BACKGROUND: Prenatal maternal stress influences the development of the fetal immune system and may increase the risk of allergic rhinitis (AR) in childhood. This meta-analysis provides a systematic assessment of the relationship between maternal stress during pregnancy and the subsequent occurrence of AR in offspring. OBJECTIVE: To explore the relationship between prenatal maternal stress and the risk of AR in offspring. METHODS: Articles were searched by using PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, and Wanfang databases. A meta-analysis was performed on 9 studies published up to May 20th, 2026, was conducted for statistical analysis with STATA16.0. The association between prenatal maternal stress and offspring AR was quantitatively assessed by calculating pooled odds ratio (OR) with corresponding 95% confidence interval (95% CI). Potential publication bias was assessed through funnel plots as well as Egger's and Begg's tests. RESULTS: A total of 9 studies involving 40,630 participants were included after systematic literature screening. Meta-analysis showed that prenatal maternal stress was significantly associated with an increased risk of AR in offspring (OR = 1.69, 95% CI:1.51-1.86, P < 0.001, I2 = 47.78%). Stratified analysis by stress type showed a gradient effect: the risk of AR was lowest for prenatal anxiety (OR = 1.42, 95% CI:1.20-1.63, P < 0.001, I2 = 42.67%), followed by depression (OR = 1.61, 95%CI:1.40-1.82, P < 0.001, I2 = 54.74%), and highest for stressful life events (OR = 1.74, 95% CI:1.29-2.18, P < 0.001, I2 = 70.04%). CONCLUSIONS: Prenatal maternal stress can increase the risk of AR in children. Various types of maternal stress experienced during pregnancy exhibit a notable gradient effect on the likelihood of children developing allergic rhinitis subsequently.
OBJECTIVE: Continuous spike-and-wave during sleep (CSWS) is an epileptic encephalopathy characterized by sleep-potentiated epileptiform activity and neurocognitive deterioration. Available therapies are frequently ineffective or poorly tolerated. We evaluated the safety, tolerability, and acute electrophysiologic effects of transcranial rotating permanent magnet stimulation (TRPMS), a novel wearable neuromodulation platform, in patients with focal CSWS. METHODS: In this prospective, open-label pilot study, 10 children (age range 3-14 years) with focal CSWS underwent a single 10-minute session of focal TRPMS during inpatient epilepsy monitoring between October 2019 through April 2024. Stimulation was targeted at the epileptogenic cortical region identified by scalp electroencephalogram (EEG). Continuous video-EEG recordings were obtained before and after stimulation. The primary outcome was change in spike-wave index (SWI) during non-rapid eye movement sleep. Secondary outcomes included changes in awake SWI, safety, and tolerability. SWI measurements were independently assessed by two blinded pediatric epileptologists. RESULTS: All participants completed the intervention without interruption. No serious adverse events, stimulation-induced seizures, clinically significant vital sign changes, or device-related complications were observed. Mean sleep SWI decreased from 90.6% to 81.7% for reviewer 1 (p = 0.0186) and from 85.3% to 77.0% for reviewer 2 (p = 0.0123). Mean awake SWI decreased from 49.31% to 35.86% for reviewer 1 (p = 0.0065) and from 44.6% to 34.7% for reviewer 2 (p = 0.0186). Five participants achieved a post-stimulation sleep SWI below 85%, meeting a predefined electrophysiologic response criterion. SIGNIFICANCE: A single session of focal TRPMS was safe, well tolerated, and associated with significant short-term reductions in spike-wave burden during both sleep and wakefulness in patients with focal CSWS. These findings provide preliminary proof-of-concept evidence that wearable low-intensity magnetic neuromodulation may represent a novel nonpharmacologic treatment approach for CSWS. Controlled studies with repeated stimulation sessions and long-term follow-up are warranted to determine clinical efficacy and durability of response.
BACKGROUND: Postoperative brain injury in congenital heart disease (CHD) impairs neurodevelopment. We aimed to identify risk factors for postoperative brain injury in infants and young children with CHD and explore age- and cyanosis-related patterns. METHODS: Infants and young children undergoing open-heart surgery with preoperative and postoperative brain magnetic resonance imaging were retrospectively enrolled. Postoperative new brain injury (intracranial hemorrhage, white matter injury, stroke, venous thrombosis) was assessed. Demographic, intraoperative, intensive care, hematological, and echocardiographic data were collected. Participants were classified according to the presence or absence of new postoperative brain injury. Differences between groups were assessed using independent t test, Mann-Whitney U, and chi-square testing, as appropriate. Multivariable logistic regression (exclusion criteria P > 0.1) was used to identify risk factors for new postoperative brain injury, supplemented by stratification analyses based on age categories and cyanotic status. RESULTS: Among 172 infants and young children (35.5% with new brain injury), independent risk factors included older age (odds ratio [OR] = 1.049), longer cardiopulmonary bypass (CPB) time (OR = 1.029), smaller main pulmonary artery diameter (OR = 0.800), lower postoperative mean corpuscular hemoglobin concentration (OR = 0.779), and lower platelet count (OR = 0.993). Stratified analyses revealed age-cyanosis interactions: in noncyanotic children ≤365 days, younger age, lower platelets and mean corpuscular hemoglobin concentration increased risk; in noncyanotic children >365 days, prolonged CPB was dominant; cyanotic subgroups showed borderline age and sex effects. CONCLUSIONS: Postoperative brain injury risk in children with CHD follows age-dependent and cyanosis-stratified patterns. Modifiable predictors include CPB duration and perioperative hematological parameters, enabling tailored neuroprotective strategies.
Meijiao Zhu, Yuting Liu, Hamzah Musaed Nasser Al-Wajih et al.
CONTEXT: Community-based coalitions are a central strategy for preventing youth substance use, yet evidence describing how coalition-based prevention functions at scale and in contemporary practice contexts remains limited. The Drug-Free Communities (DFC) Support Program represents a long-standing national investment in locally driven, multisector prevention efforts. OBJECTIVE: To examine recent trends in youth substance use in DFC-funded communities and describe coalition infrastructure and practices that provide context for these trends. DESIGN: Descriptive trend analyses of coalition-reported data and youth substance use indicators. Long-term patterns were examined among coalitions with repeated core measures collections from all DFC funded since inception with the earliest data collected in 2002, and recent national trends were summarized using data collected from DFC coalitions implementing grants between 2021 and 2025. SETTING: Community-based prevention coalitions operating across rural, suburban, urban, and tribal contexts in the United States. PARTICIPANTS: Drug-Free Communities-funded coalitions submitting annual reporting data and core measures data during the study period, including 1014 DFC-funded coalitions that received funding at some point between 2021 and 2025. Coalitions collect core measures data from youth in their service area using surveys reviewed by the National Evaluation team to ensure data harmonization. INTERVENTION: Coalition-based environmental prevention model emphasizing multisector collaboration, evidence-informed strategies, and youth engagement tailored to local community conditions. MAIN OUTCOME MEASURES: Past 30-day use of alcohol, marijuana, tobacco, and prescription drugs (misuse), reported by grade level (6 thru 12) through locally administered surveys conducted at least every 2 years. RESULTS: Across all DFC implementing from inception through 2025 with at least 2 core measures collection time points (first and most recent), significant declines over time in past 30-day use of substances (alcohol, tobacco, marijuana, prescription drug misuse) across middle and high school grade levels were observed within DFC-supported communities. Focusing on data from DFC cohorts with repeated observations from 2021 to 2025, DFC funding was again generally associated with declines in past 30-day substance use, with larger reductions among high school youth and for substances with higher baseline prevalence. Among middle school youth, declines over time for prescription drug misuse was small and was nonsignificant in 2021; the same was true for middle school tobacco use in 2025. During the same period, coalitions demonstrated stable infrastructure, consistent multisector engagement, widespread school partnerships, and sustained youth involvement. CONCLUSIONS: Overall and recent declines in youth substance use occurred within the context of the DFC coalition model characterized by multisector engagement, sustained youth involvement, and implementation of comprehensive, evidence-based and evidence-informed strategies. While correlational in nature, these findings highlight the importance of maintaining long-term community-based prevention capacity focused on youth substance use prevention. Although factors outside of DFC may also contribute to youth substance use reductions, it is possible that DFC efforts may have contributed to national youth substance use declines.
Barbara K O'Donnel, Brian G Moss, Kelly A Cooley et al.
BACKGROUND: Adenoid hypertrophy is a common condition in children and a leading cause of upper airway obstruction, associated with sleep-disordered breathing, recurrent otitis media, and chronic rhinosinusitis. Although nasal endoscopy is the most widely used diagnostic tool, its invasiveness and limited correlation with functional obstruction in intermediate cases highlight the need for alternative methods. Acoustic rhinometry (AR) is a non-invasive technique that measures nasal and nasopharyngeal geometry and may overcome several limitations of conventional assessments. OBJECTIVE: To systematically review the evidence on the role of acoustic rhinometry in the diagnosis and evaluation of adenoid hypertrophy in pediatric patients. METHODS: A systematic review was conducted following PRISMA and AMSTAR-2 guidelines, with a registered PROSPERO protocol. PubMed, Cochrane Library, EMBASE, Scopus, SciELO, and Trip Database were searched up to December 2023. Clinical studies evaluating AR in children with adenoid hypertrophy were included. Outcomes included nasopharyngeal area and volume, minimal cross-sectional area, and changes after adenoidectomy. RESULTS: Thirteen studies encompassing 650 participants (563 patients and 87 controls) met inclusion criteria. Most studies demonstrated significant differences between patients and controls and moderate to strong correlations between AR measurements and adenoid size assessed by endoscopy, radiography, or excised tissue. The majority also reported significant increases in nasopharyngeal dimensions following adenoidectomy. However, no studies evaluated test-retest or inter-rater reliability, and evidence correlating AR with nasal obstruction or symptoms was limited. CONCLUSIONS: Acoustic rhinometry is a promising, rapid, and non-invasive adjunct for assessing adenoid hypertrophy. Nevertheless, the lack of standardized protocols, normative pediatric data, and clear correlations with functional obstruction limits its current clinical implementation. Further well-designed studies are required before routine use can be recommended.
Christian Calvo-Henríquez, María Solano Marmolejo, Ainhoa García-Lliberós et al.
BACKGROUND: In recent years there has been a significant increase in the number and quality of childhood apraxia of speech (CAS) treatment research published. Much of this research has focussed on establishing treatment efficacy and identifying treatment components. A smaller subset of the literature has looked at treatment intensity, such as comparing therapy delivered twice per week with four times per week, however this literature has not been compared across interventions. AIMS: This systematic review and meta-analysis examines cumulative intervention intensity and its components (dose per session, dose frequency, intervention duration-number of weeks) and reported treatment effects to understand whether there is a relationship between dose and effect in specific treatments or overall. METHODS: A systematic search and review was registered with Prospero (CRD420251107259). Twelve electronic databases were searched supplemented by handsearching references lists. Included studies were coded for CAS diagnosis confidence, methodological quality, dose characteristics, and treatment outcomes. Standard mean difference (SMD), an effect size metric equivalent to Cohen's d, was calculated for 25 included papers and weighted Pearson's correlations performed to identify relationships between dose characteristics and treatment outcomes. MAIN CONTRIBUTION: This paper is the first to (1) create omnibus standard effect sizes across diverse interventions and (2) show the relationship between intensity and treatment outcome in children with CAS. The omnibus SMD across studies with three or more participants for treated items was 1.22 (confidence interval 0.76-1.67), a large effect, and for generalisation items was 0.66 (confidence interval 0.46-0.85) which is a moderate effect. These results show that CAS treatment works in well-controlled studies when delivered at least twice per week for at least 45 min per session. The relationship between intensity variables and generalisation SMD was less clear with weeks of therapy being moderately correlated (r = 0.39) and none of the other variables showing any relationship with study SMD. These results should be interpreted carefully as there was significant missing data and limited range in some variables. Researchers need to include more standard intensity information in reporting their results. CONCLUSIONS: Treatment for CAS is effective and leads to moderate generalisation; more weeks of therapy leads to stronger gains than fewer weeks of therapy. WHAT THIS PAPER ADDS: What is already known on this subject CAS is a neurological-based motor speech disorder that originates in childhood for which there are a number of effective treatments. For this population, high intensity treatment is recommended-over 100 production trials per session, 2-5 sessions per week, across an extended period. In studies which directly compare intensity of variables, more therapy (e.g. 20 sessions) results in greater improvement than less therapy (e.g. 10 sessions). There are no previous meta-analyses of intensity variables-dose, dose frequency, treatment duration, or cumulative intervention intensity in CAS What this study adds to the existing knowledge This study compiles data from 25 studies with a low risk of bias and high CAS diagnostic confidence in a meta-analysis of the dose effects of CAS treatment. The meta-analysis shows that CAS treatment in general works. Most studies had 2-4 sessions per week across 3-12 weeks. Within this narrow band of intensity, a significant correlation was shown between the number of weeks of therapy and outcome. There is no significant evidence for CAS therapy less frequently than twice per week at this time. Eight different treatments demonstrated efficacy for improving speech outcomes in children with CAS. What are the clinical implications of this study? Provided they are delivered at least twice per week for at least 12 sessions, with greater improvements when treatment extends over more weeks, selection of any of the included treatments should result in improved speech where the child being treated is similar to children in the research. The following treatments were shown to be effective for CAS: Integral stimulation treatments including Dynamic Temporal and Tactile Cueing, Kaufman-Speech to Language Protocol, Motor Speech Treatment Protocol, Nuffield Dyspraxia Programme-3rd Edition, Rapid Syllable Transition Treatment, Speech Motor Chaining and Ultrasound Biofeedback alone and the combination of Speech Motor Chaining with Ultrasound Biofeedback. PRACTITIONER POINTS: Therapy must be sufficiently frequent and sustained: Evidence shows that CAS treatment is effective when therapy is provided at least twice per week, over a minimum of 12 sessions, for 45 min per session with total weeks of therapy being the only intensity variable consistently associated with treatment outcomes. Dose matters, both within and across sessions: Clinicians should prioritise the number of production trials and ensure adequate cumulative intervention intensity. Sessions with low active practice time or insufficient trials are unlikely to produce meaningful change. Eight treatments are effective for CAS: Integral Stimulation including Dynamic Temporal and Tactile Cueing (DTTC), Kaufman Speech to Language Program (K-SLP), Motor Speech Treatment Protocol (MSTP), Nuffield Dyspraxia Programme (3rd ed; NDP3), Rapid Syllable Transition Treatment (ReST), Speech Motor Chaining (SMC), Ultrasound Biofeedback, and SMC + Ultrasound Biofeedback combined. Clinicians should consider the client's speech needs and overall profile when selecting from the treatments that have demonstrated effectiveness.
Patricia McCabe, Donna C Thomas, Jessica Xue Ming Choo et al.
BACKGROUND: Psychotic experiences (PEs) have been linked to suicidality, including transition from suicidal ideation to behaviour. However, it is unclear if this relationship is independent of co-occurring psychopathology, or if PEs also predict the transition from non-suicidal self-injury (NSSI) to suicidal behaviours. Our aim was to investigate whether PEs were associated with transition from suicidal ideation or NSSI to suicidal behaviours in young people, after adjusting for other psychopathology and sociodemographic factors. METHODS: Participants were from the ABCD Study, a large longitudinal cohort (n = 11,878 enrolled at ages 9-10) with six years of annual follow-up assessments. Unadjusted and adjusted logistic regression models were used to examine associations between PEs and transition from suicidal ideation or NSSI to suicidal behaviours in the following year, adjusting for psychopathology (depression, anxiety, ADHD, somatic, oppositional, and conduct symptoms), age, sex, and family income. RESULTS: Of 1811 participants with suicidal ideation, 104 (5.7%) transitioned to suicidal behaviour. PEs were significantly associated with transition in unadjusted (odds ratio [OR] = 1.32; 95% confidence interval [CI]: 1.12-1.54) and models adjusted for co-occurring psychopathology (OR = 1.32; 95% CI = 1.10-1.57). Among 1025 participants with NSSI, 50 (4.9%) transitioned to suicidal behaviour. PEs were not significantly associated with transition (OR = 1.14; 95% CI = 0.84-1.50), though depressive symptoms (OR = 1.65; 95% CI = 1.13-2.41) and conduct disorder symptoms (OR = 1.48; 95% CI = 1.06-2.05) were. CONCLUSION: PEs predict the transition from suicidal ideation to behaviour in young people independently of co-occurring psychopathology. However, PEs do not appear to predict the transition from NSSI to suicidal behaviour.
Brian Moosa, Man Hei Marcus Kam, Reagan Lee et al.
BACKGROUND: Children with speech sound disorders (SSD) constitute a heterogeneous population, with speech difficulties arising from different loci within the speech processing system. Speech perception has long been implicated in SSD; however, previous findings remain mixed, partly due to differences in task demands and limited consideration of SSD subtypes. In particular, few studies have systematically examined speech perception across multiple contrast types that are explicitly structured around common developmental error patterns and across clinically defined SSD subgroups. AIMS: This study aimed to: (a) compare speech perception performance between children with SSD and typically developing (TD) peers across different phonological contrast types, and (b) examine whether children with articulation disorder, phonological delay, and phonological disorder exhibit distinct perceptual profiles that reflect subtype-specific characteristics. METHODS: Fifty-two Korean-speaking children aged 5-6 years participated (26 SSD; 26 TD). Speech perception was assessed using a minimal-pair identification task incorporating four substitution patterns frequently observed in Korean-speaking children: velar fronting, fricative stopping, affricate stopping, and affrication. Children with SSD were further classified into articulation disorder, phonological delay, and phonological disorder subgroups based on their surface error patterns. Group differences were analyzed in terms of overall accuracy and contrast-specific performance. RESULTS: Children with SSD performed significantly below TD peers on the speech perception task. Across both groups, velar fronting contrasts were the most challenging, whereas contrasts involving manner differences were identified more accurately. Within the SSD group, subgroup comparisons did not reach significance for overall accuracy or for most contrast types; however, a descriptive trend was observed whereby children with articulation disorder showed numerically higher accuracy than children with phonological delay and phonological disorder. A significant subgroup difference emerged specifically for the affricate stopping contrast, with children in the phonological disorder subgroup showing significantly lower accuracy than those in the articulation disorder subgroup. CONCLUSIONS: The findings indicate that speech perception difficulties in SSD are contrast-dependent and preliminary evidence suggests that perceptual vulnerability for certain contrasts (specifically affricate stopping) may differ across SSD subtypes. Rather than reflecting a uniform perceptual deficit, perceptual vulnerability in SSD appears to be most pronounced for contrasts associated with common substitution patterns, with subtype-related differences observed for this specific contrast rather than uniformly across all contrasts tested. WHAT THIS PAPER ADDS: What is already known on this subject Children with speech sound disorders (SSD) often demonstrate poorer speech perception than their typically developing peers, although findings across studies have been inconsistent. Prior research suggests that perceptual weaknesses in SSD may depend on task characteristics and the phonemic contrasts examined, with some evidence pointing to sound-specific difficulties aligned with children's production errors. In addition, SSD is a heterogeneous condition comprising distinct subtypes, such as articulation disorder, phonological delay, and phonological disorder, which differ in surface error patterns and underlying speech processing profiles. However, few studies have examined speech perception across SSD subtypes using contrasts that directly reflect common developmental substitution patterns, particularly in Korean-speaking children. What this study adds to the existing knowledge This study demonstrates that speech perception difficulties in SSD are contrast-dependent rather than uniform and vary meaningfully across SSD subtypes. Using a minimal-pair identification task grounded in developmentally relevant Korean phonological contrasts, the findings show that children with articulation disorder exhibit relatively preserved perceptual sensitivity, whereas children with phonological delay and phonological disorder show reduced performance, with the weakest perception observed in phonological disorder. Importantly, subtype-related differences were evident even at the level of speech perception, extending previous Korean research that has focused primarily on downstream phonological processing measures. These results provide evidence that perceptual vulnerability contributes to the heterogeneity of SSD and aligns with subtype-specific loci of processing difficulty. What are the clinical implications of this study? The findings highlight the value of incorporating speech perception assessment into the evaluation of children with SSD, particularly when differential diagnosis among SSD subtypes is considered. Perceptual assessment may be less critical for children with articulation disorder, whose difficulties appear largely output-based, but should be considered an essential component for children with phonological delay or phonological disorder. In particular, these findings underscore the relevance of speech perception for understanding heterogeneity in SSD, without implying uniform vulnerability across contrast types or children. A subtype-sensitive approach to speech perception assessment and intervention may support more precise clinical decision-making and more effective, individualized treatment planning.
IMPORTANCE: Post-tonsillectomy sepsis is a rare but potentially life-threatening complication. Whether pediatric patients with Trisomy 21 are at increased risk compared with those without Trisomy 21 remains unclear. OBJECTIVE: To compare the incidence and risk of postoperative sepsis following tonsillectomy in pediatric patients with and without Trisomy 21. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using a large de-identified national database containing insurance claims and electronic health records. Patients younger than 18 years who underwent tonsillectomy were identified using procedural codes. Patients with prior sepsis, immunodeficiency, or recent hospitalization were excluded. Patients with Trisomy 21 were compared with those without Trisomy 21. MAIN OUTCOMES AND MEASURES: The primary outcome was sepsis within 15 days of tonsillectomy. Secondary outcomes included postoperative infection. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Among 148,376 pediatric patients who underwent tonsillectomy, 2161 had Trisomy 21. Patients with Trisomy 21 were older (mean age, 7.6 vs 6.2 years) and had a greater comorbidity burden than controls. Postoperative infection rates were similar between groups (OR, 0.80; 95% CI, 0.57-1.16). Sepsis occurred in 5 of 2161 patients with Trisomy 21 (0.23%) and 34 of 146,215 controls (0.02%). Trisomy 21 was associated with significantly greater odds of postoperative sepsis (OR, 9.97; 95% CI, 3.04-25.66). CONCLUSIONS AND RELEVANCE: Although overall postoperative infection rates were comparable, pediatric patients with Trisomy 21 had increased odds of postoperative sepsis following tonsillectomy. Further study is warranted to better characterize risk factors and potential preventive strategies.
BACKGROUND: Fragmentation across healthcare, education, welfare and community-based services creates persistent challenges for coordinating support for children with developmental difficulties. Formal integration across these sectors may be difficult to achieve. This study explored how participating professionals perceived cross-sectoral collaboration during the early implementation of a paediatrician-initiated multi-agency network operating within existing institutional structures. METHODS: An exploratory early implementation evaluation was conducted using a retrospective pre-post survey design. An anonymous questionnaire was distributed to 116 network members, of whom 32 responded. Participants retrospectively rated their pre-network experiences and their current experiences across four study-specific domains of collaboration: ease of consultation, understanding of roles across sectors, adoption of a needs-based perspective and confidence in cross-sectoral referral and collaboration. Quantitative data were analysed descriptively, and free-text responses were analysed thematically by two reviewers. RESULTS: Participants reported higher current than retrospective pre-network ratings across all four collaboration domains, with the largest perceived changes in understanding of roles and confidence in cross-sectoral referral and collaboration. Thematic analysis identified four themes: accessible consultation pathways, shared language and mutual understanding, confidence through relational trust and persistent structural constraints. Participants described the value of identifiable consultation contacts and repeated cross-sectoral interaction, while also noting limitations in network reach and continuing institutional barriers. CONCLUSIONS: This exploratory evaluation provides preliminary insight into how professionals participating in a voluntary multi-agency network perceived cross-sectoral collaboration during early implementation. Building on these findings, we propose the M-MEW (Mesh-in-Dome) model as a practice-derived conceptualisation of a bidirectional and multidirectional relational mesh developing across existing institutional structures. The model envisages an initial facilitating hub supporting network formation, with the potential for coordination to become increasingly distributed as reciprocal relationships develop. Prospective evaluation is required to determine whether this model improves collaboration or outcomes for children and families.
