantly improved viability, reduced apoptosis, and suppressed NLRP3/caspase-1 protein expression and IL-1β, IL-6, and TNF-α levels. In the co-culture system, silencing ZFPM2 significantly enhanced MLE-12 viability, reduced apoptosis and NLRP3/caspase-1 expression, lowered pro-inflammatory cytokines, and elevated anti-inflammatory cytokines.</p><p><strong>Conclusions: </strong>Silencing ZFPM2 can alleviate LPS-induced injury of pulmonary epithelial cells, which may be related to promoting the polarization of alveolar macrophages towards M2 type and inhibiting inflammatory response.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1921479"},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13684995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244244","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":"Gut microbiota dysbiosis in pediatric acute lymphoblastic leukemia: clinical consequences, mechanistic insights, and microbiota-targeted interventions.","authors":"Ke Chen, Qingqing Li, Yun Xing, Changqi Liu, Fei Yang","doi":"10.3389/fped.2026.1928304","DOIUrl":"https://doi.org/10.3389/fped.2026.1928304","url":null,"abstract":"<p><p>Gut microbiota dysbiosis has emerged as a key feature in pediatric acute lymphoblastic leukemia (ALL), driven by chemotherapy, antibiotic exposure, and treatment-related nutritional impairment. Increasing evidence indicates that disruption of microbial diversity and depletion of short-chain fatty acid-producing bacteria are closely associated with infectious complications, gastrointestinal toxicity, and potentially reduced treatment efficacy. This review synthesizes current evidence on the interplay between gut microbiota and pediatric ALL across four dimensions: clinical outcomes, treatment-related toxicity, pharmacological interactions, and prognosis. We further summarize how leukemia therapy reshapes microbial ecosystems through cytotoxic agents, antimicrobial exposure, and dietary alterations. In addition, we discuss microbiota-centered therapeutic strategies, including probiotics, prebiotics, synbiotics, postbiotics, dietary interventions, and fecal microbiota transplantation. While promising, these approaches require careful validation in pediatric oncology due to safety considerations and limited clinical trial data. Finally, we highlight methodological advances such as multi-omics integration and machine learning approaches, which may enable microbiome-based risk stratification and precision supportive care in the future. Overall, gut microbiota represents a potential modifiable factor influencing clinical outcomes in pediatric ALL.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1928304"},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238055","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":"Pathogenesis and molecular mechanisms of steroid-induced femoral head necrosis in children: a narrative review.","authors":"Fadong Gou, Lu Wu, Xingwen Bao, Wei Wang, Chen Wang, Mingxuan Gao","doi":"10.3389/fped.2026.1897364","DOIUrl":"https://doi.org/10.3389/fped.2026.1897364","url":null,"abstract":"<p><p>In recent years, significant progress has been made in the study of the pathological mechanisms and pathology of steroid-induced osteonecrosis of the femoral head (SONFH) in adults. However, research on the molecular mechanisms and clinical translation of SONFH in children remains relatively limited. This narrative review synthesizes recent studies and reviews the latest advances in etiology, pathogenesis, genetic susceptibility, and molecular mechanisms, with a particular focus on pediatric-specific features. Unlike adults, children's skeletons are still in the developmental stage, and their vascular architecture, metabolic characteristics, and injury repair mechanisms differ significantly from those of adults. Specifically, the open growth plate in children creates a unique vascular architecture with distinct epiphyseal and metaphyseal blood supplies, while the growth plate's elasticity provides a biomechanical buffering effect against increased intraosseous pressure. Children's bones also exhibit superior remodeling and regenerative capacity compared to adults. However, these advantages gradually diminish with age, particularly as the growth plate approaches closure during puberty. Furthermore, pediatric SONFH is a complex disease involving the combined effects of multiple genes and pathways, and the impact of genetic variations may vary depending on treatment regimens and ethnic backgrounds, further increasing the disease's complexity. In summary, pediatric SONFH has a unique molecular biological basis that is distinct from adult SONFH. Future efforts should incorporate assessment methods based on genetic susceptibility loci and biomarkers to establish a treatment model ranging from early warning to personalized intervention, thereby achieving precise prevention and treatment of steroid-induced pediatric femoral head necrosis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1897364"},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238043","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":"Incidence and epidemiological characteristics of congenital adrenal hyperplasia in Hangzhou newborns, China (2014-2024): a population-based cross-sectional study.","authors":"Yifei Dai, Linling Zhu, Yufeng Zeng, Yiming Chen, Xia Qian, Xiangjuan Li, Ting Wu","doi":"10.3389/fped.2026.1869920","DOIUrl":"10.3389/fped.2026.1869920","url":null,"abstract":"<p><strong>Background: </strong>Congenital adrenal hyperplasia (CAH) is a rare but potentially life-threatening autosomal recessive disorder. Its incidence varies by region and ethnicity. This study aimed to evaluate the birth incidence, trends, and clinical characteristics of neonatal classic CAH in Hangzhou (2014-2024) to support regional clinical prevention and management.</p><p><strong>Methods: </strong>This retrospective population-based study collected data from Hangzhou's information systems. Classic CAH cases were identified through newborn screening and clinical follow-up to age 3, with diagnosis confirmed by pediatric endocrinologists. Incidence was calculated per 100,000 live births. Categorical variables were compared using chi-square or Fisher's exact test. Temporal trend was assessed by Poisson regression.</p><p><strong>Results: </strong>Among 1,235,815 live births, 40 CAH cases were identified, giving an incidence of 3.24/100,000. The annual incidence ranged from 0/100,000 (2020) to 6.56/100,000 (2017), with no significant temporal trend (<i>P</i> = 0.297). The incidence was highest in urban (4.28/100,000), followed by suburban (2.37/100,000) and rural areas (1.93/100,000) (<i>P</i> = 0.16). Males accounted for 65% (26/40) of cases and females 35% (14/40), with a male-to-female ratio of 1.86:1. The incidence was 4.03/100,000 in males and 2.37/100,000 in females (<i>P</i> = 0.104). Among the 40 cases, salt-wasting (SW) was the predominant phenotype (33/40, 82.5%), and 21-hydroxylase deficiency accounted for 95% (38/40) of cases. Two neonates (5%) presented with salt-wasting crises, and two female infants with the simple virilizing (SV) form were initially misclassified as male. Prenatal ultrasound showed increased nuchal translucency in 6 cases (15%), adrenal enlargement in 3 cases (7.5%), and ambiguous genitalia in 1 case (2.5%). CAH was strongly associated with congenital heart defects (OR: 13.93, <i>P</i> < 0.001), and congenital hypothyroidism (OR: 42.26, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The incidence of classic CAH in Hangzhou (3.24/100,000) was lower than many global estimates. Although temporal and regional differences were not statistically significant, the predominance of SW cases, the occurrence of adrenal crises, and the presence of comorbidities (congenital heart defects, hypothyroidism, and cognitive developmental delay), highlight the need for improved early recognition, strengthened diagnostic capacity in suburban and rural areas, and long-term multidisciplinary management.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1869920"},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223968","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}