Frontiers in Pediatrics

Hypospadias, a common congenital anomaly requiring surgical correction, has seen growing research in surgical techniques and outcomes. However, no comprehensive bibliometric or disruption-based analysis exists to map the fields evolution. This study uses bibliometrics and the Disruption Index (DI) to identify key transformational research in hypospadias. A systematic search of five databases (PubMed, Web of Science, ScienceDirect, Scopus, and Dimensions) from January 1990 to December 2023 was conducted, yielding 7,732 articles. After applying inclusion criteria, 200 studies were analyzed. Citation data and DI scores were calculated using OpenCitations. Spearmans rank test assessed correlations between DI and citation metrics. A subgroup analysis identified trends based on the latest hypospadias research priorities. The mean citation count was 72.3 (SD = 43.1) with a mean DI of 0.011 (SD = 0.17). Five studies, focusing on complications, analgesia, and surgical techniques, had the highest DI (1.0). A moderate positive correlation was found between DI and citation rate ({rho} = 0.405, p < 0.001). Subgroup analysis showed most research focused on surgical techniques (30.5%) and etiology (25.8%), while areas like surgical training (2.6%) and innovation (0%) were underrepresented. This study identifies critical gaps in hypospadias research. The DI reveals influential studies that redirect research trajectories. Future work should focus on innovation and translational research to accelerate advancements in hypospadias care.

IntroductionChildhood asthma remains a major public health challenge in low- and middle-income countries, where social and economic factors influence disease outcomes. This study examined the sociodemographic determinants of asthma exacerbation among children attending clinic at Thika Level 5 Hospital, Kenya. MethodsThis study employed a hospital-based cross-sectional study involving 108 caregivers- child dyads, each consisting of a child with confirmed asthma and their primary caregiver. The dyads were recruited from the pediatric asthma clinic from 31st March 2025 to 30th April 2025 then follow up was conducted for six months form 1st May to 31st October 2025. Data were collected using structured questionnaires and clinic records. Descriptive statistics summarized sociodemographic characteristics, while chi-square tests and logistic regression assessed associations between caregiver factors and asthma control. ResultsThe mean age of children was 8.1 years (range 3-17), with males comprising 57.4%. Most caregivers were mothers (88%), had secondary education (57.4%), and were in informal employment (75.9%). Household income was low for 59.3% of participants (<KES 30,000/month). Caregiver education (AOR=2.8; 95% CI:1.5-5.2; p=0.001) was the strongest predictor of asthma control, followed by medical insurance ({chi}2=10.41; p=0.001). Formal employment and higher income were significantly associated with controlled asthma ({chi}2=6.45; p=0.04 and {chi}2=9.72; p=0.02 respectively). Urban residence modified the positive effect of education on asthma management (interaction AOR=1.9; p=0.03). ConclusionCaregiver education level, employment, income, and medical insurance significantly influence asthma control among children. Enhancing health literacy and expanding insurance coverage under the Social Health Authority (SHA) can improve asthma outcomes in Kenyan children.

Background: Extrauterine growth restriction (EUGR) is a common and clinically significant complication among preterm infants, contributing to adverse neurodevelopmental and metabolic outcomes. Early and individualized risk prediction remains challenging. This study aimed to develop and validate an interpretable machine learning model for early prediction of EUGR using routinely available clinical variables, and to implement a user-friendly web-based calculator for clinical use. Methods: We retrospectively analyzed 1,431 preterm infants admitted within 24 hours after birth to our hospital between May 2020 and March 2025. Infants from the Yangpu campus (n=863) formed the training set, and those from the Huangpu campus (n=568) formed the validation set. Early clinical variables available within 48-72 hours were screened using the Boruta algorithm. Logistic regression, XGBoost, random forest, decision tree, and support vector machine models were developed and compared. Model performance was evaluated using area under the curve (AUC), accuracy, sensitivity, specificity, F1 score, and Brier score. SHapley Additive exPlanations (SHAP) were applied to assess global and individual feature contributions, nonlinear effects, and interactions. A web-based calculator was constructed based on the optimal model. Results: Nine variables were identified as important predictors: birth weight, small for gestational age status, gestational age, breastfeeding, multiple gestation, neonatal respiratory distress syndrome, patent ductus arteriosus, maternal hypertension, and maternal group B Streptococcus infection. Among the five models, XGBoost achieved the best performance in the validation set (AUC 0.922, accuracy 0.849, Brier score 0.108). SHAP analysis showed that low birth weight, small for gestational age, maternal group B Streptococcus infection, and patent ductus arteriosus were major risk factors, while breastfeeding was protective. Notable nonlinear and interactive effects were observed, particularly between birth weight and gestational age and between breastfeeding and patent ductus arteriosus. The web-based calculator provides real-time individualized risk estimation and visualized interpretation. Conclusions: An interpretable XGBoost-based model and web calculator were successfully developed and validated for early prediction of EUGR in preterm infants. This tool may support clinicians in identifying high-risk infants and guiding individualized nutritional and clinical management.

ObjectiveThe immune system plays a role in the occurrence and progression of numerous pregnancy complications, particularly preeclampsia (PE). This study aims to identify critical immune biomarkers via machine learning and assess their predictive ability. MethodsGene expression data were retrieved from the GEO database, while immune-related genes were obtained from the ImmPort repository. Differential expression analysis was then conducted to identify immune genes associated with PE. Different immune-related genes (DIRGs) were subjected to functional and pathway enrichment analysis. We adopted protein-protein interaction (PPI) networks for exploring the connections among various DIRGs and integrated two machine-learning to pinpoint candidate biomarkers in PE. Diagnostic performance was assessed via ROC curve analysis, with predictive accuracy further quantified using nomogram calibration. Findings were validated through integrated computational and experimental analyses. In silico validation utilized additional GEO datasets, while experimental confirmation involved qRT-PCR and IHC assessment of placental tissues. We developed a nomogram to predict PE utilizing two immune-related genes. Cellular composition was inferred from transcriptomic data using CIBERSORT deconvolution.. ResultsWe identified 66 differentially expressed genes (DEGs) and 10 DIRGs between PE pregnancies and normotensive pregnancies. The GO analyses revealed that the DIRGs were enriched in gonadotropin secretion, the regulation of gonadotropin secretion, and the regulation of endocrine processes. Functional annotation revealed enrichment in cytokine and neuroactive ligand-receptor pathways. SERPINA3 and NDRG1 emerged as top-performing biomarkers (training AUCs: 0.812 and 0.866; external validation: 0.795 and 0.781), with overexpression validated in clinical specimens. Both genes inversely regulated M2 macrophage abundance (P < 0.05). ConclusionPE is fundamentally an immune-mediated disorder. SERPINA3 and NDRG1 can be identified as key immune genes associated with M2 macrophages, and these findings provide novel perspectives for the diagnosis and pathogenesis of PE.

BackgroundHumans and mice display elevated levels of IL-27, an immunosuppressive cytokine shown to increase during neonatal bacterial sepsis and compromise survival. This study explores two hypotheses for regulation of IL-27 expression: 1) decreased DNA methylation in newborns that contributes to increased expression of IL-27 genes; 2) neonatal hormones regulate IL-27 expression through upstream hormone response elements (HREs). MethodsWhole genome methyl-seq analysis of neonatal and adult blood-derived macrophages identified differentially methylated regions (DMRs) at steady-state. Quantitative PCR (qPCR) measured expression of IL-27 genes (IL27p28 and EBI3) in human and murine neonatal macrophages stimulated in vitro with synthetic glucocorticoid or progesterone. Confocal microscopy and chromatin immunoprecipitation (ChIP) of glucocorticoid receptor (GR) assessed translocation into the nucleus and binding to the EBI3 promoter. ResultsThe IL-27p28 promoter contained DMRs that were increased in the neonatal cohort. The analysis did not identify DMRs within the EBI3 promoter. Dexamethasone stimulation increased EBI3 gene expression in human and murine neonatal macrophages. GR localized to the nucleus in response to dexamethasone and was enriched at the EBI3 upstream regulatory region. ConclusionThese data suggest glucocorticoid (GC) signaling increases EBI3 expression. This has importance in the context of antenatal GC administration that may increase IL-27 levels. Impact Statement{blacksquare} Elevated expression of IL-27 in early life impairs the host response to invasive bacterial infection in neonates. {blacksquare}Understanding the regulatory mechanisms contributing to increased IL-27 during the neonatal period is necessary to reduce susceptibility to infection in this vulnerable population. {blacksquare}The methylation status of the IL-27 genes in macrophages from neonatal and adult blood donors does not suggest regulation of differential expression with age. {blacksquare}Glucocorticoids are a signal that can induce EBI3 gene expression in a GR-dependent manner. {blacksquare}Glucocorticoid therapy for premature infants may increase IL-27 expression and promote enhanced susceptibility to infection.

Exclusive breastfeeding (EBF) provides essential nutritional, immunological, and developmental benefits, particularly for preterm infants, who represent a vulnerable population. This study aimed to evaluate the duration of exclusive breastfeeding and investigate factors associated with early weaning among preterm infants followed in an outpatient clinic in Northern Brazil. A descriptive cross-sectional study was conducted through a retrospective review of medical records of preterm infants followed between November 2024 and April 2025. Neonatal and maternal variables were analyzed using descriptive statistics and Pearsons correlation. A total of 69 preterm infants were included, with a mean gestational age of 33.79 weeks, plus or minus 2.97 weeks. Exclusive breastfeeding was observed in 41% of infants, with a mean duration of 3.84 months, plus or minus 1.99 months. The most frequent neonatal complications were jaundice (42%) and respiratory distress (41%). No statistically significant associations were identified between exclusive breastfeeding and the analyzed variables, although a positive trend was observed between the number of antenatal consultations and the duration of EBF (r = 0.5; p = 0.07). The findings indicate that exclusive breastfeeding among preterm infants remains below recommended levels, highlighting the importance of strengthening antenatal guidance and multiprofessional support to improve breastfeeding duration in this population.

Objective: To describe the clinical characteristics of term neonates with neonatal bacterial meningitis (NBM) and explore the association between different pathogens and imaging complications, providing clinical evidence for early identification and individualized management. Methods: A retrospective study was conducted on 531 term neonates diagnosed with NBM admitted to the Capital Institute of Pediatrics from 2013 to 2025. Demographics, clinical manifestations, laboratory parameters, etiological results, imaging complications and treatment measures were collected. Patients were divided into favorable/adverse discharge outcome groups and pathogen-positive/negative groups. Statistical analyses were performed using appropriate tests, and Cramers V coefficient was used to analyze the association between pathogens and imaging complications. Results: (1) The most common clinical manifestations were abnormal body temperature (79.85%), altered consciousness (55.18%) and jaundice (46.52%). CSF/blood culture was positive in 133 cases (25.05%), with Escherichia coli (27.07%), group B streptococcus (17.29%) and Staphylococcus species (16.54%) as predominant pathogens. The overall incidence of imaging complications was 22.22%, mainly hydrocephalus (5.84%), subdural effusion (4.90%) and encephalomalacia (2.64%). (2) Adverse discharge outcomes occurred in 107 cases (20.15%). Compared with the favorable group, the adverse group had higher incidences of convulsions, altered consciousness, anterior fontanelle bulging, abnormal muscle tone and primitive reflexes (all P<0.001), more obvious laboratory abnormalities (higher CRP, CSF leukocytes and protein, lower CSF glucose, all P<0.05), higher culture positive rates and greater need for adjuvant therapy (all P<0.001). (3) Pathogen-positive patients had higher imaging complication rates. Gram-negative infections were associated with higher hydrocephalus and subdural effusion rates, while Gram-positive infections had higher brain abscess risk. Specifically, Escherichia coli correlated with hydrocephalus and subdural effusion; group B streptococcus with cerebral infarction and encephalomalacia; LM with intracranial hemorrhage and brain abscess; negative cultures correlated with no imaging complications (all P<0.05). Conclusion: Term NBM neonates have non-specific manifestations, mainly abnormal body temperature and altered consciousness. Predominant pathogens are Escherichia coli, group B streptococcus and Staphylococcus species, with hydrocephalus and subdural effusion as common imaging complications. Adverse outcomes are associated with severe symptoms, obvious laboratory abnormalities and higher pathogen positivity. Specific pathogens correlate with distinct imaging complications.

BackgroundBronchiectasis in adults often goes undiagnosed following the routine assessment. Cystic Fibrosis (CF) is usually diagnosed during childhood, but some cases are identified in adulthood when disease is mild. High-resolution computed tomography (HRCT) of chest may offer structural information that can indicate CF as an underlying etiology. ObjectiveTo compare the HRCT features of adult patients with CF and non-CF bronchiectasis and to determine the radiologic features that may be suggestive of CF. MethodsThis retrospective, analytical, cross-sectional study was carried out in Bangladesh Medical University after IRB clearance. Total 130 adults (12 with CF and 118 with non-CF bronchiectasis) of both sexes, whose bronchiectasis was confirmed by chest HRCT were included. Imaging findings were assessed based on Reid morphological classification, anatomical distribution and extent of spread within the lungs, and their association was tested using chi-square test with statistical significance of p<0.05. ResultsCystic bronchiectasis was more common in CF than non-CF patients (83.3% vs 29.7; p<0.001). Mixed central-peripheral extension had been found a considerable associated with CF (66.7% vs. 42.4; p=0.034). There was no statistically significant difference in right lung lobar distribution (p=0.540) but combined upper and lower lobe involvement on the left side was more common in CF patients (54.5%) than non-CF patients (21.3) (p=0.054). ConclusionAdult CF had unique chest HRCT imaging characteristics when compared to non-CF bronchiectasis, especially cystic morphology and mixed extension. Identification of such features could help physician in the early diagnosis and selection of treatment strategy.

ObjectiveTo investigate the burden of environmental enteric dysfunction (EED) and its association with water, sanitation, and hygiene (WASH) and linear growth amongst infants in rural Central Java, Indonesia. Study designA longitudinal study of 119 infants aged between 5-19 months was conducted in five villages of Wonosobo District, Central Java, Indonesia. Anthropometric measurements of infants and their mothers were performed at baseline and 5-month follow-up alongside a quantitative questionnaire on household, socio-economic, WASH and caregiving variables and stool sample collection for the investigation of alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO) levels. Linear mixed-effects regression models estimated the associations between WASH and height-for-age z-score (HAZ) on log-transformed EED biomarkers. ResultsBiomarkers increased from baseline to follow-up despite a declining trend with age and 68.7%, 79.0%, and 71.4% of infants experienced elevated AAT, NEO, and MPO respectively follow-up. Infants had higher AAT if they averaged > 30 minutes playing on soiled surfaces per day ({beta} = 0.11, p<0.05). NEO was elevated in infants with diarrhoea ({beta} = 1.04, p<0.05), municipal water source ( = {beta} 0.71, p<0.05), and in infants who mouthed soiled fomites weekly ({beta} = 0.55, p<0.05). Infants in houses with municipal water source had higher MPO ({beta} = 0.56, p<0.05) and higher MPO if mouthing soil weekly ({beta} = 0.41, p<0.05). Compared to infants at risk of stunting, stunted infants at baseline had lower AAT at follow-up ({beta} = -0.39, p<0.05) while infants with HAZ > -1 had lower AAT at baseline ( = -0.43, p<0.05). HAZ at baseline was positively associated with NEO at follow-up ({beta} = 0.36, p<0.05). MPO was higher in infants with HAZ > -1 at follow-up ({beta} = 0.59, p<0.05) and stunted infants ({beta} = -0.54, p<0.05) compared to infants at risk of stunting. ConclusionElevated EED biomarker levels were frequent and associated weakly with WASH and HAZ with bi-directionality, highlighting the need for quality birth cohort studies to improve understanding of EED and develop interventions.

BackgroundPatent ductus arteriosus (PDA) is a common and potentially serious cardiovascular condition in preterm infants, particularly those with low gestational age and birth weight. Its management remains controversial due to variability in screening, diagnostic criteria, and treatment strategies. This study aimed to evaluate risk factors, outcomes, and management strategies for PDA in preterm infants, and to identify predictors of clinical and echocardiographic response to therapy. MethodsWe conducted a retrospective cohort study over a 4-year period (2016-2019) in the neonatal intensive care unit (NICU) of a tertiary care center. All consecutive preterm infants admitted during the study period were eligible. Infants with echocardiographically confirmed PDA who received pharmacological treatment with intravenous paracetamol or ibuprofen were included in the analysis. Missing data were minimal and handled using available-case analysis. Statistical analyses included descriptive statistics, Pearsons chi-square test, and multivariable logistic regression. ResultsAmong 2154 preterm infants admitted to the NICU, 60 were diagnosed with PDA (incidence : 2.8%). The mean gestational age was 29 {+/-} 2.6 weeks, and the median birth weight was 1200 g. Respiratory distress occurred in 95% of cases, mainly due to hyaline membrane disease (86.7%). PDA was symptomatic in 80% of infants. First-line treatment resulted in clinical improvement in 77% and ductal closure in 83.3% of cases, most within 3 days. Predictors of successful closure included gestational age [&ge;] 28 weeks (OR = 5.9; 95% CI : 1.7-20.2) and antenatal corticosteroid exposure (OR = 1.2; 95% CI : 1.0-1.6). Overall mortality was 35% and was significantly higher in infants < 28 weeks (OR = 5.0; 95% CI : 2.4-10.3). Clinical improvement (OR = 3.7) and echocardiographic closure (OR = 4.5) after first-line treatment were associated with reduced mortality. ConclusionsPDA in preterm infants is associated with substantial morbidity and mortality, particularly in those born before 28 weeks of gestation. Early diagnosis, antenatal corticosteroid exposure, and timely pharmacological treatment may improve outcomes. Systematic echocardiographic screening in high-risk neonates should be considered.

AimsCongenital heart defects (CHD) are the most common neonatal malformations. Neonates with complex CHD present with cerebrovascular dysfunction, including deficits in cerebrovascular reactivity (CVR), a measure of vascular reserve. However, it is unknown whether these deficits persist beyond the perioperative period. Methods and ResultsHere, we compared CVR between 53 youth with CHD and 54 age-matched controls without CHD. CVR was derived using a novel approach based on resting state blood oxygen-level dependent magnetic resonance imaging. We found that youth with CHD present with relative CVR deficits in the whole gray matter and in the anterior cerebral artery territory when compared to controls. Sex differences were identified in the middle cerebral artery territory, with females having lower relative CVR than males in the CHD group. Greater CVR deficits were observed in individuals with single-ventricle as compared to participants with a two-ventricle physiology. Finally, in the CHD group, a lower CVR was found to be associated with reduced performance on the Metacognitive Abilities Index of the BRIEF-A. ConclusionThese results indicate that cerebrovascular deficits in CHD survivors persistent into young adulthood and that CVR offers great promise as a biomarker of cerebrovascular health which could be targeted in future interventions.

ObjectiveTo examine whether screen time predicts interindividual variability regarding pubertal development across adolescence. Study designThis longitudinal cohort study included 10786 participants (47.9% female) from the Adolescent Brain Cognitive Development (ABCD) study. First, associations were examined between average daily screen time (hours/day, parent-reported Screen Time Survey) at baseline (mean age = 9.91 {+/-} 0.63 years) and pubertal timing, derived from Pubertal Development Scale (PDS) scores through 4-year follow-up (mean age = 14.08 {+/-} 0.68 years) and standardized by age and sex. Second, associations were examined between screen time groups (very low: 0-1.29 h/day; low: 1.29-2.07 h/day; moderate: 2.07-2.86 h/day; high: 2.86-4.0 h/day; very high: 4.00-12.43 h/day) and age at mid-puberty, defined as the age at first parent report of Pubertal Development Scale (PDS) category at least 3. ResultsIn linear mixed models adjusting for age, sex, race/ethnicity, socioeconomic status, BMI, and physical activity, higher log-transformed screen time at baseline was associated with more advanced pubertal timing at 1-, 2- and 3- year follow-ups, with the strongest effect observed at year 2 (standardized {beta}=0.07 [95%-CI, 0.05 to 0.10]). The associations were more pronounced in girls. The group of participants with very high screen time reached mid-puberty 2.47 months earlier [adjusted effect size, 95%-CI, -3.38 to -1.56) than participants with very low screen time. ConclusionThese findings suggest that screen time in late childhood is linked with earlier pubertal development and highlight its relevance for parental guidance on preadolescents screen media use.

Subclinical rheumatic valvular disease is a significant yet underdiagnosed contributor to the global rheumatic heart disease (RHD) burden. Early detection through population screening is essential to prevent its progression to severe RHD. Rhythm changes and prolongations of PR and QTc intervals in the ECG are described in the advanced RHD cases. However, these parameters were not yet studied in asymptomatic RHD. We aimed to investigate the potential of ECG biomarkers for screening RHD in asymptomatic schoolchildren. ECG tracings from 611 schoolchildren aged 10 to 20 years were selected from a cohort screened for RHD in four schools in an RHD-endemic region. Confirmatory diagnoses were based on echocardiographic findings, where 564 (F=326, M=238) were healthy, and 47 (F=28, M=19) were positive for RHD (24 borderline RHD and 23 definite RHD). Independent, blinded reviewers manually annotated the ECGs and PR interval (PR), P-wave dispersion (PWd), and the ratio between the P-wave duration and PR interval (Pw/PR) were analyzed. The mean age of the study cohort at diagnosis was 16.1 {+/-} 2.5 years, and 58% of the participants were females. Atrial fibrillation was seen in 8% (n=4), and prolonged PR in 2% (n=1) of RHD-positive cases. The mean {+/-} std for normals vs RHD is (PR, 138{+/-}19 vs 150{+/-}19), (Pw/PR, 0.75{+/-}0.06 vs 0.71{+/-}0.07), and (PWd, 49{+/-}14 vs 56{+/-}17). The PR (p<0.001), Pw/PR (p<0.001), and PWd (p=0.008) showed a significant difference between healthy and RHD-positive subjects. The PR was increased consistently with severity across age groups above and below 16 years. The PR, PWd, and Pw/PR can serve as non-invasive biomarkers for the screening of RHD in at-risk schoolchildren. Monitoring alterations in these markers at an early stage of RHD is crucial for enabling prompt management and follow-up. It is thus evident that ECG can support an intermittent ambulatory RHD screening in resource-limited settings.

Recognizing the challenges faced by primary caregivers regarding the health of children with congenital craniofacial anomalies (CCAs) contributes to strengthening healthcare programs according to patient[s] and families differential needs. This qualitative study presents the experiences of 25 caregivers of children with CCAs from Bogota and Cali, Colombia, identified from care registries and consultation statistics provideed from public high-complexity healthcare institutions. Grounded in Giorgis descriptive phenomenology and employing thematic analysis, this research utilized semi-structured interviews and focus groups to explore the diagnostic process and its impact, experiences with healthcare services, and the caregivers role and daily care activities. Data were analyzed using MAXQDA(R) qualitative software. Findings highlighted the emotional complexity of caring for childre[n]s health. Challenges included late diagnoses, pessimistic views of the children with CCAs condition by healthcare team members; lack of effective support, information, and guidance from health staff; absence of clear care and referral protocols, and limited access to specific adaptations and timely specialized care for children with CCAs. There were also reduced therapeutic services, and a pronounced gendered caregiving burden when responsibilities fall almost exclusively on mothers. System fragmentation, reflected in deficiencies in communication and a lack of clear, coordinated, and timely pathways of care, as well as the absence of adequate psychosocial support for families, emerged as common structural problems in healthcare services in both geographic settings where this research has been conducted. Gender-sensitive strategies focused on alleviating emotional concerns and the burden of caregiving from diagnosis onward within a patient and family-centered care model are decisive. Improving comprehensive CCAs training for healthcare personnel and making adjustments to care pathways are suggested to contribute to the implementation of inclusive health programs that address the diverse needs of children and their families.

Dysglycemia is a critical metabolic disturbance associated with mortality in acutely ill children, yet its burden may be underrecognized in low-income settings due to reliance on single point-of-care measurements. Using continuous glucose monitoring (CGM), we aimed to characterize glucose patterns in acutely ill children of different anthropometric status. MethodsChildren aged 2-23 months admitted with acute illness were prospectively recruited from two hospitals in Bangladesh and Malawi. Clinical data were collected, and interstitial glucose was monitored for 48 hours using the Dexcom G4 Platinum system. Glucose excursions and variability were analyzed and associated with anthropometric status. ResultsOf 93 enrolled children, 88 had sufficient CGM data: 21 not wasted (NW), 22 moderately wasted (MW), and 45 with severe malnutrition (SAM; 29 severe wasting [SW], 16 edematous malnutrition [EM]). Low-glucose excursions were detected in 8 (38%) children with NW, 11 (50%) with MW, 12 (41%) with SW, and 10 (63%) with EM. While not confirmed hypoglycemia, these low-glucose excursions were longer and more frequently below severe thresholds in children with EM. Hyperglycemic excursions occurred in 31% of children and were longer in children with SAM compared to NW (median 41 vs. 23 min, p<0.0001). Overall, 35% of children maintained euglycemic profiles, while others exhibited marked glucose variability. ConclusionCGM revealed frequent glucose instability among acutely ill children, with patterns varying across anthropometric groups. When interpreted cautiously, CGM may serve as a research tool to detect dysglycemia and assess response to therapeutic or nutritional interventions in critically ill children in low-resource settings.

Introduction: The Pubertal Development Scale (PDS) is widely used for puberty assessment, yet its psychometric properties and norms are limited to research data. This study examined the psychometric properties of parent- and self-report PDS and established continuous norms in nationally representative samples. Methods: We analyzed two deidentified survey samples: a parent-report sample of children aged 6-18 (N=2000, Mage=11.37, 47.2% female, 74.9% White), and a youth self-report sample aged 12-18 (N=754, Mage=14.33, 49.6% female, 75.3% White). Both samples were representative of the U.S. population on key demographics, and the self-report sample consisted entirely of children whose parents also participated in the parent sample, thus creating parent-child dyads. Internal consistency was evaluated using Cronbach's alpha and McDonald's Omega. Cross-informant agreement was assessed with Intraclass Correlation Coefficient (ICC; two-way model, absolute agreement, single unit) and Bland-Altman plots. Age-dependent norms of each sex were established with Generalized Additive Models for Location, Scale, and Shape (GAMLSS), with 5th-95th percentile curves and reference tables provided. Results: Parent- and self-report PDS demonstrated acceptable-to-good internal consistency (Cronbach's alpha: 0.78-0.89; McDonald's omega: 0.79-0.90). Among the 754 parent-youth dyads, excellent cross-informant agreement was observed for both sexes (ICC(2,1)=0.88). Parents' and children's PDS total scores did not differ significantly for boys; for girls, parents rated pubertal development on average 0.13 points lower than children's self-report. Regardless of informants, PDS scores increased nonlinearly with age and exhibited sex-specific developmental patterns. Girls showed earlier pubertal onset, faster progression, and greater convergence toward pubertal completion by late adolescence. Discussion: The PDS demonstrated strong psychometrics in national samples, supporting its utility in the general pediatric population. The national norms provide empirical benchmarks for PDS score interpretation, strengthening its value as a broad estimation of pubertal status and a pre-screening tool for identifying early or delayed puberty.

BackgroundWell-child visits (WCVs) are essential for preventive care, yet missed appointments often lead to delayed interventions. We developed and validated models to predict next-visit nonattendance using routine electronic health record data. MethodsUsing data from two Chicago-area pediatric practices, Practice A (1,215 patients; 3,654 visits) and Practice B (1,271 patients; 3,044 visits), we compared regularized logistic regression, random forest, and XGBoost models. Predictors included visit context, prior utilization, and patient characteristics. Models were trained on Practice A and validated on Practice B. ResultsMissed-next-visit rates were 16.2%(A) and 20.7%(B). In external validation, performance was similar across models (AUC 0.66-0.68). At the threshold maximizing F1 score, recall ranged from 0.54-0.71. The LASSO logistic regression model identified six key predictors: timepoint, visit delay, prior no-shows, schedule lead time, new patient status, and immunization refusal. SHAP values confirmed these process measures as among the most influential features across all models. ConclusionPredicting WCV nonattendance is feasible using routine data. A simple logistic regression model performs comparably to complex algorithms, offering a practical pathway for clinical integration. By identifying at-risk families during a current appointment, this may enable clinicians to provide proactive support to support preventive care before a lapse occurs. ImpactO_LIMissed well-child visits are common, leading to an increasing number of preventable acute care visits, delayed recognition of developmental delays, and missed opportunities to initiate early intervention C_LIO_LIA multimodal approach is needed to support well-child visit attendance C_LIO_LIMachine learning is an emerging tool to predict well-child visit no show rates with implications for future interventions to support families at risk for missing well-child visits and promote positive health outcomes C_LI

Background: Adult autism services research is hampered by a lack of accessible self-reported outcome measures. The AASPIRE Outcomes Project used a community-based participatory research (CBPR) approach to create and test the AASPIRE Measurement Toolkit, a set of accessible survey instruments for use in real-world settings. The core toolkit contains 12 characteristics modules and 19 outcome measures, each with self-reported and caregiver-reported versions. Methods: In a prior phase of the project, we collaboratively adapted, revised, or co-created all instruments. We used our CBPR-nested Delphi process, our collaborative adaptation/creation process, and cognitive interviews to ensure accessibility and content validity. We then conducted a longitudinal survey to validate the 19 outcome measures in a pragmatic sample of 870 autistic adults from two healthcare systems, two disability service systems, and the larger autistic community in the United States. Participants completed surveys at 3 time points over 12-18 months. A 15% random subset completed an additional retest survey 2 weeks after the second time point. We assessed 1) accessibility using completion rates and perceived ease of use; 2) internal consistency using Cronbach's alphas and omegas; 3) convergent validity using Pearson's correlations; 4) two-week test-retest reliability using interclass correlation coefficients; and 5) six-month responsiveness to change by comparing self-perceived change with change in scores. Results: Over 90% of participants reported the survey items were easy to understand; over 90% of participants who started the survey completed all applicable sections at each time point; and participants answered 99% of items on each instrument. The outcome measures and their pre-determined subscales demonstrated strong accessibility, content validity, internal consistency reliability, test-retest reliability, convergent and discriminant validity, and responsiveness to change. Conclusion: The AASPIRE Measurement Toolkit is accessible and includes 19 outcome measures with strong initial psychometric properties. We will report in-depth assessments of construct and structural validity separately for each measure. All instruments are available for free and can help clinicians, service providers, advocacy organizations, and researchers assess the effectiveness of interventions and follow changes in outcomes over time.

Objective To examine group differences and continuity in caregiving environments of infants born preterm from Spanish- and English-speaking families. Study Design We conducted a prospective cohort study of Spanish- (n = 17) and English-speaking (n = 23) families of infants born preterm (< 32 weeks gestation). Caregiver-infant engagement was assessed neonatally via hospital visitation and skin-to-skin (STS) care, and at home via child-directed adult word counts/hour (CD-AWC/hour) from all-day audio recordings. Result No significant group differences were observed in family visitation, neonatal STS care, or in-home verbal engagement, although STS care rates varied considerably, especially within Spanish-speaking families. Across both groups, greater STS care was associated with higher CD-AWC/hour at home. Conclusion Spanish- and English-speaking families showed comparable patterns of caregiver-infant engagement, as a group, however, many Spanish-speaking families engaged in less STS than English-speaking families. STS care predicted caregiver-infant verbal engagement at home, highlighting continuity from hospital to home.

Background: Severe acute malnutrition (SAM) remains a major public health problem among under-five children, particularly in low-income countries. Comorbidity, especially pneumonia and diarrhea, significantly increases the risk of morbidity and mortality among affected children. Methods: An institutional-based cross-sectional study was conducted from April 20 to May 20, 2024, among children aged 6-59 months admitted with SAM to public hospitals in North Shoa Zone, Ethiopia. A total of 394 participants were included using systematic random sampling. Data were collected through caregiver interviews and medical record reviews using a structured, pre-tested questionnaire. Data were entered into Epi Info version 7 and analyzed using Stata version 16.1. Logistic regression analyses were performed to identify factors associated with comorbidity. Statistical significance was declared at p-value < 0.05. Results: The prevalence of comorbidity (pneumonia and diarrhea) among severely acutely malnourished children was 15.48% (95% CI: 11.89-19.06). Children with low dietary diversity (<5 food groups) were twice as likely to develop comorbidity (AOR = 2.00, 95% CI: 1.09-3.98). Children of single mothers had higher odds of comorbidity (AOR = 3.00, 95% CI: 1.21-7.65). Additionally, very low perceived birth weight was strongly associated with comorbidity (AOR = 7.11, 95% CI: 1.43-35.48). Conclusions: A substantial proportion of children with SAM had comorbid pneumonia and diarrhea. Key predictors included poor dietary diversity, maternal marital status, and low birth weight. Strengthening integrated child health and nutrition interventions is essential to reduce comorbidity and improve outcomes among vulnerable children.