Pediatric Research最新文献

{"title":"Adolescents' and parents' perspectives on addressing adverse childhood experiences in school-based health centers.","authors":"Rebecca K Tsevat, Rosina Franco, Roberta Villanueva, Kate Diaz Roldan, Gery W Ryan, Shannon M Thyne, Bahareh Gordon, Ron Tanimura, Shirley A Russ, Rebecca N Dudovitz","doi":"10.1038/s41390-026-05535-x","DOIUrl":"https://doi.org/10.1038/s41390-026-05535-x","url":null,"abstract":"<p><strong>Background: </strong>School-based health centers (SBHCs) serve many children impacted by adverse childhood experiences (ACEs), but little is known about addressing ACEs in these settings. This study explored the barriers and facilitators to addressing ACEs in SBHCs from the perspectives of adolescents and parents/caregivers in the community.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with adolescents (ages 16-22) and parents/caregivers of school-aged youth (ages 3-17) recruited from patient and family advisory groups, primary care clinic waiting rooms, and snowball sampling. We used a thematic analysis approach and continued until reaching saturation.</p><p><strong>Results: </strong>Twenty interviews were conducted (10 adolescents, 10 parents/caregivers). Four themes emerged, emphasizing the importance of relational context: (1) Participants expect trust between the patient and the provider addressing ACEs, (2) The school's social environment influences comfort with addressing ACEs, (3) Relationships and contexts outside school impact perceptions of addressing ACEs, and (4) Addressing ACEs in SBHCs can promote the health of the school community.</p><p><strong>Conclusion: </strong>SBHCs can play a vital role in educating about the management and impacts of ACEs. Addressing ACEs in SBHCs requires attention to the relational ecosystem. Policies and practices may consider addressing patient-provider relationships, the school environment, and broader social ecological contexts.</p><p><strong>Impact: </strong>School-based health centers (SBHCs) are understudied settings that may hold promise for addressing adverse childhood experiences (ACEs). This study is the first to explore barriers and facilitators to addressing ACEs in SBHCs from the perspectives of adolescents and parents/caregivers in the community. Relational context, including the patient-provider relationship, the school's social environment, and broader community influences, informed participants' attitudes toward addressing ACEs in SBHCs. SBHCs have several advantages that may promote the health and well-being of youth with ACEs. These findings may inform the development of family-centered strategies to support youth with ACEs in SBHCs.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-medical drivers of health and pediatric no-show prediction: identifying modifiable risk factors.","authors":"Ashley Gibson, Linh Nguyen, Lishan Yu, Christopher Kulesza, Yen-Chi Le, Sarah Cavenaugh, Sandra McKay, Xiaoqian Jiang","doi":"10.1038/s41390-026-05531-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05531-1","url":null,"abstract":"<p><strong>Background: </strong>No-shows to medical appointments contribute to disruptions and inefficiencies in healthcare delivery. While artificial intelligence/machine learning (AI/ML) models are increasingly used to predict no-shows, few have incorporated non-medical drivers of health (NMDOH), particularly in pediatric populations. This study evaluated the inclusion of NMDOH in pediatric AI/ML no-show prediction and identified modifiable factors associated with no-shows.</p><p><strong>Methods: </strong>A retrospective study was conducted of scheduled pediatric appointments across six general pediatrics clinics during April-August 2024 using electronic health record and NMDOH screening data. A transformer-based AI/ML no-show model was evaluated using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC). Multivariable logistic regression was used to evaluate factors associated with no-show status.</p><p><strong>Results: </strong>Among 7,931 included appointments, 2761 (34.8%) were no-shows. Models with and without NMDOH variables showed similar performance (AUROC 0.708 for both; AUPRC 0.536 vs. 0.535, respectively). Inclusion of patient demographic and insurance variables produced a small improvement in performance, with similar results with and without NMDOH inclusion (AUROC 0.721 and AUPRC 0.542 for both). No-shows were associated with unconfirmed appointments, non-active patient portal status, transportation needs, and housing instability.</p><p><strong>Conclusions: </strong>NMDOH variables did not significantly change model performance but identified actionable factors associated with no-shows. Prediction models may be most useful when paired with targeted outreach and barrier-reduction strategies.</p><p><strong>Impact: </strong>Non-medical drivers of health (NMDOH), including transportation needs and housing instability, as well as appointment confirmation and patient portal activation, were associated with missed pediatric appointments. Inclusion of NMDOH in AI/ML no-show prediction models did not meaningfully change prediction performance. The associations highlight modifiable barriers that can be targeted through clinical and operational interventions. AI-based no-show prediction may be most effective when paired with outreach and barrier-reduction strategies.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequate nutrition during pregnancy including LCPUFAs: a commentary.","authors":"Miguel Saenz de Pipaon, Ariadna Witte Castro, Alejandra Arribas Castaño","doi":"10.1038/s41390-026-05575-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05575-3","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory burden and coronary aneurysm risk in Kawasaki disease: appraising the Aggregate Index of Systemic Inflammation.","authors":"Khaled Saad, Shimaa Elwardany Aly, Saiel S K Zeid, Ahmad Roshdy Ahmad, Mohamed Shawky Elfarargy, Mohammad Elkossi, Muhammad Husnain Mumtaz, Mohamad-Hani Temsah","doi":"10.1038/s41390-026-05590-4","DOIUrl":"https://doi.org/10.1038/s41390-026-05590-4","url":null,"abstract":"<p><strong>Impact: </strong>The Aggregate Index of Systemic Inflammation (AISI) may serve as an additional inflammatory marker for identifying children with Kawasaki disease (KD) who require closer coronary surveillance. AISI integrates standard hematological parameters and may complement, rather than replace, established clinical and echocardiographic risk assessment. Current evidence supports further prospective validation before AISI can be included in treatment decision pathways. AISI-based risk stratification may contribute to future personalized approaches in KD management.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The potential role of miR-34a and miR-34c in the regulation of pediatric high-grade glioma 4 aggressiveness.","authors":"Dikla Rogachevsky, Michal Yalon, Ruty Mehrian-Shai, Amos Toren","doi":"10.1038/s41390-026-05518-y","DOIUrl":"https://doi.org/10.1038/s41390-026-05518-y","url":null,"abstract":"<p><strong>Background: </strong>Pediatric diffuse high-grade gliomas grade 4 (pHGG-4), the most aggressive malignant primary brain tumors, are incurable and associated with poor prognosis. In most pHGG-4, meaningful genetic aberrations were rarely found, and the aggressiveness is derived from epigenetic changes and dysregulated gene expression. miRNAs are significant epigenetic regulators of gene expression that play important roles in many cancers.</p><p><strong>Methods: </strong>miR-34a and miR-34c levels were analyzed in pHGG cell lines and tumor datasets. SF188 and KNS42 cells were transfected with miR-34a/miR-34c mimic or scrambled oligonucleotide, and examined for viability, migration ability, and invasiveness. Expression of survival, cell cycle arrest/progression, apoptosis, and Epithelial-Mesenchymal Transition (EMT) regulating genes was examined using quantitative PCR (qPCR), western blot, and immunofluorescence assays.</p><p><strong>Results: </strong>miR-34a and miR-34c were scarcely expressed in pHGG-4 cell lines, and miR-34c was downregulated in pHGG-4 tumor datasets. Upregulating miR-34a/miR-34c decreased cell viability, migration ability, and invasiveness, while differentially affecting the expression of genes involved in survival, cell progression, proliferation, cell cycle arrest or death, and EMT promotion, depending on the miRNA and cell line.</p><p><strong>Conclusions: </strong>miR-34a and miR-34c are multifunctional tumor suppressors that play an important regulatory role in pHGG-4 aggressiveness. Both miRNAs can serve as excellent and powerful therapeutic tools against pHGG-4.</p><p><strong>Impact: </strong>This study revealed miR-34a and miR-34c as multifunctional suppressors of pHGG-4 tumor aggressiveness, both downregulated in disease models. miR-34a/miR-34c restoration decreased cell viability, migration ability, invasiveness, and stemness marker expression Both miRNAs exerted similar phenotypic effects while differentially regulated gene expression in a miRNA-associated and cell line-dependent manner The findings reinforced that epigenetic dysregulation, rather than recurrent genetic alterations, is a central driver of pHGG-4 aggressiveness. This work suggests the rational for potential miR-34-based therapeutic strategies in this otherwise incurable disease.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current perspectives and future horizons in predicting response to nutrition therapy in children with Crohn's disease - a narrative review.","authors":"Paulina Krawiec, Lissy de Ridder","doi":"10.1038/s41390-026-05559-3","DOIUrl":"https://doi.org/10.1038/s41390-026-05559-3","url":null,"abstract":"<p><p>Exclusive enteral nutrition (EEN) and partial enteral nutrition (PEN) alongside Crohn's Disease Exclusion Diet (CDED) are evidence-based treatment strategies for children with Crohn's disease. However, the remission rates induced through nutritional therapy vary depending on the research design, treatment population, and outcome definition. The growing body of evidence highlights the necessity of a transitioning from \"one-treatment-suits-all\" strategy towards \"tailor-made\" precision-based therapeutic approach in children with Crohn's disease to obtain the optimal treatment response. Precise personalized therapeutic plan created on the patient's treatment-responsiveness phenotype prior to the treatment initiation appears to be an utmost need for children with Crohn's disease. A personalized approach to treatment has multiple benefits for individuals and the healthcare system. The identification of reliable predictors of treatment response is crucial for selecting the optimal therapy for individuals. In this review we aim to present a state-of-the-art summary of the current knowledge on predictive factors of response to nutrition therapy defined as EEN, and PEN with CDED in children with Crohn's disease. The exploration of treatment predictors may be a small but crucial step toward individualized therapeutic approach in this group of patients, potentially enabling the selection of the most appropriate therapy for each individual patient. IMPACT: This review synthetizes the current knowledge on predictive factors of a response to nutrition therapy in children with Crohn's disease. Early clinical improvement and reduction of faecal calprotectin are potential indicators of positive outcome of nutritional therapy in Crohn's disease. The anticipation of treatment response transcends patients' stratification based on clinical characteristics assemblages. Integration of clinical and multiomic data into a decision-making approach may facilitate personalized treatment in the future. However, current literature provides insufficient evidence for definitive predictors of response to nutritional therapy in Crohn's disease.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kawasaki disease: a primer for the classification of multisystem inflammatory disorders.","authors":"Eleanor J Molloy, Cynthia Bearer, Seigo Okada","doi":"10.1038/s41390-026-05573-5","DOIUrl":"https://doi.org/10.1038/s41390-026-05573-5","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric effects of forever chemicals may last for a long time.","authors":"Philippe Grandjean","doi":"10.1038/s41390-026-05366-w","DOIUrl":"https://doi.org/10.1038/s41390-026-05366-w","url":null,"abstract":"<p><p>Perfluorinated alkylate substances (PFASs) have been in use for about 75 years. Because of their persistence, concentrations in the environment have increased, and absorbed PFAS will remain in the human body, some compounds for many years. The fetus and the newborn infant are particularly vulnerable to PFAS toxicity due to the intense development of organs and body functions. In addition, PFASs pass the placenta so that a pregnant woman shares her accumulated PFAS burden with the progeny. In addition, PFASs are excreted in the milk, so that the resulting serum-PFAS concentration in the infant may greatly exceed that of the mother. Multi-organ effects have been reported, some related to endocrine disruption. Immunotoxicity can occur at very low exposure levels, with elevated risks of infectious disease and possibly also cancer development. Unfortunately, little research was carried out during the first 50 years of industrial use, and some study reports were hidden. Independent research has been carried out only recently. Due to incomplete evidence, governmental regulations have been delayed and remain insufficient, in part because of objections from industrial interests. IMPACT: The perfluorinated alkylate substances (PFASs) are persistent and accumulate in the environment and in the human body. The greatest risk of PFAS toxicity occurs at early age, as PFASs are transferred through the placenta and human milk. This means that early-life exposures may trigger development of diseases and other adverse outcomes that may seriously burden adult health. Research has been delayed due to secrecy. While pediatric studies in this field are underway, prudent decisions to protect public health should be made despite possible concerns regarding incomplete evidence. Practical complications, and current guidelines and interventions are by far insufficient. Current evidence on PFASs shows that these industrial chemicals are persistent and that highly elevated exposures occur already at early age. The maternal body burden of PFAS is shared with the fetus, and substantial amounts are transferred in human milk, thus impacting the unique nutritional advantage of breast-feeding. Recent evidence suggests that early PFAS exposure can affect public health, also during adult age, and that some adverse effects may be transferred to the next generation.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal exposure to nonpersistent endocrine disruptors and early childhood BMI: single pollutant and mixture analyses from the ECHO Program.","authors":"Dorothy Nakiwala, Wei Perng, Emily S Barrett, Zhongzheng Niu, Akram N Alshawabkeh, John D Meeker, Dana Dabelea, Anne P Starling","doi":"10.1038/s41390-026-05466-7","DOIUrl":"https://doi.org/10.1038/s41390-026-05466-7","url":null,"abstract":"<p><strong>Background: </strong>Exposure to non-persistent endocrine-disrupting chemicals (EDCs), including phenols and phthalates, has been linked to obesity risk. While many studies focus on single-chemical exposures, mixture effects on child adiposity remain unclear.</p><p><strong>Objectives: </strong>To assess associations of prenatal phenol and phthalate exposures, singly and as mixtures, with early childhood BMI in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program.</p><p><strong>Methods: </strong>We included 586 mother-child pairs from three ECHO sites with 23 phenols and phthalate metabolites measured in maternal urine during pregnancy, and child BMI z-scores (BMIZ) at 2-5 years. Associations were estimated using covariate-adjusted single-pollutant linear regression and two mixture methods: Bayesian Weighted Quantile Sum (BWQS) and Bayesian Kernel Machine Regression (BKMR). Sex-specific effects were examined in stratified models.</p><p><strong>Results: </strong>No associations were observed between the overall prenatal EDC mixture and BMIZ. In single-pollutant models, MBzP (highest tertile) was inversely associated with BMIZ (β = -0.36, 95% CI: -0.63, -0.08), while MEP (second tertile) was positively associated (β = 0.27, 95% CI: 0.01, 0.53). Among boys, MBP (second tertile) was positively associated (β = 0.45, 95% CI: 0.11, 0.79).</p><p><strong>Conclusions: </strong>We found no strong evidence for mixture effects, though some individual compounds showed non-linear and sex-specific associations.</p><p><strong>Impact: </strong>Using a 23-analyte panel of phenols and phthalate metabolites, and complementary (BKMR, BWQS) alongside single-pollutant and sex-stratified models, this study strengthens inference and addresses limitations of prior research. Prenatal exposure to ubiquitous, short-lived endocrine-disrupting phthalates showed non-monotonic, sex-specific associations with early childhood BMI in single-pollutant models. These findings contribute to the limited evidence base on mixture effects of endocrine-disrupting chemicals in early-life obesity risk.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial metabolism in CDH: mitochondrial dysfunction as a new piece of the puzzle.","authors":"Richard Wagner","doi":"10.1038/s41390-026-05569-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05569-1","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}