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Abstract Objective To conduct a narrative review of strategies and actions that can contribute to the prevention of functional constipation in children and adolescents. Source This narrative review used articles indexed predominantly in the PubMed database and compiled by the author over the past 30 years. Summary of the findings No specific prospective population-based studies have evaluated the effectiveness of preventive measures against constipation. However, some measures can contribute to the prevention of functional constipation, such as training healthcare professionals and educating the general population about the importance of breastfeeding, providing proper toilet training guidance, and encouraging actions to avoid postponing bowel movements. Nutrition is important at all life stages. When breastfeeding is prematurely discontinued, infant formulas are more effective than cow’s milk. Dietary fiber and water intake are frequently below recommended levels. Therefore, after introducing complementary feeding throughout life, the adoption of healthy eating habits, including adequate dietary fiber and fluid intake, should be recommended. Conclusions Preventive measures for functional constipation have rarely been discussed in the literature. Training healthcare professionals and educating the general population are important for understanding the physiology of defecation from newborns to adulthood and avoiding unnecessary dietary changes or therapeutic measures. After introducing complementary feeding throughout life, the adoption of healthy eating habits, including adequate dietary fiber and fluid intake, should be recommended.

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Abstract Objectives To determine the prevalence of portal vein thrombosis (PVT) in neonates following umbilical venous catheterization (UVC), and to identify risk factors associated with PVT development in this population. Methods Systematic review conducted in accordance with PRISMA guidelines. Prospective cohort studies assessing PVT in catheterized patients were included. Meta-analyses were performed using random-effects models for prevalence estimates and odds ratios (OR), heterogeneity assessment with Cochran's Q test and Higgins' I², and publication bias with funnel plot and Egger’s test. Results The search identified 344 studies, of which 11 met the inclusion criteria. The sample included 1086 neonates (1052 catheterized). Abdominal ultrasound confirmed 200 cases of PVT, yielding a prevalence of 19% (range: 0% to 49%), with six studies reporting prevalence rates above 5%. Meta-analysis showed an association between PVT and blood transfusion or exchange transfusion through the umbilical catheter (p = 0.0024). There was a trend toward increased risk of PVT in neonates with sepsis (p = 0.0705), whereas catheter tip location was not associated with increased PVT prevalence, although there is a risk of bias (p = 0.4636). Conclusion A wide variation in PVT prevalence was observed across the included studies. Blood transfusion through the umbilical catheter was confirmed as a risk factor, while neonatal sepsis was associated with a trend toward this outcome. These findings support the implementation of systematic abdominal ultrasound screening protocols for PVT in all neonates undergoing UVC.

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Abstract Objective To assess the gaze of physicians in the Neonatal ICU setting when evaluating a multiparameter monitor to determine the presence/absence of vital sign alterations. Methods Pediatricians’ gaze was tracked when they evaluated a 30-second video of a multiparametric monitor on a screen. They assessed one of three scenarios: Normal, Tachycardia, or Hyperoxia. Eight areas of interest (AOI) were defined: Heart rate(HR), Electrocardiogram(ECG), SpO₂, Pulse wave(PulseW), Respiratory rate(RR), Respiration curve(Resp.C), Blood pressure(BP), and Temperature(Temp.). Gaze fixation on each AOI was analyzed in three periods:0-3, 0-5, 0-10 s. Generalized estimating equations were used to evaluate the effect of the parameters/scenarios on the participants' likelihood of gaze fixation on each AOI. Results Eighty physicians (86% female; 35.3 ± 8.2 years old) were evaluated. At 0-3 s, 0-5 s, and 0-10 s, the percentage of physicians who fixed their gaze on each AOI was, respectively:HR: 93, 96, 98%; ECG: 73, 79, 89%; SpO2: 75, 94, 95%; PulseW: 86, 88, 98%; RR: 48, 80, 95%; Resp.C: 26, 49, 73%; BP: 35, 63, 98%; Temp: 31, 53, 91%. Compared with HR, the likelihood of gaze fixation was lower at 0-3 s, for ECG (Odds Ratio-OR: 0.21), SpO2 (OR: 0.24), RR (OR: 0.07), RespC (OR: 0.03), BP (OR: 0.04) and Temp (OR: 0.04); at 0-5 s, for ECG (OR: 0.14), RR (OR; 0.16), Resp.C (OR: 0.04), BP (OR: 0.07) and Temp (OR: 0.04); and at 0-10 s, only for Resp.C (OR: 0.07). Conclusion In the neonatal ICU setting, when assessing the monitor, HR attracts physicians’ initial attention, followed by oximetry parameters.

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Abstract Objectives The presentation of dengue as infectious myositis is considered an atypical and often underrecognized manifestation. This study aimed to characterize the clinical features and outcomes of pediatric patients diagnosed with dengue-associated infectious myositis, to delineate their sociodemographic profiles at the time of diagnosis, and to evaluate their laboratory findings and clinical outcomes. Methods The authors conducted a retrospective observational study in the pediatric department of a tertiary care hospital in the state of Bahia, Brazil, including patients up to 14 years who were admitted with clinical features of infectious myositis and laboratory-confirmed dengue infection between January 2022 and July 2024. Sociodemographic characteristics, clinical manifestations, laboratory parameters and outcomes were analyzed. Results Data from 176 patients were analyzed. A higher incidence was observed among male patients (68.8%), with most cases occurring during the winter season (56.25%). The mean age was 9.25 ± 3.22 years. Fever was the most frequent symptom (96%), followed by myalgia (89.2%). Calf pain was reported in 69.3% of cases. Regarding creatine phosphokinase (CK) levels, 46% of patients had values between 1000-5000 U/L, while 17% presented with CK > 5000 U/L at admission. None of the patients developed acute kidney injury or died. Conclusions Dengue-associated myositis exhibited a benign clinical course in this symptomatic pediatric cohort. However, these findings suggest that clinical and laboratory parameters may support a risk-based clinical approach to patient monitoring and management; prospective studies are needed to validate risk stratification strategies.

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Abstract Objective Evidence concerning total dietary selenium intake in the US pediatric population remains sparse and inconsistent. This study employs a nationally representative dataset to investigate the association between selenium intake and asthma prevalence, addressing this critical knowledge gap. Method The National Health and Nutrition Examination Survey (NHANES) (2011-2020) furnished data on asthmatic individuals aged < 20 years with quantified dietary selenium intake. Utilizing rigorous statistical methodologies — multivariable logistic regression, restricted cubic spline (RCS) modeling, and subgroup analyses — the authors evaluated the selenium-asthma association. Results In this study encompassing 7780 pediatric participants, multivariable logistic regression with comprehensive covariate adjustment revealed progressively higher asthma risk with increasing selenium exposure. Compared to the lowest intake tertile (Q1: ≤ 73.3 mg/day), adjusted ORs were 1.15 (95% CI: 0.98-1.35; p = 0.082) for Q2 (73.4-112.6 mg/day) and 1.24 (95% CI: 1.00-1.54; p = 0.048) for Q3 (≥ 112.7 mg/day). Subsequent restricted cubic spline modeling quantitatively established a significant dose-response relationship (p = 0.042) between dietary selenium levels and asthma risk. Conclusion Dietary selenium intake demonstrated a significant dose-dependent association with asthma prevalence among US pediatric populations.

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Abstract Objective Cystic fibrosis (CF) is a rare genetic disease caused by mutations in the CFTR gene, resulting in a dysfunctional protein that affects various systems in the body, including the gastrointestinal (GI) tract. The changes caused by CF in the GI tract include dysmotility, dysbiosis, intestinal inflammation, and abdominal symptoms such as pain, altered bowel habits, and distension, which are frequent in people with CF. This study aims to establish the prevalence of these complaints in children with CF and investigate associations between symptoms, clinical conditions, and markers of intestinal inflammation. Methods Twenty-two pediatric patients with a genetic diagnosis of CF, followed at a Brazilian reference center, were included. Methods involved a systematic assessment of gastrointestinal symptoms using a questionnaire, biochemical analysis of fecal calprotectin (FC) as a marker of intestinal inflammation, and collection of clinical, anthropometric, laboratory, and imaging data from medical records. Results 86.3% (n = 19) of participants showed elevated FC levels (> 50 gt; 50 mcg/g), indicating a high prevalence of intestinal inflammation. The most common abdominal symptoms were pain and flatulence, present in about half of the patients. No significant associations were observed between FC levels and clinical or symptomatic variables. Conclusion There is a high prevalence of intestinal inflammation and abdominal symptoms in this sample of Brazilian children with CF, highlighting the importance of systematically investigating these symptoms.

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Abstract Objective Citrin deficiency (CD) is an autosomal recessive disease caused by mutations in the SLC25A13 gene. This study aimed to expand the current body of data on Chinese patients with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) by analyzing their clinical characteristics, genetic mutation spectrum, and long-term follow-up outcomes. Methods From May 2013 to April 2025, 60 children diagnosed with NICCD were enrolled in this retrospective study. Related data were obtained from medical records. Results Among 60 patients, common presentations included elevated aspartate aminotransferase (100%), infantile cholestasis (95.0%), elevated citrulline (96.7%), hyperlactatemia (93.3%), hypoproteinemia (81.7%), coagulation dysfunction (60.0%), hyperammonemia (48.3%) and chubby face (36.7%). Twenty-eight SLC25A13 variants were detected, with c.852_855delTATG (42.7%), IVS16ins3kb (15.4%) and c.615+5G>A (10.3%) being the most frequent. All patients were fed lactose-free milk powder enriched with medium-chain triglycerides (MCT) after diagnosis or suspected diagnosis. Ten patients were lost to follow-up. Among 50 followed patients, 30 were followed for > 5 years. Twenty-four patients showed typical dietary features. After discharge, 11 had hypoglycemic episodes, 5 had growth retardation, 11 had dyslipidemia and 3 progressed to failure to thrive and dyslipidemia caused by citrin deficiency (FTTDCD). All patients remained in stable condition. Conclusion Patients with neonatal intrahepatic cholestasis caused by citrin deficiency present with a variety of clinical manifestations. c.852_855delTATG, IVS16ins3kb and c.615+5G>A are the mutation hotspots of the SLC25A13 gene in Zhejiang, China. Early intervention leads to a good prognosis.

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Abstract Objectives Colchicine is an essential component of familial Mediterranean fever (FMF) treatment. It is suggested that it may affect vitamin B12 levels by affecting intestinal absorption. This research focused on examining the impact of colchicine therapy on anemia parameters, as well as levels of vitamin B12 and folate in patients who have recently been diagnosed with FMF. Method This prospective cohort investigation assessed children diagnosed with FMF between October 2016 and February 2017, evaluating anemia parameters as well as vitamin B12 and folate levels at baseline and at the third and sixth months of colchicine therapy. The demographic data were recorded from patient files. Results Forty-six children were involved. M694V was the most common mutation. The most common clinical findings were fever (87%), peritonitis (76.1%), and pleuritis (23.9%). The mean hemoglobin (p 0.027), iron (p < 0.001) levels were significantly increased, while the mean ferritin (p 0.002), vitamin B12 (p < 0.001) and folate (p 0.001) levels were decreased at the 6th month of colchicine treatment. Conclusion Although it has been determined that the suppressive effect of colchicine on inflammation improves anemia by increasing hemoglobin levels, it should also be kept in mind that it may cause a decrease in the levels of other variables that can cause anemia, such as vitamin B12 and folate.

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Abstract Objective Early childhood stimulation is pivotal for enabling children to achieve their full developmental potential and thrive across the life course. Drawing on the Nurturing Care Framework (NCF) and the multigenerational life course model, this study examined the determinants of child development (CD) stimulation activities. Methods This cross-sectional study was conducted with 365 mothers of children up to three years old who were seen at Primary Health Care units in a municipality in southeastern Brazil. Poisson regression with robust variance was performed to assess associations between contextual and environmental variables and the NCF domains and the practice of four or more stimulus activities, and to evaluate each activity individually. Results Engaging in four or more stimulating activities was more prevalent among children who had books at home (IRR: 1.53; 95% CI: 1.23-1.92), attended daycare (IRR: 1.42; 95% CI: 1.15-1.75), and played with toys and/or household objects (IRR: 1.24; 95% CI: 1.02-1.51). The multigenerational life course model demonstrated that book ownership, daycare attendance, playing with toys and/or household objects, information received from health professionals, maternal occupation, and concern for CD were associated with engaging in activities that promote CD. Conclusion The availability of books, toys, and play equipment in the home environment, regular attendance at daycare, and health guidelines to promote development make a difference in the first three years of life. The findings provide insights for public policies aimed at strengthening responsive care and learning opportunities for healthy early childhood.

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Abstract Objective To describe the epidemiology of childhood chalazion surgery under general anesthesia in China and identify factors associated with it. Method The authors conducted a hospital-based, multicenter, cross-sectional study using retrospective inpatient data from the Futang Updating Medical Records System from 2016 to 2022. The study included 117,009 children who underwent ophthalmic surgery under general anesthesia at 22 tertiary hospitals. Age, sex, surgical season, and geographic region were analyzed. Results Of 117,009 pediatric ophthalmic procedures performed under general anesthesia, 33,489 (28.62 %) were chalazion excisions. Annual proportions remained stable at 25-33%. Most children were 1 to 3 years old, with a mean age at surgery of 3.30 years. After adjustment, female residents in North China, and surgery in autumn or winter were each associated with higher odds of chalazion surgery under general anesthesia than their respective reference groups. Conclusions Childhood chalazion surgery under general anesthesia accounted for a substantial share of pediatric ophthalmic surgical volume in this multicenter national cohort. The highest surgical burden was observed among toddlers, girls, children treated in North China, and those undergoing surgery in autumn and winter.

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Abstract Objective To identify factors influencing how often bronchoalveolar lavage (BAL) is performed in children with severe or refractory Mycoplasma pneumoniae pneumonia (MPP) and provide evidence to guide early intervention. Methods Clinical data for 271 children with severe or refractory MPP who underwent BAL at the studied institution between May 1, 2023, and April 30, 2024, were retrospectively divided according to the number of BAL procedures into a single-treatment group (STG, n = 219) and a multiple-treatment group (≥ 2 times; MTG, n = 52). Risk factors for multiple BAL procedures in these children were identified by logistic regression and receiver-operating characteristic curve analyses. Results Peak body temperature was significantly higher, duration of fever was significantly longer, and pulmonary consolidation, pleural effusion, atelectasis, mucus plug formation, and pulmonary lesions involving two or more lung lobes were significantly more common in the MTG than in the STG (all P < 0.05). The white blood cell count, neutrophil percentage, and C-reactive protein (CRP), lactate dehydrogenase (LDH), fibrinogen, and D-dimer levels were significantly higher and the lymphocyte percentage was significantly lower in the MTG (P < 0.05). Logistic regression and receiver-operating characteristic curve analyses showed that mucus plug formation, CRP ≥ 25.68 mg/L, LDH ≥ 374.90 U/L, and D-dimer ≥ 1.22 mg/L were independent risk factors for multiple BAL in children with severe or refractory MPP. Conclusion Mucus plug formation and increased CRP, LDH, and D-dimer levels are important risk factors for multiple BAL in children with severe or refractory MPP. Pediatricians should strengthen management and early intervention in these children to avoid the harm caused by multiple BAL procedures.

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Abstract Objective Explore the epidemiological characteristics and risk factors of overactive bladder (OAB) in children in Qingdao, China. Method A stratified random cluster sampling method was adopted from 20 primary schools of Qingdao between September 2024 and June 2025. Data were collected through anonymous questionnaires, including basic information, lower urinary tract symptoms, Overactive Bladder Symptom Score, Pediatric Sleep Questionnaire (PSQ) and Strengths and Difficulties Questionnaire. Meanwhile, body mass index (BMI), history of nocturnal enuresis (NE), diaper use, urinary tract infection, constipation, and external genitalia development were collected. Results 3200 questionnaires were distributed, with 2986 valid ones recovered, including 1492 boys and 1494 girls. The morbidity of OAB was 5.86% (175/2986), with 7.24% (108/1492) in boys and 4.46% (67/1494) in girls, and the difference was statistically significant (P < 0.001). The morbidity of children over 9-year-old (4.45%, 77/1683) and those under 9-year-old (7.52%, 98/1303) was statistically significant (P < 0.001). NE history, urinary tract infection history, constipation, excessive use of diapers, boy with phimosis or redundant prepuce were independent risk factors. The scores of emotional symptoms, conduct problems, hyperactivity symptoms, peer relationship problems, total difficulty score, and total PSQ score in the OAB group were significantly higher than those of the non-OAB group, with statistically significant differences (all P < 0.05). Conclusions Boys and children under 9-year-old are at higher risk of OAB in Qingdao. History of NE, urinary tract infection, constipation, excessive use of diapers, and a boy with phimosis or redundant prepuce are the main independent risk factors. Meanwhile, OAB significantly affects children's mental health and sleep quality.

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Abstract Objective To develop Brazilian growth charts for weight, height, body mass index (BMI), and head circumference (HC), stratified by sex, for patients with 22q11.2 deletion syndrome (22q11.2DS) from birth to 17 years. Methods This multicenter, retrospective, longitudinal study included 1826 anthropometric data collected through medical record review of 113 patients with a laboratory-confirmed diagnosis of 22q11.2DS who were followed at 11 centers participating in the Craniofacial Brazil Project. The 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for anthropometric parameters were developed for males and females from birth to 17 years old using the Lambda-Mu-Sigma (LMS) method and graphically compared with reference percentiles from the Centers for Disease Control and Prevention using the Tidyverse package in R software. Results A growth pattern distinct from that of the reference population was observed, with more pronounced deficits in height and weight during the first two years of life in both sexes. After this period, partial recovery in height was observed, more evident in females, whereas the deficit remained more pronounced in males. Differences in BMI and HC were less marked. Conclusion The Brazilian growth charts for 22q11.2DS provide more appropriate parameters for clinical monitoring and individualized care of this population.

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Abstract Objective To identify psychosocial, sociodemographic, and clinical factors associated with adherence to gestational syphilis treatment. Method cross-sectional study with a sample of 325 pregnant women diagnosed with syphilis during pregnancy. The main outcome was complete adherence to the therapeutic regimen of three doses of penicillin, including the partner’s treatment. Data were collected through structured interviews and medical records. Statistical analysis included logistic regressions and co-occurrence network analysis to explore interrelationships between factors associated with treatment adherence. Results Treatment adherence was observed in 43.6% of pregnant women and their partners. Newborns of mothers who adhered to treatment had significantly higher Apgar and Capurro scores. Positive factors associated with adherence included early diagnosis in the first trimester (odds ratio [OR]: 5.12, 95% confidence intervals [CI]: 2.8-9.7), adequate prenatal follow-up (OR: 4.37, CI: 2.5-7.7), planned pregnancy (OR: 2.36, CI: 1.3-4.1), employment (OR: 1.72, CI: 1.1-2.7), and income above the minimum wage (OR: 1.71, CI: 1.1-2.6). Negative factors included a history of substance misuse during life and pregnancy (OR: 0.34, CI: 0.1-0.7), childhood maltreatment (OR: 0.53, CI: 0.3-0.8), recurrent unprotected sex (OR: 0.61, CI: 0.3-0.9), marital conflicts (OR: 0.47, CI: 0.3-0.7), witnessed violence (OR: 0.51, CI: 0.3-0.8), and prior police detention (OR: 0.29, CI: 0.1-0.5). Network analysis revealed three clusters related to these factors: one associated with violence, another with substance use, and another involving socioeconomic factors and prenatal care access. Conclusion Adverse maternal psychosocial factors, such as violence, maltreatment, and substance use, hamper treatment adherence and may contribute to worse neonatal outcomes.