This study aimed to evaluate patients with beta thalassaemia major using the cardiac electrophysiological index of balance, a new electrocardiography parameter, and to predict ventricular arrhythmias.

In this study, 60 beta thalassaemia major and 60 healthy children were included. All patients were evaluated with echocardiography. P-wave dispersion, repolarisation times, repolarisation dispersion times, and cardiac electrophysiological balance index were measured using 12-lead electrocardiography. Heart rate variability parameters were evaluated with a 24-hour Holter electrocardiography.

Left ventricular functions were similar between the groups. Although repolarisation times (QT, JT, and JTp) were significantly lower in the beta thalassaemia major group, heart rate-corrected repolarisation times were similar. Except for Tpe/QT, which is one of the repolarisation dispersion parameters, the other parameters were similar. The heart rate-corrected cardiac electrophysiological index of balance ratio was significantly higher in the beta thalassaemia major group. QRS duration and QRS-dispersion duration (QRS-d) were similar between the groups. There was a correlation between blood ferritin levels and LVmass-i, Tpe/QT, Tpe/QTc, QTc/QRS ratio, and QT, JT, and JTp values.

Patients with beta thalassaemia major are at high risk for ventricular arrhythmia due to a high QTc/QRS ratio, despite normal left ventricular systolic, diastolic, and autonomic function in the early period. We believe that there is a moderate correlation between blood ferritin levels and the QTc/QRS ratio and that the QTc/QRS ratio can provide important information for the follow-up and evaluation of patients with beta thalassaemia major.

Despite normal early ventricular function in the beta thalassaemia major group, they were at high risk of ventricular arrhythmias.

This study compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD and identified predictors of special education or early intervention plan.

Data were analysed from the 2022 National Survey of Children’s Health using complex weighted survey data procedures. Chi-square tests compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD. Multivariate logistic regression identified predictors of the need for special education or early intervention plan.

11,097 National Survey of Children’s Health responses pertained to children aged 3–5 years. Children aged 3–5 years with CHD were more likely than heart-healthy peers to be born prematurely, have special healthcare needs, have parent-reported health as “fair” or “poor,” be diagnosed with anxiety, depression, or a developmental disorder, and receive special education or an early intervention plan. Children aged 3–5 years with CHD were less likely to have acquired communication, fine motor, personal social, and problem-solving skills than comparators at the time of the survey, even after adjustment for special healthcare needs. Having public plus private insurance, special healthcare needs designation, and a developmental disorder predicted children aged 3–5 years needing special education or an early intervention plan.

Children with predictors of receiving special education or an early intervention plan may benefit from early identification and support. Further research should investigate the impact of systemic disparities on developmental skill acquisition in children with CHD.

To evaluate the effectiveness and safety of endoscopic interventions for managing paediatric subglottic stenosis.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane Handbook, we systematically searched four databases from inception to August 2024. Studies reporting outcomes of endoscopic management of paediatric subglottic stenosis were included. The primary outcome was procedural success; secondary outcomes were recurrence, decannulation and complications.

Forty-three studies involving 1088 children were included. The pooled success rate of endoscopic treatment was 79.2 per cent. Carbon dioxide and potassium titanyl phosphate laser achieved success rates of 79.9 and 100 per cent, respectively. Balloon dilatation and rigid dilatation had success rates of 79.9 and 82.4 per cent, whereas cold knife alone had a lower rate of 47.2 per cent. The recurrence rate was 36.8 per cent and balloon dilatation showed the highest recurrence at 42.2 per cent. The pooled decannulation rate was 60.4 per cent and complications occurred in 3.0 per cent of cases.

Endoscopic interventions are effective for paediatric subglottic stenosis, but recurrence remains common.

Eustachian tube balloon dilation is increasingly recognised as a minimally invasive option for middle ear effusion. However, its role in children with cleft lip and palate remains under-explored.

We prospectively evaluated 14 cleft lip and palate children (28 ears) with middle ear effusion. Group 1 (intervention) comprised 14 ears that underwent Eustachian tube balloon dilation with intranasal corticosteroids, while Group 2 (control) included 14 ears treated with intranasal corticosteroids alone. Tympanometry, pure-tone audiometry and Eustachian Tube Dysfunction Questionnaire-7 were administered before and six weeks after intervention.

Eustachian tube balloon dilation significantly improved hearing thresholds (p = 0.03) and air-bone gap (p = 0.04), with favourable tympanometric changes (p < 0.05) and a significant reduction in Eustachian Tube Dysfunction Questionnaire-7 scores, indicating symptom improvement. No major complications occurred.

Eustachian tube balloon dilation is a safe, well-tolerated and potentially effective adjunctive procedure for cleft lip and palate children with middle ear effusion. Larger randomised controlled trials are needed to validate these findings.

To extend the current understanding of executive function (EF) deficits in youth with neurofibromatosis type 1 by investigating the impact of cognitive load on performance compared to typically developing children.

In this prospective multicenter study, 42 children with neurofibromatosis type 1 (NF1) (ages 7–18) completed neuropsychological assessments of intellect and executive functioning. Age- and sex-matched controls (n = 42) were drawn from the normative database for the tasks of executive control (TEC). Multivariate and supplementary univariate analyses examined group differences and task effects (inhibitory control and working memory demand). Associations between TEC performance and parent-reported executive dysfunction (BRIEF) were also explored.

Both groups showed reduced accuracy and speed with increased inhibitory demand and made fewer errors with increased working memory demand. However, children with NF1 were significantly less accurate and consistent across tasks, particularly under higher cognitive load, while controls improved or maintained performance. Significant group × cognitive load interactions were observed, and laboratory-based deficits in NF1 were associated with parent-reported executive dysfunction.

Children with NF1 experience unique and multidimensional decrements in EF performance in response to increased cognitive load, unlike typically developing peers. These deficits appear to be clinically relevant. Targeting working memory and inhibitory control may reduce susceptibility to cognitive overload and improve outcomes for children with NF1.

Wilson’s disease is a rare autosomal recessive disorder of copper metabolism caused by mutations in the ATP7B gene. A 4-year-old boy, born of a consanguineous marriage, presented with recurrent daily syncopal attacks. Initial cardiac evaluation showed frequent polymorphic premature ventricular contractions and non-sustained ventricular tachycardia on Holter monitoring. Despite beta-blocker therapy, episodes persisted. Persistently elevated liver enzymes prompted hepatology referral. A liver biopsy suggested metabolic liver disease, and whole-exome sequencing confirmed Wilson disease with a homozygous ATP7B mutation.

This case illustrates a rare presentation of Wilson’s disease, as ventricular arrhythmia-induced syncope was the initial and only manifestation in a young child before the development of classic hepatic or neurological signs. It underscores the importance of considering metabolic and genetic aetiologies in paediatric arrhythmias, especially when accompanied by abnormal liver function. Moreover, early recognition and initiation of chelation therapy can prevent disease progression and enable timely screening and management of affected family members.

Anorexia nervosa has potential to influence the development and function of the gastrointestinal system. We assessed the association between maternal anorexia nervosa and risk of gastrointestinal morbidity in offspring.

We analyzed a longitudinal cohort of 1,269,370 children born in Quebec, Canada, between 2006 and 2022. The exposure was maternal anorexia nervosa. The outcome was hospitalization for pediatric gastrointestinal disorders, including hypertrophic pyloric stenosis, inflammatory bowel disease, and other digestive morbidity. Follow-up ranged from 1 to 17 years. We used adjusted Cox regression models to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between maternal anorexia nervosa and pediatric gastrointestinal disorders.

A total of 2,447 children (0.2%) had a mother with anorexia nervosa. By age 17 years, the cumulative incidence of gastrointestinal disorders was higher among children whose mothers had anorexia nervosa than other children (165.7 vs. 129.4 per 1,000). Compared with no anorexia, maternal anorexia nervosa was associated with a greater risk of any childhood gastrointestinal disorder (HR: 1.42, 95% CI: 1.26–1.61), particularly hypertrophic pyloric stenosis (HR: 2.51, 95% CI: 1.35–4.66), inflammatory bowel disease (HR: 2.46, 95% CI: 1.67–3.64), and rectal hemorrhage (HR: 3.46, 95% CI: 1.97–6.09). Children whose mothers developed anorexia nervosa after age 20 years or were hospitalized more than once for anorexia had the greatest risk of gastrointestinal morbidity. The associations were not explained by digestive birth defects.

Maternal anorexia nervosa is associated with pediatric gastrointestinal disorders that could potentially be mitigated with psychosocial support, nutritional rehabilitation, and breastfeeding.

We examined cognitive performance in children with complicated mild-severe traumatic brain injury (TBI) versus orthopedic injury (OI) using the National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB).

We recruited children ages 3–18, hospitalized with complicated mild-severe TBI (n = 231) or orthopedic injury (OI, n = 146). Cognition was assessed using the NIH TB-CB at six and twelve months post-injury. We used linear mixed models to assess associations of injury group (TBI versus OI), timepoint (six versus twelve months), and the interaction of injury group and timepoint with NIH TB-CB Total Cognition, Fluid Cognition, and Crystallized Cognition composites, adjusted for sex and socioeconomic status (SES), with Bonferroni correction. We evaluated differences in cognition stratified by injury severity (complicated mild–moderate TBI vs severe TBI) using ANCOVA, adjusting for sex and SES.

Neither injury group nor the interaction of group and timepoint were associated with Total (group: p = 0.50; timepoint*group: p = 0.185), Fluid (group: p = 0.297; timepoint*group: p = 0.842), or Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017). However, children with severe TBI performed significantly worse on Fluid and Total Cognition than children with complicated mild–moderate TBI at six months (Fluid: p = 0.004, partial η2 = 0.06, moderate effect, Total: p = 0.012 partial η2 = 0.03, small–moderate effect) and twelve months post-injury (Fluid: p < 0.001, partial η2 = 0.11, moderate–large effect, Total: p = 0.002, partial η2 = 0.06, moderate effect).

The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition. Our findings suggest the NIH TB-CB may be suitable for monitoring cognition in children with TBI.

Healthy sleep contributes to better cognitive functioning in children. This study sought to investigate the role of pre-injury sleep disturbance as a predictor or moderator of cognitive functioning across 6 months post-injury in children with mild traumatic brain injury (mTBI) or orthopedic injury (OI).

Participants were 143 children with mTBI and 74 with OI, aged 8 – 16 years, prospectively recruited from the Emergency Departments of two children’s hospitals in Ohio, USA. Parents rated their children’s pre-injury sleep retrospectively using the Sleep Disorders Inventory for Students. Children completed the National Institutes of Health (NIH) Toolbox Cognition Battery at 10 days and 3 and 6 months post-injury.

Group differences in both overall performance and reaction time on the Flanker Inhibitory Control and Attention Test varied significantly as a function of the level of pre-injury sleep disturbance as well as time since injury. At the 10 day visit, among children with worse pre-injury sleep, mTBI was associated with slower reaction times relative to OI. Among children with worse pre-injury sleep, those with mTBI improved over time while those with OI did not. Main effects of pre-injury sleep and time since injury were found for several other NIH Toolbox subtests, with poorer performance associated with worse pre-injury sleep and early vs. later timepoints.

These results suggest that pre-existing sleep disturbances and mTBI are jointly associated with poorer executive functioning post-injury. Interventions to improve sleep might help mitigate the effects of mTBI on children’s cognitive functioning.

Methylphenidate (MPH), a commonly used stimulant for the treatment of attention deficit and hyperactivity disorder (ADHD) in children and adolescents, has been associated with adverse effects on weight, height, blood pressure (BP) and heart rate (HR). This study aimed to investigate whether children with ADHD prescribed MPH by a specialist ADHD service showed a change in health data percentiles compared to their pre-treatment measures, and to investigate for any correlation with MPH dose, years prescribed MPH and gender.

In this retrospective observational study health data percentiles (weight, height, BP and HR) were analysed for change between two timepoints: prior to MPH initiation (T1) and at the most recent clinic appointment (T2). Correlations between health data percentile changes and MPH dose, treatment duration, baseline growth centiles and gender were studied.

The cohort consisted of 123 youth (age 5-17.5 years) prescribed MPH (mean dose 0.67 ± 0.32 mg/Kg). Over the treatment period (2.5 ± 2.1 years) weight (P = 0.001) and height (P = 0.007) centiles significantly reduced, BP centiles did not change, while HR centiles increased (P < 0.0001). Weight centile reduction was correlated with higher MPH dose (P < 0.0001) and this effect attenuated with longer duration of MPH treatment (P = 0.005). Height centile reduction was more pronounced in the taller cohort (P = 0.008).

This study supports international guidelines for physical health monitoring of young people prescribed MPH, specifically the conversion of health data to percentiles for accurate monitoring and early identification of concerning trends. Future integration of digital approaches are necessary for rapid and accurate physical health monitoring.

An aspirated foreign body in a child can represent a potentially life-threatening emergency.

This retrospective study, carried out from 2014 to 2024, compares the estimated effective radiation dose children received during ultra-low dose computed tomography (CT) scans with that received with traditional cumulative radiographic investigations.

Of the 44 patients included in the study, 32 were in the radiograph group and 12 were in the CT group. There was a statistically significant reduction in the length of stay and cost in the CT group when compared with the radiograph group (p < 0.01). There was a statistically significant reduction in the cumulative estimated effective radiation dose in the radiograph compared to the estimated effective dose received in the CT group (p < 0.01). No patients required sedation for CT imaging.

Ultra-low dose CT is a safe, cost-effective first-line investigation in stable patients with suspected foreign body aspiration.

Little is known about the diagnostic trajectories following a first psychiatric diagnosis in childhood or adolescence. Such knowledge could aid clinicians in treatment, risk prediction, and psychoeducation. This study presents a comprehensive nationwide overview of diagnostic trajectories in children and adolescents after their first diagnosis in child and adolescent psychiatric hospitals.

Patients aged 0 to 17 years who received their first psychiatric diagnosis between January 1996 and December 2011 were identified through the Danish National Patient Registries. Shifts at the International Classification of Diseases (ICD-10) two-cipher level (F00-F99), grouped into 19 categories, were identified. Subsequent diagnoses during 10 years of follow-up until December 2021 were identified and analyzed using state sequence analysis and Cox proportional hazard regression models.

A total of 77,464 children and adolescents (32,733 [42.26%] girls) were identified with a first-time psychiatric diagnosis. Among these, 46.7% of girls and 37.6% of boys had at least one diagnostic shift after 10 years of follow-up. High entropy and low diagnostic stability were found in first-time diagnoses often presenting in adolescence, such as affective disorders, psychotic illness, and personality disorders, while lower entropy and high diagnostic stability were found in neurodevelopmental disorders and eating disorders. For most categories, girls had higher mean entropy measures than boys (P < 0.05).

Diagnostic shifts are common in child and adolescent psychiatric services, particularly when the first contact occurs in adolescence. Adequate focus on psychoeducation about emerging diagnostic shifts, and on timely detection, particularly in girls, and particularly in adolescence, is warranted.