Frontiers in Pediatrics最新文献

{"title":"Red blood cell distribution width as a predictor of mortality in critically ill pediatric patients: a systematic review and meta-analysis.","authors":"Yinhong Yu, Xiaomei Hu, Yaping Shen","doi":"10.3389/fped.2025.1646179","DOIUrl":"10.3389/fped.2025.1646179","url":null,"abstract":"<p><strong>Objective: </strong>Red blood cell distribution width (RDW) has been found to predict outcomes in critically ill adult patients. However, its utility in pediatric patients remains unexplored. We reviewed published evidence and conducted a meta-analysis to assess whether RDW can be used to predict mortality in the pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>All observational studies assessing the association between RDW and PICU mortality available on the databases of PubMed, Embase, Scopus, and Web of Science up to 4th November 2024 were included. A detailed review of study outcomes was conducted with a meta-analysis.</p><p><strong>Results: </strong>Seven studies were included. 6,327 pediatric patients were included in these studies. On qualitative analysis, five of the seven studies found a statistically significant association between high RDW and PICU mortality. Four studies used RDW as a continuous variable, while three studies reported specific RDW cut-offs. Meta-analysis showed that an incremental increase in RDW was associated with a statistically significant increased risk of mortality (OR: 1.24 95% CI: 1.07, 1.44 I² = 32%). Pooled analysis of studies using RDW as a categorical variable showed that higher values of RDW were associated with significantly higher risk of mortality (OR: 1.73 95% CI: 1.02, 2.92 I² = 77%).</p><p><strong>Conclusions: </strong>RDW could be a potential predictor of mortality in the PICU. Results need to be interpreted with caution owing to the limited number of studies with variable study populations. Additional studies are needed to strengthen evidence.</p><p><strong>Systematic review registration: </strong>PROSPERO (CRD42024606208).</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1646179"},"PeriodicalIF":2.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199117","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":"Prolonged resuscitation and systemic management of multi-organ dysfunction in a neonate with severe asphyxia: a case report.","authors":"Qingsong Wang, Jun Yin, Junru Wang, Zhihui Zhao, Taojun Du, Huimin Ou, Hongmei Cao, Hong Zhang, Haonan Cao, Wenlong Yue, Siguang Jiang, Tongyong Luo, Xianmin Wang","doi":"10.3389/fped.2025.1592769","DOIUrl":"10.3389/fped.2025.1592769","url":null,"abstract":"<p><p>Severe neonatal asphyxia can lead to multiple organ dysfunction syndrome (MODS) and increase mortality and disability risks. This case report describes the successful resuscitation and management of a neonate who experienced 15 min of severe asphyxia. The male infant, born at 36 weeks' gestation via emergency cesarean section, had extremely low Apgar scores (1 at 1, 5, and 10 min). He underwent 15 min of resuscitation, including airway clearance, endotracheal intubation, positive pressure ventilation, chest compressions, and multiple administrations of epinephrine. Post-resuscitation, he exhibited severe dysfunction in multiple organ systems. The infant received comprehensive treatment, including invasive mechanical ventilation, continuous renal replacement therapy (CRRT) for acute kidney injury, therapeutic hypothermia for neuroprotection, surgical treatment for necrotizing enterocolitis with perforation, and specialized nutritional support. His condition significantly improved, with resolution of MODS, and he was discharged with weight gain and good feeding tolerance. Neurological assessments at discharge showed no significant abnormalities; however, long-term follow-up is ongoing to monitor for potential neurodevelopmental outcomes. This case highlights the importance of timely resuscitation and meticulous systemic management in achieving a favorable prognosis for neonates with severe asphyxia and MODS. The successful collaboration of a multidisciplinary team played a key role in the neonate's recovery.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1592769"},"PeriodicalIF":2.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199144","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":"Pathogen distribution and liver injury severity in children with community-acquired pneumonia complicated by liver injury in Suzhou, China.","authors":"Kun Wang, ZhengJiayi Li, Fangfang Cheng","doi":"10.3389/fped.2025.1665002","DOIUrl":"10.3389/fped.2025.1665002","url":null,"abstract":"<p><strong>Background: </strong>Liver injury is a extrapulmonary complication of community-acquired pneumonia (CAP). However, limited data exist on the pathogen distribution and severity of liver injury in children with CAP-associated liver injury. This study aimed to investigate the characteristics of pathogen distribution and the severity of liver injury in children with CAP complicated by liver injury in the Suzhou area.</p><p><strong>Methods: </strong>A retrospective study was conducted on children with CAP hospitalized at the Children's Hospital of Soochow University between January 2018 and December 2022. The study included children aged over 28 days to under 18 years, categorized into the following age groups: >28 days to 1 year, >1-3 years, >3-5 years, and >5 years. Laboratory examination results, pathogens, and characteristics of liver injury were analyzed.</p><p><strong>Results: </strong>Among the 1525 children with CAP complicated by liver injury, the male-to-female ratio was 1.4:1. Mild elevation of transaminases were observed in 1,403 cases. In the same age group, there were differences in the proportion of cases with varying degrees of liver injury (<i>p</i> <i><</i> 0.05). Among the four age groups, both the number of cases and the incidence of liver injury were highest in the >28 days to 1-year-old group. The incidence of liver injury was higher in children with severe community-acquired pneumonia (SCAP). Additionally, the distribution of pathogens varied significantly among age groups (<i>p</i> < 0.001). Children with severe liver injury were mostly accompanied by <i>Mycoplasma pneumoniae (M. pneumoniae)</i> infection (88.89%). Alanine aminotransferase (ALT) levels also varied significantly based on age group, pathogen type, and pneumonia severity (<i>p</i> < 0.05). Importantly, none of the children progressed to liver failure.</p><p><strong>Conclusions: </strong>In the Suzhou area, children with CAP aged >28 days to 1 year were the most susceptible to liver injury, with mild elevation of transaminases being the most common presentation. Special attention was required for children with CAP complicated by <i>M. pneumoniae</i> infection, as they carried a higher risk of severe liver injury. Children with SCAP were more prone to liver injury. Additionally, pathogen distribution varied across different age groups in children with CAP complicated by liver injury.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1665002"},"PeriodicalIF":2.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199103","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: Biallelic variants in <i>MRPS36</i>, encoding a component of the 2-oxoglutarate dehydrogenase complex, cause leigh syndrome.","authors":"Huafang Jiang, Chaolong Xu, Zhimei Liu, Ruoyu Duan, Xingfeng Yao, Xiaona Fu, Jiatong Xu, Xuejing Kang, Tenghui Yu, Yuanyuan Wang, Fang Fang","doi":"10.3389/fped.2025.1608840","DOIUrl":"10.3389/fped.2025.1608840","url":null,"abstract":"<p><strong>Background: </strong>The <i>MRPS36</i> gene encodes the E4 subunit of the 2-oxoglutarate dehydrogenase complex (OGDHC), a critical enzyme in the tricarboxylic acid cycle. OGDHC deficiency can lead to metabolic disorders with a clinical spectrum ranging from fatal neonatal lactic acidosis to variable degrees of global developmental delay and movement disorders. To date, a homozygous <i>MRPS36</i> variant has been reported as a novel cause of Leigh syndrome in only two siblings, who presented with developmental delay, movement disorders, bilateral striatal necrosis, and reduced OGDHC activity.</p><p><strong>Case presentation: </strong>We report a third case of Leigh syndrome associated with <i>MRPS36</i> variants in a 2-year-old boy. The patient exhibited with global developmental delay, dystonia, early-onset chorea, and elevated serum lactate levels. Follow-up brain magnetic resonance imaging at 2 years revealed progressive degenerative lesions in the bilateral basal ganglia. Muscle biopsy showed abnormal mitochondrial accumulation beneath the sarcolemma, and the oxygen consumption rate was reduced in skin fibroblasts. Whole-exome sequencing identified two novel compound heterozygous <i>MRPS36</i> variants: c.42+1G>A (p.?) and c.296G>C (p.Arg99Pro).</p><p><strong>Conclusion: </strong>This case supports <i>MRPS36</i> as a novel pathogenic cause of Leigh syndrome, further expanding the genetic spectrum of the disorder. Key clinical features include developmental delay, involuntary movement disorders, progressive basal ganglia atrophy, and a slowly progressive disease course.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1608840"},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185690","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 phase 1b randomized, multicenter, dose determination trial of zelpultide alfa (recombinant human surfactant protein D) in preterm neonates at high risk of developing bronchopulmonary dysplasia.","authors":"Almudena Alonso-Ojembarrena, Brenda Poindexter, Samia Aleem, Helen Healy, Marta Aguar-Carrascosa, Elisenda Moliner-Calderón, María Del Mar Serrano-Martín, Raquel Arroyo, Maximo Vento","doi":"10.3389/fped.2025.1639573","DOIUrl":"10.3389/fped.2025.1639573","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD) ranks among the most severe long-term complications of prematurity. Surfactant protein D, not present in commercial surfactant, regulates the innate immune response of the lungs by clearing infectious pathogens and limiting pulmonary inflammation and inflammatory injury. We aimed to assess the safety and tolerability of zelpultide alfa vs. air-sham when added to the standard of care in preterm neonates at risk of BPD. Efficacy was a secondary outcome.</p><p><strong>Methods: </strong>A phase 1b, randomized, double-blind, dose-determination study was conducted that enrolled intubated, mechanically ventilated preterm neonates who required ≥1 surfactant treatment within 96 h of birth. Initially, eight subjects [25-28 ⁶/₇ weeks gestational age (GA)] were randomized 3:1 to receive up to two doses of intratracheal zelpultide alfa at each dosing level (2, 4, or 6 mg/kg) or air-sham 24 h apart. Moreover, 12 additional subjects (23-28 ⁶/₇ weeks GA) were randomized 3:1 to receive the highest-tolerated dose of zelpultide alfa, or air-sham, once daily for up to 7 days.</p><p><strong>Results: </strong>In total, 37 subjects were randomized and treated. Zelpultide alfa, at its highest dose of 6 mg/kg, had a favorable safety profile. Furthermore, 92.9% of zelpultide alfa subjects vs. 100.0% of those that received air-sham experienced ≥1 adverse event. The mortality rate was 21% in the zelpultide alfa group and 0% in the air-sham group, although no deaths were related to the study drug. The incidence of BPD was 32.1% vs. 66.7%, the incidence of BPD or death was 54% and 67%, and time on mechanical ventilation was 17.7 vs. 25.8 days in the zelpultide alfa group compared to the air-sham group, respectively.</p><p><strong>Conclusions: </strong>This study endorses the safety and tolerability of zelpultide alfa up to 6 mg/kg (≤7 days) and reinforces the need for further clinical development of zelpultide alfa as a therapy for preventing BPD.<b>Clinical Trial Registration</b>: https://clinicaltrials.gov/study/NCT04662151?cond=BPD&term=At-100&rank=1, identifier NCT04662151.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1639573"},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185682","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":"Early assessment and analysis of high-risk factors of neurodevelopmental impairment in neonates with congenital diaphragmatic hernia.","authors":"Boliang Bai, Wendong Liu, Ronghui Yu, Xueping Zhu, Wenqiang Sun, Lang Jiang, Xiaodong Wang, Guanghao Su","doi":"10.3389/fped.2025.1632735","DOIUrl":"10.3389/fped.2025.1632735","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to retrospectively analyze clinical data of neonates with congenital diaphragmatic hernia (CDH) to investigate risk factors for neurodevelopmental impairment and their prognosis, and to evaluate the predictive value of combined assessment using amplitude-integrated electroencephalography (aEEG), regional cerebral oxygen saturation (rSO₂), and Neonatal Behavioral Neurological Assessment (<i>N</i>BNA) for early intervention.</p><p><strong>Methods: </strong>A total of 83 neonates with CDH (36 in the neurodevelopmental impairment group and 47 in the control group) were included, all diagnosed by prenatal ultrasound and postnatal imaging, with exclusion of other congenital malformations, hemodynamic instability, and genetic disorders. Clinical data [e.g., lung-to-head ratio (LHR), postoperative pulmonary hypertension, surgical approach], neuromonitoring indices (aEEG, rSO₂), and neurodevelopmental assessments (NBNA, Gesell Developmental Schedules) were collected. Independent risk factors for neurodevelopmental impairment and the area under the ROC curve (AUC) of aEEG, rSO₂, NBNA, and their combined assessment were analyzed.</p><p><strong>Results: </strong>Severe pulmonary hypoplasia (LHR < 1.5; OR = 6.20, 95% CI: 2.15-17.80, <i>P</i> = 0.005), postoperative persistent pulmonary hypertension (PPHN; OR = 2.80, 95% CI: 1.09-13.60, <i>P</i> = 0.027), and open surgery (vs. minimally invasive repair; OR = 2.80, 95% CI: 0.82-9.58, <i>P</i> = 0.056) were identified as independent risk factors for neurodevelopmental impairment in CDH neonates. aEEG scores and rSO₂ values in the neurodevelopmental impairment group were significantly lower than those in the control group at both 14 and 28 days (<i>P</i> < 0.001). The combined assessment of aEEG, rSO₂, and NBNA showed the highest AUC (0.960), with 83.0% sensitivity and 98% specificity.</p><p><strong>Conclusion: </strong>LHR < 1.5, PPHN, and open surgery are independent predictors of neurodevelopmental impairment in CDH neonates. The combined use of aEEG, rSO₂, and NBNA significantly improves the efficiency of early neurodevelopmental impairment identification (AUC = 0.960), outperforming single indicators. Clinicians should prioritize monitoring pulmonary hypoplasia and perinatal complications while adopting multimodal neuromonitoring to optimize early intervention strategies.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1632735"},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185651","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 cavernous hemangioma in the small intestine of a teenage boy: a case report and literature review.","authors":"Tian Xie, Yi Long","doi":"10.3389/fped.2025.1654913","DOIUrl":"10.3389/fped.2025.1654913","url":null,"abstract":"<p><strong>Background: </strong>A cavernous hemangioma in the small intestine is rare. Due to its hidden location and non-specific clinical symptoms, it is difficult to diagnose accurately. Here, we describe a 14-year-old boy with a cavernous hemangioma and bleeding at the junction of the jejunum and ileum.</p><p><strong>Case summary: </strong>The patient presented with clinical manifestations including melena, dizziness, fatigue, pale complexion, and shock. Abdominal contrast-enhanced computed tomography identified a hyperdense lesion within the small bowel lumen. Digital subtraction angiography (DSA) revealed aneurysmal changes in the mid-to-lower abdominal branches of the ileojejunal artery, which were suggestive of a hemorrhage originating from a small intestinal hemangioma. However, subsequent DSA-guided interventional embolization failed to achieve hemostasis. Following a hospital-wide multidisciplinary consultation, a laparoscopic exploration was conducted. During the procedure, a 1.5 cm × 1.5 cm mass was detected at the ileojejunal junction and successfully resected. The postoperative pathological examination confirmed the lesion to be a cavernous hemangioma. One week after surgery, the patient's hemoglobin level increased to 86 g/L, with no recurrence of bloody stools. At the 1-month follow-up, no signs of disease recurrence were observed.</p><p><strong>Conclusion: </strong>This case report presents significant clinical implications for the diagnosis and management of small intestinal cavernous hemangiomas in the pediatric population.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1654913"},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185667","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":"Revisiting cytomegalovirus in pediatric allogeneic hematopoietic stem cell transplant recipients: current strategies for prevention and management in the letermovir era.","authors":"Lisa Hiskey, Diego R Hijano, Ramia Zakhour","doi":"10.3389/fped.2025.1663600","DOIUrl":"10.3389/fped.2025.1663600","url":null,"abstract":"<p><p>CMV infection remains the most common clinically significant infection in pediatric allogeneic hematopoietic stem cell (HCT) recipients, with seropositive recipients of transplants from seronegative donors at the highest risk for complications. In recent years, letermovir, a novel antiviral with a favorable toxicity profile, was approved first for adults and more recently for pediatric patients for the primary prophylaxis of CMV infection and disease in high-risk HCT recipients. Growing evidence from real-life data regarding the safety and efficacy of letermovir has transformed the landscape of CMV disease in HCT transplant recipients and led to a paradigm shift from a preemptive approach to prophylaxis. Other novel additions to the diagnosis, risk stratification, and treatment of CMV include the measurement of CMV-specific cellular-mediated immunity and the approval of maribavir as a treatment option for resistant/refractory CMV infection and disease. Other prevention and treatment modalities currently under development include virus-specific T cells, monoclonal antibodies, and vaccines. Despite these promising advancements, additional pediatric-specific studies are needed to better understand the viral and immunological implications of these novel preventive and therapeutic methods in this patient population.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1663600"},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185814","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":"Evaluation of an integrated stepwise rehabilitation model following Nuss procedure in pediatric patients.","authors":"Wen-Jing Li, Li-Li Cao, Chan Li, Jing-Jing Yang, Hui Wang, Yao Tong","doi":"10.3389/fped.2025.1591331","DOIUrl":"10.3389/fped.2025.1591331","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the application and rehabilitation outcomes of an integrated stepwise rehabilitation training model in pediatric patients undergoing minimally invasive repair of pectus excavatum (Nuss procedure).</p><p><strong>Methods: </strong>A cohort of 97 children who underwent the Nuss procedure between July 2019 and August 2021 were included in the study. Participants were divided into an observation group (<i>n</i> = 52) and a control group (<i>n</i> = 45). The observation group received a stepwise rehabilitation training model in addition to standard perioperative care, while the control group received only routine care. Rehabilitation outcomes, including physical development, pulmonary function, self-care ability, and treatment satisfaction, were assessed over a 12-month period.</p><p><strong>Results: </strong>There were no statistically significant differences in baseline characteristics or postoperative complications between the two groups. In the observation group, all pulmonary function parameters demonstrated significant improvements at both 6- and 12-months post-surgery (<i>p</i> < 0.001). The control group did not indicate significant changes at 6 months, with improvements noted only at 12 months (<i>p</i> < 0.001). Postoperative satisfaction and self-care ability in the control group improved significantly at the 12-month follow-up. In contrast, the observation group exhibited significant improvements in these parameters as early as 6 months postoperatively.</p><p><strong>Conclusion: </strong>Early implementation of an integrated stepwise rehabilitation training model enhances the recovery process in pediatric patients following the Nuss procedure. This approach is both effective and economically feasible, providing a practical framework for post-surgical rehabilitation.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1591331"},"PeriodicalIF":2.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185693","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":"Comparison of the vitamin D level between children with and without cow's milk protein allergy: a systematic review with meta-analysis.","authors":"Xueming Zheng, Yi Jin, Jianhong Luo, Fan Jiang, Limin Zhang, Xiaoxue Wang, Hui Zhang, Shaofei Ma, Yejuan Li","doi":"10.3389/fped.2025.1649825","DOIUrl":"10.3389/fped.2025.1649825","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D plays an important role in modulating immune responses, which may be associated with cow's milk protein allergy (CMPA). This meta-analysis aimed to comprehensively compare the vitamin D level between children with CMPA and healthy controls.</p><p><strong>Methods: </strong>Studies comparing the vitamin D level between children with CMPA and healthy controls were comprehensively searched in PubMed, Web of Science, Embase, Wan Fang, CNKI, and VIP until April 2025.</p><p><strong>Results: </strong>A total of 12 studies, involving 605 children with confirmed CMPA (CMPA group) and 558 healthy controls (control group) were included. The vitamin D level was lower in the CMPA group than in the control group [standardized mean difference (SMD) (95% confidence interval): -1.229 (-2.117, -0.340), <i>P</i> = 0.007]. Regarding subgroup analysis, the vitamin D level was lower in the CMPA group than in the control group in studies using mass spectrometry or automated immunoassay (<i>P</i> = 0.042), and was of no difference in those using enzyme-linked immunosorbent assay (<i>P</i> = 0.200) or chemiluminescence (<i>P</i> = 0.097). Moreover, the vitamin D level was lower in the CMPA group than in the control group in studies conducted in Asia (<i>P</i> < 0.001) or South America (<i>P</i> = 0.041), but not in studies conducted in Europe (<i>P</i> = 0.500). All included studies were high-quality. No publication bias was found. Sensitivity analyses indicated high robustness of the results.</p><p><strong>Conclusion: </strong>Vitamin D is decreased in children with CMPA, indicating its potential association with CMPA. These findings may enhance the understanding of CMPA and guide the prevention or management of CMPA in children.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1649825"},"PeriodicalIF":2.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185704","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}