INTRODUCTION: This retrospective cohort study evaluates the impact of timing of automated insulin delivery (AID) initiation on glycemic outcomes in youth with type 1 diabetes. METHODS: Data from 9856 children and adolescents diagnosed with type 1 diabetes between 2020 and 2022 across 27 U.S. centers were analyzed. Participants were grouped by AID initiation timing in months: <6, 6-12, 13-24, or no AID use. Hemoglobin A1c (HbA1c) trajectories, diabetes-associated ketoacidosis (DKA), and severe hypoglycemia rates were assessed over 24 months after T1D diagnosis. RESULTS: Earlier AID initiation was associated with lower HbA1c at 24 months (median 7.1% in the <6-month group vs. 9.8% in non-users, P < 0.001). DKA rates were threefold higher in non-AID users. Adjusted models confirmed the timing of AID initiation independently predicted HbA1c outcomes. CONCLUSIONS: Early AID initiation is associated with improved glycemic control and reduced DKA risk, underscoring the importance of timely and equitable access to AID systems.
Elizabeth A Mann, Priya Prahalad, Risa Wolf et al.
OBJECTIVE: This study aims to design and evaluate the feasibility of an interactive multisensory learning room to support engagement and school readiness among children with Down syndrome (DS) and autism spectrum disorder (ASD) in Indonesia. METHODS: A qualitative observational design was employed involving 10 participants aged 3-15 years. The system integrates four interactive components: mimic stimulation, motor coordination, colour recognition, and auditory feedback. Participants engaged in supervised sessions lasting 30-45 minutes. Behavioural responses were assessed using a four-point Likert-type observational scale and supported by semi-structured interviews with parents, caregivers, therapists, and a primary school teacher. Since 2022, the system has been implemented twice weekly with rotating small groups, with additional observations conducted between January 2023 and June 2025. RESULTS: Findings indicate that the motor coordination component significantly increased physical activity and engagement. The music and video components contributed to emotional comfort and improved willingness to participate. Sustained observations suggest consistent engagement patterns over time, supporting the system's usability and adaptability in real-world settings. CONCLUSION: The study demonstrates the feasibility and sustainability of implementing an affordable multisensory learning environment in under-resourced contexts. The findings provide a foundation for future controlled and outcome-based studies and contribute to broader efforts toward inclusive education aligned with Sustainable Development Goals (SDGs) 4, 9, 10, and 17.
Rinda Hedwig, Ade Septian Alfianto, Louis Putra Purnama et al.
OBJECTIVE: To investigate the status of anticipatory grief, psychological resilience, family resilience, and parental pain catastrophizing about the child's pain in parents of children with cancer, and to identify factors associated with anticipatory grief. The study also explored the potential mediating role of parental pain catastrophizing about the child's pain in the relationship between psychological resilience and anticipatory grief, as well as the moderating role of family resilience. METHODS: A total of 236 parents of children with cancer were recruited from four Grade A tertiary hospitals in China between November 2024 and April 2025. The participants were assessed using the Anticipatory Grief Scale (AGS), Connor-Davidson Resilience Scale (CD-RISC), Family Resilience Scale (FRS), and Pain Catastrophizing Scale (PCS). RESULTS: The parents of pediatric cancer patients reported a mean AGS score of 76.74 (standard deviation [SD] = 16.92). Multiple linear regression showed that educational level, psychological resilience, family resilience, and pain catastrophizing were significantly associated with anticipatory grief, explaining 63.5% of the variance. Parental pain catastrophizing about the child's pain partially mediated the relationship between psychological resilience and anticipatory grief (indirect effect: B = -0.125, 95% confidence interval [CI]: [-0.182,-0.070]). Furthermore, family resilience moderated the pathway from psychological resilience to pain catastrophizing, with a significant psychological resilience × family resilience interaction (B = -0.319, P < 0.001). The index of moderated mediation was also significant (index = -0.061, 95% CI: [-0.102, -0.026]). CONCLUSIONS: Anticipatory grief in parents of children with cancer was directly associated with psychological resilience and indirectly associated with parental pain catastrophizing about the child's pain. Family resilience moderated the relationship between psychological resilience and pain catastrophizing, suggesting that higher family resilience may strengthen the protective association of psychological resilience against pain catastrophizing. These findings suggest that strengthening the protective function of family resilience may inform future supportive interventions and provide potential targets for clinical support aimed at alleviating anticipatory grief in parents and promoting overall family adjustment.
BACKGROUND: Child maltreatment is a major risk factor for depression and impairs social functioning in adulthood. The COVID-19 pandemic, through its widespread social restrictions, provided a unique opportunity to examine how adults with and without histories of child maltreatment re-established social contacts after a shared period of isolation. OBJECTIVE: This study investigated whether adults with a history of child maltreatment were slower to recover social contact after the COVID-19 lockdowns and whether these social contact trajectories predicted depressive symptoms one year after the pandemic. METHOD: Longitudinal data from the German cohort of the ADJUST study (N = 701) were analysed across five waves collected between June 2020 and April 2024. Child maltreatment (conceptualised to include both domains of child abuse and neglect) was assessed at baseline. Social contact frequency and depressive symptoms (PHQ-9) were measured at all timepoints. Cumulative link mixed models and linear regressions examined associations between child maltreatment, social contact change, and depressive symptoms while controlling for sociodemographic variables and baseline depression. RESULTS: Overall, social contact increased as restrictions eased. While overall child maltreatment was not associated with social contact change, child neglect (but not abuse) predicted weaker increases in social contact over time, suggesting reduced social re-engagement. Child neglect was significantly associated with higher depressive symptoms one year after the pandemic, even when baseline symptoms were controlled. Greater individual increases in social contact recovery predicted lower depressive symptoms, and this association was stronger among participants with a maltreatment history. CONCLUSIONS: Recovery of social contact after large-scale social disruptions is impaired among adults with a history of child neglect and is associated with persistent depressive symptoms. Interventions fostering social reconnection and trust rebuilding may mitigate long-term mental-health risks among neglect survivors.
Meret Sophie Wallimann, Ariela Rosenblum, Ritika Chokhani et al.
BACKGROUND: Tosufloxacin (TFLX), a fluoroquinolone, is widely used in Japanese children with macrolide-resistant Mycoplasma pneumoniae infection. Acute kidney injury (AKI) associated with TFLX has been reported, often with urinary drug crystals; however, its incidence and clinical characteristics remain unclear. METHODS: In this multicenter retrospective study, we included 227 children (2-15 years) who underwent blood and/or urine testing. AKI was defined according to KDIGO criteria. Kidney function and clinical characteristics were compared between patients with and without TFLX exposure at the initial visit and during follow-up. Among TFLX-treated patients, factors associated with AKI and urinary drug crystals were analyzed. RESULTS: At the initial visit, AKI was more frequent in patients already receiving TFLX than in those not treated with TFLX (10% vs. 2.0%; p = 0.018). However, when analysis was restricted to patients in whom TFLX was newly initiated at our institutions, AKI incidence was 2.6% and not significantly different from controls. Gastrointestinal symptoms were more common in the AKI group (70% vs. 11%; p < 0.0001). Urinary drug crystals were detected with similar frequencies in the AKI and non-AKI groups (63% vs. 57%), and continuation of TFLX after crystal detection did not lead to AKI progression. CONCLUSIONS: Our findings suggest an association between TFLX exposure and creatinine elevation. We also evaluated AKI incidence among patients newly initiated on TFLX. Urinary drug crystals were frequently detected; however, crystal formation alone did not fully explain AKI development. Clinicians should be aware of the potential for AKI during TFLX therapy, particularly in patients with gastrointestinal symptoms.
BACKGROUND: Early fluid management may influence disease severity and long-term kidney outcomes in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS). We evaluated the association between early volume expansion and severe long-term kidney sequelae. METHODS: We conducted a multicenter retrospective cohort study including children with STEC-HUS and severe acute kidney injury, defined by the need for dialysis for at least 48 h. Kidney outcome at follow-up was classified according to estimated glomerular filtration rate (GFR) as normal kidney function or chronic kidney disease stage 1 versus chronic kidney disease stages 2-5. RESULTS: A total of 232 children were included. Median age was 2.34 years (interquartile range 1.6-4). At the end of follow-up (median 4.8 years, interquartile range 3.2-6.6), 72 patients (31%) had kidney sequelae corresponding to chronic kidney disease stages 2-5. Early volume expansion was performed in 102 patients (44%). These patients required dialysis for a shorter duration, had higher estimated GFR at follow-up, and less frequently developed chronic kidney disease stages 2-5. Lack of early volume expansion was independently associated with higher odds of kidney sequelae (odds ratio 2.46, 95% confidence interval 1.25-5.03), as was longer dialysis duration (odds ratio 1.10 per day, 95% confidence interval 1.05-1.15). Estimated GFR at follow-up was inversely correlated with dialysis duration; this association was not evident in patients who received early volume expansion but remained significant in those who did not. CONCLUSIONS: Early volume expansion and shorter dialysis duration were associated with long-term improved kidney outcomes.
Paula A Coccia, Laura F Alconcher, Alejandro Balestracci et al.
BACKGROUND: Child and adolescent depression are a public health issue worldwide. In Mexico, depressive disorders affect more than 16% of this population. OBJECTIVE: This study aims to identify factors associated with the earliest age at which emotional and behavioral disturbances were evident in child and adolescent with depression. METHODS: We conducted a retrospective observational study of children and adolescents receiving care at two specialized psychiatric hospitals in Mexico between January 2018 and February 2020. Clinical data were collected through structured surveys, and diagnoses were established by board-certified child psychiatrists according to ICD-10. Cox proportional hazard and logistic regression models identified factors associated with earlier onset of depressive symptoms. RESULTS: A total of 400 participants were included (mean age 12.23 years, SD 3.71; 148 girls [37%] and 252 boys [63%]). The most frequent diagnoses were hyperkinetic disorders (51%), depressive disorders (33.8%), and anxiety disorders (7.8%). Depression and anxiety were more common in girls, whereas boys showed earlier symptom onset and were more frequently diagnosed with hyperkinetic disorders. Based on the visual inspection of symptom onset distribution, age 10 was considered the cutoff between childhood- and adolescent-onset depression. Childhood-onset depression was associated with male sex, comorbid hyperkinetic or anxiety disorders, and family history of psychiatric illness. In Cox models, male sex (HR = 1.84), comorbid hyperkinetic disorder (HR = 2.17), familial antecedent of depression (HR = 1.81) and familial antecedent of hyperkinetic disorder (HR = 2.13) predicted earlier onset. CONCLUSIONS: Earlier-onset depression was associated with male sex, psychiatric family history, and comorbid hyperkinetic disorder, supporting differences between childhood- and adolescent-onset depression.
Lina Díaz-Castro, Kurt L Hoffman, María E Márquez-Caraveo et al.
BACKGROUND: To quantify the association between ambulatory arterial stiffness index (AASI) and hypertensive status, and to identify additional predictors of AASI, including body mass index (BMI), proteinuria, and mineral metabolism, in children and adolescents with chronic kidney disease (CKD). METHODS: We analyzed data collected from 654 participants during 1283 study visits in the Chronic Kidney Disease in Children (CKiD) prospective cohort study. AASI was calculated from ambulatory blood pressure monitoring (ABPM) data as 1 minus the slope coefficient from a least squares linear regression of diastolic blood pressure (BP) on systolic BP. Hypertensive status was determined by clinic BP and ABPM. Linear regression with generalized estimating equations to account for repeated AASI measurements over time within the same participant were used to quantify the relationship between AASI and hypertensive status. RESULTS: At their first successful ABPM visit, the median age was 12 years, 61% were male, 15% had obesity and the median eGFR was 49 ml/min/1.73 m2. Over half (57%) reported current antihypertensive therapy use with RAAS inhibitors, yet 42% met criteria for abnormal ABPM (elevated mean total/awake/sleep DBP/SBP per updated guidelines). Masked hypertension (MH) was common (27%) and associated with significantly higher AASI compared to being normotensive (difference in mean AASI: + 0.051, 95% CI: 0.032, 0.071). Male sex and higher BMI were associated with higher AASI, but the presence of proteinuria, abnormal serum calcium or phosphate were not. CONCLUSION: AASI is associated with MH and BMI in children and adolescents with CKD and may be a useful non-invasive measure of vascular stiffness in this population.
Susan M Halbach, Jennifer Roem, Michael F Schneider et al.
OBJECTIVE: Borderline intellectual functioning (BIF), defined by intelligence quotient (IQ) scores between 71 and 84, is associated with increased psychiatric vulnerability but remains poorly characterized in terms of clinical severity and treatment complexity. This study aimed to compare psychopathological burden, adaptive functioning, suicidality, and psychopharmacological treatment patterns among hospitalized adolescents with BIF, average intellectual functioning, and intellectual disability. METHODS: A retrospective chart review was conducted on adolescents aged 12-18 years admitted to a tertiary child and adolescent neuropsychiatry inpatient unit. Participants were classified into three groups based on full-scale IQ. Standardized assessments of cognitive functioning, psychiatric diagnoses, symptom severity, adaptive behavior, global functioning, and suicidality were integrated with clinical indicators derived from medical records, including emergency service utilization and psychotropic medication at discharge. Group differences were examined using nonparametric statistical analyses. RESULTS: The sample included 194 adolescents. Adolescents with BIF showed significantly poorer adaptive functioning across conceptual and practical domains compared with peers with average intellectual functioning, despite comparable global functioning. Overall psychiatric symptom severity at admission and discharge did not differ across groups; however, the BIF group displayed a mixed clinical profile with both internalizing and externalizing symptoms and persistent behavioral dysregulation. Compared with adolescents with average intellectual functioning, those with BIF demonstrated more frequent emergency psychiatric admissions and a higher likelihood of antipsychotic prescription at discharge. Suicidality differed qualitatively across cognitive groups: adolescents with cognitive impairment showed lower rates of suicide attempts, characterized by precipitation (i.e., falling from height) or defenestration (i.e., jumping from a window) as the only suicidal modality observed in this group. CONCLUSIONS: BIF in adolescence is associated with a distinct pattern of functional impairment and clinical complexity, characterized by adaptive difficulties and increased reliance on psychopharmacological treatment. These findings highlight the importance of considering cognitive functioning when planning treatment strategies in inpatient child and adolescent psychiatry.
Roberto Averna, Gianluca Sesso, Massimo Apicella et al.
BACKGROUND: Acute kidney injury (AKI) is a frequent complication after pediatric cardiovascular surgery (CS) and is associated with higher morbidity and mortality. Early, modifiable predictors are needed to improve outcomes. METHODS: We conducted a prospective cohort study at a high-complexity center in Cali, Colombia (November 2020-July 2022). Children aged 0-60 months undergoing CS and admitted to the pediatric cardiovascular ICU were included. AKI was defined and staged according to KDIGO criteria. Serum lactate and capillary refill time (CRT) were measured preoperatively, at ICU admission, and at 6, 12, and 24 h postoperatively. Univariate and multivariate Cox proportional hazards models were used to assess associations with AKI. RESULTS: Of 127 patients, 14.17% developed AKI, 66.7% of which were severe. The 28-day mortality was 11.8% overall and 44.4% among patients with AKI. In the multivariate analysis, elevated serum lactate was associated with higher risk of AKI at 24 h postoperatively (HR 1.61; 95%CI 1.24-2.08). Prolonged CRT at ICU admission was also a significant predictor (HR 1.80; 95%CI 1.03-3.15). Higher surgical complexity (RACHS-1), vasopressor use, and low systolic blood pressure were also associated with AKI. CONCLUSIONS: In this cohort, postoperative tissue perfusion markers-elevated serum lactate and prolonged CRT-were associated with AKI following pediatric CS. These accessible bedside measures may support early risk stratification and targeted kidney protective strategies.
Vanesa A Ochoa Jimenez, Inés E Gómez Hernández, Ana María Portilla Buenaventura et al.
