Clinical and Experimental Pediatrics最新文献

{"title":"Intramuscular and subcutaneous gonadotropin-releasing hormone agonist tests for central precocious puberty in girls: a randomized controlled trial.","authors":"Worapimon Lerdrassameethad, Suttipong Wacharasindhu, Vichit Supornsilchai, Khomsak Srilanchakon","doi":"10.3345/cep.2026.00052","DOIUrl":"https://doi.org/10.3345/cep.2026.00052","url":null,"abstract":"<p><strong>Background: </strong>Central precocious puberty (CPP) results from premature activation of the hypothalamic-pituitary-gonadal axis. Although the standard intravenous gonadotropin-releasing hormone (GnRH) stimulation test is often inaccessible, a subcutaneous (SC) GnRH analogue (GnRHa) test is used. However, the conventional SC route presents logistical challenges including prolonged observation times and the need for multiple blood draws. Thus, identifying a more efficient administration route could optimize clinical workflows and enhance patient comfort. This study aimed to determine whether intramuscular (IM) administration is comparable to SC administration by analyzing the time to peak luteinizing hormone (LH) levels.</p><p><strong>Purpose: </strong>To evaluate and compare the time to peak LH levels and diagnostic timing of IM versus SC GnRH stimulation tests in girls with CPP.</p><p><strong>Methods: </strong>This randomized controlled trial enrolled 92 girls with suspected CPP. Participants were assigned via 2:1 block randomization to receive 100 mcg triptorelin acetate via SC (n=62) or IM (n=30) injection. Serial blood samples for LH and follicle-stimulating hormone were collected at 0, 30, 60, 90, and 120 minutes.</p><p><strong>Results: </strong>There were no significant differences between the 2 groups in demographic characteristics. Peak LH responses were most frequent at 30 minutes in both groups (IM, 33.3%; SC, 35.5%; P=0.88). The mean LH levels at 30, 60, 90, and 120 minutes did not differ significantly between groups. Diagnostic confirmation of CPP occurred within 30 minutes in 96.7% and 96.8% of patients in the IM and SC groups, respectively.</p><p><strong>Conclusion: </strong>The IM GnRH stimulation test was comparable to the standard SC test in terms of LH response magnitude and timing.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum metabolomic profile in children with sepsis-associated acute kidney injury.","authors":"Nisha Chaudhary, Praveen Singh, Abhijeet Saha, Shantanu Sengupta","doi":"10.3345/cep.2025.02439","DOIUrl":"https://doi.org/10.3345/cep.2025.02439","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute kidney injury (SA-AKI) contributes to high morbidity and mortality rates in children; however, current diagnostic tools (serum creatinine and urine output) lack sensitivity for early detection. Metabolomics can be used to discover novel metabolic markers to enable early diagnosis and prognosis and provide therapeutic targets for SA-AKI.</p><p><strong>Purpose: </strong>This study was aimed to identify the differentially expressed serum metabolites in children with SA-AKI.</p><p><strong>Methods: </strong>We conducted an untargeted serum metabolomic analysis using liquid chromatography-mass spectroscopy (LC-MS) in 75 children: 45 with sepsis and acute kidney injury (AKI) (15 each in Kidney Disease Improving Global Outcomes [KDIGO] stages 1-3), 15 with sepsis without AKI, and 15 healthy controls. Fasting blood samples were collected and centrifuged. Supernatant serum was stored at -80°C and subjected to untargeted metabolomic analysis using LC-MS. Reverse-phase and hydrophilic liquid interaction chromatographic separation was performed in positive and negative ion scan modes, while metabolite identification was performed using the SCIEX All-In-One HR-MS/MS Library with National Institute of Standards and Technology 2017 Library bundle.</p><p><strong>Results: </strong>The significantly altered metabolites in AKI stage 3 were lipids belonging to the glycerophosphoethanolamine subgroup of the phospholipid class. Eighteen metabolites were differentially expressed in patients with SA-AKI versus healthy controls, with phosphoethanolamines (e.g., 1-palmitoyl-2-hydroxy-sn-glycero-3-phosphoethanolamine) showing a consistent association with AKI stage. Thirty-one metabolites were significantly altered in severe AKI (KDIGO stages 2-3), of which only 4 could be annotated and increased proportionally with AKI severity. A pathway analysis revealed significant enrichment of glycerophospholipid, linoleic acid, and alpha-linolenic acid metabolism in stage 3 SA-AKI.</p><p><strong>Conclusion: </strong>Serum metabolomics is a feasible approach to identifying novel biomarkers of SA-AKI. Phosphoethanolamine metabolites both distinguished AKI from sepsis controls and were correlated with clinical severity (estimated glomerular filtration rate decline), suggesting its potential prognostic value. However, its diagnostic feasibility requires.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The High-Risk CCL14 Lineage Drives Severe Mycoplasma pneumoniae Pneumonia in Children: A Study in Central China.","authors":"Chunbo Hao, Zijie Li, Yanjuan Yu, Song Wang, Genhao Wang, Gaijing Jia, Tiantian Sun, Shouhang Chen, Yang Wu, Yu Tang, Fang Wang, Guangcai Duan, Yuefei Jin","doi":"10.3345/cep.2025.02796","DOIUrl":"https://doi.org/10.3345/cep.2025.02796","url":null,"abstract":"<p><strong>Background: </strong>The post-pandemic resurgence of Mycoplasma pneumoniae (MP) infections, particularly in China, underscores the need to understand the drivers of disease severity. However, the genotypic landscape of the prevalent strains in central China and its link to clinical outcomes remain poorly characterized.</p><p><strong>Purpose: </strong>This study aimed to evaluate the associations between predominant circulating strains of MP and disease severity. Method: We integrated the clinical data of 3,060 pediatric patients and analyzed the epidemiological characteristics of Mycoplasma pneumoniae pneumonia (MPP) in Henan region from 2020 to 2024. Bronchoalveolar lavage fluid (BALF) from 137 patients was analyzed using multilocus sequence typing (MLST) and variable-number tandem-repeat analysis (MLVA) to investigate the correlation between genotype and clinical outcomes.</p><p><strong>Results: </strong>A significant post-COVID MPP outbreak was predicted in 2023. Genotyping revealed the cocirculation of 2 major genotypes: the prevalent ST3 (57.7%, severe ratio [31.6%]) and the less common but highly virulent ST14 (26.3%, severe ratio [72.2%]). Phylogenetic clustering confirmed ST14/3-5-6-2 as part of a broader hypervirulent lineage, common cluster label 14 (CCL14), which was significantly associated with disease severity (χ2=19.39; P<0.001). Patients infected with CCL14 strains exhibited a distinct hyperinflammatory profile marked by elevated D-dimer levels, complement C4 levels, and platelet count. The mutation ratio of macrolide resistance sites in the MP strains from Henan Province was approximately 75%.</p><p><strong>Conclusion: </strong>Our findings identified the CCL14 lineage as a key driver of disease severity in macrolide-resistant pediatric MPP in Henan Province, China. This underscores the importance of integrating molecular surveillance with clinical monitoring to mitigate disease burden.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anthropometric trajectories of Korean children and adolescents with severe obesity.","authors":"Jeongho Han, Hakyung Lee, Dong Jun Ha, Jieun Lee, Yong Hee Hong, Hwa Young Kim, Jaehyun Kim","doi":"10.3345/cep.2025.02999","DOIUrl":"https://doi.org/10.3345/cep.2025.02999","url":null,"abstract":"<p><strong>Background: </strong>The burden of severe pediatric obesity is increasing globally, including in South Korea, and associated with metabolic and cardiovascular complications. However, longitudinal data of Korean children with severe obesity are limited.</p><p><strong>Purpose: </strong>This study evaluated the changes in body mass index (BMI) and associated metabolic syndrome components in children and adolescents with severe obesity managed without pharmacological or surgical treatment.</p><p><strong>Methods: </strong>We retrospectively reviewed participants diagnosed with severe obesity (BMI ≥120% of the 95th percentile) before the age of 18 years at 3 medical centers in 2017-2024. Participants with more than 1 year of follow-up were included. Management consisted exclusively of lifestyle modifications, including nutritional counseling and physician-led education on physical activity, screen time, and sleep. Patients with chronic illnesses, with psychiatric disorders, or who were taking medications that affect weight were excluded. The primary outcome was the change in BMI z score from baseline to the last visit. Predictors of a change in the BMI z score were analyzed using multivariable linear regression with adjustment for age, sex, pubertal stage, baseline BMI z score, and follow-up duration and frequency.</p><p><strong>Results: </strong>Among 124 participants (mean age, 9.69±3.39 years; 61.3% boys) followed for a mean duration of 2.64±1.51 years, BMI z scores significantly decreased (from 3.68±0.75 to a mean change of -0.27±0.79, P<0.001). Younger age and male sex were associated with greater reductions in BMI z scores. However, most participants remained severely obese. Except for modest improvements in liver transaminase levels, no substantial differences were observed in other metabolic syndrome components.</p><p><strong>Conclusion: </strong>Lifestyle modification resulted in a modest BMI z score reduction; however, most participants remained severely obese with no significant improvements in most metabolic syndrome components. These findings underscore the need for early and intensive interventions for pediatric obesity.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamics and cerebral oxygenation in the neonatal transition: a prospective pilot study.","authors":"Daniel Pfurtscheller, Christoph Schlatzer, Nina Höller, Bernhard Schwaberger, Lukas P Mileder, Nariae Baik-Schneditz, Magdalena Holter, Gerhard Pichler","doi":"10.3345/cep.2025.02572","DOIUrl":"10.3345/cep.2025.02572","url":null,"abstract":"<p><strong>Background: </strong>The impact of arterial blood pressure on cerebral oxygenation during immediate postnatal transition is poorly understood.</p><p><strong>Purpose: </strong>Here we investigated the association between arterial blood pressure (BP), cerebral tissue oxygenation index (cTOI), and cerebral fractional tissue oxygen extraction (cFTOE) during the immediate postnatal transition in preterm and full-term neonates.</p><p><strong>Methods: </strong>This prospective observational study included preterm and term neonates who did versus did not require respiratory support. Oscillometric BP was measured at 5, 10, and 15 minutes after birth. cTOI was continuously monitored using near-infrared spectroscopy, while arterial oxygen saturation (SpO2) was recorded using pulse oximetry. cFTOE was calculated from cTOI and SpO. cTOI and cFTOE values were correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at all time points. Correlation and mixed-model analyses were then performed.</p><p><strong>Results: </strong>A total of 102 neonates were enrolled: 51 preterm (33 with, 18 without respiratory support) and 51 term (14 with, 37 without respiratory support). In preterm neonates requiring respiratory support, cTOI was positively correlated with DABP at all time points and with MABP at 15 minutes. cFTOE was negatively correlated with MABP and DABP throughout the experiment and with SABP at 5 minutes. No significant correlations were observedamong the other groups. A mixed-model analysis showed that MABP and DABP were significantly associated with cFTOE but not cTOI independent of gestational age or respiratory support.</p><p><strong>Conclusion: </strong>Among preterm neonates requiring respiratory support, cTOI and cFTOE were associated with arterial BP during the immediate neonatal transition. Only cFTOE showed a slight association with BP among stable preterm and full-term neonates. These findings suggest impaired cerebral autoregulation in compromised preterm infants during the immediate postnatal transition.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"330-339"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adiposity rebound in early childhood: understanding body mass index percentiles and monitoring on growth charts to be healthy.","authors":"Sochung Chung","doi":"10.3345/cep.2026.00668","DOIUrl":"10.3345/cep.2026.00668","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":"69 4","pages":"301-303"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on \"Assessing kidney outcomes in childhood-onset lupus nephritis: role of National Institutes of Health-modified histological indices\".","authors":"Yanlan Ma, Yunyun Zhu","doi":"10.3345/cep.2025.02712","DOIUrl":"10.3345/cep.2025.02712","url":null,"abstract":"","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"362-363"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of hematopoietic stem cell transplantation for pediatric patients with transfusion-dependent thalassemia in Thailand.","authors":"Kleebsabai Sanpakit, Kamala Laohverapanich, Bunchoo Pongtanakul, Nattee Narkbunnam, Chayamon Takpradit, Usanarat Anurathapan, Samart Pakakasama, Supanun Lauhasurayotin, Kanhatai Chiengthong, Thirachit Chotsampancharoen, Pornpun Sripornsawan, Piya Rujkijyanont, Duantida Songdej, Nongnuch Sirachainan, Suradej Hongeng","doi":"10.3345/cep.2025.02173","DOIUrl":"10.3345/cep.2025.02173","url":null,"abstract":"<p><strong>Background: </strong>Hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with transfusion-dependent thalassemia (TDT), and the outcomes are influenced by multiple factors.</p><p><strong>Purpose: </strong>We retrospectively evaluated the clinical characteristics, risk factors, complications, and treatment outcomes in Thai patients aged <20 years using 30-year multicenter HSCT data. This study sought to evaluate the contributing factors affecting survival outcomes and complications, provide insights into the evolution of HSCT for TDT, and inform practice guidelines in developing countries.</p><p><strong>Methods: </strong>The outcomes of 266 HSCT procedures from related and unrelated donors in 249 Thai patients with TDT performed from 1988 to 2016 (median follow-up, 102 months) were analyzed.</p><p><strong>Results: </strong>The median age at HSCT was 6.9 years (range, 1-19 years). Most HSCT procedures used human leukocyte antigen-matched related donors (MRDs; 71.8%), with bone marrow serving as the primary graft source (69.5%). The thalassemia recurrence rate was 11.6%, whereas the mortality rate was 9.0%, primarily due to Gram-negative sepsis. The 5-year overall (OS) and event-free survival (EFS) were 91.3% and 81.0%, respectively. The outcomes did not differ significantly between MRDs and matched unrelated donors (MUDs: OS rate, 91.5% vs. 88.0%, P=0.52; EFS rate, 82.0% vs. 76.2%, P=0.45). Since 2000, advances in pre-HSCT transfusion, iron chelation, graft-versus-host disease prophylaxis, and supportive care have been implemented, with intravenous busulfan adopted after 2009. Over three periods (1988-1999, 2000-2009, and 2010-2016), the OS rate rose from 89.4% to 93.0% (P=0.74), and the EFS rate rose from 67.7% to 87.2% (P=0.01). Age ≤10 years was associated with better overall OS and EFS, although significance was limited to the earliest period. A multivariate analysis identified a pre-HSCT ferritin level >2,500 ng/mL, low CD34+ doses, and the use of oral busulfan conditioning as factors associated with unfavorable survival. Long-term complications, primarily endocrine disorders, affected 22.7% of survivors.</p><p><strong>Conclusion: </strong>Our results broaden the donor pool by demonstrating comparable outcomes between MRD and MUD transplantation. Optimizing pretransplant care, such as regular pre-HSCT transfusion, adjusting conditioning intensity, and improving posttransplant supportive care, may mitigate age-related risks in older recipients.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"340-352"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal postnatal corticosteroid regimens to prevent bronchopulmonary dysplasia with minimal adverse effects.","authors":"Ga Won Jeon","doi":"10.3345/cep.2026.00108","DOIUrl":"10.3345/cep.2026.00108","url":null,"abstract":"<p><p>Postnatal corticosteroids can facilitate ventilator weaning and reduce the risk of bronchopulmonary dysplasia (BPD); therefore, they are commonly used to prevent or treat BPD in preterm infants, particularly those born extremely preterm. Despite their frequent use in high-risk infants with severe BPD, no clear guidelines have been established for the optimal timing of administration, dosage, corticosteroid type, route of delivery, and indication based on the infant's baseline risk of BPD. Early systemic corticosteroid administration, particularly dexamethasone within the first week of life, appears to be associated with adverse neurodevelopmental outcomes and is generally not recommended. Dexamethasone and hydrocortisone exhibit distinct biological and clinical effects, yet evidence from direct comparative studies is limited. Dexamethasone may improve cerebral palsy-free survival of infants at high risk of BPD but poses potential harm in those at low risk, highlighting the need for individualized risk-based decision-making. Optimal dosing remains unclear: lower doses may reduce systemic side effects despite the uncertainty of their neurodevelopmental safety, whereas higher doses may be more effective in selected high-risk infants. Inhaled corticosteroids have inconclusive benefits compared with systemic therapy. The intratracheal administration of corticosteroids with surfactant improves distal airway delivery and reduces death or BPD rates; however, short- and long-term safety data remain limited. Overall, postnatal corticosteroids should be used cautiously and selectively in high-risk, ventilator-dependent infants with severe BPD. Future high-quality trials are needed to evaluate long-term survival free of neurodevelopmental impairments.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":"69 4","pages":"293-300"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of demographic factors in early identification of pediatric malignant vasovagal syncope in head-up tilt test.","authors":"Shuo Wang, Yuwen Wang, Hong Cai, Ping Liu, Fang Li, Chuan Wen, Liqun Liu, Runmei Zou, Cheng Wang","doi":"10.3345/cep.2025.02397","DOIUrl":"10.3345/cep.2025.02397","url":null,"abstract":"<p><strong>Background: </strong>Malignant vasovagal syncope (VVS) is characterized by cardiac arrest lasting more than 3 seconds during a syncope episode or head-up tilt test (HUTT). We aim to conduct a risk assessment for potential malignant VVS before the HUTT by using economic, simple and convenient demographic data, in order to prevent adverse outcomes for pediatric VVS.</p><p><strong>Purpose: </strong>To explore the correlation between demographic factors and pediatric malignant VVS, and verify the value of these factors in early risk assessment for malignant VVS before HUTT, so as to optimize test safety and reduce adverse events.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the clinical data of 3,734 children who were initially diagnosed with VVS due to unexplained syncope and presyncope. Finally, 122 children who met the diagnostic criteria for malignant VVS were included in the malignant VVS group, and 661 children who did not meet the criteria during the same period were matched as the control group. By analyzing demographic data and other factors, we attempted to clarify the association between these factors and malignant VVS.</p><p><strong>Results: </strong>Linear relationship: age and body mass index (BMI) have independent protective effects on malignant VVS. For every 1-year increase in age and every 1 kg/m2 increase in BMI, the risk of malignant VVS decreases by 12% and 9%, respectively. Nonlinear relationship: When the age is <12.9 years old, for every additional year of age, the risk of malignant VVS decreases by 20%. For ages 12.9 years and above, the efficacy is not significant. There is no significant nonlinear relationship between BMI and malignant VVS.</p><p><strong>Conclusion: </strong>Age and BMI are independent protective factors for pediatric malignant VVS. Before the age of 12.9 years, the incidence of malignant VVS gradually decreases with the increase in age, and thereafter there is no significant impact.</p>","PeriodicalId":36018,"journal":{"name":"Clinical and Experimental Pediatrics","volume":" ","pages":"353-361"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}