Pediatric Reports最新文献

{"title":"Toward Child-Centred Artificial Intelligence in Pediatric Emergency Medicine: A Perspective on Clinical Decision Support, Stakeholder Engagement and Education.","authors":"Lorenzo Gasparini, Nicola Gobbi, Daniele Zama, Marcello Lanari","doi":"10.3390/pediatric18040091","DOIUrl":"10.3390/pediatric18040091","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly recognized as a transformative technology in healthcare, with growing evidence supporting its applicability across time-critical clinical environments. This perspective aims to evaluate the integration of AI and machine learning (ML) into pediatric emergency departments (PEDs) across three core domains: clinical decision support, stakeholder engagement, and medical education. Within clinical decision support, ML architectures have demonstrated high predictive performance across several high-acuity clinical scenarios, including triage stratification, pediatric traumatic brain injury risk classification, early sepsis detection and clinical deterioration prediction, and dermatological assessment. Model interpretability and real-world implementability remain critical prerequisites for clinical adoption, with explainability methods representing fundamental instruments to enhance transparency and stakeholder trust. Regarding stakeholder engagement, the triadic dynamic among clinicians, caregivers, and patients defines a unique communication challenge in PEDs, with large language models (LLMs) showing preliminary utility; however, stakeholder-inclusive model validation and robust data privacy protections for minors remain key challenges, particularly regarding legal ambiguities of LLM deployment in clinical pipelines. In medical education, AI-driven simulation platforms and LLM-generated adaptive curricula represent promising tools for competency-based training across pediatric emergency scenarios. Future directions emphasize the imperative of prospective multicenter validation in pediatric-specific cohorts, rigorous data quality standards addressing conformance, completeness, and plausibility, and the development of pediatric-tailored governance frameworks. Real-world implementation will require the systematic involvement of all stakeholders-including children, caregivers, clinicians, developers, and institutions-as co-designers of equitable, transparent, and safe AI systems for this uniquely vulnerable population.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580483","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":"The Effects of Digital Interventions on Language Development in Children with Autism Spectrum Disorder: A Systematic Review and Interdisciplinary Synthesis.","authors":"Murat Demirekin, Hatice Yalçın","doi":"10.3390/pediatric18040090","DOIUrl":"10.3390/pediatric18040090","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Digital technologies are increasingly used in interventions for children with Autism Spectrum Disorder (ASD) to support language development. However, existing evidence remains fragmented due to heterogeneity in intervention types, participant characteristics, and outcome measures. This systematic review aims to synthesize current empirical findings on the effects of digital interventions on language development in children with ASD and to identify key factors influencing intervention effectiveness. <b>Methods:</b> A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, Web of Science, ERIC, and PsycINFO for studies published between 2010 and 2025. Eligible studies included experimental, quasi-experimental, and intervention-based designs involving children aged 2-18 years with ASD and reporting at least one language-related outcome. Data extraction was performed independently by two reviewers using a structured form. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklist and CASP tools. Due to heterogeneity across studies, a narrative synthesis approach was applied. <b>Results:</b> A total of 61 studies met the inclusion criteria. Findings indicate that digital interventions generally have positive effects on language development in children with ASD, with stronger and more consistent outcomes in receptive and expressive language domains. Intervention effectiveness varied according to duration, intensity, content quality, and contextual factors such as family involvement and technological access. <b>Conclusions:</b> The evidence suggests that digital interventions may have positive effects on language development in children with ASD, particularly in receptive and expressive language domains. Among intervention types, video modeling and AI-supported approaches appear to show promising outcomes; however, these findings should be interpreted with caution due to the limited number of AI-focused studies and substantial heterogeneity in study designs, sample characteristics, and outcome measures. Gamified and mobile applications demonstrate moderate effects, especially in vocabulary and pragmatic language skills. Overall, intervention effectiveness varies according to duration, intensity, content quality, and contextual factors such as family involvement and technological access. Future research should prioritize standardized methodologies and longitudinal designs.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580520","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":"Children's Internalizing Symptoms and Well-Being: The Role of Parental Anxiety and Health-Related Quality of Life.","authors":"Vasiliki Georgousopoulou, Georgios Manomenidis, Aspasia Serdari","doi":"10.3390/pediatric18040089","DOIUrl":"10.3390/pediatric18040089","url":null,"abstract":"<p><strong>Background: </strong>Children's health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when parent-proxy reports are used.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 242 parents of children aged 8-12 years in Northern Greece. Parents completed proxy measures of children's HRQoL and internalizing symptoms, as well as self-reported measures of their own HRQoL and anxiety. Nonparametric tests were used for bivariate analyses, and multiple linear regression was applied to identify independent predictors of children's HRQoL.</p><p><strong>Results: </strong>Higher parental mental HRQoL was positively associated with children's HRQoL (ρ = 0.213, <i>p</i> = 0.031), while parental anxiety (trait anxiety: ρ = -0.204, <i>p</i> = 0.004; state anxiety: ρ = -0.314, <i>p</i> < 0.001) and parent-reported child internalizing symptoms (depression: ρ = -0.369, <i>p</i> < 0.001; anxiety: ρ = -0.322, <i>p</i> < 0.001) were negatively associated with HRQoL; however, in the multivariable model, only parental mental HRQoL (B = 0.344, <i>p</i> = 0.020) and parental education (B = -2.944, <i>p</i> = 0.044) remained significantly associated with parent-proxy child HRQoL, explaining 29.2% of the variance in children's HRQoL (R² = 0.292).</p><p><strong>Conclusions: </strong>The findings suggest that parent-proxy child HRQoL is associated with parental psychosocial functioning in this community-based sample. Parental mental HRQoL was the strongest independent correlate of parent-proxy child HRQoL. However, given the exclusive use of parent-proxy reports and the convenience-based sample, these findings should be interpreted cautiously, as shared method variance, rater-related effects, and limited generalizability may have contributed to the observed associations. Further multi-informant and longitudinal studies conducted in more diverse populations are warranted.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580713","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":"Utilizing Machine Learning for Diagnostic Assistance of Pediatric Sepsis and Septic Shock in Resource-Limited Settings.","authors":"Kaden Bunch, Shamsun Nahar Shaima, Gazi Md Salahuddin Mamun, Sai Gopal Jarabana, Monique Gainey, Abu Sayem Mirza Md Hasibur Rahman, Alicia Genisca, Atin Jindal, Nidhi Kadakia, Monira Sarmin, Farzana Afroze, Adam C Levine, Mohammod Jobayer Chisti, Stephanie Chow Garbern","doi":"10.3390/pediatric18040088","DOIUrl":"10.3390/pediatric18040088","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a leading cause of pediatric mortality worldwide, disproportionately affecting children in low- and middle-income countries (LMICs). However, timely recognition of potential sepsis and access to healthcare resources needed to diagnose pediatric sepsis according to international guidelines are challenging in LMICs. This exploratory study aimed to develop machine learning (ML) models to detect pediatric sepsis and septic shock using a simplified set of clinical data contextualized for practical use in resource-limited settings.</p><p><strong>Methods: </strong>This was a secondary analysis of an observational study of 100 children with potential sepsis admitted to a non-profit referral hospital in Dhaka, Bangladesh. The outcomes were sepsis as defined by a Phoenix Sepsis Score (PSS) ≥ 2 and septic shock (sepsis plus PSS cardiovascular sub-score ≥ 1). Models were trained using either clinical + laboratory variables or clinical-only variables. A single 24 h worst-value assessment window was derived per patient; stratified 5-fold cross-validation was used to maintain class proportions across the training and test folds. Model performance was assessed using area under the precision-recall curve (AUPRC) and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CIs) derived from a 2000-resample patient-level bootstrap of out-of-fold classifications. Logistic regression coefficients were used to assess feature contributions.</p><p><strong>Results: </strong>For sepsis classification, the non-laboratory model achieved an AUPRC of 0.942 (95% CI: 0.884-0.979) and an AUROC of 0.945 (95% CI: 0.890-0.983), with comparable performance from the clinical + laboratory model (AUPRC 0.941, 95% CI: 0.880-0.981; AUROC 0.945, 95% CI: 0.881-0.986). For septic shock, AUROCs of 0.870 (95% CI: 0.761-0.952) and 0.878 (95% CI: 0.758-0.967) were observed. However, these estimates should be interpreted cautiously, given the low prevalence (23%) and absence of external validation. SpO₂:FiO₂ ratio, GCS, and systolic blood pressure were consistently strong predictors across models.</p><p><strong>Conclusions: </strong>ML models using pragmatic clinical variables demonstrate preliminary diagnostic performance, with the non-laboratory model showing discrimination comparable to models incorporating laboratory data. Logistic regression demonstrated the most stable performance and may represent an early proof of concept for assistive diagnostic support. However, these models are not clinically usable without external validation. These findings are hypothesis-generating; external validation in larger, independent cohorts is essential before any clinical use, particularly for septic shock.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580507","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":"Longitudinal Variability of Fecal Calprotectin in Preterm Newborns: A Prospective Cohort Study.","authors":"Mariana A Polimeni Cavassin Jayme, Cristina Terumi Okamoto, Fernanda Tiemi Takei, Paula Haus de Oliveira, Eloisa Medeiros Nisihara, Renato Nisihara","doi":"10.3390/pediatric18040087","DOIUrl":"10.3390/pediatric18040087","url":null,"abstract":"<p><p>Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of ≤34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 µg/g in the first week to 65 µg/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580506","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":"Intramural Duodenal Hematoma-A Rare Post-Endoscopy Complication in Pediatric Noonan Syndrome: A Case Report.","authors":"Mariusz Olczyk, Anna Socha-Banasiak, Natalia Lwow, Bartosz Waszczyk, Elżbieta Czkwianianc","doi":"10.3390/pediatric18040086","DOIUrl":"10.3390/pediatric18040086","url":null,"abstract":"<p><strong>Background: </strong>Noonan syndrome is a rare genetic disorder from the group of RASopathies, characterized by facial dysmorphism, congenital heart defects, hematologic abnormalities, and growth impairment.</p><p><strong>Case presentation: </strong>We report the case of an 8-year-old girl with Noonan syndrome admitted for evaluation of abdominal pain and failure to thrive. Hematological evaluation before EGD did not identify contraindications to biopsy, and initial laboratory tests, including coagulation parameters, were normal. Several hours after upper gastrointestinal endoscopy, the patient developed abdominal pain and coffee-ground vomiting. Abdominal ultrasonography revealed an intramural duodenal hematoma (58 × 37 mm), which was confirmed and further characterized by computed tomography as an extensive, long-segment lesion involving the duodenum. Progressive anemia required transfusion of blood products. Conservative management, including nasogastric decompression, parenteral nutrition, and pharmacological treatment, was implemented. Despite the severity and prolonged clinical course, gradual clinical and radiological improvement was achieved, and the patient was discharged in good general condition after one month.</p><p><strong>Conclusions: </strong>Intramural duodenal hematoma is an extremely rare complication of upper gastrointestinal endoscopy with duodenal biopsy. This case highlights the importance of individualized assessment and close monitoring in patients with Noonan syndrome, and indicates that this complication should be considered early when abdominal pain, vomiting, or progressive anemia develops after the procedure, even when hematological evaluation and baseline coagulation parameters are reassuring.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580501","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":"Surgical Management of a Large Congenital Melanocytic Nevus of the Face-A Technical Case Report and Comparison with Classic and Novel Approaches.","authors":"Kostadin Gigov, Petra Kavradzhieva, Ivan Ginev, Mihaela Prandzheva, Mariya Miteva","doi":"10.3390/pediatric18040085","DOIUrl":"10.3390/pediatric18040085","url":null,"abstract":"<p><p>Large congenital melanocytic nevi (LCMN) of the face can pose significant functional, esthetic, and psychosocial challenges in childhood. In selected patients, staged excision offers a practical reconstructive strategy when primary closure is not feasible without distortion of nearby facial landmarks. We report the management of a child with a facial LCMN using a planned multistage surgical approach aimed at lesion removal while preserving contour and minimizing scar burden. The lesion was excised sequentially over three procedures, with careful attention given to relaxed skin tension lines and facial esthetic units. When required, adjunctive reconstruction was performed to optimize closure and support tissue healing. This approach allowed a gradual reduction in the nevus, improved tissue accommodation, and avoidance of excessive tension on the surrounding skin. Postoperative recovery was uncomplicated, and the final esthetic outcome was satisfactory for both the patient and parents. Staged excision was selected over tissue expansion and skin grafting because it allowed progressive lesion reduction while preserving adjacent facial landmarks and minimizing donor-site morbidity. This technical case highlights the importance of individualized surgical planning, preservation of facial esthetic units, and staged scar placement when managing large facial congenital melanocytic nevi in pediatric patients. The educational value of the report lies in illustrating the decision-making process used to balance lesion removal, esthetic outcomes, and long-term surveillance in a challenging facial location.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580452","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":"Markerless Motion Capture for Human Movement Estimation Using Artificial Intelligence: A Systematic Review.","authors":"Georgina Domènech-Garcia, Xavier Marimon, Andoni Carrasco-Urribarren, Alejandro E Portela, Caritat Bagur-Calafat","doi":"10.3390/pediatric18040083","DOIUrl":"10.3390/pediatric18040083","url":null,"abstract":"<p><p><b>Background</b>: Artificial intelligence (AI)-driven markerless motion capture (MMC) technologies are increasingly being integrated into pediatric healthcare to improve the assessment and management of movement disorders. These video-based systems enable non-invasive motion analysis without wearable sensors, facilitating more natural movement assessment in children, particularly those with neurological or developmental conditions. <b>Objectives</b>: We evaluated the clinical applicability of AI-based MMC tools in pediatric settings for diagnosis, monitoring of motor development, and rehabilitation. <b>Methods</b>: This systematic review was registered in PROSPERO (CRD42024511787) and conducted by two independent reviewers, with a third reviewer resolving disagreements. The literature published between 2018 and 2025 was systematically searched. Studies involving pediatric populations or clinically relevant pediatric applications of MMC were included. <b>Results</b>: Of 1521 identified studies, 52 were finally selected. The included studies evaluated populations across a wide age range. However, seven of the included articles were specifically focused on underage populations. Infant studies primarily analyzed whole-body movements, emphasizing the relevance of global motor patterns in early development. OpenPose and AlphaPose were the most frequently used frameworks in pediatric research because of their automatic full-body key point detection, whereas DeepLabCut was commonly selected for its customizable labeling capabilities. Theia3D emerged as a promising clinically applicable solution with high accuracy. Most studies evaluated kinematic parameters as objective markers of motor performance and development. However, methodological heterogeneity and limited pediatric-specific validation remain important limitations. <b>Conclusions</b>: AI-driven MMC technologies show considerable potential to support objective, accessible, and child-friendly movement assessment in pediatric clinical practice.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580511","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":"Heterogeneous Renal Trajectories in Pediatric IgA Nephropathy: A Single-Center Experience Highlighting the Dynamic Nature of Early Disease.","authors":"John Dotis, Antonia Kondou, Vasiliki Karava, Maria Tsirevelou, Ioannis Koutras, Olympia Dadoudi, George Liapis, Despoina Tramma, Maria Stamou, Nikoleta Printza","doi":"10.3390/pediatric18040084","DOIUrl":"10.3390/pediatric18040084","url":null,"abstract":"<p><strong>Background/objectives: </strong>Pediatric IgA nephropathy (IgAN) is often considered to have a favorable early course. However, its progression is variable, and the prognostic value of histopathological classifications, such as MEST-C, remains incompletely defined in children. This study aimed to characterize clinicopathological features and the early disease course in pediatric IgAN and to descriptively examine histopathological findings and clinical outcomes.</p><p><strong>Methods: </strong>This retrospective, single-center study included children with biopsy-confirmed IgAN diagnosed between 2016 and 2025. Clinical, laboratory, and histopathological data were collected, and biopsies were assessed using the Oxford MEST-C classification. Follow-up data, including estimated glomerular filtration rate (eGFR), were analyzed descriptively, with follow-up extending from diagnosis to early 2026.</p><p><strong>Results: </strong>Fourteen patients were included, showing heterogeneous clinical presentations. Mesangial hypercellularity was observed in all cases (100%), with frequent endocapillary hypercellularity (78.6%) and segmental sclerosis (57.1%), consistent with a predominance of active lesions. Over a median follow-up of approximately five years, renal function remained stable in 57.1% of patients, declined in 21.4%, and improved in 14.3%, indicating variability in renal function during follow-up and potential reversibility in a subset of patients. One patient (7.1%) developed severe acute kidney injury requiring temporary dialysis, followed by full recovery. Given the descriptive design and limited sample size, no conclusions regarding associations between histopathological findings and renal outcomes can be drawn.</p><p><strong>Conclusions: </strong>Within this small cohort, pediatric IgAN showed variable renal function courses ranging from stability to decline or partial recovery. These findings should be considered descriptive and hypothesis-generating, supporting longitudinal monitoring in larger pediatric cohorts.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580065","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":"When Platelet Stimulation Becomes Marrow Stress: Rethinking Thrombopoietin Receptor Agonist Intensification in Pediatric Immune Thrombocytopenia.","authors":"Maurizio Aricò","doi":"10.3390/pediatric18030082","DOIUrl":"10.3390/pediatric18030082","url":null,"abstract":"<p><p>Thrombopoietin receptor agonists (TPO-RAs) have become central second-line treatments for children with persistent or chronic immune thrombocytopenia (ITP). Their efficacy has encouraged broad use, but difficult-to-treat patients who respond suboptimally may be exposed to repeated agent switching, prolonged treatment, or doses exceeding approved limits. This commentary uses a focused narrative approach to address whether the risk of treatment-associated marrow fibrosis should be interpreted primarily as a consequence of treatment duration or as a risk marker linked to supraphysiological treatment intensity in non-responders. A recent Haematologica report by Ma and colleagues identified clinically significant bone marrow myelofibrosis in a highly selected cohort of children with chronic ITP undergoing marrow re-evaluation after suboptimal response or loss of efficacy during TPO-RA therapy. The most relevant message is not simply that fibrosis can occur, but that it was independently associated with treatment intensification, particularly overdose and frequent switching. The biological plausibility of this association is supported by the known capacity of sustained megakaryocytic stimulation to promote local pro-fibrotic signaling and reticulin deposition. This commentary places this safety concern in the context of pediatric ITP epidemiology, current regulatory indications, expert approaches to refractory disease, and practical surveillance considerations. TPO-RAs should not be viewed as routine treatment for newly diagnosed pediatric ITP; their principal role remains in selected children with persistent or chronic disease who require second-line therapy. Failure to respond at the maximum approved dose should prompt diagnostic and therapeutic reassessment rather than automatic treatment escalation. The emerging lesson is that response-adapted therapy must also be risk-adapted therapy.</p>","PeriodicalId":45251,"journal":{"name":"Pediatric Reports","volume":"18 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13304626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148319963","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}