Clinical Pediatrics

The objective of this study was to examine the association between parental education and the occurrence of asthma, allergic rhinitis, and eczema in children, while accounting for potential confounding factors. Data were collected through questionnaires completed by 379 children aged 10 to 12. Maternal, paternal, and combined parental educational levels were assessed. Logistic regression models were used to evaluate associations with the odds of atopic diseases, adjusting for confounders. High parental educational level was significantly associated with a lower occurrence of allergic rhinitis in children (adjusted odds ratio [aOR] = 0.52, 95% CI: 0.27-0.99, P = .048), particularly when mothers had high, and fathers had low educational levels (aOR = 0.30, 95% CI: 0.13-0.71, P = .006). In addition, children with highly educated fathers were less likely to develop eczema (aOR = 0.56, 95% CI: 0.33-0.93, P = .028). These findings suggest that parental education influences atopic diseases in children, reflecting the complex role of social determinants of health.

Bronchiolitis is the leading cause of hospitalization in infants under 12 months of age, most often due to respiratory syncytial virus (RSV). Following pandemic-related seasonal disruptions and the introduction of RSV immunoprophylaxis, monitoring bronchiolitis trends is essential for public health planning and resource allocation. We conducted an institutional review board approved retrospective cohort study of children aged ≤ 24 months who presented to a tertiary children’s hospital with bronchiolitis during RSV seasons (October-April) from 2018-2019 through 2024-2025, excluding 2020-2022 due to COVID-19-related disruptions. Among 12 741 included patients, 3493 had RSV-positive bronchiolitis. In the 2024-2025 season, bronchiolitis accounted for 6.2% (6.0%-6.4%) of emergency department (ED) visits, up from approximately 4% in the 2018-2023 seasons (Table 1). Despite increased ED presentations, the proportion of bronchiolitis patients requiring hospitalization declined, while intensive care unit (ICU) admission rates remained stable. Respiratory syncytial virus testing among bronchiolitis patients increased from 35.8% (34.0%-38.0%) in 2018-2019 to 59.3% (57.0%-61.0%) in 2024-2025. Trends were consistent in age-stratified and RSV-positive subgroups. Findings highlight a meaningful shift in bronchiolitis epidemiology, underscoring the need for ongoing surveillance and adaptable clinical planning.

In this retrospective single-centred cohort study, we investigated pathogens associated with paediatric airway infections during the 2023 surge of respiratory illnesses in Japan. Data from electronic medical records of children who underwent BioFire® Respiratory Panel testing were analysed. Among 228 hospitalized children, 306 pathogens were identified in 188 patients (82.45%), predominantly rhinovirus/enterovirus (RV/EV; 36.93%), respiratory syncytial virus (RSV; 12.75%), adenovirus (12.42%), and parainfluenza virus type 3 (PIV3; 9.48%). RV/EV positivity was linked to higher rates of laboured breathing (25.34% vs 7.47%, P < .0001) and wheezing (26.03% vs 10.34%, P = .0003). RSV-positivity was associated with increased rhonchi (16.67% vs 3.40%, P = .0009) and crackles (22.22% vs 7.52%, P = .025). Patients with RSV and PIV3 had significantly lower transcutaneous oxygen saturation than those with other viruses. RV/EV were the most prevalent pathogens, underscoring the need for vigilance regarding viruses causing respiratory distress and hypoxemia in children.

Recognition of wheezing by parents of children with asthma is often difficult, potentially delaying care and worsening exacerbations. We evaluated whether caregiver report of wheezing at presentation was associated with hospital outcomes. Using chart review of 732 pediatric asthma admissions over 3 years, symptom and demographic data were extracted from the electronic health record, and regression models examined length of stay (LOS) and pediatric intensive care unit (PICU) admission. Wheezing was reported in 45% of cases and was linked to a 10% shorter LOS (IRR 0.9, 95% CI 0.82-0.99, P = .04). Commonly reported symptoms included shortness of breath (89%), cough (79%), and congestion (47%). Longer LOS was associated with older age (IRR 1.04, 95% CI 1.03-1.06, P < .001) and female sex (IRR 1.14, 95% CI 1.03-1.26, P = .01). No variables predicted PICU admission. These findings suggest under-recognition of wheezing by caregivers may contribute to longer hospitalizations and greater exacerbation severity.

Windshield surveys (WS) have been used to teach about social determinants of health (SDOH) through direct observation of communities. Limited information exists about how pediatric residency programs design and implement WS; therefore, the authors created a survey to understand their use. Twenty-one percent (61/290) of pediatric residency programs responded and 42 report using WS. Most require completion during first year of training (19/33). Learning objectives for the WS included themes on barriers to health, understanding resources and community characteristics. Resident assessment involved discussion with faculty (15/33), reflective writing (3/33), faculty review of WS (1/33), or a combination of these (8/33). To evaluate the curriculum, discussion (17/33), formal evaluations (7/33), or both (3/33) were used. Experiential activities like WS can teach about communities and SDOH, however, no standardization of methods or evaluation exist. Further research is needed on effective learner assessment and curriculum evaluation methods for residency programs wanting to implement WS.

To assess the feasibility of an electronic nose (e-nose) for volatile organic compounds (VOCs) to classify respiratory diseases and establish a protocol for use. We analysed exhaled air samples with Cyranose 320 nose from 67 children (14 healthy, 34 asthmatics and 19 other respiratory diseases) (mean age 11.4 years). Three samples were collected for each patient. We used machine learning models to generate an algorithm to classify children according to disease. There were significant differences in 30/32 sensors between plastic and tedlar bags. The Cronbach alpha was <0.5 in all cases, so that the consistency of the measurements was low. An analysis was performed to distinguish between healthy and asthmatics, P < .05 in 27/32 sensors. The algorithm predicted asthma disease with high sensitivity (over 99%) and accuracy (over 96%). The negative and positive predictive values were over 90%. The e-nose seems a valuable tool for screening asthma disease in the paediatric population in clinical practice.

This study aims to compare the clinical characteristics of children with general Mycoplasma pneumoniae pneumonia (GMPP) and refractory Mycoplasma pneumoniae pneumonia (RMPP), identify predictive factors for RMPP, and construct a predictive nomogram for early clinical prediction of RMPP. This retrospective study included 223 children with Mycoplasma pneumoniae pneumonia admitted to Lishui District People’s Hospital in Nanjing from June 2023 to February 2024. Children were divided into GMPP (171 cases) and RMPP (52 cases) based on treatment response. Baseline characteristics, laboratory findings, and imaging results were compared between groups. Multivariate logistic regression and receiver operating characteristic curve analysis were used to identify and evaluate predictive factors for RMPP. The RMPP group had higher incidence of dyspnea, lung consolidation, atelectasis, and pleural effusion, and longer hospital stays. Laboratory tests showed elevated C-reactive protein, interleukin-6 (IL-6), D-dimer, and lactate dehydrogenase (LDH) levels in RMPP compared with GMPP. Multivariate analysis identified LDH, IL-6, and D-dimer as significant predictive factors for RMPP. The combined model’s area under the curve was 0.946, indicating high prediction efficacy. Elevated levels of LDH, IL-6, and D-dimer are associated with RMPP. The predictive nomogram based on these markers improves RMPP risk assessment, providing a scientific basis for early recognition and personalized treatment.

Rotavirus remains a major cause of acute gastroenteritis and hospitalization among young children worldwide, particularly where routine vaccination is not widely implemented. This retrospective hospital-based study evaluated children aged 1 month to 5 years hospitalized with laboratory-confirmed rotavirus gastroenteritis, focusing on demographics, clinical outcomes, length of stay, vaccination status, and direct medical costs. Among 540 rotavirus-positive children, 434 were outpatients, 20 received day-care treatment, and 77 were hospitalized. The median age was 8 months; 88.3% were younger than 24 months, and admissions clustered in spring and winter. The median hospital stay was 6 days, and the median hospitalization cost was $125 (range: $35.1-$414), with higher costs among those hospitalized for more than 7 days (P < .001). None of the patients had received rotavirus vaccination. Vaccine prices were comparable to or lower than median hospitalization costs, supporting the potential cost-effectiveness of including rotavirus vaccine in the national immunization program.

Competency in the pediatric genital examination is critical, but physician comfort and ability are often limited. Contributing factors include lack of standardized teaching, inconsistent training, and the examination’s sensitive nature. These gaps may lead to missed signs of abuse or misinterpreted findings. A trauma-informed approach emphasizing patient safety, empowerment, and healing may help address these challenges. We conducted a qualitative study to explore pediatricians’ experiences and identify barriers, facilitators, and recommendations. We interviewed 7 pediatricians in an ambulatory setting at an academic hospital in New York City. Data were analyzed thematically, with transcripts coded by the research team. Themes focused on provider experiences, barriers, and recommendations. Barriers included limited training, time constraints, discomfort, and fear of causing trauma. Pediatricians suggested building rapport, empowering patients, standardizing examinations, and ensuring cultural sensitivity. Trauma-informed strategies may improve provider comfort, examination frequency, and patient care.

Having a premature infant hospitalized in the neonatal intensive care unit (NICU) is a highly stressful experience for mothers and may affect their psychological well-being. Psychological resilience is considered an important factor that may help mothers cope with the emotional challenges of the NICU environment. This study aimed to examine the relationship between psychological resilience and stress levels among mothers of premature infants hospitalized in the NICU. This descriptive, correlational, cross-sectional study was conducted with 187 mothers whose premature infants were hospitalized in an NICU. Data were collected using a Personal Information Form, the Psychological Resilience Scale for Adults, and the Neonatal Intensive Care Unit Parental Stress Scale. Mothers experienced notable levels of stress related to their infants’ hospitalization. A significant negative association was identified between maternal stress and several dimensions of psychological resilience, including self-perception, future perception, family cohesion, and structural style. Strengthening psychological resilience through psychosocial support programs may help reduce maternal stress and support maternal well-being during the NICU hospitalization period.

Pediatric invasive Group A Streptococcus (iGAS) infections two years before, during, and a year after the Coronavirus Disease 2019 (COVID-19) pandemic were analyzed in an urban hospital in the Northeastern United States. Invasive GAS was diagnosed in 38 patients. There were as many infected children post-COVID as in the prior 4.5 years combined. The post-pandemic surge was most striking in late spring. The median age was youngest during the post-pandemic year at 2.3 years. During and after the pandemic, about half the children had concurrent virus detection, and two-thirds had no known chronic comorbidities, highlighting Streptococcus pyogenes’ potential for significant morbidity in healthy and young children. The spectrum of iGAS disease manifestations was similar among the 3 time periods, with soft tissue infections predominating overall. Of post-pandemic GAS isolates, 67% were emm1 and 33% were emm12. Preventive efforts of this grave disease at all ages should continue.