Frontiers in Pediatrics最新文献

{"title":"Development and validation of a nomogram for stratifying severe <i>Mycoplasma pneumoniae</i> pneumonia risk in children early.","authors":"Zhongying Chen, Wugao Ding, Zhengyan Gao","doi":"10.3389/fped.2026.1927137","DOIUrl":"10.3389/fped.2026.1927137","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate a clinically applicable diagnostic predictive model to facilitate early identification of severe <i>Mycoplasma pneumoniae</i> pneumonia (SMPP) within 24 h of admission.</p><p><strong>Methods: </strong>Clinical data from children with MPP hospitalized from January 2023 to December 2023, were retrospectively collected as the training set. Patients were classified into general MPP (GMPP) or SMPP groups based on whether SMPP occurred within 24 h of admission. After comparing the differences in clinical data between the two groups at admission, multivariate logistic regression was used to identify risk indicators for SMPP and construct a diagnostic predictive model. A nomogram was developed to visualize the model. Subsequently, data from children with MPP hospitalized between January 2024 and December 2024 were collected to conduct temporal external validation of the model. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC).</p><p><strong>Results: </strong>In total, 412 children with MPP were included, with 222 cases within the training set (119 SMPP, 53.60%) and 190 within the temporal external validation set (129 SMPP, 67.89%). Independent risk indicators for the occurrence of SMPP included the duration of fever before admission (OR = 2.019, 95% CI: 1.387-2.938), shortness of breath (OR = 111.599, 95% CI: 11.512-1,081.834), unresponsive to macrolide before admission (OR = 3.687, 95% CI: 1.529-8.892), interleukin-6 (IL-6) (OR = 1.052, 95% CI: 1.010-1.095), and pulmonary consolidation (OR = 31.634, 95% CI: 11.643-85.948) (all <i>P</i> < 0.05). The nomogram based on the five aforementioned variables demonstrated favorable discriminative performance, with areas under the ROC curve (AUC) of 0.916 (95% CI: 0.880-0.951) within the training set, 0.907 (95% CI: 0.873-0.946) within the internal validation, and 0.817 (95% CI: 0.758-0.876) within the temporal external validation set. The calibration curve and Hosmer-Lemeshow goodness-of-fit test showed that the model had good calibration. Both the DCA and CIC demonstrated favorable clinical utility of the model.</p><p><strong>Conclusion: </strong>The model developed in this study provides valuable reference for early risk stratification of pediatric SMPP and timely, individualized clinical decision-making in children with MPP. However, extensive external validation is required.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1927137"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215744","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":"Temporal trends in surfactant replacement therapy among U.S. infants, 2016-2024.","authors":"Xuezheng Sun, Wenhao Wang, Daniel Fuentes","doi":"10.3389/fped.2026.1907867","DOIUrl":"10.3389/fped.2026.1907867","url":null,"abstract":"<p><strong>Objective: </strong>Surfactant replacement therapy (SRT) remains a cornerstone of neonatal respiratory management, but contemporary national data on temporal trends in SRT use across gestational age groups in the United States remain limited. We aimed to characterize gestational age-specific SRT rates among U.S. live-born infants and assess temporal trends over time.</p><p><strong>Study design: </strong>We conducted a serial cross-sectional analysis using the U.S. Centers for Disease Control and Prevention WONDER Natality Expanded database from 2016 to 2024. Findings were examined in parallel using a cohort of preterm infants from the Premier Healthcare Database from 2020 to 2024. In CDC WONDER, SRT was defined using the birth certificate item for surfactant replacement therapy. In the Premier Healthcare Database, SRT was defined as receipt of exogenous surfactant during the birth hospitalization identified from billing records. Annual percentages of infants receiving SRT were estimated by gestational age group. Temporal trends were summarized as annual percent change (APC) using Poisson regression.</p><p><strong>Results: </strong>From 2016 to 2024, the observed SRT rate increased from 0.48% (95% CI, 0.48%-0.49%) to 0.51% (95% CI, 0.50%-0.51%), an absolute difference of approximately 0.03 percentage points, corresponding to a model-estimated cumulative relative increase of 7.60% [95% CI, 6.00%-9.22%; APC, 0.92% (95% CI, 0.73%-1.11%)], with a transient deviation in 2021. The increase was most pronounced among late preterm infants born at 34-36 weeks (APC, 0.90% [95% CI, 0.45%-1.36%]) and term infants born at 37 weeks or later (APC, 3.31% [95% CI, 2.82%-3.79%]). Similar upward patterns were observed in the Premier Healthcare Database among preterm infants. The calibrated SRT rate among preterm births in 2024 was 11.39% (95% CI, 11.23%-11.54%).</p><p><strong>Conclusion: </strong>Across 2 national data sources, SRT rates increased among infants born at 34 weeks' gestation or later. These findings suggest evolving patterns of neonatal respiratory care and inform surveillance and interpretation of national birth data.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1907867"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216076","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: Contezolid-containing regimens for disseminated Bacillus Calmette-Guérin disease in three children with primary immunodeficiency.","authors":"Zhen Zhang, Junchi Xu, Li Gao, Junjia Liu, Zhijian Ye, Yong Xu, Jianping Zhang, Xin Yu","doi":"10.3389/fped.2026.1928342","DOIUrl":"10.3389/fped.2026.1928342","url":null,"abstract":"<p><strong>Introduction: </strong>Disseminated Bacillus Calmette-Guérin (BCG) disease is a rare but life-threatening complication in children with primary immunodeficiency (PID). Linezolid (LZD) is effective but limited by myelosuppression. Contezolid (CZD), a novel oxazolidinone, has shown better hematological safety in adults, but pediatric data are scarce. This retrospective case series aims to provide real-world experience on CZD use in this challenging population.</p><p><strong>Case description: </strong>We report three children (aged 3-9.5 months) with PID (Wiskott-Aldrich syndrome, X-linked severe combined immunodeficiency, and IL-12 receptor β1 deficiency) who developed clinically presumed or confirmed disseminated BCG disease after routine vaccination. All received CZD-containing regimens (12-20 mg/kg/dose, q12 h) alongside other antimycobacterial agents and hematopoietic stem cell transplantation (HSCT).</p><p><strong>Outcomes: </strong>Over 11-12 months of CZD-containing multidrug therapy followed by 1 year of post-treatment telephone follow-up, all patients achieved satisfactory clinical resolution of infectious lesions and no clinical relapse was observed. No CZD-attributable hematological, hepatic, renal, or neurological adverse events occurred. However, because all patients received concurrent HSCT and multiple antimycobacterial agents, the independent contribution of CZD cannot be determined.</p><p><strong>Conclusion: </strong>CZD-containing regimens were well tolerated and associated with clinical improvement in these complex cases. CZD may serve as a valuable alternative when LZD is poorly tolerated. However, definitive attribution of efficacy to CZD alone is precluded by concurrent HSCT and multi-drug therapy.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1928342"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215583","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":"Ketogenic diet in treating NADH accumulation caused by complex I dysfunction: the metabolic wisdom of \"dredging, not repairing\".","authors":"Xiaoying Qiao, Jianxiang Liao","doi":"10.3389/fped.2026.1939961","DOIUrl":"10.3389/fped.2026.1939961","url":null,"abstract":"<p><p>Genetic mutations causing Complex I (CI) dysfunction lead to the accumulation of NADH in the mitochondrial matrix due to impaired oxidation. An elevated NADH/NAD⁺ ratio feedback-inhibits key enzymes of the tricarboxylic acid (TCA) cycle, reducing metabolic flux, while concurrent electron transport chain (ETC) blockade exacerbates reactive oxygen species (ROS) generation and oxidative stress. Conventional views propose that the ketogenic diet (KD) bypasses the defective CI to restore downstream ETC electron transfer. However, this perspective harbors an inherent contradiction: CI is the primary entry point for NADH oxidation; bypassing it may sustain some electron flow but fails to consume the accumulated NADH in the matrix, leaving the fate of this critical reducing equivalent inadequately explained. This article proposes the metabolic wisdom of \"dredging, not repairing\", positing that KD, through metabolic reprogramming, diverts the accumulated NADH into multiple utilizable pathways. These include intra-matrix conversion and consumption (generating NADPH and ketone bodies), pumping malate from the matrix into the cytosol via the reverse malate-aspartate shuttle (rMAS), and further cytosolic malate utilization (gluconeogenesis, NADPH generation, glycerol-3-phosphate shuttle, etc.). This multi-pathway synergy achieves \"dredging\"rather than \"repair\". This paper aims to elucidate how KD, via metabolic reprogramming, alleviates the inhibition of the TCA cycle caused by NADH accumulation and restores its flux, thereby offering new insights into metabolic therapeutic strategies for CI-deficient mitochondrial diseases.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1939961"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215956","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":"Interactions between chronic kidney disease and hyperuricemia in children: mechanisms, clinical manifestations and management updates.","authors":"Huang Xiaoxia, Liu Yuhua","doi":"10.3389/fped.2026.1975951","DOIUrl":"10.3389/fped.2026.1975951","url":null,"abstract":"<p><p>A bidirectional pathogenic interplay exists between pediatric chronic kidney disease (CKD) and hyperuricemia (HUA). Hyperuricemia serves as an independent risk factor for the onset and progression of CKD, while also representing a common complication arising from impaired renal excretory function. Amid the rising global prevalence of pediatric CKD and growing evidence implicating metabolic disturbances in renal injury, the reciprocal pathological mechanisms underlying uric acid-mediated kidney damage have emerged as a critical research focus. Elevated serum uric acid induces renal tubulointerstitial injury through oxidative stress, systemic inflammatory cascades, and endothelial dysfunction. Conversely, diminished uric acid excretion resulting from CKD further aggravates hyperuricemia, establishing a self-perpetuating vicious cycle. However, epidemiological evidence specific to the pediatric population remains limited, and current clinical management strategies are largely extrapolated from adult studies, lacking evidence-based guidelines tailored to the unique growth and developmental characteristics of children. This review systematically summarizes the epidemiological features, molecular pathogenic mechanisms, clinical implications, and therapeutic approaches for HUA comorbid with pediatric CKD. We specifically highlight uric acid-driven renal injury pathways, the accelerating effect of HUA on CKD progression, and age-specific challenges in pediatric diagnosis and standardized intervention. By integrating recent advances in preclinical and clinical research, this review aims to provide a theoretical foundation for the early screening, timely diagnosis, and individualized standardized management of hyperuricemia in children with CKD.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1975951"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215761","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":"Editorial: Indoor environmental quality in day-care centers, kindergartens, and primary schools.","authors":"Dadi Zhang, Hailin Zheng","doi":"10.3389/fped.2026.2005928","DOIUrl":"10.3389/fped.2026.2005928","url":null,"abstract":"","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"2005928"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215777","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":"Translating the 2024 ACR lupus nephritis guidelines to pediatric practice.","authors":"Minh Dien Duong, Quang Le, Siddharth Shah","doi":"10.3389/fped.2026.1970903","DOIUrl":"10.3389/fped.2026.1970903","url":null,"abstract":"<p><p>Lupus nephritis (LN) is more common and often more aggressive in children than in adults, yet most randomized trials informing current LN management have enrolled adults. The 2024 American College of Rheumatology (ACR) guideline is the first ACR guideline on lupus nephritis to explicitly state that its recommendations apply to both adults and children<b>,</b> although its evidence base remains largely adult-derived. This review uses the 2024 ACR guideline as an organizing framework, cross-referenced with the 2024 KDIGO and 2025 EULAR recommendations, to examine which aspects of LN management translate effectively to pediatric practice and which require caution. We review the diagnostic pathway, including screening, kidney biopsy, and ISN/RPS classification, as well as therapeutic strategies, including the shift from sequential dual therapy to upfront triple therapy, response targets, class-specific treatment, and selection between belimumab and calcineurin inhibitors. We then examine areas where pediatric evidence remains limited, particularly glucocorticoid dosing, long-term biologic safety, fertility and growth, and transition to adult care. While the fundamental principles of LN management are largely age-agnostic, many quantitative recommendations are not. Steroid dosing, long-term treatment exposure, and developmental consequences remain important pediatric-specific considerations that current guidelines cannot fully address. We conclude by highlighting the pediatric evidence available to date and the need for dedicated pediatric trials to replace adult-derived extrapolation with child-specific evidence.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1970903"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216137","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":"S100A8/A9 as a biomarker for differentiating pulmonary tuberculosis from community-acquired pneumonia in children: a multicenter cohort study in China.","authors":"Xiaoxue Li, Xu Li, Min Fang, Xiaomei Liu, Li Duan, Ming Li, Yanan Fu, Yanchun Wang, Li Jiang, Xiaotao Yang, Tingting Jiang, He Tang, Li Tan, Meifen Wang, Yang Liu, Yu Zhu, Jing Bi, Adong Shen","doi":"10.3389/fped.2026.1910674","DOIUrl":"10.3389/fped.2026.1910674","url":null,"abstract":"<p><strong>Background: </strong>Differentiating pulmonary tuberculosis (PTB) from community-acquired pneumonia (CAP) in children remains a significant diagnostic challenge. This study aimed to evaluate the diagnostic value of serum S100A8/A9 in pediatric populations.</p><p><strong>Methods: </strong>This multicenter prospective study enrolled 1,629 children aged 0∼≤ 18 years with definitive diagnostic classifications, including a discovery cohort (<i>n</i> = 1,092) and a validation cohort (<i>n</i> = 537). Participants were stratified into three groups: PTB (Confirmed, Unconfirmed), CAP (Viral, Bacterial, <i>Mycoplasma pneumoniae</i>, Mixed), and healthy controls (HC). Serum S100A8/A9 levels were quantified by enzyme-linked immunosorbent assay, and diagnostic performance was assessed using ROC analysis.</p><p><strong>Results: </strong>In both cohorts, S100A8/A9 levels were markedly lower in PTB than in CAP but higher than in healthy controls. (both <i>p</i> < 0.001). For distinguishing PTB from CAP, S100A8/A9 achieved AUC values of 0.916 (95% CI: 0.895-0.937, sensitivity 87.1%, specificity 81.8%) in the discovery cohort and 0.932 (95% CI: 0.906-0.958, sensitivity 87.5%, specificity 86.4%) in the validation cohort. Compared with all CAP etiological subgroups, PTB children had the lowest S100A8/A9 levels, with the highest AUC of 0.954 for PTB vs. <i>Mycoplasma pneumoniae</i> CAP. Age-stratified analysis revealed excellent discriminatory performance in children aged 5-18 years (AUC = 0.955 for PTB versus overall CAP). but impaired in children under 5 years (AUC = 0.838 for PTB versus overall CAP), with lower sensitivity (57.4%) for discriminating PTB from Viral-CAP. Furthermore, a concentration-dependent distribution was observed, with higher S100A8/A9 levels associated with a decreasing proportion of PTB and an increasing proportion of CAP. In children aged 5-18 years, levels < 1,000 ng/mL were predominantly PTB (92.1%), and levels > 1,900 ng/mL were highly predictive of CAP (96.8%).</p><p><strong>Conclusions: </strong>Serum S100A8/A9 is a promising potential biomarker for distinguishing pediatric PTB from CAP, characterized by age-related distribution and concentration-dependent diagnostic pattern.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1910674"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216010","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: Early-onset portal hypertension revealing pediatric ADPKD with a truncating PKD1 variant.","authors":"Ana Katerin Minota Idarraga, Ivan Mauricio Llanos Arango","doi":"10.3389/fped.2026.1851979","DOIUrl":"10.3389/fped.2026.1851979","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is a multisystemic ciliopathy whose clinical spectrum extends into childhood. Although hepatic cysts are the most common extrarenal manifestation, early portal hypertension associated with congenital hepatic fibrosis (CHF)-like features is uncommon and likely underrecognized.</p><p><strong>Case presentation: </strong>We report a 10-year-old girl with no known family history of ADPKD who presented at 9 years of age with upper gastrointestinal bleeding secondary to grade III esophageal varices. The diagnostic evaluation established non-cirrhotic portal hypertension, and she underwent endoscopic variceal ligation followed by secondary prophylaxis with propranolol. Imaging demonstrated hepatosplenomegaly, patent portal and splenic veins, and no hepatic cysts. Liver biopsy showed mild portal fibrosis (METAVIR F1), while liver stiffness measured 6.4 kPa, consistent with mild fibrosis. Renal imaging revealed multiple bilateral cortical cysts, and whole-exome sequencing identified a heterozygous truncating PKD1 variant (p.Glu1633Ter), classified as pathogenic according to ACMG criteria. The patient remains clinically stable without recurrent bleeding during multidisciplinary follow-up.</p><p><strong>Discussion: </strong>This case expands the phenotypic spectrum of pediatric ADPKD by illustrating clinically significant portal hypertension despite only mild hepatic fibrosis. It also highlights the importance of integrating histopathology, non-invasive liver assessment, imaging, and molecular testing when evaluating children with unexplained non-cirrhotic portal hypertension.</p><p><strong>Conclusion: </strong>ADPKD should be considered in the differential diagnosis of pediatric non-cirrhotic portal hypertension, even in the absence of hepatic cysts. Early genetic testing may facilitate accurate diagnosis and appropriate multidisciplinary management.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1851979"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215666","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":"Association between discretionary screen time and depressive symptoms in Chinese adolescents: a cross-sectional study.","authors":"Zhi Xu, Shuye Yang, Shibin Wang, Xing Wang","doi":"10.3389/fped.2026.1957282","DOIUrl":"10.3389/fped.2026.1957282","url":null,"abstract":"<p><strong>Background: </strong>Adolescents globally exhibit growing engagement with discretionary screen time, but its association with depressive symptoms remains unclear in developing economies.</p><p><strong>Objective: </strong>To examine the relationship between discretionary screen time and depressive symptoms among Chinese adolescents.</p><p><strong>Methods: </strong>A cross-sectional study of 4,706 adolescents in Maoming City, Guangdong Province, China. Participants were stratified into four discretionary screen time categories: <1 h (<i>n</i> = 1,372), 1-2 h (<i>n</i> = 1,277), 2-4 h (<i>n</i> = 1,032), and ≥4 h (<i>n</i> = 1,025). Depressive symptoms were assessed using the validated CESD-9, with a cutoff score of ≥10. The primary analysis was a multilevel logistic regression model with random intercepts for school and class, adjusted for all measured covariates except BMI, anxiety and insomnia; a model additionally adjusted for BMI, anxiety and insomnia served as a sensitivity analysis. Subgroup analyses evaluated potential effect modification.</p><p><strong>Results: </strong>The prevalence of depressive symptoms was 29.7% (1,398/4,706). In the primary multilevel model (random intercepts for school and class; adjusted for sociodemographic, socioeconomic and lifestyle factors, without BMI, anxiety and insomnia), compared with the <1 h reference group, the odds ratios were 1.21 (95% CI: 0.98-1.49; <i>p</i> = 0.082) for 1-2 h, 1.88 (95% CI: 1.52-2.33; <i>p</i> < 0.001) for 2-4 h, and 2.54 (95% CI: 2.04-3.16; <i>p</i> < 0.001) for ≥4 h; each screen-time category increment was associated with 39% higher odds of depressive symptoms (OR = 1.39, 95% CI: 1.29-1.49; <i>p</i> < 0.001). When additionally adjusted for BMI, anxiety and insomnia (sensitivity analysis, Model 4), the associations were attenuated but remained statistically significant for the higher categories (≥4 h: OR = 1.69, 95% CI: 1.28-2.22; per-category OR = 1.19, 95% CI: 1.09-1.29). Subgroup analyses revealed no statistically significant evidence of effect modification (all <i>p</i>-interaction >0.05).</p><p><strong>Conclusion: </strong>Prolonged discretionary screen time is significantly associated with higher odds of depressive symptoms among Chinese adolescents, indicating a graded association that strengthens with increasing screen time. These findings are relevant to public-health monitoring of discretionary screen use in adolescents.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1957282"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215351","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}