Frontiers in Pediatrics最新文献

{"title":"The hope of children and families in the context of cancer: a scoping review.","authors":"Camila Garófalo, Aline Oliveira Silveira, Dhiovanna Tavares, Hellen Seganfredo, Monika Wernet, Zaida Charepe","doi":"10.3389/fped.2026.1958432","DOIUrl":"10.3389/fped.2026.1958432","url":null,"abstract":"<p><strong>Context: </strong>Childhood cancer affects children, adolescents, and their families. This sudden and uncertain context threatens hope, a vital, multidimensional, and evolving force.</p><p><strong>Objective: </strong>To map scientific evidence for the hope of children, adolescents, and families, the meanings, perceptions, and manifestations of hope associated with coping during childhood cancer treatment.</p><p><strong>Method: </strong>This scoping review was based on the Dufault and Martocchio model and followed Joanna Briggs Institute methodological guidelines. The search was conducted in six databases (PUBMED, CINAHL, LILACS, SCOPUS, PSYCINFO, and SCIELO) in May 2025 and updated in February 2026, returning 4,380 studies.</p><p><strong>Results: </strong>A total of 31 studies were eligible, most conducted in the United States with a qualitative approach and interviews. The predominance of the maternal perspective was identified. Evidence revealed meanings of hope as \"lifeblood\" and \"ray of light,\" undergoing transformations as the expectation of healing was redefined and culminated in hoping for relief from suffering and dignity at the end of life (Cognitive Dimension). Trust and fear coexist (Affective Dimension), but living \"day-to-day,\" maintaining family rituals and dynamics, and practicing faith help alleviate helplessness (Affiliative and Behavioural Dimension). Meaningful relationships, coping actions, and the ability to redefine healing justify the predominance of the Affiliative, Behavioral, and Cognitive Dimensions.</p><p><strong>Conclusion: </strong>Hope is a dynamic and metamorphic force that sustains the family in the face of sudden diagnosis and prognostic uncertainties. Relationships with healthcare professionals can amplify or threaten the family's sense of hope. Expanded family representation and as a systemic unit were gaps.</p><p><strong>Systematic review registration: </strong>https://osf.io/atk6v, identifier 10.17605/OSF.IO/ATK6V.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1958432"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216099","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":"Shared reading and independent book engagement in early childhood: associations with the home literacy environment in a Turkish pediatric outpatient population.","authors":"Enes Kaan Kilic, Furkan Kalayci, Kaan Çelebier, Aybars Ataus, Metehan Yaşar Tekin, Arif İsmet Çatak, Metin Yigit","doi":"10.3389/fped.2026.1939681","DOIUrl":"10.3389/fped.2026.1939681","url":null,"abstract":"<p><strong>Objective: </strong>To explore parental reading practices and factors associated with parental reading to children and children's independent engagement with books within the Home Literacy Environment (HLE).</p><p><strong>Methods: </strong>This cross-sectional study included 362 parents of children aged 1-6 years who attended the Pediatric Outpatient Clinic of Ankara Bilkent City Hospital between October and December 2025. Parents completed a 28-item questionnaire assessing their demographic characteristics, home literacy practices, parental reading habits, access to books, and children's independent book engagement. Firth's bias-reduced penalized likelihood logistic regression was used for multivariable analyses.</p><p><strong>Results: </strong>Shared reading was common, occurring daily in 47.3% and 2-3 times per week in 29.3% of families, most often during the evening or bedtime routines (64.2%). Maternal education was strongly associated with parental reading to the child; mothers with a university degree or higher had higher odds of reading to their children than those with a high school education or below [odds ratio (OR) = 14.31; 95% confidence interval (CI): 4.73-50.21; <i>p</i> < 0.001]. Independent book engagement was associated with older child age (OR = 1.38 per year; 95% CI: 1.11-1.73, <i>p</i> = 0.004), parental reading (OR = 3.82; 95% CI: 1.50-9.79,<i>p</i> = 0.005), a home library (OR = 2.48; 95% CI: 1.18-5.23,<i>p</i> = 0.017), and at least one parent with a regular reading habit (OR = 2.35; 95% CI: 1.02-5.18,<i>p</i> = 0.044), whereas maternal education was not independently associated with this outcome (<i>p</i> = 0.121).</p><p><strong>Conclusion: </strong>Parental reading and children's independent book engagement were associated with different components of the HLE. These exploratory findings suggest that both parental characteristics and everyday home literacy practices may be relevant to shared reading and independent book engagement, and may help inform future efforts to integrate family-centered literacy guidance into pediatric care.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1939681"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216096","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":"Transcatheter arterial embolization for hemoptysis in children with bronchopulmonary artery fistulas: a single-center retrospective analysis.","authors":"Zhuang Liu, Liang Wang, Jing Li, Xin Zhang, Jie Zhou, Dan Song","doi":"10.3389/fped.2026.1822389","DOIUrl":"10.3389/fped.2026.1822389","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of transcatheter interventional embolization for hemoptysis secondary to bronchopulmonary artery fistula (BPAF) in pediatric patients.</p><p><strong>Methods: </strong>A retrospective review was conducted on the clinical profiles and digital subtraction angiography (DSA) characteristics of 17 pediatric patients with BPAF-related hemoptysis. Clinical outcomes and follow-up data were analyzed.</p><p><strong>Results: </strong>The cohort comprised 11 boys and 6 girls, aged 7 months to 14 years. DSA demonstrated varying degrees of bronchopulmonary shunts. All patients successfully underwent super-selective embolization of the target vessels via a microcatheter. During hospitalization, hemoptysis was immediately resolved in 16 patients (94. 1%), while Patient No. 17 experienced persistent bleeding post-intervention and required immediate surgical treatment. During the long-term post-discharge follow-up, three patients experienced recurrence: Patient No. 12 developed recurrent hemoptysis at 2 years post-procedure, which was managed with a second and a subsequent third embolization due to another recurrence 3 months later, achieving long-term remission thereafter; Patient No. 15 experienced recurrence 1 year post-procedure and remained symptom-free after a second embolization; Patient No. 14 recurred 2 months post-procedure, and due to the inability of the microcatheter to reach the target vessel during the second angiography, the patient was successfully treated with surgery.</p><p><strong>Conclusion: </strong>Transcatheter interventional therapy is a safe and effective approach for managing BPAF-related hemoptysis in pediatric patients. For fistulas with high-volume shunts, positioning the microcatheter as close to the fistula orifice as possible for embolization may optimize technical and clinical success. Considering the relatively small sample size, the present results should be interpreted with caution and verified by larger follow-up studies.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1822389"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181360","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":"Building a framework for successful transition from pediatric to adult healthcare in Down syndrome.","authors":"J Hubrechts, N Mahlaoui, H Franckx, I Loeckx, A Monier, T Boiy, G Wieërs","doi":"10.3389/fped.2026.1932363","DOIUrl":"https://doi.org/10.3389/fped.2026.1932363","url":null,"abstract":"<p><strong>Background: </strong>Adults with Down syndrome (DS) increasingly require structured transition from pediatric to adult healthcare, yet disease-specific guidance remains limited.</p><p><strong>Methods: </strong>We reviewed current evidence and combined it with the multidisciplinary clinical experience of the Belgian National Scientific Board for Down Syndrome to identify barriers and propose practical recommendations.</p><p><strong>Results: </strong>Transition in DS is challenged by intellectual disability, multimorbidity, fragmented adult care, structural healthcare inequalities, delayed primary care involvement, parental ageing, and poor coordination between medical and social services. We propose a person-centered framework emphasizing early preparation, supported decision-making, multidisciplinary collaboration, early engagement of general practitioners, accessible communication, and integrated medico-social support.</p><p><strong>Conclusions: </strong>Disease-specific transition pathways are needed to improve continuity of care, promote autonomy, and reduce health inequalities. Prospective studies should evaluate transition models and include the perspectives of people with DS and their families.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1932363"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192181","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":"Age-dependent dissociation between sleep-disordered breathing severity and ventilatory impairment in children with Prader-Willi syndrome.","authors":"Mihail Basa, Jelena Visekruna, Tijana Grba, Sanja Cirkovic, Danijela Radivojevic, Bojana Dobric, Marijana Miskovic, Slavica Ostojic, Aleksandar Sovtic","doi":"10.3389/fped.2026.1919314","DOIUrl":"https://doi.org/10.3389/fped.2026.1919314","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep-disordered breathing (SDB) is highly prevalent in children with Prader-Willi syndrome (PWS), encompassing central, obstructive, and ventilatory abnormalities. However, its longitudinal evolution remains incompletely understood.</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal study of children with genetically confirmed PWS who underwent serial respiratory polygraphy with concurrent transcutaneous carbon dioxide (TcCO₂) monitoring. Clinical characteristics, therapeutic interventions, and longitudinal respiratory parameters were analyzed using linear mixed-effects models.</p><p><strong>Results: </strong>Twenty-nine children were included. SDB demonstrated an age-dependent pattern, with central respiratory abnormalities predominating in early childhood and obstructive events becoming more prominent during preschool and school age. In contrast, nocturnal ventilatory impairment was mainly observed in older children and adolescents. Clinical symptoms were independently associated with ENT intervention, whereas higher body mass index was associated with a greater likelihood of requiring non-invasive ventilation, supporting distinct obstructive and ventilatory phenotypes. Although unadjusted analyses suggested increasing TcCO₂ values with age, adjusted mixed-effects models indicated that this relationship was largely explained by obesity and treatment-related factors.</p><p><strong>Conclusions: </strong>SDB in children with PWS appears to represent an evolving continuum of central, obstructive, and ventilatory abnormalities. Conventional apnea indices alone may not adequately reflect ventilatory impairment, supporting longitudinal assessment of nocturnal gas exchange in addition to standard respiratory event indices.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1919314"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192912","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":"Duration of surfactant administration and its impact on stabilisation of vital parameters in very preterm neonates <28 weeks of gestational age (SurfStab): 1 min versus 5 min-study protocol for a prospective randomised-controlled phase IV trial.","authors":"C H Wolfsberger, B Schwaberger, N Baik-Schneditz, A Avian, M Holter, G Pichler","doi":"10.3389/fped.2026.1939771","DOIUrl":"https://doi.org/10.3389/fped.2026.1939771","url":null,"abstract":"<p><strong>Background: </strong>Respiratory distress syndrome remains one of the leading causes of morbidity and mortality in extremely preterm neonates. Surfactant replacement therapy substantially improves survival. Current European Consensus Guidelines recommend the less invasive surfactant administration (LISA) technique. However, no evidence exists on whether the duration of administration affects physiological stability. Rapid surfactant administration may provoke transient hypoxia or bradycardia due to airway obstruction, whereas slower delivery could potentially reduce such fluctuations.</p><p><strong>Methods/design: </strong>The SurfStab Trial is a single-centre, randomised, controlled phase IV clinical trial conducted at the Division of Neonatology, Medical University of Graz, Austria. Extremely preterm neonates (< 28 weeks of gestation) requiring surfactant via LISA will be randomly allocated (1:1) to receive surfactant administration over either 1 min (\"1-min group\") or 5 min (\"5-min group\"). The primary outcome is the maximum change in cerebral oxygen saturation (crSO₂), measured continuously using near-infrared spectroscopy (NIRS) from 5 min before LISA catheter insertion (baseline) to 15 min after completion of the procedure. Secondary outcomes include changes in arterial oxygen saturation (SpO₂), heart rate (HR), arterial blood pressure (ABP), thoracic electrical impedance tomography (EIT), lung ultrasound, and the need for repeat surfactant administration, invasive ventilation, or supplemental oxygen up to three and up to 48 h after study intervention, as well as short-term outcomes at hospital discharge. The planned sample size is 76 neonates.</p><p><strong>Discussion: </strong>This trial will address a crucial gap in neonatal care by determining whether the duration of surfactant administration influences cerebral and systemic oxygen stability in extremely preterm neonates. The findings may refine evidence-based recommendations for optimal LISA procedure and may contribute to improved outcomes.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, Identifier: NCT NCT07261787. Registered 02/12/2025. Eu CT number 2025-522754-39-00. Registered 01/12/2025.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1939771"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192653","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 association between adjunctive repetitive transcranial magnetic stimulation and seizure reduction in a pediatric patient with DNM1L-associated EMPF1: a case report.","authors":"Xianghui Chen, Pinglian Sun, Xiaohong Ren, Gege Liu, Xiaoyuan Bai, Feng Guo, Rui Guo, Shirun Wu, Huifang Wang","doi":"10.3389/fped.2026.1933161","DOIUrl":"https://doi.org/10.3389/fped.2026.1933161","url":null,"abstract":"<p><strong>Background: </strong>Encephalopathy, lethal, due to defective mitochondrial and peroxisomal fission 1 (EMPF1) is a rare, severe mitochondrial disorder characterized by acute-onset refractory seizures that rapidly progress to status epilepticus and are associated with a poor prognosis. Conventional therapies, including antiepileptic drugs and the ketogenic diet, exhibit limited efficacy. Although repetitive transcranial magnetic stimulation (rTMS) has shown promise in other forms of drug-resistant epilepsy, its potential role in managing EMPF1 remains unexplored.</p><p><strong>Case presentation: </strong>A 7-year-old boy, previously healthy with normal development, presented with right-hand clonic movements and impaired consciousness, which progressed to status epilepticus. Brain MRI revealed diffuse cytotoxic edema involving the bilateral frontal, parietal, and temporal cortices, basal ganglia, and thalami. EEG recording showed generalized periodic spike-wave discharges with background slowing. Genetic testing identified a novel <i>de novo</i> DNM1L mutation (c.1949T > C, p.Leu650Pro), which was classified as likely pathogenic according to ACMG/AMP guidelines and provided strong support for the diagnosis of EMPF1. In addition to a regimen of antiepileptic drugs and a metabolic \"cocktail,\" 1-Hz rTMS (90% of the resting motor threshold, 40 trains daily) was applied over the left primary motor cortex on Day 16. Following initiation of this combined therapy, seizure frequency was temporally associated with a marked reduction, decreasing from ∼20 to 5-6 episodes/day after one day, 2-3 by Day 27 (12 days after rTMS initiation), and 0-1 by Day 36 (21 days after rTMS initiation). Despite this reduction in clinical seizure burden, the patient developed progressive pneumonia leading to sepsis and acute heart failure, and died on Day 65 (hospital day 65).</p><p><strong>Conclusions: </strong>In this case, adjunctive rTMS applied alongside standard antiepileptic and metabolic \"cocktail\" therapy was temporally associated with a pronounced reduction in seizure frequency in a patient with DNM1L-associated EMPF1. This temporal association is hypothesis-generating and does not permit attribution of the observed seizure reduction to rTMS; further investigation in larger cohorts is warranted.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1933161"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192707","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 early blood lactate trajectories and mortality in neonates: a retrospective cohort study.","authors":"Xingxing Zhan, Yu Zhang, Hua Lu","doi":"10.3389/fped.2026.1959433","DOIUrl":"10.3389/fped.2026.1959433","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lactate is a widely used prognostic biomarker in critically ill patients, but its dynamic trajectory and prognostic value in critically ill neonates remain underexplored. This study aimed to investigate the association between dynamic lactate trajectories during the first 48 h after neonatal intensive care unit (NICU) admission and 30-day all-cause mortality risk in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The association between admission blood lactate levels and 30-day all-cause mortality was assessed using multivariable Cox regression and restricted cubic spline (RCS) analysis in 1,112 neonates admitted to the NICU who were included in the blood lactate trajectory classification. Blood lactate trajectories over the first 48 h were identified using a latent growth mixture model (LGMM) based on the highest blood lactate value within each 12-hour interval. A 48-hour landmark analysis was then performed, and survival follow-up was initiated at 48 h after NICU admission among neonates who were alive and eligible for trajectory classification, yielding an analysis cohort of 1,080 neonates. The association between trajectory patterns and 30-day all-cause mortality was further evaluated using multivariable Cox regression models, adjusting for potential confounders including demographics, clinical parameters, and laboratory variables. Kaplan-Meier survival curves were generated for the four trajectory groups in the landmark cohort, and differences in survival were compared using the log-rank test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Admission lactate levels demonstrated a linear positive association with 30-day all-cause mortality risk (&lt;i&gt;p&lt;/i&gt; for non-linearity = 0.78), with each 1 mmol/L increase associated with a 9% increase in risk after multivariable adjustment (HR 1.09, 95% CI 1.06-1.13, &lt;i&gt;p&lt;/i&gt; &lt; 0.01) in 1,112 neonates. Four distinct blood lactate trajectory patterns were identified during the first 48 h after NICU admission: a rapidly declining group (Class 1, 5.75%), a stably low group (Class 2, 88.22%), a persistently intermediate group (Class 3, 4.41%), and a persistently high group (Class 4, 1.62%). In the 48-hour landmark cohort (&lt;i&gt;n&lt;/i&gt; = 1,080), compared with the stably low group, the persistently high group had the highest risk of 30-day all-cause mortality (HR 25.61, 95% CI 8.99-73.01, &lt;i&gt;p&lt;/i&gt; &lt; 0.01), followed by the persistently intermediate group (HR 6.84, 95% CI 3.39-13.78, &lt;i&gt;p&lt;/i&gt; &lt; 0.01), while the rapidly declining group also showed a significantly increased risk after full adjustment (HR 2.63, 95% CI 1.20-5.80, &lt;i&gt;p&lt;/i&gt; = 0.02).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Elevated lactate levels are associated with increased short-term mortality in neonates. Early lactate trajectories are associated with 30-day all-cause mortality and may provide additional clinically relevant information beyond a single admission lactate measurement, potentially aiding early risk stratification. Prospective mul","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1959433"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181341","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":"Evidence quality assessment of traditional Chinese medicine and integrated traditional Chinese and Western medicine for acute upper respiratory infection in children: an umbrella review of systematic reviews and meta-analyses.","authors":"Zhen Liu, Yumeng Yang, Yuetong Liu, Yichen Lin, Zongkai Wang, Huiyang Shi, Zhenqi Wu","doi":"10.3389/fped.2026.1896116","DOIUrl":"10.3389/fped.2026.1896116","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To systematically appraise the reporting completeness, methodological quality, risk of bias, and certainty of evidence for a prespecified outcome in systematic reviews and meta-analyses evaluating traditional Chinese medicine (TCM), either alone or in combination with conventional Western medicine, for acute upper respiratory tract infection (AURI) in children using an umbrella review approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and the Chinese Biomedical Literature Database (SinoMed) were systematically searched from database inception to February 5, 2026, without restrictions on publication year. Systematic reviews and meta-analyses evaluating TCM alone or TCM combined with conventional Western medicine for pediatric AURI were eligible for inclusion. Reporting completeness was assessed using the PRISMA 2020 statement, methodological quality using AMSTAR 2, and risk of bias using ROBIS. In addition, the certainty of evidence for the outcome of total effective rate was independently reassessed for each included systematic review using the GRADE framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 41 systematic reviews and meta-analyses involving 57,590 children were included. The eligible reviews were published between 2010 and 2024; no systematic review or meta-analysis published between 2025 and February 5, 2026 met the prespecified eligibility criteria. Assessment against PRISMA 2020 identified varying degrees of underreporting, particularly with respect to protocol registration, complete search strategies, the influence of risk of bias on interpretation of findings, sensitivity analyses, and funding sources. According to AMSTAR 2, 37 reviews were rated as having moderate methodological quality, three as low quality, and one as critically low quality. ROBIS identified 38 reviews as being at high risk of bias. Across the 41 review-specific GRADE assessments of total effective rate, one was rated as moderate-certainty evidence, four as low-certainty evidence, and 36 as very-low-certainty evidence. These ratings apply exclusively to total effective rate, a non-standardized composite outcome, and should not be extrapolated to other outcomes such as time to fever resolution, duration of cough, or adverse events. Although most existing reviews suggested that TCM, either alone or combined with conventional Western medicine, may provide potential benefits in terms of total effective rate and selected short-term symptom outcomes, substantial clinical heterogeneity and methodological limitations were evident across the evidence base.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Existing systematic reviews suggest that TCM, either alone or in combination with conventional Western medicine, may offer potential clinical benefits for children with AURI. However, the overall evidence base is characterized by a h","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1896116"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181416","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":"Effects of formal aquatic activities on health and developmental outcomes in infants and toddlers younger than 36 months: a systematic review and meta-analysis.","authors":"Jiayi Lyu, Guangnan Liu, Yang Liu, Lei Lei, Xinyi Li, Mo Bai, Leyi Sun, Jie Gao","doi":"10.3389/fped.2026.1910257","DOIUrl":"https://doi.org/10.3389/fped.2026.1910257","url":null,"abstract":"<p><strong>Aims: </strong>To systematically review and meta-analyze controlled evidence on the effects of formal aquatic activities on health and developmental outcomes in infants and toddlers younger than 36 months.</p><p><strong>Background: </strong>Formal aquatic activities-including infant swimming, neonatal swimming, hydrotherapy, and warm-water bathing-are increasingly used in early-life care, yet existing studies vary in populations, intervention formats, and outcome measures, making overall effects difficult to determine. A structured synthesis is needed to clarify their potential role in early health and development.</p><p><strong>Methods: </strong>We conducted an updated search of PubMed, Ovid MEDLINE(R) ALL, EMBASE, PsycINFO, Scopus, SportDiscus, Web of Science, and EBSCOhost (December 2022 to May 25, 2026) and CNKI (inception to May 25, 2026). Controlled studies evaluating formal aquatic activities in infants or toddlers younger than 36 months were eligible. Outcomes were coded and organized using the WHO International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) framework. Random-effects meta-analyses pooled standardized mean differences (SMDs) for continuous outcomes and risk ratios (RRs) for binary developmental classification outcomes. Sensitivity and subgroup analyses were conducted where heterogeneity was substantial.</p><p><strong>Results: </strong>25 studies (3,526 participants; 1,822 aquatic intervention, 1,704 comparator) were included; 22 contributed to the meta-analysis. Across six outcome domains, 87 effect sizes were synthesized. Aquatic activities showed favourable effects on: neurodevelopmental and motor function (SMD = 0.96, 95% CI 0.78-1.15), growth and anthropometry (SMD = 0.54, 95% CI 0.44-0.63), physiological regulation and safety (SMD = 0.85, 95% CI 0.49-1.22), beneficial developmental classification (RR = 1.45, 95% CI 1.29-1.62), jaundice burden and bilirubin metabolism (SMD = 2.31, 95% CI 1.37-3.26), and feeding, stool transition, and digestion (SMD = 0.81, 95% CI 0.61-1.01). Heterogeneity was highest for jaundice-related outcomes; sensitivity and subgroup analyses confirmed the favourable direction of effects.</p><p><strong>Conclusions: </strong>This ICF-CY-informed systematic review and meta-analysis suggests that formal aquatic activities may have beneficial effects across multiple health and developmental domains in infants and toddlers under 36 months. These findings support using aquatic activities as a complementary approach in early-life care, while underscoring the need for more rigorous randomized trials, standardized intervention protocols, and longer follow-up to strengthen the evidence base.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"14 ","pages":"1910257"},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192674","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}