Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 132 appraisals
Journal of pediatric surgery
Interpretable deep learning model for pediatric strangulated small bowel obstruction on CT: A multicenter study
OBJECTIVE: To develop and validate a deep learning-based multi-instance learning (MIL) model that integrates CT imaging and clinical data to improve the accuracy of discriminating between strangulated small bowel obstruction (StSBO) from simple small bowel obstruction (SiSBO) in pediatric patients. MATERIALS AND METHODS: This multicenter retrospective study, conducted between January 2018 and June 2024, enrolled hospitalized pediatric patients aged 1-14 years with a diagnosis of small bowel obstruction. We developed the clinical, multi-instance learning, and combined models based on CT and clinical features. Model performance was evaluated using receiver operating characteristic (ROC) analysis, while SHapley Additive exPlanations (SHAP) interpreted feature contributions. We further assessed whether MIL-assisted diagnosis could enhance physician accuracy in diagnosing StSBO. RESULTS: The study sample comprised 168 patients (mean age, 6.36 ± 3.97, 118 men). Ascites and closed-loop sign were identified as independent predictors of StSBO on multivariate analysis (both p< 0.05). The MIL model achieved the area under the curve (AUC) of 0.86 (95%CI 0.70-1.00), p= 0.01 in the external test cohort. The combined model showed the highest diagnostic performance (AUC 0.87, 95%CI 0.72-1.00, p= 0.01) in the external test cohort, with MIL-derived features showing predominant importance in SHAP analysis. Both junior and experienced radiologists and surgeon demonstrated improved diagnostic performance with MIL assistance, showing AUC increases of 16%, 2%, and 20%, respectively. CONCLUSIONS: The MIL model performed well in diagnosing StSBO, and clinical data integration improved its performance. As a decision support tool, the model may aid risk stratification and facilitate timely escalation of care in pediatric StSBO management.
3 Aug 2026
Read appraisal →European journal of pediatrics
Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities
UNLABELLED: This narrative review synthesizes recent technological and organizational developments in pediatric telemedicine, maps their principal clinical applications, and critically discusses implementation, safety, equity, and future priorities. This narrative review used a transparent, non-systematic literature-search approach in PubMed/MEDLINE, Scopus, and Google Scholar, considering publications available through April 2026. Searches were intended to identify and contextualize relevant literature across pediatric settings rather than to provide an exhaustive, reproducible systematic evidence synthesis. No formal risk-of-bias assessment, meta-analysis, or certainty-of-evidence grading was undertaken; therefore, findings are interpreted cautiously and according to the maturity and consistency of the available evidence. Evidence suggests that telemedicine can support follow-up, access to specialist care, and family engagement in several pediatric chronic-care pathways, particularly diabetes and asthma. However, the evidence base is heterogeneous across specialties, frequently relies on observational or implementation studies, and is less mature for acute assessment, neonatal and rehabilitation uses, wearables, and AI-enabled tools. CONCLUSION: Telemedicine should be considered a complementary component of pediatric healthcare rather than a replacement for in-person assessment. Hybrid models may support accessibility, continuity, and sustainability when embedded in structured, patient-centered, equitable, and clinically appropriate pathways. WHAT IS KNOWN: • Telemedicine expanded rapidly in pediatrics during the COVID-19 pandemic and is now used across many specialties. • It can improve access, continuity of care, remote monitoring, and family engagement, especially in chronic and complex conditions. WHAT IS NEW: • This review summarizes recent technological and organizational innovations, including wearables, mHealth, EHR integration, AI, and hybrid care models. • It highlights current limits and future requirements for safe, equitable, and sustainable integration into routine pediatric care.
2 Aug 2026
Read appraisal →European radiology
Deep learning improves image quality in motion-robust and sedation-free pediatric brain MRI
OBJECTIVES: Motion and limited compliance compromise diagnostic MR image quality, particularly in pediatric patients who frequently require sedation. Single-shot sequences offer a time-efficient alternative but suffer from reduced image quality. This study aimed to evaluate the diagnostic performance of a deep learning (DL) framework combining compressed sensing (CS) and convolutional neural networks (CNNs) to enhance T2-weighted single-shot MRI (T2-SSHDL) compared with conventional CS-based reconstruction (T2-SSHconv) and routinely acquired high-resolution T2-weighted sequences. MATERIALS AND METHODS: This prospective single-center study included 62 pediatric patients (mean age, 7.4 ± 4.9 years; 36 males, 26 females), who underwent T2-weighted single-shot brain MRI (29 sedated, 33 awake). Raw data were reconstructed using a DL-based pipeline and compared with conventional CS-based reconstructions. Quantitative metrics included apparent contrast-to-noise ratio (aCNR), apparent signal-to-noise ratio (aSNR), and edge rise distance (ERD). Two radiologists rated images for artifacts, sharpness, lesion conspicuity, and overall quality on a 5-point Likert scale. RESULTS: T2-SSHDL-sequences showed significantly higher aCNR (29.9 ± 22.6 vs. 26.7 ± 16.5; p < 0.001), aSNR (41.6 ± 27.9 vs. 38.2 ± 20.8; p = 0.003), and improved sharpness (ERD 0.90 ± 0.35 mm vs. 1.35 ± 0.42 mm; p < 0.001). Qualitative assessments confirmed superior image quality, lesion conspicuity, and sharpness (p < 0.001). Compared with high-resolution T2-weighted sequences, T2-SSHDL-sequences showed fewer motion artifacts and comparable lesion conspicuity in non-sedated patients. CONCLUSION: DL-based reconstruction significantly enhances the diagnostic quality of T2-weighted single-shot brain MRI in pediatric patients, enabling clinically usable, ultrafast, motion-robust imaging with potential to reduce the need for sedation. KEY POINTS: Question Can deep learning-based reconstruction elevate motion-robust single-shot T2-weighted pediatric brain MRI to diagnostic image quality levels, enabling reliable imaging without sedation? Findings Both quantitative and qualitative evaluations confirmed significantly improved image quality of deep learning-enhanced single-shot T2-weighted brain MRI compared with conventional reconstruction. Clinical relevance Deep learning-enhanced reconstruction improves image quality in ultrafast, motion-robust single-shot pediatric brain MRI, potentially reducing the need for sedation while preserving diagnostic accuracy. This approach may enhance patient safety and shorten examination time in routine neuroimaging.
2 Aug 2026
Read appraisal →Indian journal of pediatrics
Emerging Applications of Artificial Intelligence in Pediatric Care
Artificial intelligence (AI) technologies such as machine learning (ML), deep learning (DL), predictive analytics and other tools are rapidly changing pediatric health care, using large amounts of health data. AI tools aid in triage, real-time monitoring and risk stratification in acute care settings, towards improving overall outcomes and fewer complications. During newborn resuscitation, AI analyses real-time data, can guide decisions and enhance training. Computer vision systems with AI tools can generate reliable neonatal bilirubin estimates without the need for blood sampling. AI technology is also being used in the management of necrotising enterocolitis, respiratory distress syndrome, and screening and early diagnosis of retinopathy of prematurity. ML models assist in detecting brain injuries on MRI for conditions such as hypoxic-ischemic encephalopathy, intraventricular hemorrhage; MRI biomarkers can be analyzed using AI to predict neurodevelopmental outcomes. AI-based clinical decision support systems have been deployed to enhance workflows and outcomes by early detection of disease, reducing medication errors and help clinicians improve decision-making. However, there remain ethical and practical challenges in the use of AI including data privacy, the need for high-quality pediatric datasets, rigorous clinical validation and transparency, to ensure that AI strengthens clinical judgement and is trustworthy.
2 Aug 2026
Read appraisal →Current opinion in pediatrics
Clinical implementation of artificial intelligence in adolescent mental healthcare
PURPOSE OF REVIEW: This review aims to summarize recent literature on artificial intelligence (AI) tools for adolescent mental health, including the types of tools available, their clinical applications, effectiveness, and safety, as well as relevant ethical considerations. RECENT FINDINGS: For clinicians, AI can facilitate clinical documentation, enhance therapy, and support the diagnosis process. Adolescents show interest in using AI for their mental healthcare and can benefit from AI-guided therapy apps and chatbots. Most studies that show effectiveness focus on depression treatment. Many tools are only in the prototyping stage, not tested on clinical samples, or lack safety measures, highlighting the need for further safety evaluation before specific app recommendations can be made. SUMMARY: AI is increasingly being implemented in pediatric health systems and adolescents' daily lives. Adolescent medicine practitioners should recognize the growing potential for certain AI applications to enhance access and support adolescents, review and utilize those applications that have empirical support of efficacy, and that provide guardrails for safe and ethical use.
1 Aug 2026
Read appraisal →PloS one
Analysis of swimming teaching programs, aquatic competencies and specific skills in school settings from early childhood to secondary education: A systematic review.
The teaching of swimming in school contexts has become increasingly important due to the benefits in the integral development of students and the prevention of aquatic accidents.This study analyses, by means of a systematic review, the aquatic teaching programmes and Competencies implemented in school settings over the last 25 years, from infant to secondary education. The Methodological approach was based on the PRISMA guidelines, with searches in scientific databases (PubMed, Scopus, Sport Discus and Web of Science) and secondary sources. Sixteen studies were selected according to the PICOS model, assessed with the STROBE and TREND tools. The results show a predominance of technical-utilitarian approaches focused on specific swimming skills, with little curricular integration and limited involvement of PE teachers. Most of the studies focused on infant and primary school, being scarce in secondary school. A high variability in duration, frequency, Contents and Assessment instruments was evidenced. The studies highlight the need for greater inclusion of swimming in school curricula, with more comprehensive pedagogical approaches adapted to each stage. It is concluded that although progress has been made, systematic implementation is still limited, requiring greater institutional support, teacher training and methodological coherence.
25 July 2026
Read appraisal →Journal of medical Internet research
Digital Peer Support Intervention for Family Caregivers of Individuals With Neuromuscular Disease: Randomized Controlled Trial
BACKGROUND: Neuromuscular diseases (NMD) affect nerves and muscles, resulting in weakness and often profound disability. Family caregivers of individuals with NMD experience significant psychological burden, stress, and reduced well-being. Digital peer support interventions may help to ameliorate these negative impacts. OBJECTIVE: This study evaluated the effect of a 12-week digital peer support intervention compared to usual care on caregiver mastery, competence, stress, burden, anxiety, and depression among family caregivers of individuals with NMD. METHODS: We conducted a parallel-group multicenter randomized controlled superiority trial in Ontario, Canada. Family caregivers of children or adults with NMD were recruited between August 2022 and September 2023 through 7 sites, social media, and national organizations. Participants were randomized 1:1 to a 12-week digital peer support intervention or usual care. The 12-week intervention comprised access to a trained peer mentor, private app-based communication via aTouchAway (Aetonix, Canada), and weekly moderated digital group discussion forums. The primary outcome was caregiver mastery measured using the Pearlin Mastery Scale, adjusted for baseline score. Secondary outcomes included caregiver stress, competence, burden, anxiety, and depression. We calculated adjusted (for baseline score) mean differences using analysis of covariance and generated multivariable linear regression models exploring associations with the intervention and caregiver age, years of caregiving, care recipient medical diagnosis, care recipient ventilation type, adjusting for baseline outcome scores. Intervention fidelity was evaluated through participant engagement metrics. RESULTS: A total of 100 participants were randomized (n=50 intervention and n=50 control). Participants had a mean age of 46.8 (SD 11.6) years, 70% (n=70) were mothers, with a mean length of caregiving of 11.8 (SD 7.6) years. We found no difference in 12-week Pearlin Mastery Scale scores (adjusted mean difference 0.67, 95% CI -1.7 to 3.1). We also found no difference in any of our secondary outcomes. Mentors and participants sent a mean of 21.3 (SD 33.3) and 17.7 (SD 33.0) messages, respectively. Overall, 62% (n=31) of participants and 92% (n=11) of mentors engaged in at least 1 program element for ≥8 of the 12 weeks. CONCLUSIONS: Our 12-week digital peer support program had no effect on caregiver mastery or other caregiving or psychological outcomes among family caregivers of individuals with NMD. This might be partly due to moderate fidelity and variability in participant engagement. Unlike prior caregiver interventions that incorporated structured psychoeducation or self-management training, this intervention evaluated primarily peer support delivered through a digital platform. This study contributes important evidence regarding the feasibility and limitations of scalable digital peer support programs for caregivers of individuals with NMD. These findings highlight the importance of intervention tailoring, participant matching, and sustained engagement. Future research should evaluate longer-duration and more individualized peer support models targeting caregivers earlier in the caregiving trajectory to improve intervention fidelity and ultimately caregiver well-being.
24 July 2026
Read appraisal →JMIR formative research
Development of a User-Informed Decision Aid for Contraceptive Decision-Making Among Adolescents and Young Adults: Qualitative Study
BACKGROUND: Adolescents and young adults seeking contraceptive care face many considerations related to differences in contraceptive indications and knowledge, which are often overlooked and can lead to contraceptive nonadherence or nonuse as well as adverse health outcomes. OBJECTIVE: This study aimed to develop a digital decision aid that meets the contraceptive decisional needs of adolescents and young adults from diverse backgrounds. METHODS: We developed a web-based decision aid using a user-centered design framework and the International Patient Decision Aid Standards. The design and development process was informed by a literature review and consultations with scientific experts, health informatics specialists, clinicians experienced in adolescent reproductive health, and a diverse group of adolescent and young adult advisors. We gathered feedback on the decision aid's content and functionality from clinicians, adolescents, and young adult stakeholders during focus group interviews conducted across 2 user testing cycles. Each focus group was recorded and transcribed, and the data were analyzed using a focus group guide to identify key attributes, patterns, and perspectives among users. Two qualitative researchers used rapid qualitative analysis to explore and summarize findings across 4 key domains, which contributed to the refinement of the decision aid content and the improvement of its functionality. RESULTS: Twenty-four clinicians, adolescents, and young adult participants from diverse backgrounds shared their perspectives on the decision aid's content, relevance, design, and usability across 2 user testing cycles conducted from February 2023 to June 2024. The decision aid includes a survey, a decision algorithm that generates a summary of contraceptive method recommendations, infographics, and a health care provider summary view. The decision algorithm applies a weighted scoring system ranging from +1 or -1 to +10 or -10 for each method, reflecting the user's primary indication for seeking contraception, contraceptive use preferences, and relevant health history. CONCLUSIONS: This approach allowed us to capture rich perspectives from a diverse group of stakeholders that accounted for the unique contraceptive decision-making needs of adolescents and young adults, resulting in a functional, youth-informed decision aid prototype, MyPlanMyChoice, ready for pilot and feasibility evaluation in a clinical setting.
22 July 2026
Read appraisal →European journal of nutrition
The effect of system-level intervention in early childhood education and care on children's dietary intake and environmental impact of the diet
PURPOSE: Food systems have a large impact on human health and environmental sustainability. Early childhood education and care is an ideal setting for systemic change. We performed a cluster-randomised trial aiming at climate-friendly and healthy sustainable diet at 23 daycare centres in four Finnish municipalities in 2022 and evaluated system-level intervention effects on food consumption and nutrient intake, and climate and biodiversity impacts of the diet. METHODS: The intervention was initially designed by the research group and refined through co-creation workshops with food service and daycare professionals, and municipal decision makers. The 10-month intervention comprised a modified menu towards more plant-based food supply, and food education. Children's (n = 111) diet was assessed at baseline, mid-term, and/or at the end of the intervention by food frequency questionnaires. The climate and biodiversity impacts per megajoule were assessed using previously specified coefficients for the foods. Multilevel linear mixed models were used in the analysis. RESULTS: During the intervention, children's consumption of legumes and legume products and fish from nearby areas increased, while that of red meat, sausages, and other meat products decreased (Bonferroni-corrected p < 0.001). The changes in food consumption were substantial, with effect sizes ranging from 0.9 to 2.69. Nutrient intake was not affected by the intervention. Intervention decreased climate and biodiversity impacts of food provided at daycare (Bonferroni-corrected p < 0.001, p = 0.003, respectively). CONCLUSION: This study demonstrated that well-planned systemic change in meal provision and food education at daycare resulted in healthier and more climate-friendly diets among children.
20 July 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Genetics versus environment in the pathophysiology of sagittal synostosis
PURPOSE: This systematic review aims to provide an updated overview of the relative contribution of germline genetic and environmental factors to the pathophysiology of sagittal craniosynostosis (sCS). METHODS: Using the PubMed database in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies addressing genetic and/or environmental determinants of sCS in paediatric patients were systematically reviewed. RESULTS: A total of 1238 records were identified, of which 97 studies met inclusion criteria after full-text review. Overall, 25,877 patients were included, with 11,086 diagnosed with sCS (42.8%). Germline genetic variants potentially associated with craniosynostosis were reported in 251 patients, accounting for 12.6% of genetically tested individuals with sCS. Identified variants were distributed across 125 genes, with recurrent findings in 25 genes. Environmental and perinatal factors were more consistently reported across large population-based and case-control studies. Frequently associated factors included male sex, advanced maternal age, maternal smoking, thyroid dysfunction, fertility treatments, foetal constraint, prematurity, and abnormal birth weight, although effect sizes varied across studies. CONCLUSION: Identifiable germline genetic causes appear to account for only a minority of sCS cases, whereas epidemiological evidence suggests that environmental and perinatal influences may also contribute to disease pathogenesis. Nevertheless, most cases lack identifiable germline mutations in key signalling pathways, and the available evidence does not support either genetic or environmental factors as individually deterministic drivers of disease development. Overall, the evidence synthesized in this review supports a multifactorial model for sCS, in which rare genetic susceptibility and non-genetic influences likely interact in the etiopathogenesis of the condition rather than reflecting a single dominant aetiology. However, heterogeneity across studies, differences in genetic testing methodologies, potential bias in exposure assessment, and the limited availability of integrative analyses restrict definitive conclusions regarding the relative contribution of these factors.
19 July 2026
Read appraisal →JMIR research protocols
A Health Promoting School Intervention in 10th Grade ('My Life - I Decide'): Protocol for a Pragmatic Controlled Trial
BACKGROUND: Health promoting school (HPS) interventions have the potential to improve adolescent health and well-being, but evidence regarding implementation and system-level impact in real-world school settings remains limited. "My Life - I Decide" (My Life) is a systems-oriented HPS intervention developed to strengthen positive mental and physical health, school well-being, and health-promoting school practices among 10th-grade students in Denmark. OBJECTIVE: This study aims to describe the intervention, study design, and evaluation framework of the "My Life" intervention and its pragmatic controlled trial, including effectiveness, process, and system-level evaluations. METHODS: The intervention is informed by the World Health Organization HPS framework and combines curriculum-based health education, action-oriented teaching, life-psychological approaches, and education outside the classroom. The intervention includes four phases: (1) preparation through cross-sectoral collaboration between health and education sectors; (2) planning and local adaptation; (3) delivery of a health education program; and (4) anchoring of health-promoting practices at the school level. Effectiveness is evaluated using a pragmatic controlled waiting-list trial design. Four intervention schools (11 classes) were matched with 4 control schools (15 classes), including approximately 416 students aged 15-17 years. Primary outcomes include social and emotional competences, self-efficacy, mental well-being, health literacy, school connectedness, and student interpersonal relations. Student survey data are collected at baseline, postintervention, and follow-up, and effectiveness will be analyzed using multilevel mixed models. System-level impacts are assessed using a mixed-methods design, including school staff surveys, interviews with school and municipal stakeholders, and student focus groups. A realist-informed multimethod process evaluation examines implementation fidelity, acceptability, contextual factors, and mechanisms of impact across intervention schools. Data sources include observations, interviews, student registration, and postsession surveys completed by health consultants after each teaching session. RESULTS: The study will generate quantitative and qualitative data on student outcomes, implementation processes, intersectoral collaboration, and development of health-promoting practices within schools. Findings from the effectiveness, process, and system-level evaluations will be triangulated to test and refine the initial program theory of the intervention. Recruitment of schools and student enrollment have been completed, and baseline data collection commenced in September 2025. Follow-up assessments are being conducted according to the study timeline. Qualitative data collection for the process and system-level evaluations were completed in June 2026. CONCLUSIONS: The "My Life" study will contribute knowledge on the implementation and evaluation of complex HPS interventions in real-world educational settings. The findings may inform future HPS initiatives and provide methodological insights into combining effectiveness, process, and system-level evaluations in adolescent health promotion research.
19 July 2026
Read appraisal →Biomedical physics & engineering express
Simulation-driven deep learning for the diagnosis of middle ear pathologies using wideband acoustic immittance
Wideband acoustic immittance (WAI) provides comprehensive frequency-dependent information for diagnosing middle ear pathologies. However, the scarcity of clinical data and complex response patterns significantly hinder automated diagnosis, particularly in data-limited scenarios. To address this issue, this study proposes a simulation-driven computer-aided diagnosis framework for WAI based on finite element (FE) modeling. Latin hypercube sampling was employed to systematically perturb key physiological parameters of the human ear FE models, generating a standardized virtual WAI dataset comprising 12 000 samples across the 0.2-6 kHz frequency range. The dataset includes four middle ear conditions: normal ear, ossicular chain discontinuity, ossicular chain fixation, and otitis media with effusion. Based on this dataset, a lightweight convolutional neural network tailored for multi-channel WAI inputs, termed WAIHybrid, was developed. It was benchmarked against traditional feature-based machine learning models and five representative deep learning architectures on simulated data and subsequently evaluated on an external clinical dataset comprising 206 ear-level WAI records. WAIHybrid achieved a macro-F1 of 96.30% and a balanced accuracy of 96.29% on an independent simulated test set. On the external clinical dataset, the corresponding values were 87.76% and 88.07%, respectively. Response-level comparisons, learned-representation analyses, and Integrated Gradients maps identified partial class-related correspondence between the simulated and clinical data, residual simulation-to-clinical discrepancy, and class-dependent channel-frequency attribution patterns. These findings support a simulation-driven proof of concept for automated WAI analysis in data-limited middle ear assessment. Further evaluation in larger, more balanced, and clinically heterogeneous cohorts is needed.
19 July 2026
Read appraisal →European journal of pediatrics
Efficacy and safety of procedural sedation-analgesia during laser photocoagulation for retinopathy of prematurity: a systematic review
UNLABELLED: Laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants causes significant procedural pain. Although general anaesthesia (GA) is the standard of care, many settings frequently rely on inadequate sedation-analgesia or topical anaesthesia alone, exposing neonates to considerable pain and clinical instability. This systematic review aimed to evaluate the efficacy and safety of procedural sedation-analgesia during laser photocoagulation for ROP. We searched MEDLINE, Embase, and Cochrane CENTRAL for trials investigating sedation-analgesic agents during laser photocoagulation. Primary outcome was analgesic efficacy (pain score reduction, rescue analgesics required). Additional outcomes included adverse effects (e.g., apnea, oxygen requirement). Two reviewers extracted relevant information and assessed risk-of-bias using ROB2 and evidence certainty using GRADE methodology. Of 540 articles screened, four relevant RCTs were identified (n = 265). These RCTs compared varying combinations of agents (oral dextrose vs. no dextrose, fentanyl vs. oral sucrose, fentanyl vs. ketamine, ketamine-propofol vs. GA). Three RCTs evaluating pain-related outcomes (PIPP-R score and intra-procedural crying duration) suggested that the investigated non-general anaesthetic regimens may provide inadequate procedural analgesia (low to very low-certainty evidence). The evidence is very uncertain about the effect of ketamine-propofol on post-procedure ventilation requirement compared with general anaesthesia. Apnea was the commonest adverse effect (three studies), especially with high-dose fentanyl (30%). Three studies had a low risk-of-bias, while one had some concerns (randomisation, outcome measurement). CONCLUSION: Overall, the included studies were small RCTs evaluating varying combinations of interventions, precluding concrete conclusions about the superiority of any analgesic regimen during laser photocoagulation. Further high-quality studies are needed to identify safe and effective analgesia for settings where GA is unavailable. REVIEW REGISTRATION: Prospectively registered on PROSPERO (CRD420251070146). WHAT IS KNOWN: • Laser photocoagulation procedure for retinopathy of prematurity is immensely painful. • Despite general anaesthesia being the standard, most neonates undergo the procedure under inadequate analgesia, particularly in high-burden settings. Optimal analgesic regimen for the laser procedure, in settings where general anaesthesia is unavailable, is unknown. WHAT IS NEW: • This systematic review of trials investigating analgesic agents for laser procedure for ROP found four RCTs with significant heterogeneity in intervention agents. • Low- to very low-certainty evidence suggests that none of the evaluated sedo-analgesic regimens consistently achieved optimal analgesia, and most infants continued to experience moderate-to-severe procedural pain.
13 July 2026
Read appraisal →Vaccine
Instruments for measuring parents' vaccine hesitancy towards their children based on the COSMIN guidelines: A systematic review
BACKGROUND: Parental vaccine hesitancy undermines immunization gains, leading to resurgent outbreaks and increased child mortality. Reliable assessment instruments are urgently needed to guide effective interventions and improve coverage. Despite multiple vaccine hesitancy assessment instruments, no systematic reviews have evaluated the measurement properties of these instruments against established methodological standards, limiting evidence-based selection. OBJECTIVE: To systematically evaluate the methodological quality and measurement properties of vaccine hesitancy assessment instruments for parents of 0-18 children, providing an evidence-based basis for selecting appropriate instruments. DESIGN: Measurement properties are systematically reviewed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. METHODS: Six electronic databases were systematically searched from inception until July 15, 2025. Methodological quality was assessed using the COSMIN Risk of Bias Checklist and measurement properties were synthesized according to the COSMIN criteria. A modified Grading, Recommendations, Assessment, Development, and Evaluation system was used to assess the certainty of evidence. RESULTS: Forty studies evaluating 31 vaccine hesitancy assessment instruments were included. Based on COSMIN evidence grading, the Malay version of the modified vaccine hesitancy scale (MVHS-M), the Vietnamese version of the parent attitudes about childhood vaccines survey (PACV-Viet), and the parental attitude scale towards vaccination (PASV) received Category A recommendation. The general vaccine hesitancy scale (GVHS), vaccination attitudes examination (VAX), vaccine acceptance instrument (VAI), and vaccine barriers assessment tool (VBAT) received Category C recommendation, while others were Category B recommendation. CONCLUSIONS: This systematic review identified MVHS-M, PACV-Viet, and PASV as effective tools for assessing vaccine hesitancy in parents, suitable for both research and clinical use. Future research should comprehensively assess their measurement properties, especially exploring measurement error and responsiveness. REGISTRATION: A protocol was registered on the PROSPERO (CRD420251070194).
12 July 2026
Read appraisal →Vaccine
Interventions to improve pre-school vaccination timeliness: a systematic review.
BACKGROUND: Improving the timeliness of pre-school vaccinations (children aged 0 to 5 years) is an important public health goal to prevent outbreaks and maximise protection during early childhood. Multiple studies have highlighted the need for effective public health interventions to improve timely vaccination, and consequently the overall effectiveness of vaccination programmes. We aim to synthesise evidence on vaccination timeliness interventions and subsequently provide recommendations to improve pre-school vaccination timeliness in England. METHODS: We conducted a systematic review of randomised controlled trials (RCTs) and non-randomised studies. Studies were eligible if they were conducted in high-income countries and evaluated an intervention to improve timeliness of any pre-school vaccination on the United Kingdom (UK) national childhood vaccination schedule. Five databases and grey literature were searched to February 2025. Risk of bias was assessed using Cochrane risk of bias tools. Data were analysed using random-effects meta-analyses and synthesis without meta-analysis (using effect direction plots). RESULTS: Of the 10,385 records from database searches and 1490 records from citation searches, 33 studies were eligible (15 RCTs, 18 non-randomised studies). Most studies were conducted in the USA (n = 24) and reported on the timeliness of multiple pre-school vaccines (n = 23). Twelve studies (36%) were judged as serious or critical risk of bias, eleven at moderate and ten at low risk. Various intervention groups were identified: call-recall (n = 10), quality improvement (n = 9), education (n = 5), multicomponent (n = 5), combination vaccines (n = 2), communication (n = 1) and vaccination schedule change (n = 1). We found limited evidence from a small number of studies of a potential beneficial effect of combination vaccines, communication, quality improvement, education and schedule change interventions. CONCLUSION: We identified several possible interventions to improve pre-school vaccination timeliness. However, we found limited quantity and quality of evidence on this topic. We recommend further high-quality studies evaluating interventions to improve vaccination timeliness in England, and application of consistent vaccination timeliness definitions.
12 July 2026
Read appraisal →JMIR mHealth and uHealth
Safer Sleep Guidance in Standalone UK Smartphone Apps for Parents of Newborns and Infants: Systematic mHealth App Review
BACKGROUND: Parents are increasingly using smartphone apps to help guide decision-making around aspects of caregiving, including safer sleep. However, it remains unclear whether the guidance provided aligns with best practice guidelines. OBJECTIVE: This review aimed to identify smartphone apps that provide safer sleep guidance and to assess their content, technical features, functionality, and quality. A secondary aim was to make recommendations on the improvements that existing and future apps can make to provide safer sleep guidance. METHODS: In January 2026, we searched the UK Google Play Store and Apple App Store for safer sleep guidance apps for parents and caregivers of newborns and infants (babies aged ≤12 months). Information regarding content, technical features, and functional features was extracted and summarized descriptively. Each app was evaluated by 2 raters using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality score. Adherence to best practice sleep guidance was assessed using bespoke criteria. Interrater reliability was calculated. RESULTS: A total of 1345 apps were identified, with 12 meeting the inclusion criteria. All were free to download, with 42% (5/12) containing in-app purchases. Only 17% (2/12) were affiliated with a professional health, medical, clinical, or government body. All 12 apps contained some information regarding safer sleep practices, although this was addressed and named differently (eg, calling it cot death, sudden infant death syndrome, or safe sleep). Of the 9 criteria relating to safer sleep best practice guidance, the apps mentioned an average of 6.75 (SD 1.71; range 3-9) criteria. Some promoted unsafe sleep practices (ie, around swaddling and cosleeping). The apps included an average of 5.4 of the 11 IMS functionality criteria (SD 2.5; range 2-9). The mean MARS score was 3.7 out of 5 (SD 0.43; range 2.92-4.13), and most (11/12, 92%) had a minimum acceptability score of 3 or above. Two had been formally trialed or tested. Although the language used was considered accessible (easy to understand), none of the apps allowed the language to be changed (beyond English), and very few (3/12, 25%) enabled users to change to night/dark mode, which would be considered essential when using these apps at night. CONCLUSIONS: Several apps about safer baby sleep exist. Few discuss safer sleep guidance comprehensively or raise awareness about sudden infant death syndrome and its links with unsafe sleep. All the reviewed apps met the minimum acceptability criteria for quality; however, not many were formally trialed or tested. More long-term research should be conducted on the effectiveness of safer sleep apps on adherence to safer sleep guidance. We recommend that apps relating to infant and baby safety in general include information on realistic safer sleep practices that are informed by best practice guidelines and take a risk minimization approach.
11 July 2026
Read appraisal →PloS one
Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial.
BACKGROUND: Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS: Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS: We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION: Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.
11 July 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Language-Common and Language-Specific Error Patterns in Children With Speech Sound Disorders: A Systematic Review
OBJECTIVES: This systematic review synthesized cross-linguistic evidence on speech error patterns in children with speech sound disorders (SSDs), focusing on percent consonants correct (PCC), SODA (substitution, omission, distortion, and addition) error profiles, and phonological processes, as well as factors contributing to variations in error patterns. METHOD: Comprehensive searches were conducted in PubMed, CINAHL Ultimate, Scopus, Web of Science, and Linguistics and Language Behavior Abstracts in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included empirical research on children with phonological, articulation, or functional SSDs that reported quantitative error analyses. Twenty-eight studies met the inclusion criteria. Methodological quality, evaluated using a 16-item framework, ranged from 50.0% to 100.0% (M = 82.7%). RESULTS: The 28 studies spanned nine languages (English, German, Spanish, Portuguese, Italian, French, Turkish, Korean, and Chinese), including three dialects each of Spanish and Chinese and two dialects of Portuguese. Reported PCC values (typically 65.0%-85.0%) indicated predominantly mild-moderate to moderate impairment. Substitution errors were the most prevalent across languages, followed by omissions and distortions. Both language-common and language-specific phonological processes were documented. DISCUSSION: The findings indicate that PCC is generally comparable across languages, whereas SODA error profiles and phonological processes reflect both cross-linguistic similarities and language-specific characteristics. Phonological processes, in particular, exhibit greater cross-linguistic variation. Collectively, these results emphasize the need for culturally responsive diagnostic practices and highlight the importance of developing cross-linguistic frameworks to guide the assessment of SSDs. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32649549.
10 July 2026
Read appraisal →European journal of psychotraumatology
Assessment of functional impairment related to post-traumatic stress in children and adolescents: a systematic review
Background: Post-traumatic stress disorder (PTSD) often impairs children's and adolescents' functioning across different life domains. Significant functional impairment is a diagnostic criterion for PTSD in both the DSM-5 and the ICD-11, but the methods in terms of domains covered and scoring rules to assess functional impairments are quite inconsistent.Objective: This systematic review evaluates instruments specifically designed to assess post-traumatic stress symptoms (PTSS), PTSS modules within diagnostic interviews, and generic functional impairment measures used to capture PTSS-related functional impairment in children and adolescents.Method: A systematic search was conducted across six databases for studies published between January 2010 and November 2025. Eligible papers included the development or psychometric evaluation of PTSS-specific measures, PTSS modules in diagnostic interview, and generic functional impairment measures validated in samples exposed to trauma or adverse childhood experiences. Data were extracted and categorized based on assessed content domains, scoring methods, and psychometric properties, with results stratified by age group (6 years and younger versus 7 years and older).Results: From 3519 records, 30 papers met the inclusion criteria. Thirteen PTSS-specific instruments, one diagnostic interview module, and one generic functional impairment measure were identified. Together, these instruments assessed 11 different life domains, although considerable variation existed in the domains covered across tools. Scoring methods also varied, with approximately half using dichotomous response formats and the remainder using multi-categorical scales. Psychometric properties of the functional impairment scales were reported in only 20.7% of publications.Conclusion: Current tools for assessing PTSS-related functional impairment in youth lack standardization. There is a critical need for well-validated instruments that comprehensively capture the presence and severity of PTSS-related functional impairment. This systematic review identified and evaluated 15 instruments, comprising PTSS-specific measures, diagnostic interview modules, and generic functional impairment tools, used to assess PTSS-related functional impairment in children and adolescents.The instruments collectively assessed 11 different life domains; however, substantial variability existed in the domains covered, and scoring methods ranged from dichotomous formats to Likert-type scales.Only 20.7% of papers reported psychometric properties for functional impairment items, highlighting the critical need for standardized, developmentally appropriate tools with robust validation in children and adolescents with potentially traumatic experiences.
8 July 2026
Read appraisal →Journal of medical Internet research
Attitudes and Needs of Health Care Providers Toward Artificial Intelligence-Assisted Pediatric Palliative Care: Mixed Methods Study
BACKGROUND: While artificial intelligence's (AI's) transformative potential in health care is widely acknowledged, its application in highly sensitive, humanistic domains like pediatric palliative care (PPC) remains largely unexplored. OBJECTIVE: This study aims to explore the attitudes and needs of health care providers on the PPC assisted by AI, with the goal of informing future development and implementation of AI systems in this field. METHODS: This was an explanatory sequential mixed methods study consisting of a nationwide cross-sectional questionnaire survey (March-April 2025) followed by qualitative semistructured interviews (August-October 2025). The quantitative study aimed to investigate PPC health care providers' experiences, attitudes, and needs for the application of AI. Participants included team members of all recognized PPC teams in mainland China. The qualitative study aimed to explore in greater depth the potential future roles of AI in this field, as well as the features of an ideal AI-assisted tool for PPC. Potential interviewees were recruited from the pool of quantitative survey respondents. RESULTS: Among 352 survey respondents, most (n=205, 58.24%) reported moderate familiarity with AI, with large language models being the most commonly used (n=280, 79.55%). Among large language model users, over half (161/280, 57.50%) reported using them for clinical purposes. Attitudes were generally positive: 67.05% (236/352) believed AI's benefits would outweigh drawbacks, and 75% (264/352) considered its implementation feasible. The most desired applications were patient and family education (276/352, 78.41%) and symptom management (257/352, 73.01%). Interviews with 17 providers revealed three themes: (1) clinical roles and boundaries, (2) elements for clinical integration, and (3) challenges in development and deployment. CONCLUSIONS: This study reveals that PPC providers express positive attitudes and strong demand for AI-assisted clinical work. Furthermore, the research clarifies appropriate roles for AI, outlines elements for clinical integration, and highlights potential challenges in development and integration. This study provides evidence for the feasibility of AI application in PPC and offers guidance for the future development and deployment of AI tools.
5 July 2026
Read appraisal →Child and adolescent psychiatric clinics of North America
Technology-Enabled Crisis Care for Youth: Bridging the Gap
The article discusses technological advancements in mental health care for youth in crisis, addressing workforce shortages and enhancing care delivery. Technologies like remote patient monitoring, telehealth, mobile health applications, virtual reality therapy, and artificial intelligence improve symptom tracking, communication, and treatment accessibility. Clinical decision support systems and therapy chatbots enhance crisis assessment and management. Various settings employ telepsychiatry and extend reach, while digital therapeutics and monitoring ensure ongoing support. Challenges include regulatory compliance, data privacy, and technological limitations. Future directions emphasize interoperability, safeguards for new and adapting technologies, patient-centered care, and integrated digital health systems.
3 July 2026
Read appraisal →Emergency medicine journal : EMJ
Interventions to reduce imaging in children with upper or lower extremity injuries: a systematic review and meta-analysis
BACKGROUND: Radiation exposure, transition delays and costs associated with unnecessary imaging in children have stimulated research into clinical decision rules and other interventions to reduce imaging in the emergency department (ED). The objective of this systematic review is to examine the effectiveness of implementing interventions to reduce imaging in children with upper/lower extremity injuries in the ED. METHODS: Seven databases and the grey literature were searched up to May 2024. Comparative studies assessing interventions to reduce imaging in children with upper/lower extremity injuries implemented in the ED were eligible. Two independent reviewers screened for study eligibility, quality assessment and data extraction, with disagreements settled via third-party adjudication. Changes in imaging are reported as ORs with 95% CIs, using a random effects model. RESULTS: From 9387 citations, eight unique studies enrolling 7793 children were included with the majority using a before-after design. Potential concerns for bias were documented due to a lack of reporting of key quality domains. Decision rules for ankle injuries successfully reduced radiography (OR=0.11; 95% CI 0.07 to 0.16, I2=38%). A decision rule for wrist injuries reduced imaging (OR=0.06; 95% CI 0.03 to 0.11); however, eight injuries were missed. Two studies implementing clinical guidelines reported decreases in radiographs per patient (p<0.001). One trial reported increased imaging in children assessed by triage nurses using an established clinical decision rule (OR=5.44; 95% CI 2.96 to 10.02), with 16 missed injuries identified. CONCLUSIONS: Guidelines incorporating clinical decision rules, particularly decision rules for ankle injuries, can reduce radiography for children with extremity injuries in the ED. Further investigations are warranted to identify other extremity injuries, the components of the intervention and the most efficient clinicians to target. PROSPERO REGISTRATION NUMBER: CRD42016042875.
1 July 2026
Read appraisal →The Journal of dermatological treatment
Intralesional human papillomavirus vaccination for cutaneous verrucae: a systematic review and meta-analysis of therapeutic efficacy
OBJECTIVES: To evaluate the efficacy of intralesional human papillomavirus (HPV) vaccination in the management of cutaneous warts. METHODS: A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and ClinicalTrials.gov was conducted in accordance with a registered PROSPERO protocol (CRD420251170324). Chronic or persistent warts were defined as lesions lasting more than six months or showing inadequate response to conventional therapies. The primary outcome was complete wart clearance, and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Six studies were included. Intralesional HPV vaccination was associated with a significantly higher rate of complete clearance compared with intralesional normal saline (RR 18.54; 95% CI 6.59-52.18). Subgroup analyses demonstrated comparable efficacy between bivalent and quadrivalent vaccines. Reported adverse events were mild and localized. CONCLUSION: Intralesional HPV vaccination demonstrated significant therapeutic efficacy in the treatment of cutaneous warts and represents a promising immunotherapeutic option for patients with persistent or treatment-refractory disease.
30 June 2026
Read appraisal →European journal of pediatrics
Feasibility of image-based 3D avatar anthropometry assessment of pediatric obesity: a pilot study.
UNLABELLED: The purpose of this study is to evaluate the feasibility and validity of 3D avatar-based anthropometry for assessing anthropometric indicators of overweight and obesity in children based on artificial intelligence-derived 3D body reconstruction. This cross-sectional study included 171 children aged 8-10 years from five primary schools in southern Spain. Due to technical constraints of the reconstruction software, 75 children meeting predefined image quality and body weight requirements (≥ 30 kg) were eligible for 3D avatar analysis. Manual anthropometric measurements were obtained following International Society for the Advancement of Kinanthropometry (ISAK) standards and compared with avatar-derived circumferences. Agreement was assessed by using Wilcoxon tests, Spearman correlations, Bland-Altman analyses, and false discovery rate-adjusted comparisons. Avatar-derived circumferences were consistently greater than manual measurements, although waist-to-hip and waist-to-stature ratios demonstrated no significant differences. Avatar and manual circumferences were moderately to strongly correlated (Spearman's ρ = 0.62-0.72; adjusted p < 0.05). However, the mean absolute errors ranged from 6.21 to 7.11 cm, and Bland-Altman analysis revealed systematic overestimation with wide limits of agreement, particularly for waist and hip circumferences. Despite these discrepancies, both methods similarly discriminated between weight status categories. CONCLUSION: Image-based 3D avatar anthropometry is a feasible, noninvasive approach for population-level screening and research in pediatric settings. Although the system reliably captures relative differences and body proportions, its current accuracy is insufficient for individual-level clinical assessment. Further algorithmic refinement and validation in lighter and more diverse pediatric populations are needed before clinical implementation. WHAT IS KNOWN: • Childhood obesity remains a major public health challenge requiring accurate monitoring. • Anthropometric assessment still relies mainly on manual measurements, while AI-based 3D body modeling offers a promising non-invasive alternative. WHAT IS NEW: • Image-based 3D avatar anthropometry is feasible in school settings but is constrained by technical requirements. • Avatar measurements are correlated with manual anthropometry and preserve weight status discrimination but demonstrate systematic overestimation and limited agreement.
29 June 2026
Read appraisal →ACS sensors
Machine Learning-Enabled Gas Sensor Based on MOF-Derived In2O3-CuO for Exhaled CO Detection
Noninvasive, precise breath analysis holds significant importance for the screening and monitoring of neonatal jaundice, with its core challenge lying in the specific detection of the key biomarker carbon monoxide (CO) within complex breath matrices. This research employed a controlled process to fabricate five sets of In2O3-CuO sensors derived from bimetallic metal-organic frameworks (Bi MOFs). These were assembled into a microsensor array, and by incorporating a linear discriminant analysis algorithm, an electronic nose system was constructed. This approach utilizes thermodynamic feature engineering to enhance data validity and optimize algorithm selection, thereby reducing reliance on large-scale data and computational resources. By integrating thermodynamically feature-driven machine learning, the electronic nose system-comprising merely five In2O3-CuO sensors-ultimately achieved accurate discrimination between CO and acetone. Concurrently, the single 3In2O3-CuO sensor exhibits excellent reproducibility, moisture resistance, and stability, with a low detection limit of 1 ppm and relatively rapid response/recovery times (5/21 s). By introducing machine learning algorithms to analyze the multidimensional response signals from the sensor array, the study successfully addressed the cross-sensitivity issue between CO and coexisting interfering gas C3H6O in clinical environments, achieving qualitative identification of CO ranging from 1 to 50 ppm (cross-validation accuracy reached 82%), providing a highly reliable technical platform for noninvasive screening of neonatal bilirubin metabolic abnormalities.
29 June 2026
Read appraisal →Human genetics
AI in variant analysis: fast track to genetic diagnoses
While falling costs have expanded access to genomic sequencing, clinical utility is frequently hindered by the challenge of interpreting complex genetic data. Variant analysis for rare disease patients especially requires significant time and expertise, creating a bottleneck that delays diagnostics. Although advances in genetic variant classification have improved diagnostic precision, they have also increased the identification of variants of uncertain significance (VUSs), widening the interpretation gap between data generation and clinical actionability. The high prevalence of VUSs can lead to false reassurance or psychological distress by misinterpretting inconclusive results. We propose that artificial intelligence (AI) is a critical clinical decision-support tool for bridging this gap, offering a scalable framework to optimize variant interpretation and shorten the diagnostic odyssey. While reclassification ultimately requires biological evidence that AI cannot replace, these tools serve as essential aggregators and prioritizers, especially as guidelines transition toward the upcoming quantitative ACMG v4 framework. We advocate integrating AI throughout the genetic diagnostic workflow-from initial phenotyping to variant prioritization-to facilitate data-driven, personalized treatment. We outline current AI-assisted approaches and discuss anticipated challenges in this pursuit, such as privacy, training data bias and quality, model explainability, and the necessity of a total product life cycle for validation. To address these challenges, we provide recommendations for "human-in-the-loop" design and intuitive workflow integration to ensure AI tools meet the highest standards of precision, reproducibility, and transparency to maximize adoption. By standardizing AI across the variant analysis pipeline, we can fast-track the path to genetic diagnoses, effectively bridging the interpretation gap and enabling rapid delivery of personalized medical interventions.
28 June 2026
Read appraisal →Journal of medical Internet research
Digital Interventions Targeting Parents to Improve Early Childhood Movement, Nutrition, and Sleep Behaviors: Systematic Review
BACKGROUND: Early childhood (0-5 years) is key for shaping health behaviors, yet optimal behaviors are rarely achieved. Digital health promotion interventions offer scalable support for families; however, most research has focused on childhood more broadly, leaving limited evidence for the early childhood period. OBJECTIVE: The primary aim of this systematic review was to examine whether autonomously delivered digital interventions targeting parents are effective at increasing physical activity, reducing sedentary behavior, improving nutrition (breastfeeding, feeding practices), and/or optimizing sleep among children aged 0-5 years. The secondary aim was to review the reporting of co-design practices, user engagement, and process evaluation, and to assess how engagement influences intervention effectiveness. METHODS: Seven databases were searched for randomized controlled trials (RCTs) evaluating autonomously delivered digital interventions targeting one or more of the following behaviors: physical activity, sedentary behavior, nutrition, or sleep among children (published to January 2026). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Findings were narratively synthesized by target age-group and behavior, and the direction of effect was summarized in structured tables. RESULTS: Of the 14,352 identified records, 38 interventions (33 RCTs, 4 pilot RCTs, and 1 feasibility RCT) were included. Most studies focused on pregnancy to infancy (n=24; 0-1 y), followed by preschoolers (n=8; 3-5 y) and toddlers (n=6; 1-2 y). Intervention duration ranged from 2 weeks to 1000 days, and various digital formats were used (apps n=11, SMS text messaging n=10, web- or internet-based platforms n=6, WeChat [Tencent] n=3, tablet-based program n=2, a combination of app and SMS text messaging n=1, website and emails n=1, emails and SMS text messaging n=1, automated voice calls n=1, Facebook Messenger Chatbot [Meta] n=1, and online videos n=1). Interventions spanning pregnancy to infancy reported mixed findings for breastfeeding and feeding practices. Studies targeting toddlers showed improvements in sleep, mixed findings for diet and screen time, and no differences in physical activity. Most studies targeting preschoolers reported significant improvements for feeding practices and diet, but no differences in physical activity, sedentary behavior and sleep, and mixed findings for screen time. Most studies reported co-design or engagement (n=24), but few examined the impact of engagement on intervention effectiveness (n=6), and those that did reported mixed findings. Interpretation was limited by heterogeneous designs, inconsistent outcome measures, and mixed risk-of-bias ratings across studies. CONCLUSIONS: This review advances the field by synthesizing evidence on scalable digital interventions that support parents in promoting healthy lifestyle behaviors across the first 2000 days, together with key design and implementation factors that have rarely been reported in previous reviews. Unlike prior work, it focuses exclusively on autonomously delivered digital interventions in early childhood. Findings show heterogeneous designs and mixed effectiveness, and highlight 3 priority evidence gaps: limited studies in toddlers and preschoolers, incomplete reporting of engagement, and limited understanding of how engagement influences outcomes. These findings define priorities for future research to strengthen the evidence for scalable digital interventions in early childhood.
28 June 2026
Read appraisal →Archives of disease in childhood
AI-simulated clinical consultations: Assessing the potential of ChatGPT to support medical training
BACKGROUND: Simulated medical scenarios are useful for evaluating and developing clinical competencies but scheduling them is expensive and time-consuming. Large language models show promise in role-playing tasks. We investigated the fidelity with which ChatGPT can mimic patients, clinicians and examiners in educational settings. OBJECTIVE: To determine the realism with which ChatGPT can portray patient, doctor and examiner roles, and the utility of these agents in clinical education. METHOD: We selected four paediatric scenarios from mock objective structured clinical examinations (OSCEs) and set up separate patient, doctor and examiner ChatGPT agents for each. The patient and doctor agents conversed with each other in written format. The examiner agent marked the doctor agent based on this conversation. Patients and clinicians familiar with the OSCE assessed the dialogues. RESULTS: The patient agent was judged to be true to character most of the time and good at expressing emotion. The doctor agent was reported to be an effective communicator but occasionally used jargon. Both agents tended to produce repetitive responses which undermined realism. The examiner agent had good correlation with human clinicians. There was moderate support for using the simulated interactions for educational purposes. CONCLUSION: Although the realism of the agents can be improved, ChatGPT can generate plausible proxies of participants in medical scenarios and could be useful for complementing standardised patient-based training.
24 June 2026
Read appraisal →European journal of emergency medicine : official journal of the European Society for Emergency Medicine
Effect of a liquid crystal vein locator on intravenous catheterization in young children: a randomized trial
BACKGROUND AND IMPORTANCE: Peripheral intravenous catheterization (PIVC) in young children is notoriously challenging because of factors like poor patient cooperation and small vessel diameter. Repeated attempts cause distress and delay critical emergency treatment. OBJECTIVES: This study aimed to evaluate the effect of a novel liquid crystal display-based near-infrared vein locator on PIVC performance in children aged under 3 years. DESIGN: This is a prospective, randomized controlled trial. SETTINGS AND PARTICIPANTS: A total of 105 children aged 0-3 years requiring PIVC were enrolled in a pediatric emergency department. INTERVENTION: Participants were randomly assigned to undergo PIVC using either a liquid crystal vein locator (study group, n = 50) or the traditional landmark-based method (control group, n = 55). OUTCOME MEASURES AND ANALYSIS: The primary endpoint was the first-attempt success rate. Secondary endpoints included the number of puncture attempts, vein localization time, and total insertion time. Multivariable logistic and Poisson regression models were used to adjust for covariates, such as vein difficulty and patient demographics. Analyses included effect sizes with 95% confidence intervals (CIs). MAIN RESULTS: The baseline characteristics of both groups were comparable. The first-attempt success rate was significantly higher in the study group compared to the control group (86.0% vs. 54.5%; absolute difference: 31.5%; 95% CI: 15.2-47.8%). The study group also demonstrated a significantly shorter median vein localization time (16.5 vs. 60.0 s) and median total insertion time (40.0 vs. 185.0 s). In addition, the device significantly reduced the median number of puncture attempts (adjusted rate ratio: 0.77; 95% CI: 0.66-0.90). Multivariable analysis revealed that device assistance was an independent predictor of first-attempt success (adjusted odds ratio: 3.35; 95% CI: 1.13-9.95). CONCLUSION: In this study, the use of a liquid crystal vein locator was associated with a significantly higher first-attempt success rate, fewer puncture attempts, and reduced procedural times for PIVC in young children.
24 June 2026
Read appraisal →Current psychiatry reports
Artificial Intelligence in Child and Adolescent Psychiatry: A Narrative Review of Recent Clinical Applications and Ethical Considerations
PURPOSE OF REVIEW: This narrative review examines recent literature of artificial intelligence (AI) in child and adolescent psychiatry. With increasing mental health disorders in young people along with persistent workforce shortages, AI has emerged as a potential tool to improve efficiency and support clinical decision making. However, using AI raises important ethical concerns which are summarized in our review. RECENT FINDINGS: Most AI applications in child and adolescent psychiatry remain early in development and are not ready for routine clinical use. AI scribes are likely impractical in many child psychiatry settings because of multiparty visits, consent concerns, and sensitive clinical discussions. Many multimodal diagnostic tools using machine learning still require further testing and can be impractical when relying on costly diagnostics like neuroimaging. Similarly, AI-assisted therapeutics requiring physical hardware like robotics and virtual or augmented reality devices can also be prohibitively expensive. One of the few exceptions includes AI-enabled video and eye-tracking approaches for autism diagnosis. Chatbots and robot companions may provide modest improvements for depression, but evidence remains limited in the pediatric population with risk of serious harm. Concerns of AI include misinformation, algorithmic biases, privacy risks, crisis mismanagement, and excessive emotional attachments to chatbots. AI may eventually support child and adolescent psychiatry, but current evidence supports cautious, supervised use rather than broad clinical adoption. Clinicians should help families understand AI's limits, encourage digital literacy, and ensure that AI remains an adjunct to human care rather than a substitute.
22 June 2026
Read appraisal →BMJ paediatrics open
Smartphone-based support for early childhood development in a rural low-resource setting: an individually randomised pilot feasibility trial from Guatemala
OBJECTIVE: To test the feasibility of a smartphone app, BebeApp, that provides evidence-based early childhood development (ECD) guidance in rural Guatemala and pilot procedures for an adequately powered randomised controlled trial. DESIGN: We conducted an individually randomised pilot feasibility trial to compare BebeApp to printed ECD guidance. SETTING: This trial was conducted in Tecpán, Chimaltenango, a semi-rural community that is 95% Kaqchikel Indigenous Maya. PATIENTS: First-time primary caregiver-infant (0-28 days) dyads. INTERVENTIONS: BebeApp provides age-dependent, evidence-based caregiver guidance for breastfeeding and complementary feeding, sleep and developmental support. MAIN OUTCOME MEASURES: A mixed-methods evaluation of BebeApp's implementation and acceptability using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. App usability, usefulness and satisfaction were assessed via questionnaires, semi-structured interviews and app interaction data. RESULTS: 41 infant-caregiver dyads were enrolled with 40 completing the study. Engagement was high with caregivers opening BebeApp a median (IQR) 11 (6-21) times per month. Usability was found to be acceptable but no difference was found between pre-measurements and post-measurements. In interviews, caregivers expressed some initial difficulty using BebeApp but were able to gain confidence with a training session. App usefulness and satisfaction responses were positive. Caregivers often noted that BebeApp was their only source of ECD information outside of their family. CONCLUSIONS: We found that caregivers in rural Guatemala responded positively to a smartphone ECD app and engaged with it throughout the trial. Given the urgent need for ECD programmes in low- and middle-income settings, smartphone apps may be a method to deliver services directly to caregivers.
14 June 2026
Read appraisal →British journal of sports medicine
Multimodal symptom-targeted treatment for young people with persisting post-concussion symptoms: a randomised clinical trial
OBJECTIVE: To evaluate the effectiveness of Concussion Essentials (CE), a symptom-targeted, multidisciplinary treatment for persisting post-concussion symptoms (PPCS). METHODS: This single-site, open-label, assessor-blinded, parallel-group randomised clinical trial recruited 8-18-year-olds within 17 days of concussion from the emergency department of a tertiary paediatric hospital and from community referrals. Participants who endorsed ongoing PPCS on review at 14 (±3) days post-injury were invited to a baseline assessment at 3 weeks post-injury, where symptoms were re-assessed. Symptomatic participants were randomised to CE or usual care (UC). CE participants received individualised, multidisciplinary treatment modules (education, psychological, physiotherapy) for up to 8 weeks, while UC participants received weekly monitoring. Primary outcome was full recovery at intervention completion, defined as <1 symptom of increased severity compared with pre-injury on the Post-Concussion Symptom Inventory, parent version (PCSI-P). RESULTS: Participants were recruited between August 2019 and July 2024. Outcomes were analysed for 158 participants (CE=78; UC=80, mean age 13±2.5 years, 57.6% male). Pre-treatment PCSI-P total mean scores were: CE 36.7 (95% CI 31.0 to 42.4) and UC 33.5 (95% CI 28.4 to 38.7). Proportions with full resolution were CE 62.5% and UC 37.0% (adjusted risk difference=25.5%, 95% CI -10.0 to 41.0%). Post-treatment mean scores were CE 8.5 (5.9-11.2), UC 21.8 (95% CI 15.6 to 27.9) (p<0.0001). Seven adverse events, unrelated to trial factors, were recorded. CONCLUSION: Individualised, multidisciplinary treatment is associated with accelerated recovery in young people with PPCS. Implementation of such approaches should be considered in routine clinical care of concussion. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (number: ACTRN12617000418370).
14 June 2026
Read appraisal →BMJ (Clinical research ed.)
Low concentration atropine eye drops and progression of myopia in children: multicentre placebo controlled, double masked, randomised trial in the UK (CHAMP-UK)
OBJECTIVES: To evaluate the efficacy and safety of low concentration atropine eye drops for reducing progression of myopia in children in the UK. DESIGN: Multicentre, double masked, superiority, placebo controlled, randomised trial. SETTING: National Health Service hospital eye services and academic institutions at five UK centres. PARTICIPANTS: 289 children aged 6-12 years with myopia between -0.50 and -10.0 dioptres (D). Participants were allocated in ratio of 2:1 to atropine or placebo. INTERVENTIONS: One eye drop of preserved atropine 0.01% or placebo daily for two years. MAIN OUTCOME MEASURES: The primary outcome was spherical equivalent refractive error of both eyes measured by autorefractor under cycloplegia after two years. Secondary outcomes included change in axial length, best corrected distance and near visual acuity, reading speed, pupil diameter, spectacle correction, adverse event rates, quality of life, and tolerability. Outcomes were collected every six months. An electronic monitoring system was used to assess adherence. RESULTS: 192 participants were included in the atropine group and 97 in the placebo group, with an average age of 9.3 years (standard deviation (SD) 1.7 years). 207 (72%) reported white ethnicity, 161 (56%) were girls, and the mean level of myopia was -2.87 D (SD 1.71 D). A total of 235 (81%) participants completed the study, with primary outcome data available for 230 (80%) participants: 151 (79%) in the atropine group and 79 (81%) in the placebo group. Atropine eye drops were more effective than placebo in reducing myopia progression (mean difference 0.33 D, 95% confidence interval (CI) 0.17 to 0.49 D, P<0.001). Prespecified subgroup analyses did not show differences according to age, ethnicity, sex, or severity of myopia. Changes in central axial length were significantly less in the atropine group versus placebo group: mean difference 0.14 mm (95% CI 0.07 to 0.21, P<0.001). There were no differences in other secondary outcomes, except pupil diameter, which was greater in the atropine group (0.36 mm, 95% CI 0.17, 0.55, P<0.001), and no differences in frequency of adverse events or in tolerability measures. No serious adverse events were related to the trial drugs. CONCLUSIONS: Low concentration atropine (0.01%) eye drops significantly reduced progression of myopia and were well tolerated compared with placebo in children in the UK. TRIAL REGISTRATION: ISRCTN registry ISRCTN99883695, ClinicalTrials.gov NCT03690089.
13 June 2026
Read appraisal →Vaccine
Immunogenicity and safety of Sabin-strain inactivated poliovirus vaccine in infants: a systematic review and meta-analysis
BACKGROUND: Poliomyelitis remains a threat to children under five despite global vaccination efforts. The Sabin-strain inactivated poliovirus vaccine (sIPV) has emerged as a safer alternative to conventional Salk-strain IPV (cIPV) due to lower biosafety requirements. This systematic review and meta-analysis evaluated the immunogenicity and safety of sIPV compared with cIPV in healthy infants completing the primary IPV series. METHODS: PubMed, Embase, Scopus, and Cochrane Library were searched for RCTs. Outcomes included seroconversion rates, seroprotection rates, geometric mean titers (GMTs), and adverse events. Data were pooled using random-effects models, and evidence certainty was assessed using RoB 2.0 and GRADE. RESULTS: Seven RCTs with 4646 infants were included. Seroconversion rates were comparable: PV1 100% (RR 1.00, 95% CI 1.00-1.01), PV2 102% (RR 1.02, 95% CI 0.98-1.07), PV3 100% (RR 1.00, 95% CI 0.99-1.01). GMTs were higher for sIPV after PV1 (MD 1.50, 95% CI 0.98-2.02) and PV2 (MD 0.52, 95% CI 0.06-0.98). Local adverse events were similar (OR 1.27, 95% CI 0.95-1.71), while systemic adverse events were higher with cIPV (OR 1.36, 95% CI 1.15-1.60). Fever (OR 1.50, 95% CI 1.20-1.87) and allergic reactions (OR 2.19, 95% CI 1.02-4.69) were slightly more frequent with sIPV. CONCLUSIONS: sIPV provides immunogenicity comparable to cIPV with an acceptable safety profile in infants. Its lower biosafety requirements support its use in global polio eradication programs.
11 June 2026
Read appraisal →Human vaccines & immunotherapeutics
Safety and immunogenicity of 4CMenB and MenACWY-CRM meningococcal vaccines when administered concomitantly in healthy adolescents: A phase 3b, randomized, observer-blind study.
Meningococcal vaccination of adolescents/young adults is recommended in various countries, including the United States (US). This phase 3b, observer-blind study (NCT04318548) evaluated the safety, reactogenicity, and immunogenicity of serogroup B vaccine, 4CMenB, and quadrivalent conjugate vaccine, MenACWY-CRM, when co-administered to healthy individuals aged 16-18 y, as per US Advisory Committee on Immunization Practices recommendations. Adolescents, who had received MenACWY vaccination ≥4 y previously, were randomized (N = 940; 1:1:1) to one of three groups to assess co-administration versus 4CMenB and MenACWY-CRM administered alone. Co-primary objectives were to demonstrate the non-inferiority of antibody responses after concomitant administration to antibody responses after 4CMenB (two doses administered 2 months apart) and MenACWY-CRM (single dose), as measured by human serum bactericidal assay (hSBA). Vaccine safety and reactogenicity were assessed as another primary objective. The co-primary endpoints were met: the lower limit of 2-sided 95% confidence intervals for all between-group ratios of hSBA geometric mean titers was >0.5 for the concomitant administration group versus 4CMenB group and MenACWY-CRM group. hSBA data after two 4CMenB doses and one MenACWY-CRM dose showed comparable between-group geometric mean ratios versus baseline, and percentages of participants with 4-fold rises in titers and titers ≥lower limit of quantitation. The safety profile of 4CMenB co-administered with MenACWY-CRM was comparable with that of 4CMenB administered alone. In conclusion, 4CMenB and MenACWY-CRM co-administration was well tolerated in adolescents aged 16-18 y and immune responses were comparable versus administration of each vaccine alone, which is consistent with a previous study of co-administration in infants. Invasive meningococcal disease, caused by the bacterium Neisseria meningitidis, poses a life-threatening risk but can be prevented through vaccination. Effective vaccines are available against the most common disease-causing meningococcal serogroups, A, B, C, W, and Y. Evidence from clinical studies and immunization programs over the last decade with the 4-component meningococcal serogroup B vaccine, 4CMenB, and serogroups A, C, W, and Y vaccine, MenACWY-CRM, confirms the effectiveness of both vaccines in population age groups at higher risk of meningococcal disease, including infants and adolescents. It was previously shown that the administration of 4CMenB and MenACWY-CRM to healthy infants at the same visit induced good immune responses and was well tolerated by young children. Adolescent vaccination with 4CMenB and MenACWY-CRM is recommended in various countries, including in the United States. We conducted a study to test the safety of concomitant administration and its ability to induce immune responses in 945 healthy adolescents aged 16–18 y; 834 from the United States and 111 from Italy. We found that most reactions to the 4CMenB and MenACWY-CRM injections were mild or moderate, and were similar whether the vaccines were given together or separately, with no unexpected side effects. Co-administration to adolescents induced robust immune responses against serogroup B and serogroups A, C, W, and Y. These results support the use of concomitant meningococcal vaccinations in adolescent immunization programs.
11 June 2026
Read appraisal →European journal of medicinal chemistry
Machine learning-based prediction of drug lactation risk: Bridging molecular features and breastfeeding safety
BACKGROUND: Breastfeeding medication safety assessment presents critical challenges due to limited clinical evidence and ethical constraints on lactation studies. While existing computational models focus on predicting pharmacokinetic surrogates such as milk-to-plasma ratios, these endpoints lack direct clinical actionability for therapeutic decision-making. METHODS: We developed LRCpredictor, a computational framework for predicting drug lactation risk based on Dr. Thomas W. Hale's evidence-based Lactation Risk Categories (LRC) system. A dataset of 391 drugs (179 high-risk L4/L5, 212 low-risk L1/L2) was characterized using three complementary molecular representations. Systematic feature engineering with four selection algorithms identified optimal feature subsets. Five ensemble machine learning algorithms were evaluated through cross-validation and independent testing. Multi-level SHAP analysis and structural alert mining were employed to elucidate molecular determinants of lactation risk. RESULTS: The optimal Gradient Boosting Decision Tree (GBDT) model using 35 selected features achieved robust cross-validated performance (AUC = 0.80, MCC = 0.52) and demonstrated notably superior discrimination for extreme risk categories (L1 vs. L5: AUC = 0.85, MCC = 0.62). Analysis revealed lactation risk is governed by the complex interplay of electronic properties, structural topology, electrotopological characteristics, polarizability and drug-likeness attributes. Matched molecular pair analysis demonstrated how specific structural modifications translate into interpretable risk changes. We further identified 18 structural alerts, including five exclusive to high-risk drugs, enabling rapid toxicophore recognition during risk assessment and drug design. CONCLUSIONS: LRCpredictor provides the first interpretable framework for clinically actionable lactation risk prediction with mechanistic molecular insights. The freely accessible web platform (https://lrcpredictor.streamlit.app/) with integrated visual explanations supports evidence-based decision-making for healthcare providers and drug design optimization.
7 June 2026
Read appraisal →BMJ paediatrics open
The efficacy of oral sucrose for relieving lumbar puncture pain in neonates: a randomised clinical trial
OBJECTIVE: To evaluate the analgesic efficacy and physiological effects of oral sucrose during lumbar puncture (LP) in term neonates. STUDY DESIGN: This double-blind, randomised trial enrolled 60 full-term neonates undergoing LP. Participants were randomly given 2 mL of 25% oral sucrose or sterile water 2 min before the procedure. The primary outcome was pain score change from baseline via the Neonatal Infant Pain Scale (NIPS). Secondary outcomes included changes in heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO₂). Measurements were taken at baseline, 1 min, and 3 min post-LP. RESULTS: The sucrose group showed significantly smaller changes in NIPS scores at 1 min (1.0 vs 5.0, p<0.001) and 3 min (0.0 vs 4.0, p<0.001), along with smaller HR increases (p=0.012) and SpO₂ decreases (p=0.023) at 1 min post-procedure. Clinically significant tachycardia (HR >160 bpm) occurred in 40% of controls vs 13.3% of sucrose-treated infants (p=0.045), and desaturation (SpO₂ <90%) in 26.7% of controls vs 6.7% of the sucrose group (p=0.038). CONCLUSION: A 2 mL dose of 25% oral sucrose administered 2 min prior to LP is a safe and effective intervention that significantly reduces behavioural and physiological markers of pain in term neonates during the immediate post-procedural period.
1 June 2026
Read appraisal →Medicine
Prevalence of GJB2 gene mutations in nonsyndromic hearing impairments: A systematic review and meta-analysis
BACKGROUND: Nonsyndromic hearing impairment (NSHI) is the most common type of inherited hearing loss. Mutations in GJB2, which encodes connexin 26, are a major cause worldwide, but their prevalence and variant distribution vary across populations. To systematically evaluate the global prevalence of GJB2 mutations and 5 hotspot variants (c.35delG, c.176_191del16, c.235delC, c.299_300delAT, and c.109G > A) in NSHI patients, and assess their diagnostic relevance. METHODS: A meta-analysis was conducted on studies published between January 2019 and June 2024 retrieved from PubMed, Scopus, Web of Science, and Cochrane Library. Only high-quality studies (Newcastle-Ottawa Scale ≥ 7) with molecular diagnostic data were included. Pooled prevalence, 95% confidence intervals, and heterogeneity (I2) were calculated. Subgroup and meta-regression analyses were performed according to geographic region. RESULTS: Fifty-one studies from 24 countries covering 18,968 patients with NSHI were included. The overall prevalence of GJB2 mutations was 25.9% (95% confidence intervals: 21.7-30.1%; I2 = 96%). The variant-specific rates included c.235delC (15.2%), c.35delG (12.0%), c.109G > A (7.6%), c.299_300delAT (3.1%), and c.176_191del16 (0.7%). The highest prevalence occurred in the Middle East (38.5%), whereas Africa had the lowest (11.1%). CONCLUSION: GJB2 mutations show marked geographic and ethnic variability in populations with NSHI. These findings support region-specific genetic screening to improve the early diagnosis, counseling, and targeted interventions for hereditary hearing loss.
31 May 2026
Read appraisal →Medicine
Burden of Helicobacter pylori infection in children and adults in Vietnam: A systematic review and meta-analysis of prevalence
BACKGROUND: Although Helicobacter pylori (H. pylori) prevalence has declined in many high-income countries, data from Vietnam remain limited and fragmented. This systematic review and meta-analysis aimed to estimate the pooled prevalence of H. pylori infection in Vietnamese adults and children. METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted for observational studies published between January 2000 and September 2025. Eligible studies reported H. pylori prevalence in Vietnamese populations using validated diagnostic methods. Random-effects meta-analyses were used to calculate pooled prevalence estimates with 95% confidence intervals (CIs). Subgroup analyses were conducted by age group, geographic area, and study setting. RESULTS: Twenty-five studies met inclusion criteria, comprising 8204 adults and 4641 children. The pooled prevalence of H. pylori infection was 58.7% (95% CI: 49.9%-67.2%) in adults and 77.2% (95% CI: 67.1%-86.0%) in children, with high heterogeneity across studies (I2 > 98%, P < .001). Among adults, prevalence was 56.4% in those aged <50 years and 65.8% in those ≥50 years (P = .455). Prevalence was lower in rural areas (46.8%) compared to urban areas (60.7%) (P = .045), with no significant difference between community- and hospital-based settings (P = .723). Funnel plot assessment did not indicate evident publication bias. CONCLUSION: H. pylori infection remains common in the populations represented in this study, particularly among urban and healthcare-seeking groups in Vietnam. These findings underscore the need for expanded surveillance and monitoring to better characterize H. pylori infection patterns and inform appropriate response strategies.
31 May 2026
Read appraisal →PloS one
Effect of digitizing Community Health Information System on the delivery and use of maternal and child health services: Propensity score matching analysis
INTRODUCTION: In 2018, Ethiopia's government digitized its Community Health Information System (eCHIS) to enhance Health Extension Program service delivery. However, the impact of eCHIS on health outcomes remains unclear. This study, therefore, examined the effects of eCHIS on the uptake of maternal and child health services. METHODS: A post-test-only, non-equivalent group household survey design was used, collecting data from July to August 2024 in rural communities with and without eCHIS. A stratified multistage sampling technique was employed to recruit respondents. A sample of 1,728 women of reproductive age (271 in eCHIS and 1,457 in non-eCHIS woredas), 1,118 women with children ages 0-11 months (188 in eCHIS and 930 in non-eCHIS), and 569 women with children ages 12-23 months (301 in eCHIS and 268 in non-eCHIS) were included in this study. Propensity scores were used to match intervention and comparison communities based on women's age, religion, parity, education, household wealth, distance to health facilities, and autonomy. A modified Poisson regression analysis, adjusting for covariates, was conducted to estimate the adjusted prevalence ratios (PR) for maternal and child health outcomes. RESULTS: Modern contraceptive use was 66% in intervention areas versus 56% in comparison areas. Institutional delivery rates were 95% in intervention and 79% in comparison areas. In intervention areas, 94% of children received the first dose of the Pentavalent vaccine compared to 83% in comparison areas, while 85% and 68%, respectively, received the third dose. Adjusted analyses showed that eCHIS intervention areas had statistically significant increases in contraceptive use (13.0 percentage points; PR: 1.25; p-value < 0.01) and institutional deliveries (8.9 percentage points; PR: 1.18; p-value < 0.01) compared to comparison areas. Similarly, the average treatment effect of eCHIS on Pentavalent 1, Pentavalent 3, and full vaccination coverage showed significant increases of 10.3 (PR: 1.13; p-value < 0.01), 13.6 (PR: 1.26; p-value < 0.01), and 14.6 (PR: 1.36; p-value < 0.01) percentage points, respectively. CONCLUSION: This study underscores the transformative potential of eCHIS in improving maternal and child health outcomes in Ethiopia. Sustained investment in digital health systems can help scale effective health care services to rural and underserved communities.
31 May 2026
Read appraisal →European journal of pediatrics
Effect of probiotics on allergic rhinitis in children; A systematic review and meta-analysis
BACKGROUND: Allergic rhinitis (AR) is a prevalent chronic inflammatory disorder in children, often undiagnosed and associated with reduced quality of life and risk of comorbidities such as asthma. Probiotics have been found to be potential modulators of immune responses in allergic conditions. This systematic review and meta-analysis evaluated the efficacy of probiotics compared with placebo in the management of pediatric AR. METHODS: Searches were conducted in accordance with a pre-registered protocol using MEDLINE (PubMed), the Web of Science, Scopus, and Embase through April 8, 2025. Randomized controlled trials (RCTs) of children aged < 18 years that compared probiotics, prebiotics, or synbiotics with a placebo were considered for inclusion. Outcomes of interest included clinical and laboratory parameters. Random-effects models with Hedges' g were used; heterogeneity was assessed via I2. RESULTS: Fourteen RCTs involving 1,739 children were included. Meta-analysis revealed a significant reduction in nasal symptom scores (SMD = -1.40; 95% CI: -2.26 to -0.54; I2 = 91.3%) and eye symptom scores (SMD = -3.59; 95% CI: -5.84 to -1.33; I2 = 94.3%). Quality of life (RQLQ) was also significantly improved (SMD = -2.98; 95% CI: -4.85 to -1.12; I2 = 95.7%). Among laboratory markers, a small but significant increase in serum eosinophils was observed (SMD = 0.29; 95% CI: 0.06 to 0.52; I2 = 0%). CONCLUSION: Probiotics were associated with improvements in nasal and ocular symptoms and quality of life in children with AR; however, these findings should be interpreted with caution due to substantial heterogeneity across studies. Probiotics may have a potential role as an adjunctive therapy, but further high-quality, standardized trials are needed. PROSPERO registration code: CRD420250654461 on 24 February 2025. What is Known • Probiotics have been investigated as adjunctive therapy for pediatric allergic rhinitis because of their potential immunomodulatory effects. • Previous studies and meta-analyses have reported inconsistent findings regarding the clinical and immunological effects of probiotics in allergic rhinitis. What is New •This meta-analysis demonstrated significant improvements in nasal symptoms, ocular symptoms, and quality of life in children with allergic rhinitis receiving probiotics versus placebo. • Probiotic supplementation showed no consistent beneficial effects on immunological markers, while substantial heterogeneity remained across studies.
30 May 2026
Read appraisal →Neurology
Vamorolone for Duchenne Muscular Dystrophy: A Cross-Trial Efficacy Comparison With Classic Corticosteroids From the FOR-DMD Trial
BACKGROUND AND OBJECTIVES: Vamorolone demonstrated similar efficacy for Duchenne muscular dystrophy (DMD) compared with prednisone in a 24-week exploratory analysis and may reduce key side effects compared with classic corticosteroids. In this study, we compare the efficacy and anthropometric effect of vamorolone 6 mg/kg/d with prednisone 0.75 mg/kg/d and deflazacort 0.9 mg/kg/d in steroid-naïve boys aged 4 to <7 years using data from 2 trials. METHODS: VISION-DMD was a phase 2b, 48-week randomized, double-blind trial assessing vamorolone 2 and 6 mg/kg/d vs placebo and prednisone 0.75 mg/kg/d to 24 weeks. Finding the Optimum Steroid Regimen for DMD (FOR-DMD) was a double-blind, parallel-group randomized trial comparing daily prednisone 0.75 mg/kg/d, daily deflazacort 0.9 mg/kg/d, and intermittent prednisone 0.75 mg/kg (10/10 days on/off). Entropy balancing generated weighted data for mixed model for repeated measures analyses that compared VISION-DMD vamorolone 6 mg/kg/d efficacy and anthropometric outcomes with FOR-DMD prednisone and deflazacort outcomes at 6 and 12 months. Inclusion criteria were boys with genetically confirmed DMD, age 4 to <7 years, ambulatory, and able to complete a time-to-stand (TTSTAND) assessment in <10 seconds at baseline. RESULTS: All interventions showed motor improvements relative to baseline at 6 and 12 months. Using the weighted cohorts and at 12 months, vamorolone 6 mg/kg/d (n = 28) had similar changes in TTSTAND velocity, the primary motor endpoint component in both trials, vs daily prednisone (n = 50) or deflazacort (n = 55; mean baseline age 5.42 years all groups), but with CIs overlapping minimal clinically important thresholds of 0.023 rises per second (TTSTAND velocity least squares mean [LSM] difference [95% CI]: vamorolone 6 mg/kg/d vs prednisone 0.75 mg/kg/d, 0.004 rises per second [-0.025 to 0.032] and vs deflazacort 0.9 mg/kg/d, 0.001 rises per second [-0.027 to 0.028]). Body mass index (BMI) Z-scores increased in all groups, greatest with vamorolone (12-month LSM difference [95% CI]: vamorolone vs prednisone 0.57 [0.24-0.90]; vamorolone vs deflazacort 0.29 [0.03-0.56]), whereas growth slowdown occurred in prednisone- and deflazacort-treated boys but not vamorolone (12-month LSM difference in height Z-scores [95% CI]: vamorolone vs prednisone 0.57 [0.24-0.90]; vamorolone vs deflazacort 0.72 [0.53-0.91]). DISCUSSION: Vamorolone demonstrated numerically similar TTSTAND velocity changes to prednisone and deflazacort at 1 year; however, interpretations of differences are limited by 95% CIs crossing minimally important difference thresholds. Further evidence of the growth-protective effect of vamorolone was observed; however, all treatments increased BMI. Vamorolone provides a linear growth-protective classic corticosteroid alternative. TRIAL REGISTRATION INFORMATION: NCT03439670; NCT01603407. CLASSIFICATION OF EVIDENCE: This Class III study did not definitively identify differences in efficacy between vamorolone and classic corticosteroids but found that vamorolone protects linear growth in boys with DMD.
30 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Comparison of safety and immunogenicity between high-dose and low-dose quadrivalent influenza vaccines in children aged 6-35 months in China: A randomized, double-blind clinical study
Influenza vaccines for children aged 6-35 months are typically low-dose (0.25 mL, 7.5 μg hemagglutinin per strain). However, studies have shown that high-dose influenza vaccines (0.5 mL, 15 μg hemagglutinin per strain) can enhance protective efficacy without increasing the risk of adverse reactions. We conducted a randomized, double-blind clinical study in children aged 6-35 months in China. A total of 3,000 participants were randomized (1:1:1) to receive two doses of either an investigational high-dose quadrivalent influenza vaccine (H-QIV), an investigational low-dose quadrivalent influenza vaccine (LQIV-01) or a commercially available low-dose quadrivalent influenza vaccine (LQIV-02). Hemagglutination inhibition (HI) antibody titers 30 d post-vaccination were measured and vaccine safety and tolerability within 6 months post-vaccination were evaluated in these participants. The primary objectives were to demonstrate the non-inferiority of investigational vaccines to the commercially available vaccine in immunogenicity and to compare the H-QIV to L-QIVs. Both investigational vaccines demonstrated non-inferiority, with their seroprotection rates (SPRs), seroconversion rates (SCRs) and geometric mean titers (GMTs) meeting immunogenicity criteria. The H-QIV exhibited >11-fold increases in GMTs against H1N1, H3N2, B/Yamagata and B/Victoria strains compared to pre-vaccination levels, with SPRs exceeding 95% and SCRs exceeding 89%. The H-QIV was superior to both L-QIVs as it induced a stronger immune response to influenza viruses. All vaccines showed comparable safety profiles. The H-QIV can provide greater protection and benefits to this high-risk population.
29 May 2026
Read appraisal →The New England journal of medicine
Decompression with or without Duraplasty for Chiari I and Syringomyelia
BACKGROUND: In children with Chiari type I malformation and syringomyelia, neurosurgical posterior fossa decompression (PFD) provides clinical improvement, but whether duraplasty (incising the dura and placing a dural graft) improves outcomes is unclear. METHODS: We conducted a multicenter, cluster-randomized, controlled trial of PFD with duraplasty (PFD-D) as compared with PFD alone. Persons 21 years of age or younger with cerebellar tonsillar ectopia of at least 5 mm and a maximum syrinx diameter of 3.0 to 9.9 mm were enrolled at 38 centers. Centers were cluster-randomized: all the participants within each center underwent the same intervention. The primary outcome was surgical complications within 6 months. Secondary outcomes were clinical improvement, syrinx reduction, and repeat decompression at 10 to 24 months and the change in overall health-related quality of life at 6 to 24 months. RESULTS: A total of 162 participants were included in the trial, of whom 78 were assigned to undergo PFD-D and 84 to undergo PFD alone. The percentage of participants with complications within 6 months was 14% with PFD-D and 6% with PFD (adjusted odds ratio, 2.59; 95% confidence interval [CI], 0.86 to 7.84; P = 0.11). At 24 months, the percentage of participants with clinical improvement was 58% with PFD-D and 46% with PFD; the mean (±SD) syrinx reduction was 3.08±2.33 mm and 1.22±1.79 mm, respectively; and the percentage of participants with repeat decompression was 3% and 14%. Changes in health-related quality of life were similar in the two groups. CONCLUSIONS: The percentage of participants with surgical complications did not differ significantly between those who underwent PFD-D and and those who underwent PFD alone. Larger trials are needed to determine the relative benefits and risks of these two procedures. (Funded by the Patient-Centered Outcomes Research Institute and others; ClinicalTrials.gov number, NCT02669836.).
29 May 2026
Read appraisal →Clinical and experimental dermatology
An open-label phase II study of bitopertin in adults and adolescents with erythropoietic protoporphyria or X-linked protoporphyria
BACKGROUND: Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are rare genetic disorders characterized by accumulation of protoporphyrin IX (PPIX), painful phototoxic reactions and hepatobiliary disease. No disease-modifying therapies are approved for these conditions. OBJECTIVES: To evaluate the safety and efficacy of bitopertin in adults and adolescents with EPP or XLP. METHODS: BEACON (ACTRN12622000799752) was a phase II, randomized, open-label, parallel-arm study in adult and adolescent participants with EPP or XLP. Participants received an oral, once-daily administration of bitopertin 20 mg or 60 mg for 24 weeks. RESULTS: Twenty-six participants were randomized to 20 mg (n = 14) or 60 mg (n = 12) of bitopertin. The study met its primary efficacy endpoint. Treatment with bitopertin resulted in significant, dose-dependent reductions in PPIX levels compared with baseline at both the 20-mg and 60-mg dose levels (mean -31.7%, SE 7.0; P < 0.001 vs. baseline and mean -57.7%, SE 7.4; P < 0.001 vs. baseline, respectively). Similar efficacy was observed across the adult and adolescent populations. No serious adverse events were reported. Dizziness was the most common adverse event reported with bitopertin, in 9 (64%) and 8 (67%) participants completing the study in the 20-mg and 60-mg dose groups, respectively. CONCLUSIONS: By reducing whole-blood PPIX levels, bitopertin targets the underlying pathophysiology of EPP, resulting in consistent improvements in multiple measures of light tolerance and quality of life. Bitopertin was well tolerated, and most adverse events were mild or moderate in severity.
27 May 2026
Read appraisal →Journal of perinatal medicine
Effect of preterm birth on neonatal, infant, child, young adult and adult mortality: a systematic review and meta-analysis
OBJECTIVES: Preterm birth is associated with a higher risk of mortality. In 2020, the global incidence of preterm births was reported at 9.9 per 100 live births. This meta-analysis was undertaken to evaluate the effect of preterm birth on mortality among various age groups. METHODS: A thorough search was done on four electronic databases: "PubMed, Scopus, Web of Science, and Embase". Adhering to PRISMA 2020 guidelines, observational analytical studies published till 4th December 2024 were included. Screening of the studies was done by two independent reviewers in two stages: title/abstract, followed by full text review of the advanced articles. It was followed by data extraction. Study quality was assessed with the Newcastle Ottawa Scale. Meta-analysis using a random-effects model was done in R Studio. PROSPERO ID: CRD42024622282. RESULTS: Database search yielded 1775 unique studies. 23 studies met the final predefined eligibility criteria. Preterm babies showed an increased risk of mortality compared to term babies with a pooled relative risk of 6.12 (95 % CI: 3.16-11.84) for neonatal mortality, 11.84 (95 % CI: 6.88-20.37) for infant mortality and 1.88 (95 % CI: 1.24-2.83) for 1-5 year. However, it was similar in adult mortality with a pooled relative risk of 1.21 (95 % CI: 0.07-20.12). CONCLUSIONS: Preterm birth is strongly associated with increased risks of childhood mortality, especially in extreme and very preterm infants, but the risk persists even for late preterms.
27 May 2026
Read appraisal →Journal of perinatal medicine
Early kangaroo care in preterm ≤32 weeks and very low birth weight infants: a systematic review and meta-analysis
OBJECTIVES: Kangaroo care (KC), involving skin-to-skin contact, early breastfeeding and early discharge, demonstrated benefits in improving outcomes for preterm and low birth weight infants. This systematic review and meta-analysis aimed to evaluate the effectiveness of early KC (initiated within the first 24 h) vs. conventional neonatal care in very preterm infants (≤32 weeks) and/or very low birth weight (VLBW) infants (<1,500 g). METHODS: A comprehensive search of MEDLINE, SCOPUS, Web of Science, and CENTRAL databases was conducted. Randomized controlled trials (RCTs) comparing early KC to conventional care in very preterm and/or VLBW infants were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted using R, with relative risks (RR) and 95 % confidence intervals (CI) calculated. RESULTS: Four RCTs, encompassing 1,679 newborns, were included. Meta-analysis revealed a significant reduction in mortality risk (RR=0.81, 95 % CI: 0.67-0.98) with early KC. The pooled RR for infection risk was 0.89 (95 % CI: 0.77-1.02). The impact on hypothermia was mixed, with moderate heterogeneity observed. CONCLUSIONS: Early KC may reduce mortality and morbidity in very preterm and VLBW infants although its effects on hypothermia vary by severity. Further studies are required to assess its effects on infants weighing <1,000 g or born before 28 weeks of gestation.
26 May 2026
Read appraisal →European journal of pediatrics
Gut microbiota-modulating interventions in paediatric type 1 diabetes: a systematic review and meta-analysis
To evaluate the efficacy and safety of gut microbiota-modulating interventions in children and adolescents with type 1 diabetes. A systematic review and meta-analysis was conducted according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, and CENTRAL were searched from inception to 28 February 2026 for randomised controlled trials of oral probiotics, prebiotics, or synbiotics in participants aged ≤ 19 years with type 1 diabetes. Primary outcomes were glycated haemoglobin, fasting blood glucose, total daily insulin dose, and C-peptide. Immune-inflammatory, microbiota-related, intestinal permeability, and safety outcomes were narratively synthesised. Twelve randomised controlled trials involving 808 paediatric participants were included. Interventions varied in formulation, dose, and duration. Pooled analyses showed significant reductions in glycated haemoglobin and fasting blood glucose, whereas no significant effects were found for total daily insulin dose or C-peptide. Immune-inflammatory, microbiota-related, and intestinal permeability outcomes suggested possible benefits, but reporting was inconsistent and quantitative pooling was not feasible. Overall, the evidence was limited by substantial clinical and methodological heterogeneity. Conclusion: Gut microbiota-modulating interventions may improve glycaemic control in children and adolescents with type 1 diabetes, particularly glycated haemoglobin and fasting blood glucose. However, current evidence is insufficient to support any specific formulation, dose, or duration, and larger well-designed paediatric trials are still needed. What is Known: • Gut microbiota-modulating interventions are biologically plausible adjunctive strategies in paediatric type 1 diabetes. • Earlier paediatric reviews included few randomised trials and reported inconsistent glycaemic findings. What is New: • This updated review included 12 randomised controlled trials involving 808 children and adolescents. • It adds a structured synthesis of immune-inflammatory, microbiota/barrier, metabolite-related and safety outcomes beyond glycaemic endpoints.
26 May 2026
Read appraisal →Medicine
Effect of a sports-medicine-guided football program on physical fitness in adolescents: A controlled school-based trial
Integrating artificial intelligence (AI) with sports medicine principles into school-based physical education may enhance physical fitness and reduce injury risk among adolescents. This study aimed to evaluate whether a 10-week sports-medicine-guided football curriculum augmented with explainable machine-learning feedback produces greater improvements in physical fitness and injury-prevention outcomes than a standard physical-education curriculum. A total of 195 healthy junior high school students (mean age 14.1 ± 0.7 years) participated in a controlled school-based intervention and were allocated to either an AI-supported sports-medicine curriculum (intervention) or a standard curriculum (control). Physical fitness outcomes, including lung capacity, estimated maximal oxygen uptake (VO2max), sprint performance, standing long jump, and middle-distance running performance (800 m girls/1000 m boys), were assessed before and after the 10-week program. Outcomes were analyzed using 2-way mixed analysis of variance to test Group × Time interactions. Injury risk prediction was supported by an explainable machine-learning ensemble model (CatBoost + Gradient Boosting) interpreted using SHAPley Additive explanations. Significant Group × Time interactions were observed for lung capacity (P < .01) and VO2max (P < .01), indicating greater improvements in the intervention group compared with controls. The intervention group also demonstrated superior improvements in sprint performance, middle-distance running, and lower-limb power (P < .05), while no significant between-group differences were observed for upper-body strength (P > .05). A school-based football curriculum integrating sports-medicine principles with explainable AI-driven feedback leads to significantly greater improvements in key physical-fitness outcomes than a standard physical-education curriculum. This approach directly supports individualized training adaptation and injury-risk awareness, offering a scalable model for enhancing adolescent health and safety in school physical education.
25 May 2026
Read appraisal →BMC psychology
Single-exposure messages for child sexual abuse prevention: a randomized controlled online trial testing educational and humanizing approaches
BACKGROUND: Child sexual abuse and exploitation, including online material depicting such acts, constitute a major public health concern. Prevention efforts likely benefit from public understanding and destigmatization, yet communication strategies on this topic face persistent misconceptions and strong emotional reactions. This randomized controlled online study examined whether brief educational and humanizing communication interventions influenced knowledge, attitudes, and behavioral intentions related to prevention, while avoiding adverse emotional or ethical effects. METHODS: A total of 2,019 adults from Spain and Portugal were recruited via an online panel and randomly assigned to one of four conditions: an educational message, a humanizing message with empathy focus, a humanizing message with prevention focus, or a neutral control message. Each intervention consisted of a short video and accompanying text presented as part of a health information campaign. Measures included affective state, stigma-related attitudes, literacy about therapeutic options, openness toward the topic, and behavioral intention to seek information. RESULTS: Exposure to any intervention message led to short-term changes in affective responses, with lower positive valence and slightly higher arousal compared to the control group (medium effect for valence, small for arousal). No significant differences emerged for stigma dimensions, knowledge, openness, or behavioral intentions. All three intervention formats performed similarly. The study did not identify measurable short-term adverse or rebound effects on stigma. Dropout rates did not differ across conditions, but languages. CONCLUSIONS: Brief communication interventions elicited short-term affective responses without evidence of increased stigma or avoidance on the measured outcomes. While the present single exposures appear insufficient to change attitudes or behavior, such formats may serve as a foundation for repeated, multi-channel prevention messaging integrated into broader educational efforts. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00038927, retrospectively registered on 09/01/2026.
25 May 2026
Read appraisal →BMJ paediatrics open
Enhancing parental health knowledge through digital knowledge mobilisation tools: a randomised controlled trial and qualitative study
OBJECTIVE: To assess the effectiveness of blogshots (ie, image-based digital knowledge mobilisation tools) to increase knowledge and manage expectations with respect to six Choosing Wisely Canada (CWC) recommendations about common childhood conditions. DESIGN: Multimethod study including a non-pharmacological randomised controlled trial and qualitative interviews. SETTING: Online questionnaires and semistructured interviews across Canada. PARTICIPANTS: Parents or legal guardians of children under 5 years. INTERVENTION: Participants were randomly allocated to receive one of two sets of blogshots whereby a blogshot on a new CWC topic was delivered weekly over 3 weeks (Group A: pharyngitis (diagnosis), common cold, asthma; Group B: pharyngitis (treatment), bronchiolitis, otitis media). Study investigators were blinded to participant allocation. Baseline and follow-up (week 5, month 3, month 6) questionnaires were administered. Qualitative interviews contextualised intervention data. MAIN OUTCOME MEASURES: The primary outcome was change in knowledge. Secondary outcomes were change in expectations, intentions, actions over time and usability of the blogshots. RESULTS: 167 participants (n=133 (80%) mothers) were included in the final analysis (group A, n=85; group B, n=82). Baseline knowledge scores did not differ between groups. At follow-up 1, those who received the blogshot for a given topic scored significantly higher (p<0.001, d=0.30) on knowledge questionnaires, compared with those that did not. No differences were observed in knowledge scores between groups at follow-up 2 and 3. Participants expressed intentions to use the blogshots (eg, share with friends, physicians), as well as actions (eg, wait/watch approach vs seek healthcare) to manage their child's condition. Qualitative data (n=13 interviews) showed that blogshots are aesthetically pleasing and contain easy to read and understandable information. CONCLUSIONS: Blogshots can be an effective tool to disseminate child health information to parents. Due to the online dissemination, this approach could be scaled to a broader international level and applied to different health topics that are relevant across the world. TRIAL REGISTRATION NUMBER: NCT06005337.
24 May 2026
Read appraisal →Studies in health technology and informatics
Hybrid AI Decision Support in Healthcare: Insights into Usability and Trust
Decision Support Systems (DSS) increasingly integrate Artificial Intelligence (AI) to enhance clinical reasoning, yet adoption depends on professionals' trust and usability. This study explored how hybrid AI decision support, combining rule-based guideline logic with generative reasoning, can be designed and evaluated in practice. Using a human-centred design approach within preventive child healthcare, a prototype integrating Large Language Models (LLMs) into an existing guideline-based DSS was developed and tested. Usability and trust were evaluated with nine healthcare professionals through task observations, usability scales, and interviews. The system showed good usability and moderate trust; highest scores were for traceability, workflow integration, and autonomy, while confidence indicators and contextual reasoning needed improvement. The study demonstrates the feasibility and acceptability of hybrid AI DSS in child healthcare and provides initial design requirements for usable, trustworthy, and human-centred AI integration across clinical domains.
24 May 2026
Read appraisal →European journal of pediatrics
Application of machine learning to predict bronchiolitis severity in children: a single-centre retrospective cohort study
UNLABELLED: Several severity scores have been developed to assess disease severity in infants with bronchiolitis, but they often lack objectivity and may not reliably reflect clinical outcomes. We performed a single-centre retrospective cohort study including infants younger than 12 months admitted with a clinical diagnosis of bronchiolitis over three epidemic seasons (2021-2024). Cluster analysis was applied to identify groups of infants with similar clinical patterns, which were subsequently mapped to severity levels. A machine learning (ML) model was then trained to predict these severity levels using anamnestic and clinical variables available at admission. For comparison, the bronchiolitis risk of admission score (BRAS) and the respiratory severity score-heart rate (RSS-HR) were also calculated at admission. A total of 112 infants were included, and three severity levels were identified. Mild bronchiolitis corresponded to infants not requiring NICU admission or supplementary ventilation. Moderate cases involved infants needing supplementary ventilation without NICU admission. Severe bronchiolitis was associated with both NICU admission and supplementary ventilation. BRAS showed only a weak association with the newly defined clinical severity score (τ = 0.354, p < 0.001), while RSS-HR showed no significant correlation. In contrast, the ML model demonstrated strong predictive performance (τ = 0.731, p < 0.001 in the test set). A simplified decision tree based on three admission variables-age, retractions, and oxygen saturation-also showed good predictive ability (τ = 0.654, p < 0.001). CONCLUSIONS: A new dynamic approach for assessing bronchiolitis severity at hospital admission, capable of robust and adaptable prediction across clinical settings, has been elaborated. WHAT IS KNOWN: • Several bronchiolitis severity scores exist, but many lack validation, are subjective, and have limited applicability across settings, making early and accurate severity prediction difficult. WHAT IS NEW: • Our study introduces a three-level, outcome-based severity score and a dynamic ML tool, plus a simplified ARS decision tree, all outperforming conventional scores in predicting severity at admission.
23 May 2026
Read appraisal →BMJ paediatrics open
Enhancing respiratory virus surveillance among hospitalised children: a machine learning-based predictive model.
BACKGROUND: Viral respiratory tract infections (vRTIs) are a leading cause of paediatric hospitalisation and healthcare utilisation. Existing syndromic surveillance tools, including the WHO Severe Acute Respiratory Infection definition, demonstrate limited diagnostic accuracy in children whose symptom profiles vary widely. This study aimed to develop a machine learning (ML) model to predict microbiologically confirmed vRTIs in hospitalised children and to evaluate performance across age groups and viral pathogens. METHODS: We conducted a retrospective cross-sectional study of 2050 paediatric patients (<18 years) admitted with acute respiratory infections to two tertiary paediatric hospitals in Canada. Predictors included age, sex, hospital transfer status, chronic comorbidity status and 22 presenting symptoms. The primary outcome was microbiologically confirmed vRTI, determined by multiplex PCR or rapid antigen testing. Six ML algorithms were trained and the best-performing model, identified by area under the receiver operating characteristic curve (auROC), was tested on age subgroups, viral pathogens and sites. RESULTS: Among 2050 patients (median (IQR) age 2.4 (0.8-5.2) years), 1831 (89.3%) tested positive, most commonly for respiratory syncytial virus (RSV) (38.7%) and enterovirus/rhinovirus (32.8%). Logistic regression with L2 regularisation demonstrated the best performance (auROC, 0.754; 95% CI 0.697 to 0.808; sensitivity, 69.2%; specificity, 69.9%), with greatest performance among children <1 year (auROC, 0.763) and RSV cases (auROC, 0.727). CONCLUSIONS: An ML-based logistic regression model using admission data accurately predicted paediatric vRTIs, outperforming traditional syndromic surveillance definitions, especially among infants <1 year. By integrating ML models into hospital electronic medical records, healthcare systems can achieve enhanced respiratory virus surveillance, faster outbreak detection, greater diagnostic efficiency and improved pandemic preparedness.
23 May 2026
Read appraisal →The Journal of dermatological treatment
Sustained on/off-treatment disease control with abrocitinib for moderate-to-severe atopic dermatitis.
PURPOSE: Achieving sustained on- and off-treatment disease control is an important therapeutic goal in atopic dermatitis (AD). This study evaluated achievement of off-treatment disease control in patients randomized to placebo following 12 weeks of abrocitinib 200 mg. MATERIALS AND METHODS: In the phase 3 JADE REGIMEN study, patients with moderate-to-severe AD who achieved Investigator's Global Assessment (IGA) of 0/1 (with ≥2 grades of improvement) and ≥75% improvement in Eczema Area and Severity Index (EASI) after 12 weeks of abrocitinib 200 mg were randomized (1:1:1) to placebo, abrocitinib 100 mg, or abrocitinib 200 mg for 40 weeks. This post-hoc analysis evaluated patients by flare status (protocol flare definition: ≥50% loss of initial EASI post-randomization response and IGA score ≥2). EASI, IGA, Peak Pruritus Numerical Rating Scale (PP-NRS), and Dermatology Life Quality Index (DLQI) were evaluated. RESULTS: There were no off-treatment flares in 21.3% of patients in the placebo arm. The no-flare group had EASI, IGA, PP-NRS, and DLQI mean scores indicating clear/mild AD at week 52 (2.9, 1.0, 2.6, and 3.5, respectively). CONCLUSIONS: After 12 weeks of abrocitinib 200 mg, some patients achieved 40 weeks of sustained off-treatment disease control, with assessments demonstrating clear/mild AD, suggesting attainment of disease remission. TRIAL REGISTRATION: NCT03627767.
22 May 2026
Read appraisal →Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Evaluating Personal and Environmental Decolonization Strategies for Children With Skin and Soft Tissue Infection and Their Households - A Randomized Clinical Trial
BACKGROUND: Staphylococcus aureus colonization predisposes to skin and soft tissue infection (SSTI). Given the waning effectiveness of decolonization, we evaluated periodic-personal decolonization and household environmental decontamination to reduce SSTIs among households affected by S. aureus. METHODS: Households of children with community-associated S. aureus SSTI participated in an open-label randomized trial. After baseline decolonization, households were randomized 1:1:1 to a 3-month decolonization intervention: (1) periodic-personal (twice weekly chlorhexidine bathing and monthly intranasal mupirocin application); (2) environmental-hygiene (weekly household surface disinfection and enhanced laundry measures); or (3) integrated-approach of both periodic-personal and environmental-hygiene. Over 9 months, participants and household surfaces were sampled at 5 study visits to detect S. aureus; SSTI incidence was recorded. The primary outcome was household-level cumulative SSTI at 3 months, comparing the integrated-approach to the combined personal-periodic and environmental-hygiene groups. RESULTS: Between 2015 and 2021, 196 index patients and their household contacts (n = 623) were enrolled. Cumulative SSTI incidence did not differ between groups during the 3-month intervention. In index patients and household contacts with SSTI in the year prior to enrollment, SSTI incidence was lower among the integrated-approach at 6- and 9-months compared to the combined periodic-personal and environmental-hygiene groups. In multivariable analyses, prior year SSTI was associated with subsequent SSTI; intervention group was not significant. All interventions reduced methicillin-resistant S. aureus, but not methicillin-susceptible S. aureus, personal colonization over 9 months. CONCLUSIONS: While an integrated-approach of prolonged personal and environmental decolonization reduced SSTIs among participants with prior year SSTI, prior SSTI strongly predicted SSTI incidence longitudinally. Novel prevention strategies are needed.
22 May 2026
Read appraisal →BMC public health
Little All Children in Focus (Little ACF) - evaluation of a parenting support programme for parents of children aged 1-2 years in Sweden: a randomised controlled trial
INTRODUCTION: The first two years of life affect health over the life course. Universal parenting support programmes may promote child health during these years but there is a lack of such evidence-based programmes. Our aim was to study the direct effects of a structured 4 sessions universal parenting programme for parents with children 1-2 years old, Little All Children in Focus, in Sweden. METHODS: A two-arm parallel randomised controlled superiority trial with 832 Swedish-speaking parents was conducted to evaluate the effectiveness of the Little All Children In Focus programme in comparison with an active control receiving four digital lectures on child development and parenthood. The participants completed questionnaires at baseline and post intervention measuring the primary outcomes: parenting self-efficacy and stress, coparenting quality, emotion regulation for parents and emotion regulation strategies for their children, and secondary outcome: child socioemotional development. A third research question concerned whether the intervention could engage and retain parents in groups. An intention-to-treat approach was applied using linear mixed models for analysing the effectiveness of the programme. RESULTS: Parents who participated in the programme demonstrated greater improvements in supportive emotion regulation strategies compared to the active control (β = 3.0, CI = 0.9 - 5.0), while no notable group differences emerged across the remaining outcome measures. The program demonstrated high levels of parental engagement and retention in group settings. CONCLUSIONS: Little All Children in Focus demonstrates potential in promoting supportive parenting emotion regulation strategies among Swedish speaking parents to 1-2-year-olds. The intervention also seems to have potential to engage parents. However, further evaluations must be conducted to provide a deeper understanding of the long-term impact of this universal parenting support programme. TRIAL REGISTRATION: The study protocol https://rdcu.be/eAxn2 was published at www. CLINICALTRIALS: gov with registration number: NCT05445141 (registered on July 06, 2022).
21 May 2026
Read appraisal →The British journal of dermatology
Efficacy and safety of stapokibart in adolescents with moderate-to-severe atopic dermatitis: a multicentre randomized double-blind placebo-controlled phase III trial
BACKGROUND: Moderate-to-severe atopic dermatitis (AD) imposes a significant burden on adolescents and their families, leading to a substantial reduction in quality of life. Treatment options remain limited. Stapokibart, a novel humanized monoclonal antibody that targets interleukin-4Rα, has been approved in China for the treatment of adults with moderate-to-severe AD. OBJECTIVES: To evaluate the efficacy and safety of stapokibart in adolescents with moderate-to-severe AD. METHODS: In this randomized double-blind placebo-controlled phase III trial (NCT06277765), eligible patients were randomized (2 : 1) to stapokibart 300 mg (loading dose 600 mg) or placebo for 18 weeks. Patients with a baseline weight ≥ 60 kg received subcutaneous stapokibart or placebo every 2 weeks (Q2W), while those weighing 30 to < 60 kg received treatment every 3 weeks (Q3W). All patients were given moisturizers during the entire study period. Co-primary endpoints were the proportions of patients achieving a ≥ 75% improvement from baseline in Eczema Area and Severity Index (EASI 75) and an Investigator's Global Assessment (IGA) score of clear or almost clear (IGA 0 or 1) with ≥ 2-point reduction from baseline (IGA response) at week 18. Safety was also assessed. RESULTS: Of the 180 enrolled patients, 120 received stapokibart (Q2W, n = 54; Q3W, n = 66) and 60 received placebo (Q2W, n = 26; Q3W, n = 34). In total, 178 (98.9%) patients completed the double-blind treatment. At week 18, higher proportions of patients treated with stapokibart than those treated with placebo achieved EASI 75 [73.9% (n = 88/119) vs. 43% (n = 26/60); difference: 30.5% (95% confidence interval 15.3-44.3; P < 0.001)] and an IGA response [57.1% (n = 68/119) vs. 25% (n = 15/60); difference: 31.8% (95% confidence interval 16.6-44.4; P < 0.001)]. The proportion of patients achieving ≥ 4-point reductions in weekly average of daily Peak Pruritus Numerical Rating Scale score was also significantly higher in the stapokibart group than in the placebo group [36.1% (n = 43/119) vs. 15% (n = 9/60); difference: 21.1% (95% confidence interval 7.4-32.4; P = 0.004)]. The incidence of adverse events was similar between the stapokibart (62.5%; n = 75/120) and placebo (62%; n = 37/60) groups. No conjunctivitis was seen. CONCLUSIONS: Stapokibart has a high efficacy and favourable safety in adolescents with moderate-to-severe AD. An author video to accompany this article is available online. Atopic dermatitis is a long-term skin condition. It causes intense itching and painful patches of dry skin. It is more commonly known as eczema. Adolescents with moderate or severe eczema often need long-term treatment to control the symptoms. In China, a drug called ‘stapokibart’ has recently been approved to treat adults with moderate or severe eczema. This study was done in 32 hospitals in China. We included adolescents with moderate or severe eczema. We treated them with stapokibart or placebo (an inactive or ‘dummy’ medication) for 18 weeks. The patients received their treatment via an injection under their skin. Depending on their weight at the start of the study, patients received treatment every 2 or every 3 weeks. After 18 weeks, patients treated with stapokibart were less itchy and had more of an improvement in their skin than those treated with the placebo. Over half of the patients achieved clear (or almost clear) skin. Finally, we found that stapokibart was safe to take. Undesired results from taking the medication (called ‘adverse events’) were mild or moderate. Our results suggest that stapokibart is an effective and safe treatment option for adolescents with moderate or severe eczema.
20 May 2026
Read appraisal →The British journal of dermatology
Burden and risk of asthma and rhinitis in people with atopic dermatitis: global estimates from a hierarchical Bayesian model
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with asthma and rhinitis. However, epidemiological evidence on these comorbidities remains fragmented and is largely limited to high-income countries. OBJECTIVES: To provide comprehensive global, regional and country-level estimates of the prevalence and odds ratios (ORs) of asthma, rhinitis and their subtypes among individuals with AD. METHODS: We systematically reviewed 278 studies retrieved from PubMed, Embase, Web of Science and CNKI (China National Knowledge Infrastructure). Standardized prevalence estimates and ORs were derived using a Bayesian hierarchical linear mixed-effects model. RESULTS: Among individuals with AD, the global prevalence estimate of asthma, rhinitis, allergic rhinitis, rhinoconjunctivitis, and coexisting asthma and rhinitis was 20.1% (ranging from 2.5% in Israel to 59.4% in India), 45.1% (ranging from 7.8% in Israel to 82.7% in India), 41.4% (ranging from 6.8% in Israel to 80.3% in India), 30.7% (ranging from 4.3% in Israel to 71.9% in India) and 10.4% (ranging from 1.1% in Israel to 40.8% in India), respectively. Estimates were higher when restricted to patients with AD diagnosed by dermatologists or physicians. The highest comorbid prevalence rates were found for India, Cuba, Finland and Puerto Rico. Compared with healthy control individuals, AD was associated with higher odds of asthma (OR 2.73; ranging from 1.59 in China to 6.64 in Ethiopia), rhinitis (OR 2.98; ranging from 1.73 in China to 7.23 in Ethiopia), allergic rhinitis (OR 2.42; ranging from 1.41 in China to 5.89 in Ethiopia), rhinoconjunctivitis (OR 4.21; ranging from 2.45 in China to 10.19 in Ethiopia), and coexisting asthma and rhinitis (OR 2.42; ranging from 1.41 in China to 5.89 in Ethiopia). CONCLUSIONS: This study provides the first globally standardized estimates of respiratory comorbidities in AD, and can inform clinical practice and public health policy. Atopic dermatitis is a common long-term inflammatory skin disease. It is also called eczema. It affects more than 200 million children and adults worldwide. People with the disease often have other conditions, particularly asthma and rhinitis. Asthma affects breathing and rhinitis causes sneezing or congestion. Most studies on these conditions have been in wealthy countries. They have also used a range of different research methods. This makes it difficult to compare and understand the global situation. In this study, researchers in China and the USA analysed data from 278 studies from around the world. We estimated how common asthma and rhinitis are in people with eczema in different regions and countries. We found that about 1 in 5 people with eczema have asthma and almost half have rhinitis. We also found that people with eczema are 2 to 4 times more likely to have these conditions than people without eczema. Some countries showed particularly high rates of these conditions. Our findings suggest that asthma and rhinitis are common problems for people with eczema. This is true no matter where they live. The information from this study may help doctors recognize and manage these conditions in people with eczema. These findings could also support future research to improve disease prevention and patient care.
20 May 2026
Read appraisal →Archives of disease in childhood
Effects of metformin on anthropometric indices and hormones and adipocytokine concentrations in children with overweight or obesity: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: The aim of this systematic review was to assess the effect of metformin on anthropometric indices, hormones and adipocytokine concentrations in children with overweight or obesity. METHODS: Eligible studies were searched via PubMed, Scopus, Cochrane Central Register of Controlled Trials, alongside clinical trial registries and the reference lists of included studies, from inception to October 2024. Screening was carried out independently by two reviewers, involving title-abstract screening for relevance, followed by full-text review for eligibility confirmation. Data extraction was performed by two independent investigators using an identical Excel spreadsheet. A meta-analysis was conducted using the random-effects model. RESULTS: A total of 19 original studies were deemed eligible for this systematic review. Metformin was more effective than placebo in improving Body Mass Index (BMI), BMI-Z score, body weight, fasting insulin and leptin concentrations (mean difference (MD) -1.07 kg/m2, 95% CI -1.62 to -0.52; MD -0.09, 95% CI -0.13 to -0.05; MD -3.20 kg, 95% CI -4.21 to -2.19; MD -3.38 μU/mL, 95% CI -6.00 to -0.75; MD -3.73 ng/mL, 95% CI -6.28 to -1.18, respectively). There was no difference between metformin and placebo on adiponectin and resistin concentrations, as well as adiponectin to leptin ratio. CONCLUSION: Metformin may have a role as an adjuvant therapy in managing overweight and obesity among the paediatric population. Regarding the concentrations of adipokines and hormones, the results are inconclusive. More randomised controlled trials with rigorous methodology and homogeneity in population and intervention characteristics are needed to shed light on this topic. TRIAL REGISTRATION NUMBER: PROSPERO CRD42023401732.
20 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Coverage and determinants of childhood immunization in Somalia: A systematic review and meta-analysis
Childhood immunization is a cost-effective public health intervention, yet coverage remains suboptimal in Somalia. This systematic review and meta-analysis aimed to pool childhood immunization coverage and its determinants in Somalia. The electronic database search strategy yielded 11 eligible cross-sectional studies conducted between 2010 and 2025. Using Comprehensive Meta-Analysis Version 5 (Biostat, Englewood, NJ, USA), the pooled coverage for receiving at least one vaccine was 57.9%, while completion of the four basic vaccines was 16.1%, Full immunization coverage was 42.2%. Children born in health facilities were more likely to be immunized than home births (AOR = 2.10; 95% CI: 1.87-2.35). Unexpectedly, mothers with ≥4 ANC visits had lower odds of child immunization (AOR = 0.27; 95% CI: 0.24-0.30). Maternal education increased immunization likelihood (AOR = 1.14; 95% CI: 1.09-1.20). Children in rural areas were likely to be immunized than urban counterparts (AOR = 1.55; 95% CI: 1.49-1.61). These findings highlight the urgent need to strengthen integrated maternal and child health services.
19 May 2026
Read appraisal →Gut and liver
Global Prevalence of Functional Abdominal Pain Disorder among Children and Adolescents According to the Rome III and IV Criteria: A Systematic Review and Meta-Analysis
BACKGROUND/AIMS: Despite the global burden of functional abdominal pain disorder (FAPD) and its four subtypes (irritable bowel syndrome [IBS], functional dyspepsia [FD], abdominal migraine [AM], and functional abdominal pain not otherwise specified [FAP-NOS]), studies involving an estimation of FAPD prevalence based on the Rome III or IV criteria are limited. Therefore, we aimed to estimate the prevalence of FAPD and its four subtypes. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Google Scholar, and the Cochrane Library. Studies that were performed with the general population and applied Rome III or IV diagnostic criteria were included. Data were extracted to estimate the prevalence of FAPD using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. The study protocol was preregistered with PROSPERO (CRD420251004116). RESULTS: The overall prevalence of FAPD was 10.89% (95% CI, 9.51% to 12.48%), with pooled prevalence rates of 11.84% (10.29% to 13.61%) with the Rome III criteria and 8.42% (6.10% to 11.62%) with the Rome IV criteria. With the Rome III criteria, IBS had the highest prevalence, while FD had the lowest. In contrast, with the Rome IV criteria, the prevalence of IBS, AM, and FAP-NOS decreased, whereas FD became the most prevalent, affecting approximately one in 23 individuals, compared to one in 51 individuals affected by IBS, one in 68 individuals affected by AM, and one in 115 individuals affected by FAP-NOS. Additionally, females exhibited higher prevalence rates of FAPD and all its subtypes than males. CONCLUSIONS: The diagnostic criteria of Rome IV are stricter than those of Rome III, which likely affects the estimated prevalence of FAPD and its subtypes.
18 May 2026
Read appraisal →European journal of pediatrics
Prevalence of common respiratory viruses of infants with respiratory tract infections in European countries in the past decade: a systematic review and meta-analysis comparing between the pre-COVID-19, pandemic, and post-COVID-19 periods
UNLABELLED: The purpose of this study is. to determine the leading cause of respiratory tract infections over the decade; this review examined the proportions of airway viruses in infants with respiratory tract infections in Europe before, during, and after the COVID-19 pandemic. The protocol for this systematic review was registered in the PROSPERO database (CRD42024497097). Literature searches in PubMed, Embase, Scopus, and Web of Science (WoS) identified 20,453 studies reporting respiratory viral testing in Europe over the past decade (2012/13-2022/23). Eligible studies were English-language full-text or grey articles with low risk of bias and complete data, and reports that explicitly provided the number of positive airway virus cases (n, virus) and the total infant population (N). Risk of bias was assessed using the Hoy et al. scoring system. Pooled prevalence estimates (pooled proportion [95% CI]) were calculated for pre-, during-, and post-COVID-19 periods using proportional meta-analysis with the MetaProp package in R. Fifty studies before, ten studies during, and 18 studies after the COVID-19 pandemic were eligible for proportional meta-analyses of viral testing in infants. Before the pandemic, the predominant viruses in infants with respiratory infections were Respiratory Syncytial Virus (RSV) (0.48 [0.41-0.56]), Human rhinovirus (HRV) (0.24 [0.18-0.29]), and Influenza virus (IV) (0.08 [0.04-0.12]). Post-pandemic, the leading viruses were RSV (0.63 [0.51-0.75]), HRV (0.25 [0.11-0.40]), and IV (0.10 [0.00-0.20]) again. CONCLUSIONS: RSV and HRV remained the two most identified viruses in infants with respiratory infections, pre- and post-COVID-19 pandemic. Interestingly, both RSV and IV were suppressed during the pandemic. The trajectory dynamics of respiratory viruses were divergent, with resilient viruses (RSV, HRV, and IV) regaining dominance more rapidly than persistently suppressed viruses. WHAT IS KNOWN: • The COVID-19 pandemic induced an infection precautions policy, which reduced the spread of respiratory infectious diseases. • Respiratory Syncytial Virus (RSV) was estimated as one of the most common causes of respiratory infections in infants. Still, there are no reports summarising the geographical distributions of the various viral agents of infant respiratory diseases. WHAT IS NEW: • This meta-analysis shows that the prevalence of RSV and HRV infections in infants remains high in Europe following the COVID-19 pandemic and the associated precautionary policy. Furthermore, RSV proportionally experienced a marked reduction during COVID-19 pandemic (lockdown periods). However, the immunological debt may have led to a re-emergence in RSV positivity after the lockdown periods. • Our proportional meta-analysis indicates the heterogeneous post-pandemic recovery patterns of each respiratory virus commonly identified in infants, where HRV was shown to be resilient whilst RSV was rapidly rebound.
18 May 2026
Read appraisal →Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
Injuries from falling out of bed in infants under 1 year of age: a systematic review
CONTEXT: Falls from beds are a leading cause of unintentional injuries in infants under 1 year of age. While most cases result in mild outcomes, the potential for severe injuries, such as skull fractures or intracranial haemorrhages, exists. Despite the prevalence of these incidents, no systematic review has focused specifically on injuries from bed falls in this specific age. OBJECTIVE: To evaluate the risk and severity of injuries caused by falls from beds in infants under 1 year of age through a systematic review. DATA SOURCES: We searched in PubMed, Embase, Cochrane Library and Lilacs Scielo for studies published between 1984 and December 2024. STUDY SELECTION: We included observational studies that reported injuries from falls from beds in infants under 1 year. DATA EXTRACTION: We extracted the relevant data from the included study details, recruitment setting, study design, sample size and outcome measures. We conducted a quality assessment using the Newcastle-Ottawa Scale. RESULTS: Out of 297 initially identified studies, three met inclusion criteria, comprising a total of 2034 infants under 1 year of age. Most falls resulted in minor or no injuries. Warrington et al reported <1% of cases leading to concussion or fractures. Samuel et al identified two cases of intracranial haemorrhage and linear skull fractures without intervention. Kolulu et al observed significant injuries, including skull fractures and cerebral contusions, in 10.2% of infants. CONCLUSIONS: Falls from beds are frequent in infants under 1 year, with most resulting in minor outcomes. However, serious injuries occur in around 5% of infants below 1-year old, emphasising the need for prevention strategies and clinical guidelines for managing post-fall assessments. Further research is required to refine understanding and improve prevention and management practices. PROSPERO REGISTRATION NUMBER: CRD42024626255.
17 May 2026
Read appraisal →Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
Large language models in public health: opportunity or threat? The case of button battery injuries.
BACKGROUND: Button battery (BB) injuries in children represent a severe and growing public health burden. The literature on the topic is extensive; however, there is a notable lack of structured public health initiatives addressing the problem. The present study aimed to test the feasibility of using large language models (LLMs) to draft recommendations for preventing and managing BB ingestion in children. METHODS: A set of questions was generated and submitted to ChatGPT-4o and ChatGPT-o1-preview. Questions were based on statements and websites of scientific societies and not-for-profit organisations and were developed to produce comprehensive recommendations that provided information on BB risks, primary and secondary prevention, clinical management and follow-up, and general public health initiatives. Two independent reviewers rated the accuracy and readability of the questions submitted to the LLMs. The accuracy was rated using a four-level scale, while the readability was assessed using two established readability tools, the Flesch Reading Ease (FRE) and the Flesch-Kincaid Grade Level (FKGL). RESULTS: None of the answers provided by the LLMs were rated as completely incorrect or partially incorrect. ChatGPT-o1-preview outperformed ChatGPT-4o in accuracy, with eight answers rated as accurate and complete. Both models showed similar readability levels, with high FKGL and FRE scores indicating college-level comprehension. DISCUSSION: LLM demonstrated a strong performance in this study, with no responses rated as incorrect or partially incorrect, showing its great potential and feasibility for use in public health. CONCLUSIONS: The present findings suggested the potential feasibility of LLMs in public health for preventing paediatric injuries.
17 May 2026
Read appraisal →European journal of pediatrics
Leveraging artificial intelligence to predict non-adherence to pediatric immunization schedules: a systematic review
UNLABELLED: Immunization is one of the most effective interventions to prevent infectious diseases. Identifying individuals at risk of non-adherence to immunization schedules could enable early interventions to improve coverage. With the increasing availability of large datasets with sociodemographic, medical, and geographic data, artificial intelligence (AI) offers new possibilities for identifying predictive patterns. We performed a systematic literature review of original studies that used AI to predict immunization non-adherence in children. Searches were conducted in PubMed, Embase, and Web of Science and no restrictions were applied regarding publication year, language, or study design. Study characteristics, dataset size, AI methods, performance metrics, and validation approaches were extracted. Risk of bias was assessed using PROBAST + AI. A total of 843 records were identified; after screening, 12 studies were included. Nine of 12 studies were conducted in low- and middle-income countries, used cross-sectional survey data, and analyzed vaccines from routine immunization schedules. Model performance was generally high; 9/12 studies reported an accuracy or an area under the receiver operating characteristic curve exceeding 80%, but no study conducted external validation. Predictors clustered into seven categories: maternal, paternal, family, child, geographic, wealth, and others. Among maternal and child-related factors, prenatal care and previous immunization history had a high predictive weight. CONCLUSION: AI demonstrates a promising potential for identifying individuals at risk of vaccine non-adherence. However, the lack of external validation raises concerns about model overfitting and limits real-world applicability. Demographic health surveys were routinely repeated across countries and time periods and could therefore represent an ideal resource for external validation. WHAT IS KNOWN: • Geographic, sociodemographic, and medical factors contribute to non-adherence to the immunization schedule. • Identifying these individuals can guide early interventions to improve immunization coverage. WHAT IS NEW: • Artificial intelligence can reveal unknown influential factors; prenatal care and delivery setting emerged as key factors in this systematic review.
17 May 2026
Read appraisal →Journal of affective disorders
Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis
BACKGROUND: Intolerance of uncertainty (IU) is a development and maintenance factor for depression and anxiety. Previous reviews found that it associated with anxiety in children and adolescents. However, there was insufficient evidence at the time to review its association with depression in this population. METHOD: 20 studies investigating the relationship between IU and depression in children and adolescents were identified. Random effects meta-analysis was used to aggregate cross-sectional associations, with age, gender, and measure as moderators. A narrative review of longitudinal findings from relevant studies (K = 6) was also conducted. RESULTS: Meta-analysis of cross-sectional associations found an overall effect size of r = 0.47. There was limited evidence that age or gender moderated the effect, however there was a significant moderating effect of measure. Namely, when including studies using 'child-friendly' measures (i.e., developed and normed with children as opposed to adults), the effect size was r = 0.37. Another analysis revealed that the inhibitory IU subscale was more strongly associated with depression than prospective IU. Longitudinal findings suggested that the association between IU and depression persists over time. LIMITATIONS: Studies were limited to those published in English and including general population samples (e.g., typically developing, without significant medical needs). CONCLUSIONS: There is a medium-strong association between IU and depression symptoms in children and adolescents. However, it may be overestimated by the use of IU measures that are not child-friendly. Future research can further extend the evidence-base through careful measure selection, as well as longitudinal and experimental designs.
17 May 2026
Read appraisal →Philosophical transactions of the Royal Society of London. Series B, Biological sciences
Is iron supplementation likely to impair linear growth and gut microbiota composition of Myanmar young children when complementary feeding is not optimized? A randomized controlled trial.
Iron deficiency, with or without anemia, remains a major public health concern among young children in Myanmar. While iron supplementation is widely recommended, its potential adverse effects on growth and gut microbiota warrant investigation, particularly in contexts of poor complementary feeding. To assess the effects of iron supplementation, with or without complementary feeding recommendations (CFRs), on micronutrient status, linear growth and gut microbiota composition among Myanmar children aged 12-23 months, a 24-week randomized controlled trial was conducted in Ayeyarwady Region of Myanmar. Fourteen clusters (villages/wards) were randomized to receive CFRs or not, and children within the clusters were randomized to receive daily aqueous iron or placebo, creating four arms: Placebo (n = 104), CFR (n = 112), Fe (n = 105) and CFRFe (n = 112) totalling 433 children. All intervention groups (CFR, Fe, CFRFe) improved haemoglobin and reduced anaemia risk compared with Placebo (AOR = 0.31 (0.15-0.62), 0.15 (0.07-0.32), 0.14 (0.07-0.31), respectively). CFR and CFRFe also improved zinc status. However, iron-alone (Fe) increased the stunting risk (AOR= 2.74 (1.04-7.23)), while CFRFe did not. No significant effects were observed on gut microbiota composition. Aqueous iron supplementation may impair linear growth when diets are not optimized; combining supplements with optimized complementary feeding may support healthier outcomes. This article is part of the theme issue 'Biological, biomedical and environmental drivers of stunting'.
17 May 2026
Read appraisal →European heart journal
Digital profile of children's hearts: automated echocardiogram strain analysis facilitates earlier detection of cardiac dysfunction
BACKGROUND AND AIMS: Paediatric myocardial strain analysis through echocardiography is often characterized by high variance and limited precision, highlighting the need for a standardized and vendor-agnostic approach applicable for diverse image qualities and populations, which could enhance cardiac function evaluation and enable early detection of cardiac impairment. METHODS: The Motion-Echo system was proposed, a semi-supervised deep learning framework built on 11 096 paediatric and 11 297 adult echocardiograms spanning diverse image qualities and vendors. It integrated context compensation and motion estimation modules for temporally coherent segmentation, myocardial motion estimation, and global strain assessment with minimal manual annotations. Clinical utility was further evaluated through downstream applications. RESULTS: Motion-Echo achieved mean absolute errors of 2.099% [95% confidence interval (CI) 1.803-2.401] and 2.665% (95% CI 2.339-3.026) for global longitudinal and circumferential strain assessments, with Pearson correlation coefficients of 0.799 (95% CI 0.715-0.871) and 0.781 (95% CI 0.687-0.844), respectively. To validate the clinical utility, automated strain values achieved an area under the curve (AUC) of 0.906 (95% CI 0.816-0.981) for cancer therapy-related cardiac dysfunction risk prediction. For late gadolinium enhancement detection, automated global longitudinal strain reached an AUC of 0.782 (95% CI 0.666-0.885). For left ventricular ejection fraction decline forecasting, the system outperformed manual strain values (DeLong P < .001). In addition, incorporating estimated motion flows yielded a remarkable AUC improvement to 0.952 (95% CI 0.917-0.980) for myocardial infarction detection. CONCLUSIONS: Leveraging a large-scale paediatric dataset, Motion-Echo provided a reliable and generalizable framework for myocardial strain analysis, demonstrating potential to facilitate earlier detection of cardiac dysfunction and generate digital cardiac function profiles of children.
16 May 2026
Read appraisal →Philosophical transactions. Series A, Mathematical, physical, and engineering sciences
Empowerment gain and causal model construction: children and adults are sensitive to controllability and variability in their causal interventions
Learning about the causal structure of the world is a fundamental problem for human cognition. Causal models and especially causal learning have proved to be difficult for large pretrained models using standard techniques of deep learning. In contrast, cognitive scientists have applied advances in our formal understanding of causation in computer science, particularly within the causal Bayes net formalism, to understand human causal learning. In the very different tradition of reinforcement learning (RL), researchers have described an intrinsic reward signal called 'empowerment' which maximizes mutual information between actions and their outcomes. Empowerment may be an important bridge between classical Bayesian causal learning and RL and may help to characterize causal learning in humans and enable it in machines. If an agent learns an accurate causal world model, they will necessarily increase their empowerment, and increasing empowerment will lead to a more accurate causal world model. Empowerment may also explain distinctive features of children's causal learning, as well as providing a more tractable computational account of how that learning is possible. In an empirical study, we systematically test how children and adults use cues to empowerment to infer causal relations and design effective causal interventions. This article is part of the theme issue 'World models in natural and artificial intelligence'.
15 May 2026
Read appraisal →Journal of Korean medical science
Cardiovascular Risk Stratification in Youth-Onset Type 2 Diabetes Using Machine Learning
BACKGROUND: The rising incidence of youth-onset type 2 diabetes mellitus (T2DM), along with the risk of early cardiovascular complications, is concerning. Brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT) are noninvasive markers of arterial stiffness and atherosclerosis. They serve as important markers for cardiovascular risk assessment. This study aimed to apply machine learning models to identify high-risk individuals who may benefit from early and targeted cardiovascular screening. METHODS: This retrospective study included 129 patients with youth-onset T2DM who underwent baPWV and cIMT measurements between January 2018 and July 2024. High-risk groups were defined as having values of ≥ mean + 1 standard deviation for baPWV (arterial stiffness) and cIMT (atherosclerosis). Clinical predictors were evaluated using linear, logistic regression, and machine learning analyses. Multiple machine learning models were trained using oversampling and cross-validation techniques to enhance prediction performance. RESULTS: Among the models tested, the gradient boosting model with adaptive synthetic sampling oversampling achieved the best performance in predicting both arterial stiffness (accuracy 0.81) and atherosclerosis prediction (accuracy 0.92). Age and hypertension were consistently identified as the most important factors for arterial stiffness. For atherosclerosis risk, traditional analysis identified dyslipidemia, male sex, and duration of illness as relevant factors; machine learning more clearly emphasized low-density lipoprotein cholesterol and triglyceride levels as key predictors of increased cIMT. CONCLUSION: Hypertension and age were consistent predictors of arterial stiffness, while atherosclerosis risk factors were further clarified with lipid parameters by machine learning analysis. These findings suggest that conventional and machine learning analyses offer complementary strengths. Their combined use may enable earlier to detect nuanced cardiovascular risk patterns and support early and targeted vascular screening in youth-onset T2DM.
14 May 2026
Read appraisal →Pediatric surgery international
Effect of anticholinergics vs. alpha-1 blockers vs. combination therapy on bladder function in patients with posterior urethral valve after transurethral fulguration: a pilot randomized controlled trial
PURPOSE: To identify preliminary efficacy signals of anticholinergics, alpha-1 blockers, and their combination on bladder and renal function in boys with bladder dysfunction following posterior urethral valve (PUV) ablation, and to assess the feasibility of conducting a definitive randomized, controlled trial. STUDY DESIGN: In this single-center, prospective, randomized pilot trial boys under 12 years who had undergone cystoscopic valve ablation were randomized into three groups: anticholinergic therapy (Group I), alpha-1 blocker therapy (Group II), and combination therapy (Group III). The study was designed to detect within-group preliminary efficacy signals in urodynamic parameters following 6 months of pharmacotherapy. Secondary outcomes included changes in patient-reported symptom scores, renal function, and feasibility metrics. Between-group comparisons were performed as exploratory analyses. Feasibility and safety outcomes were analyzed in the intention-to-treat population, while efficacy analyses were conducted in participants who received intervention and had evaluable baseline and follow-up data. RESULTS: Thirty-five eligible patients were randomized (Group I, n = 12; Group II, n = 11; Group III, n = 12). and their clinical and biochemical analyses at baseline were recorded. Two deaths in Group II occurred prior to baseline urodynamics and pharmacotherapy initiation; efficacy analyses, therefore, included 33 patients (Group I, n = 12; Group II, n = 9; Group III, n = 12) with evaluable data. Urodynamic evaluation demonstrated favourable within-group trends: Group I showed a significant improvement in voided volume, while changes in voiding time, cystometric capacity (CC), static compliance, and maximum detrusor pressure (Pdetmax) were favourable but not uniformly statistically significant. Group II showed modest, favourable effects on Qmax, Time@Qmax, CC, and Pdetmax, with wide confidence intervals and no clear significant changes across most UDS measures. Group III demonstrated the most consistent favourable pattern, particularly for CC and Pdetmax, although most confidence intervals overlapped the null. Baseline-adjusted exploratory analyses did not demonstrate statistically significant between-group differences. Symptom scores improved across all groups. Feasibility outcomes were robust, with 81% recruitment, 91% urodynamic study completion, and 94% participant retention. CONCLUSION: This pilot trial demonstrates the feasibility of conducting urodynamic-guided pharmacotherapy studies in young boys with PUV-related bladder dysfunction. The observed within-group efficacy signals across all treatment arms-particularly with combination therapy-are hypothesis-generating and provide effect size and variability estimates to inform the design of a definitive randomized controlled trial.
13 May 2026
Read appraisal →Lancet (London, England)
Impact of introducing RTS,S/AS01E malaria vaccine on mortality in young children in Ghana, Kenya, and Malawi: an observational evaluation of a cluster-randomised implementation programme
BACKGROUND: Malaria vaccines have been added to immunisation schedules in 25 sub-Saharan African countries, with the expectation that deaths in young children would be prevented. The introduction of the RTS,S/AS01E malaria vaccine (RTS,S) in Ghana, Kenya, and Malawi in 2019 was evaluated over 4 years to show the impact on mortality in young children and to monitor severe malaria admissions, vaccine uptake, and safety. Favourable evidence on safety and impact on severe malaria admissions during the first 2 years contributed to WHO's recommendations on malaria vaccines. Here, we report the primary analysis of the impact on mortality at 46 months. METHODS: Clusters of administrative units (districts in Ghana, subcounties in Kenya, and groups of immunisation clinics in Malawi), each with an estimated annual birth cohort of about 4000 children, were randomly assigned 1:1 to introduce the RTS,S malaria vaccine in 2019 (implementation areas), or to implement later (comparison areas). RTS,S was delivered in a four-dose schedule, at age 6, 7, 9, and 24 months in Ghana and Kenya, and at age 5, 6, 7, and 22 months in Malawi. Surveillance for post-neonatal mortality in children younger than 5 years was established throughout by a network of 26 000 local reporters who notified deaths in their community. The families were then visited at home by study staff to confirm details and complete a verbal autopsy. Surveillance for severe malaria and other conditions was strengthened in 18 sentinel hospitals serving part of the study area and maintained for 46 months. Uptake of RTS,S and other vaccines was monitored by the Expanded Programme on Immunisation in each country and independently through three household coverage surveys, at baseline, and at about 18 months and 30 months after introduction of RTS,S. The primary outcome of this impact evaluation was mortality due to any cause, except injury, in children eligible to receive three doses of RTS,S. Mortality rate ratios were estimated by comparing the ratio of deaths among vaccine-eligible age groups to deaths in non-eligible age groups between implementation and comparison areas. This evaluation is registered on ClinicalTrials.gov (NCT03806465) and is complete. FINDINGS: 158 clusters (66 in Ghana, 46 in Kenya, and 46 in Malawi) were selected and randomly assigned; 79 areas served as implementation areas and 79 as comparison areas. By the end of the 46-month evaluation period, 1 289 504 children had received the first dose of RTS,S, 1 158 850 had received the second dose, 1 068 039 had received a third dose, and 436 527 had received a fourth dose. Coverage assessed in 2022 was 82·8% (95% CI 80·7-84·9) for the first dose, 71·1% (68·8-73·5) for the third dose, and 39·9% (36·9-42·9) for the fourth dose. Excluding deaths due to injury, there were 5576 deaths in implementation areas versus 6152 in comparison areas in children eligible to have received the third dose of RTS,S, and 7534 versus 7044 deaths among non-eligible children. The mortality rate ratio was 0·87 (95% CI 0·77-0·97; p=0·016). INTERPRETATION: Introduction of the RTS,S malaria vaccine in routine immunisation programmes was associated with a significant reduction in mortality in young children, averting about one in eight deaths, in areas with moderate coverage of three doses of the vaccine and low uptake of the fourth dose. These results highlight the urgency to accelerate the deployment of malaria vaccines in areas of Africa where malaria continues to be a leading cause of child mortality. FUNDING: WHO; Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid. TRANSLATIONS: For the French translation of the abstract see Supplementary Materials section.
13 May 2026
Read appraisal →Journal of medical systems
Feasibility, Adherence, Acceptance and Usability of a Multimodal Telemonitoring for Pediatric Post-COVID Syndrome: A Bicentric Pilot Study
Existing healthcare infrastructure struggles to meet the complex care required for pediatric Post-COVID Syndrome (pPCS). Telemonitoring offers potential to enhance care access, reduce patient burden, and ensure continuity. This study introduces and evaluates a novel, multimodal telemonitoring concept for pPCS with high translational potential for broader pediatric chronic and post-infectious conditions. Telemonitoring included a patient app, digital sensors (spirometer, smartwatch), Patient Reported Outcome Measures, chat/video consultations (VC), and a medical telemonitoring platform. Patients aged 12-17 years with diagnosed PCS were recruited from two pPCS outpatient university clinics in Bielefeld and Munich, Germany. Monitoring lasted three months. Evaluation focused on feasibility, adherence, acceptance, and usability, using monitoring data, the System Usability Scale (SUS), Technology Usage Inventory (TUI), and a custom survey completed by patients and parents. 30 patients (mean age: 15y ± 1.9; 57% female (17/30); mean Baseline Bell-Score: 36.4) and 30 parents participated. Adherence was high, with an average of 3.4 (smartwatch) to 4.6 (spirometry) measurements/week. Questionnaire response rate was 86% (411/480) and 97% (58/60) of VCs were conducted. SUS scores indicated very high usability (patients: 81.25/100; parents: 75.42/100). TUI results showed low skepticism, and high interest. Telemonitoring supported symptom management independent of in-person visits, despite sensor connectivity issues. This is the first study to demonstrate successful integration of telemonitoring in pPCS, with high adherence and positive feedback from all stakeholders supporting its potential. Despite occasional technical challenges and resource needs, this concept shows promise for broader hybrid telemonitoring care implementation in PCS and other post-infectious syndromes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), trial registration number: DRKS00029354. Registered 07 February 2023 - Retrospectively registered https://drks.de/search/en/trial/DRKS00029354/entails.
13 May 2026
Read appraisal →Vaccine
Effect of neonatal BCG vaccination on oral herpes in early childhood: A nested study within a randomised controlled trial
BACKGROUND: Bacille Calmette-Guérin (BCG) vaccine, primarily used against tuberculosis, has off-target (non-specific) immunomodulatory effects, including potential protection against recurrences of latent herpes simplex virus (HSV) infections. Recurrent episodes of HSV herpes labialis (oral 'cold sores') affect a substantial proportion of the population, including young children, and there is currently no effective preventive intervention. METHODS: This pilot study, nested within the MIS BAIR randomised controlled trial (RCT), explored whether neonatal BCG vaccination, compared with no BCG vaccination, reduces the incidence and recurrence of herpes labialis during the first five years of life. FINDINGS: Among the 563 children (44% of 1272 randomised) who completed the 5-year follow-up, children in the BCG group were less likely to develop herpes labialis, compared with the control group (5% vs 8%; 38% relative risk reduction, p = 0.1). Risk of recurrence was significantly lower in the BCG group (33% vs. 71%; 53% relative risk reduction, p = 0.02). BCG-vaccinated children also reported a later onset of symptoms and a reduced impact on fluid intake during episodes. INTERPRETATION: This exploratory study suggests a protective role for neonatal BCG against HSV in children. However, its limitations, including its sample size, incomplete follow up and lack of virological confirmation, mean further studies are needed to confirm these findings. FUNDING: National Health and Medical Research Council (NHMRC) of Australia and others, as detailed in the acknowledgements.
12 May 2026
Read appraisal →Journal of epidemiology and community health
Children's views of obesity, body size and weight: systematic review of UK qualitative evidence
BACKGROUND: Understanding views about body size and weight is key to addressing both obesity and weight stigma. The views of younger children are not well understood and may differ in important ways from those of adults and young people. This review aimed to fill this gap. METHODS: Systematic review of qualitative evidence. We searched 19 database sources in February 2025 and included qualitative studies from the UK published since 2008 reporting data on children's (4-12 years) views of obesity, body size, body shape or weight. We assessed study quality using the Critical Appraisal Skills Programme checklist and conducted a thematic synthesis of the data. RESULTS: We included 34 studies. Study quality overall was fairly high. Children reported a range of perceived impacts of body weight, including health impacts, limitations on activities, bullying and teasing, which generated negative perceptions of overweight and fear of fatness. Ideas about body shape may be influenced by family members and by media or social media content. Children identified diet and physical activity as the main influences on body weight. There may be differences in views between girls and boys at older ages, although both are concerned about weight. We found very little data on differences relating to ethnicity or socioeconomic status. Children with overweight or obesity reported a pervasive experience of negative attitudes and bullying, which could be a barrier to participating in activities. CONCLUSION: Children, including very young children, generally hold very negative views of overweight and obesity. Overweight is seen to be linked with unhealthiness, limited agency and with being bullied. These links may influence how children understand messages about weight and health. PROSPERO REGISTRATION NUMBER: CRD42025650306.
12 May 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Vocal Biomarkers of Childhood Trauma: A Machine-Learning Approach to Speech Analysis
PURPOSE: Childhood trauma can disrupt communication, yet early signs often go unrecognized in regions affected by ongoing war, where immediate physical needs take precedence. Vocal biomarkers-acoustic features linked to emotional and motor regulation-offer a promising, noninvasive means of detecting trauma-linked speech disruptions. This study applied a hybrid framework to distinguish trauma exposure in Arabic-speaking children living amid active conflict. The aim was to support scalable, speech-based tools for early trauma identification in low-resource, humanitarian settings. METHOD: We analyzed 200 publicly available recordings of spontaneous speech from Arabic-speaking girls (ages 8-12 years): 100 trauma-exposed participants from Gaza (Palestinian) and 100 non-exposed controls from Jordan. Core acoustic features (fundamental frequency [F0], jitter, shimmer, harmonics-to-noise ratio [HNR], voice onset time [VOT], first formant, second formant) informed statistical testing and theory-driven composite indices. Exploratory features-including Mel-frequency cepstral coefficients and eGeMAPSv02 descriptors-were used to train binary classification models. Three classifiers (random forest, ridge regression, and logistic regression) were evaluated using nested cross-validation and bootstrap resampling. Composite indices were combined into a 0-10 Trauma Risk Score. Generalizability was assessed using an independent Lebanese cohort (n = 80), with the trained classifier applied using fixed exploratory features and preprocessing parameters. Core features were tested post hoc for cross-cohort stability. RESULTS: Trauma-exposed children showed reduced F0 and HNR, elevated shimmer and jitter, and prolonged VOT (Cohen's d > 1.2). Binary classification models achieved strong performance (area under the curve [AUC] = .89-.92); logistic regression reached AUC = .996 under cross-validation. Composite indices (AUCs > .90) stratified 68% into Moderate/High Trauma Risk. Lebanese validation confirmed generalizability, with theory-driven features showing stable predictive patterns. CONCLUSIONS: Vocal biomarkers reliably distinguished trauma exposure in Arabic-speaking children using a simple logistic regression model. This strong performance highlights the potential of speech-based tools as scalable, noninvasive methods for early trauma detection. Further validation is needed to support their use in diverse humanitarian and conflict-affected settings.
12 May 2026
Read appraisal →Journal of global health
The effectiveness and cost-effectiveness of cash plus interventions to prevent acute malnutrition in Somalia: evidence from an adaptive cluster randomised control trial
BACKGROUND: Acute malnutrition affects millions of children aged <5 years, as well as pregnant and lactating women globally, especially in humanitarian settings. Although cash plus interventions - cash or food transfers combined with complementary components - are widely implemented, evidence remains limited on which combinations and durations are most effective at preventing acute malnutrition. METHODS: We conducted a three-arm cluster-randomised trial within the 'Save the Children's Cash Plus for Nutrition' programme in Somalia. Monthly support was provided as cash alone (arm 1), cash plus social and behaviour change communication (arm 2), or cash plus an additional cash top-up (arm 3). Further, we randomised 33 villages across arms, targeting approximately 1500 households. Primary outcomes included the prevalence and incidence of acute malnutrition in children aged 6-59 months and in mothers, assessed at baseline, midline (three months), and endline (six months). We also conducted market monitoring, qualitative data collection, and analysis. RESULTS: Child acute malnutrition prevalence was approximately 15.0% in each arm at baseline. After three months, prevalence declined by 2.0 percentage points in arm 1 to 13.0% (95% confidence interval (CI) = 10.3, 16.1), representing a relative reduction of 13.3%. In arm 2, prevalence declined by 5.9 percentage points to 9.1% (95% CI = 6.8, 11.8), a relative reduction of 39.3%. In contrast, prevalence in arm 3 remained essentially unchanged, increasing to 15.1% (95% CI = 12.1, 18.6). By endline, there was little change from midline in all arms. Maternal malnutrition improved most in arm 2, but differences were not statistically significant. All arms showed improvements in dietary diversity and food security, but only arm 2 achieved sustained nutrition gains. Household livelihood conditions appeared to improve overall, though monthly expenditures nearly doubled. Arm 2 was the most effective and cost-effective. CONCLUSIONS: Adding social and behaviour change communication to cash transfers significantly improved child nutrition compared to cash alone, highlighting that integrated approaches can enhance nutritional outcomes and at minimal additional cost in humanitarian settings. REGISTRATION: ClinicalTrials.gov: NCT06642012.
12 May 2026
Read appraisal →International health
Pneumonia in Ghana: prevalence, mortality and antimicrobial resistance-a systematic review and meta-analysis
Pneumonia is a major cause of morbidity and mortality in Ghana, especially among children <5 y of age and the elderly. However, comprehensive data on its prevalence and distribution remain limited. This systematic review addresses this gap by analysing the prevalence, regional variations, risk factors, antimicrobial resistance and mortality rates of pneumonia in Ghana. We searched PubMed, ScienceDirect, Web of Science and African Journals Online databases, including 21 studies with a total of 124 582 participants. A random-effects meta-analysis estimated pooled prevalence and subgroup differences based on age, region and participant type. Heterogeneity was assessed using the I2 test and meta-regression, with sensitivity analysis also conducted. Study quality was evaluated using standardized Joana Briggs Institute checklists for prevalence studies. The pooled prevalence of pneumonia in Ghana was 22.01%, with significant regional variations. The highest prevalence was observed in a study conducted in the Greater Accra and Northern regions (32.31%), while the lowest was in the Upper West (4.83%). The prevalence in children <5 y of age was 17.79%. Hospitalized patients had a higher prevalence (22.14%) than community children (21.49%). Streptococcus pneumoniae was the most common pathogen, with high resistance (>70%) to co-trimoxazole, gentamicin and tetracycline. Key risk factors included indoor air pollution and seasonal changes. The mortality rate for pneumonia was found to be 3.07%. This systematic review highlighted significant regional disparities, pathogen resistance patterns and environmental risk factors that shape the burden of pneumonia in Ghana, providing critical evidence for targeted public health strategies. The findings highlight avenues for future research, including environmental drivers of transmission, focusing on underreported regions and surveillance of antibiotic resistance of pathogens isolated from pneumonia patients.
11 May 2026
Read appraisal →American journal of epidemiology
Predicting first onset of suicide attempt among children with suicidal ideation or non-suicidal self-injury using machine learning: a prospective population-based cohort study
While children with suicidal ideation or non-suicidal self-injury (NSSI) are at high risk of suicide, most do not attempt suicide. This study aims to identify predictors of first suicide attempts among children with suicidal thoughts or NSSI. We utilized longitudinal data from the Adolescent Brain and Cognitive Development study to examine a broad range of risk factors in children reporting suicidal ideation (N = 344, mean age = 9.93) or NSSI (N = 261, mean age = 9.88) at baseline, predicting first attempt of suicide during a 4-year follow-up. Predictive models were developed through bivariate feature selection followed by Discrete-Time Random Survival Forest machine learning, identifying predictors of subsequent suicide attempts. During the follow-up, 40 of 344 children (11.6%) with suicidal ideation, and 32 of 261 children (12.3%) with NSSI at baseline initiated suicide attempts. For suicidal ideation, risk for attempting suicide increased with caregiver-reported NSSI, witnessing domestic violence, severity of suicidal thoughts, being female, online social screen use, and less parental supervision. For NSSI, risk of suicide attempt increased with witnessing domestic violence, anxiety disorders, caregiver-reported NSSI, being female, and disruptive, impulse control, and conduct disorders. Our findings shed light on the development of population-based suicide prevention strategies for children.
11 May 2026
Read appraisal →European journal of pediatrics
Prognosis of neonates receiving invasive mechanical ventilation in low-resource settings: a systematic review and prognostic meta-analysis
Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current evidence base being restricted to single-centre observational studies, thus limiting comparative analyses and effective healthcare planning. This study aims to estimate the pooled proportion of mortality and morbidity among neonates exposed to IMV in low-resource settings. Medline, Embase, and CENTRAL were searched until 22 August 2025. Randomised and non-randomised studies were included. Two reviewers, blinded to each other, extracted data independently. Proportion-based meta-analyses using random-effects model were performed. Risk of bias was assessed using ROBINS-E, and evidence-certainty was evaluated using the GRADE approach. One hundred of 117 studies were included, with most conducted in South Asia. In-hospital mortality was reported in 68 studies (7193 neonates), with a pooled estimate of 45% (39%-50%), evidence-certainty being very low. Among the secondary outcomes, the pooled rates were as follows: bronchopulmonary dysplasia, 10% (5%-18%); intraventricular haemorrhage (any grade), 10% (5%-19%); necrotising enterocolitis (any stage), 14% (6%-31%); retinopathy of prematurity (any stage), 33% (22%-46%); ventilator-associated pneumonia, 21% (14%-29%); sepsis, 32% (25%-40%) and pulmonary haemorrhage, 9% (6%-14%). Evidence-certainty for all the secondary outcomes was also very low. Subgroup analysis comparing two distinct time epochs revealed a significant difference in mortality, 43% (36%-50%) (I2 = 93.5%) in the post-2010 epoch compared to 55% (48%-63%) (I2 = 82.9%) in the pre-2010 epoch (p = 0.004). Heterogeneous outcome definitions and predominance of unadjusted analyses across studies limit the existing evidence.Conclusions: In LRS, the mortality and morbidity rates among neonates receiving IMV remain substantially high with a modest improvement in survival in the past decade. Improving outcomes mandates moving beyond access to the provision of IMV to investing in comprehensive training and scaling up critical auxiliary resources. Future research must adopt standardised outcome definitions and adjusted analyses to precisely quantify the impact of IMV in LRS.
11 May 2026
Read appraisal →American journal of speech-language pathology
Parental Roles in Language Intervention: A Systematic Review
BACKGROUND: Children with language delays (LDs) or language disorders face persistent challenges in their development. Speech and language therapy is vital, and within it, parental involvement is recognized as a key factor in therapeutic success. Although many parent-implemented interventions exist, little is known about the specific roles parents assume, particularly across different diagnostic groups: LD, developmental language disorder (DLD), and language disorder associated with other conditions (LD + X). OBJECTIVE: The aim of this study was to review and synthesize evidence on parental roles in language interventions for children with LD, DLD, and LD + X. METHOD: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42023452616), this systematic review analyzed studies from four databases. Eligible studies involved parent participatory language interventions reporting child language outcomes. Two independent reviewers conducted screening, quality appraisal, and data extraction. RESULTS: Across 37 studies, parents most frequently assumed the roles of Learner, Implementer, and Informer, highlighting their functions in acquiring knowledge, applying strategies, and providing feedback on children's progress. Less common roles included Adaptor and Collaborative Decision-Maker, suggesting that although caregivers are increasingly active, their engagement rarely extends to shared decision making with professionals. The studies reviewed here demonstrated considerable variability in intervention dosage, total duration, delivery format, and strategies taught. In contrast, less variability was observed in the identity of the parents/caregivers (most often the mother) and the trainer (typically a speech-language therapist) as well as in the type and mode of delivery. CONCLUSIONS: Parental engagement in language interventions continues to be largely determined by professional guidance, positioning parents as learners and implementers rather than full collaborators. Strengthening adaptive roles and promoting shared decision making can enhance family-centered practice. Future programs could consider the specific needs of each context, encourage parental involvement, and explore telepractice to expand access. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32060328.
11 May 2026
Read appraisal →Chinese medical journal
Artificial intelligence in atopic dermatitis: Current applications and future perspectives.
Atopic dermatitis (AD) is a prevalent and burdensome chronic skin disease, with profound effects on patient quality of life. Advancing its diagnosis and management remains a pressing clinical need. Artificial intelligence holds growing promise in addressing this challenge. This review outlines the current landscape of AD and explores the expanding role of AI in its care-from improving diagnostic accuracy and objective severity scoring to predicting therapeutic outcomes and personalizing treatment strategies. While these technologies are poised to transform dermatology practice, their successful integration will depend on overcoming technical and practical barriers through collaborative, interdisciplinary efforts. Further research and thoughtful implementation are essential to translate AI's potential into better, more precise patient care.
11 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Incidence of Bacille Calmette-Guérin associated lymphadenitis in healthy children: A systematic review and meta-analysis
Few systematic reviews or meta-analyses have addressed on the incidence of Bacille Calmette-Guérin (BCG) lymphadenitis in healthy children. A systematic literature search was independently conducted by two researchers using four English and Korean databases (PubMed, Scopus, KMbase, RISS). The risk of bias was assessed. A total of 52 peer-reviewed journal articles (about 1.8 million children) were included in meta-analyses. The incidence proportion of BCG lymphadenitis ranged from 0.0% to 25.6%. The pooled incidence proportion was 2.5% (95% CI, 1.6-3.6; I2 = 99%). Studies employing active (vs. passive) surveillance reported a significantly higher incidence proportion of lymphadenitis, as did randomized controlled trials (vs. prospective and retrospective cohort studies). Also, the incidence significantly differed according to study quality, publication period, and BCG strain. This study highlights substantial variability in the incidence of BCG lymphadenitis among diverse studies and underscores the influence of surveillance methods, study design, and vaccine strain on reported outcomes.
10 May 2026
Read appraisal →Psychiatry research
Physiological correlates of emotional dysregulation in youth with psychopathology: an exploratory study using wearable technology
The failure to regulate one's own emotions, defined as Emotional Dysregulation (ED), has become a diagnostic challenge in the last decades. Peripheral indexes of functioning of the autonomic nervous system (ANS) activity emerged as reliable transdiagnostic biomarkers of psychopathology. The present study aimed to evaluate the feasibility of wearable sensors in capturing ANS correlates of affective reactivity to emotionally salient videoclips in a stimulation protocol conducted in a clinical sample of youths. Thirty subjects (mean age: 13.93 ± 11.74) were recruited and presented with videoclips showing emotional content (joy, fear, anger, sadness, and anger). Before (Baseline), during (Task), and after (Recovery), the registration, electrocardiogram (ECG), and electrodermal response (EDR) were recorded using wearable technologies. Several indices related to the activation of sympathetic and parasympathetic nervous system were extracted. These indices were compared among the different phases and emotions and correlated with clinical measures. Preliminary results showed that some emotions are more able to elicit ANS response than others, and there is a correlation between physiological activation and clinical profile. These preliminary findings could help to explore the mechanisms of ED in psychopathology and can be useful to guide behavioral and pharmacological treatment. This study supports the success of wearable-based protocols for monitoring emotional reactivity in youth with psychopathology.
6 May 2026
Read appraisal →Scientific reports
Hybrid deep learning and YAMNet features for asthma diagnosis from respiratory sounds
A prompt and precise diagnosis is necessary to lessen the worldwide burden of asthma, a common chronic respiratory condition. Spirometry is one of the resource-intensive conventional methods that frequently misclassifies cases because of overlapping symptoms with other respiratory illnesses. The Asthma Detection Dataset v2, which is openly accessible and comprises actual audio recordings of respiratory noises, is used in this work to demonstrate a hybrid deep learning architecture for automated asthma detection. After applying thorough preprocessing, which includes denoising, segmentation, and augmentation, the suggested pipeline employs a dual-path feature extraction technique that combines pretrained YAMNet embeddings with handmade acoustic descriptors (MFCCs, chromagram, ZCR, and spectral features). Atrous Spatial Pyramid Pooling (ASPP) and Squeeze-and-Excitation (SE) modules are used to further improve these embeddings, and a Multi-Layer Perceptron is used for classification. The proposed model achieved high performance, with an accuracy of 98.6% ± 0.14, an F1-score of 97.5% ± 0.14, and a macro-AUC of 99.1% ± 0.14 using stratified 5-fold cross-validation. SHAP-based interpretability and visualization (waveforms, spectrograms, t-SNE) verified that the model records clinically significant auditory biomarkers such as crackles and wheezes. These results indicate the potential of the proposed model as an explainable and scalable computer-aided asthma diagnostic tool.
3 May 2026
Read appraisal →The Cochrane database of systematic reviews
Vitamin D for preventing acute respiratory infections in children up to five years of age
RATIONALE: Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in children under five years of age and contribute to healthcare visits and hospitalisations globally. Vitamin D deficiency is common amongst pregnant women and young children. Given that vitamin D supplementation is safe, affordable, and easy to administer, its potential to reduce ARI-related healthcare visits holds substantial public health relevance. This review evaluates the benefit and harm of vitamin D supplementation in preventing ARI-related healthcare visits in young children, aiming to inform supplementation policies during pregnancy and early childhood. OBJECTIVES: To determine the benefit and harm of vitamin D supplementation for preventing ARIs in children up to five years of age. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, WHO Global Index Medicus, and four clinical trial registries on 18 March 2025. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) comparing vitamin D to placebo, or a higher dose (≥ 1000 IU) versus a lower dose (≤ 1000 IU) administered from early pregnancy through to five years of age. We excluded studies involving children with chronic respiratory or systemic conditions. OUTCOMES: Critical outcomes: 1) healthcare visits made by children for an ARI: (a) the proportion of children with healthcare visits made for ARIs; (b) the mean number of healthcare visits made for ARIs per child; and 2) hypercalcaemia: the number of pregnant women and children with hypercalcaemia. RISK OF BIAS: We assessed risk of bias using the Cochrane risk of bias (RoB) 1 tool for outcomes reported in the summary of findings tables. SYNTHESIS METHODS: We synthesised outcome data using meta-analyses, calculating risk ratios (RR) for dichotomous, and mean differences (MD) for continuous outcomes, each with 95% confidence intervals (CI). Where meta-analysis was not feasible, we summarised the results narratively. We used GRADE to assess the certainty of the evidence for pre-specified outcomes. INCLUDED STUDIES: We included 107 RCTs involving 31,521 participants. Vitamin D supplementation was administered during pregnancy, early childhood, or both, and in some cases to both infants and lactating mothers. Interventions used vitamin D2, D3, both, or unspecified forms, with dosages ranging from daily administration to large single or quarterly boluses. Most were delivered orally, typically on a daily schedule, but also weekly or quarterly, over durations ranging from a single dose to 18 months. Settings included hospitals, day-care centres, communities, and homes. SYNTHESIS OF RESULTS: Vitamin D supplementation may result in a slight reduction in the proportion of children who make ARI-related healthcare visits compared to placebo (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.91 to 1.00; P = 0.03; 10 studies, 2447 participants; low-certainty evidence), but probably does not reduce the mean number of ARI-related healthcare visits per child (mean difference (MD) 0.07, 95% CI -0.06 to 0.20; P = 0.32; 3 studies, 561 participants; moderate-certainty evidence). Comparisons between higher and lower doses of vitamin D probably do not reduce the proportion of children making ARI-related healthcare visits (RR 0.94, 95% CI 0.81 to 1.10; P = 0.46; 2 studies, 1382 participants; moderate-certainty evidence), and do not reduce the mean number of ARI-related healthcare visits per child (MD -0.10, 95% CI -0.59 to 0.39; P = 0.69; 1 study, 579 participants; low-certainty evidence). No cases of hypercalcaemia were reported among pregnant women in trials comparing vitamin D supplementation with placebo. In higher versus lower dose comparisons, supplementation may result in little to no difference in the risk of hypercalcaemia among pregnant women (RR 1.61, 95% CI 0.60 to 4.31; P = 0.34; 6 studies, 2379 participants; low-certainty evidence). Similarly, the evidence that vitamin D supplementation has little to no effect on the risk of hypercalcaemia in children, when compared with placebo, is very uncertain (RR 0.81, 95% CI 0.53 to 1.24; 7 studies, 1542 participants; very low-certainty evidence) and may result in little to no difference in the risk of hypercalcaemia in children when higher doses are compared to lower doses (RR 1.23, 95% CI 0.82 to 1.85; 7 studies, 1287 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence that vitamin D supplementation during pregnancy or early childhood may result in a slight reduction in the proportion of children under five years of age who make ARI-related healthcare visits, but probably does not reduce the mean number of healthcare visits for ARIs per child. This finding highlights the need for large, well-designed, placebo-controlled trials to confirm the potential benefit. We found moderate-certainty evidence that higher-dose vitamin D supplementation, compared with lower doses, probably does not reduce the proportion of children making healthcare visits for ARIs and does not reduce the mean number of ARI-related healthcare visits per child. Hypercalcaemia occurs infrequently in both pregnant women and children receiving vitamin D supplementation. Where hypercalcaemia could be measured, specifically in children receiving vitamin D versus placebo, vitamin D supplementation may have little to no effect on the risk of hypercalcaemia (very low-certainty evidence). In both children and pregnant women, a higher dose of vitamin D compared to a lower dose may result in little to no difference in the risk of hypercalcaemia (low-certainty evidence). FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol (2022) DOI: 10.1002/14651858.CD015111.
2 May 2026
Read appraisal →Lancet (London, England)
Safety and efficacy of the monoclonal antibody L9LS for malaria prevention in children exposed to perennial malaria transmission in Kenya: a randomised, double-blind, placebo-controlled, phase 2 trial
BACKGROUND: Malaria remains a major cause of mortality globally, especially among young children in sub-Saharan Africa. The long-acting monoclonal antibody L9LS has shown high efficacy in preventing malaria in children aged 6-10 years exposed to seasonal transmission but remains untested in perennial transmission settings and younger children. We assessed the safety, tolerability, and efficacy of L9LS in infants and children in a high perennial malaria transmission setting. METHODS: This double-blind, two-part, randomised, placebo-controlled, phase 2 trial was done in Siaya county in western Kenya. In parts 1a and 1b, we tested the safety and tolerability of L9LS using an age de-escalation and dose escalation approach and randomly assigned (3:1) cohorts of healthy children (three cohorts aged 5-10 years, three cohorts aged 5-59 months, and two cohorts aged 5-71 months) to L9LS at doses of 5, 10, 20, 30, or 40 mg/kg subcutaneously or to placebo (normal saline). In part 2, healthy children aged 5-59 months were randomly assigned (1:1:1) by use of centralised computer-generated lists to receive two doses of L9LS at 10-20 mg/kg at baseline and month 6, one dose of L9LS at baseline and placebo at month 6, or placebo at both timepoints. Children were followed up for 12 months with monthly clinic visits and blood smear collections. Primary safety outcomes were incidence and severity of local and systemic solicited adverse events within 7 days of dosing and serious adverse events throughout follow-up. The primary efficacy endpoint was Plasmodium falciparum infection detected by blood smear over 12 months. Primary analyses were done in the modified intention-to-treat population, consisting of all randomly assigned participants who received the study intervention. This trial is registered with ClinicalTrials.gov (NCT05400655) and is complete. FINDINGS: In parts 1a and 1b, 96 children were enrolled and randomly assigned between Oct 1, 2022, and Jan 16, 2024; 72 participants were assigned to L9LS and 24 were assigned to placebo. In part 2, 324 children aged 5-59 months were enrolled and randomly assigned between Jan 26 and June 2, 2023; 108 children were assigned to one-dose L9LS, 106 to two-dose L9LS, and 110 to placebo. Across all study parts, grade 3 or worse treatment-related adverse events occurred after four (1%) of 384 L9LS injections and two (1%) of 338 placebo injections; these events all resolved by study end. The proportion of solicited and unsolicited adverse events was similar across all L9LS dose groups. There were no serious adverse events related to the trial. In part 2, 70 (66%) of 106 children in the two-dose L9LS group had at least one P falciparum infection during the 12-month follow-up versus 91 (83%) of 110 children in the placebo group (protective efficacy 42·7%, 95% CI 22·5-57·7; p=0·0003). INTERPRETATION: L9LS was protective against malaria in young children in western Kenya without evident safety concerns over 6-12 months. A higher dose of L9LS might be needed to achieve high-level efficacy against malaria in young children exposed to intense perennial P falciparum transmission. FUNDING: Gates Foundation.
2 May 2026
Read appraisal →BMJ health & care informatics
Does the accuracy of medication administration documentation improve with electronic medication systems? A stepped-wedge cluster randomised trial.
OBJECTIVES: Accurate documentation of medication administration is crucial for patient safety. This study compares the accuracy of documentation between paper-based and electronic medication management (eMM) systems. METHODS: A secondary analysis of data from a stepped-wedge cluster randomised trial of an eMM implementation was conducted. The eMM module allowed electronic prescribing, recording of drug dispensing, drug administration and medication reconciliation and monitoring. Medication administration processes were observed in a tertiary paediatric hospital in Sydney, Australia. Trained nurse observers recorded details of medication administrations which were then compared with the information documented by nurses about the administrations. RESULTS: 5095 administrations were analysed. With eMM compared with paper, significantly fewer administrations had no time documented (adjusted OR (aOR) 0.15; 95% CI 0.07 to 0.34; p<0.001), but documented details were more often inaccurate (aOR 4.6; 95% CI 3.3 to 6.6). Fewer doses were administered from incorrect prescriptions with eMM (aOR 0.25; 95% CI 0.18 to 0.36). CONCLUSION: eMM improves certain aspects of documentation but introduces new challenges, particularly in accurately recording administration details. Further investigation is needed to optimise these systems. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry 370325.
27 Apr 2026
Read appraisal →BMJ open
Breastfeeding initiation and continuation among women on medicines: a systematic review and meta-analysis
OBJECTIVES: Breastfeeding provides essential health benefits for infants and mothers, yet initiation and continuation can be influenced by maternal medication use. Uncertainty regarding medication safety may lead to early discontinuation or avoidance of necessary treatment. We conducted a systematic review and meta-analysis to estimate the prevalence of breastfeeding initiation and continuation at 6 months post partum among women using medications. DESIGN: Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES: PubMed, Web of Science, Academic Search Premier (EBSCO) and Google Scholar were searched up to 30 November 2024. ELIGIBILITY CRITERIA: For selecting studies: We included cohort, cross-sectional and observational studies reporting breastfeeding initiation at birth and continuation at 6 months post partum among women aged ≥18 years using medications during pregnancy or post partum. Studies reporting medication type and duration of breastfeeding were prioritised. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened, extracted and coded data using standardised methods. Risk of bias was assessed using validated tools. Pooled prevalence estimates were calculated using a random effects meta-analysis and meta-regression was performed to explore factors associated with breastfeeding outcomes. Findings were summarised in GRADE evidence profiles and synthesised qualitatively. RESULTS: Of 286 retrieved articles, 29 met the inclusion criteria and 28 were included in the meta-analysis. 14 (48%) were cohort studies reporting breastfeeding prevalence while using medications. The pooled prevalence of breastfeeding initiation among women on medication during pregnancy or post partum was 75.2% (95% CI 69.8% to 80.7%; range 14-98%), with high heterogeneity (I²=99.2%, p<0.001). Overall prevalence of breastfeeding at 6 months post partum was 53.2% (95% CI 43% to 63%). Meta-regression showed that women in high-income countries were less likely to initiate (β=-0.27, 95% CI -0.54 to -0.00, p=0.04) or continue breastfeeding at 6 months (β=-0.27, 95% CI -0.54 to -0.01, p=0.04). Women using antidepressants (β=-0.45, 95% CI -0.87 to -0.02, p=0.04) and opioids (β=-0.50, 95% CI -0.93 to -0.08, p=0.02) were less likely to continue breastfeeding at 6 months. Women living with HIV on ART in low- and middle-income countries had higher continuation rates, likely due to supportive public health programmes. CONCLUSION: Breastfeeding initiation among women using medications is generally high, but continuation declines substantially, particularly among women on psychotropic, opioid or antiepileptic drugs. HIV status, medication type, healthcare support and national guidelines influence breastfeeding outcomes. Targeted interventions, including provider education, medication-specific lactation guidance and supportive workplace policies, are essential to promote sustained breastfeeding among women using medications.
27 Apr 2026
Read appraisal →BMJ mental health
Using electronic health records to evaluate a children and young people's social prescribing service: challenges and implications for research and practice
BACKGROUND: Preliminary evidence indicates that social prescribing (SP) can improve children and young people's (CYP) well-being but is limited by small non-representative samples and often relies on descriptive statistics. Given the wide implementation of SP in the UK, administrative records provide a unique opportunity to understand current practice and assess impacts on well-being. OBJECTIVES: (1) To understand the quality of data captured in SP administrative records. (2) To explore which CYP are currently receiving SP and what SP entails in practice. (3) To assess the impact of SP on well-being. METHODS: We used administrative records from one CYP SP service in England. Records were extracted from Joy, an online platform for managing SP. Over 18 months, 770 age-eligible CYP were referred to SP, 203 of whom were successfully discharged and completed two pre-post measures of well-being (the short Warwick-Edinburgh Mental Wellbeing Scale; SWEMWBS) at least 7 days apart. We used descriptive statistics, a paired t-test to assess changes in well-being and linear regressions with interactions to test effect modification. FINDINGS: Missing data was the largest issue, with ethnicity missing for 94% of CYP. A lack of detail and inconsistent recording for both individual characteristics and SP practices also presented challenges. Despite this, we identified that most CYP were referred by their GP, followed by their school, with 97% referred because of their mental health. The most common pathway was to receive SP for around 90 days, with 10-15 link worker contacts and 6 contact hours. Following SP, SWEMWBS scores improved by 3.72 points (t(202)=17.50, 95% CI 3.30 to 4.14, p<0.001), a 20% relative increase. Exploratory analyses suggested that this increase was greater for those with lower baseline well-being. CONCLUSIONS: Despite numerous challenges with missing data and data quality, we found that CYP well-being increases following SP (as it is currently implemented). The moderate effect size was consistent with larger studies of adults. CLINICAL IMPLICATIONS: Further development of online platforms is needed to monitor access to, nature of and efficacy of SP. For those working in SP, we recommend more training, implementation of standardised guidelines and designated time to update records.
27 Apr 2026
Read appraisal →BMJ health & care informatics
i-MoMCARE: AI-enabled mobile app for maternal and child health care in Cambodia - a pilot implementation and evaluation study
OBJECTIVES: In Cambodia, village health support groups (VHSGs) are central to maternal and child health (MCH) service delivery, yet maternal mortality remains high with regional disparities. Although digital health solutions show promise, their real-world use is underexplored. This study therefore aims to evaluate the i-MoMCARE app in supporting VHSGs and health centre staff for delivering MCH services. METHODS: A mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used. Reach was assessed using programme records (number of users trained and MCH cases managed). Effectiveness and adoption were evaluated using the mHealth App Usability Questionnaire (MAUQ) and qualitative data on user experience and intention to use. Implementation was examined through system usage monitoring and feedback on workflow integration. Maintenance was explored using qualitative insights on long-term use, barriers and recommendations. RESULTS: 44 VHSGs and 10 health centre staff were trained, and 96 MCH cases were managed with the app. Usefulness was rated highly (MAUQ 5.58, SD 1.04), with users appreciating the user-centric design that improved usability and integration into daily workflows. Effectiveness was similarly high (MAUQ 5.50, SD 0.95); the clinical decision support system and point-of-care alerts were valued as reliable decision-support tools, and the electronic medical record (EMR) was seen as a secure data repository. However, adoption was hindered by hardware and software limitations (MAUQ 5.79, SD 0.75), including device availability and low digital literacy. DISCUSSION: Our findings highlight the value of the i-MoMCARE app in supporting VHSGs, particularly those with limited training, by enhancing their decision-making. The study also lays the groundwork for a unified EMR in primary care. However, concerns around hardware and software limitations hinder adoption and sustained use. CONCLUSION: To enable scale-up, we recommend reducing access barriers and supporting sustained use through diversifying the platform's design and implementing phased incentivisation strategies.
27 Apr 2026
Read appraisal →BMJ paediatrics open
Metabolically obese normal weight phenotype in children and adolescents aged 3 to 18 years: a systematic review
BACKGROUND: Children with normal Body Mass Index (BMI) may still exhibit adverse metabolic profile-termed as the metabolically obese normal weight (MONW) phenotype, placing them at increased risk of long-term cardiometabolic complications. OBJECTIVE: To systematically synthesise the evidence of the MONW phenotype in children and adolescents aged 3-18 years, and to identify early-life determinants. METHODS: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and searched PubMed/ MEDical Literature Analysis and Retrieval System On-Line (MEDLINE), Scopus, Web of Science (WoS), Google Scholar, Embase and Cochrane Library for studies from 2000 to January 2026. Observational studies of children and adolescents aged 3-18 years with normal BMI and at least one metabolic abnormality were included. Two reviewers independently screened the studies, extracted data and assessed risk of bias. Searches were conducted between March 2025 and January 2026, and 11 studies met the predefined inclusion and exclusion criteria. RESULTS: The reported prevalence of MONW ranged from 10.6% to 56.2%, varying by diagnostic criteria and population. Children with MONW consistently showed higher visceral adiposity, insulin resistance (IR), dyslipidaemia, hypertension, impaired glucose metabolism and elevated markers of low-grade inflammation despite having normal BMI. Early-life determinants included extremes of birth weight, rapid infant weight gain, adverse maternal metabolic status, unhealthy dietary patterns and sedentary behaviour. Overall risk of bias across studies was judged to be low to moderate, with the main concerns relating to residual confounding and use of heterogeneous MONW definitions. CONCLUSIONS: MONW represents a clinically relevant but under-recognised paediatric phenotype. Reliance on BMI alone may delay identification of vulnerable children. Early risk stratification integrating metabolic proofing and central adiposity measures may enable timely prevention of long-term metabolic disease. Harmonised operational definitions of MONW and robust longitudinal life-course studies are required to inform evidence-based screening thresholds and preventive interventions.
27 Apr 2026
Read appraisal →PloS one
Machine learning identifies pupil size and corneal thickness as key predictors of axial elongation rate
PURPOSE: This study aimed to develop a machine learning-based prediction model for myopia progression using ocular biometric parameters to provide an objective assessment tool for clinical practice. METHODS: A retrospective analysis was conducted on patients treated at Shanghai Parkway Health Ophthalmology Department as the training set, and myopic individuals from the Optometry Center of Peking University People's Hospital as the validation set. Demographic and biometric data were collected, including central corneal thickness (CCT), axial length (AL), corneal curvature (K-value), anterior chamber depth (ACD), corneal diameter (WTW), and pupil size (PS). Seven machine learning models (e.g., XGBoost, random forest, support vector machine) were employed for modeling, with performance optimized via 5-fold cross-validation. Model accuracy was evaluated using mean squared error (MSE) and the coefficient of determination (R²), and variable importance was analyzed. RESULTS: No statistically significant differences were observed in baseline characteristics between the training and validation sets (all P > 0.05). The XGBoost model demonstrated the best performance, achieving R² = 0.913 (MSE = 0.005) on the training set and R² = 0.766 (MSE = 0.016) on the test set. Variable importance analysis revealed pupil size (score 100) and corneal thickness (40.88) as the key predictors of axial elongation rate, followed by age of onset (17.96). CONCLUSION: The machine learning-based prediction model effectively utilizes ocular biometric data to assess myopia progression risk, with pupil size and corneal thickness identified as core predictive factors. This model provides a quantitative tool for early clinical intervention. Future studies should expand the sample size and incorporate additional biomarkers to optimize performance.
27 Apr 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Cumulative access to print books improves literacy achievement: Evidence from a five-year randomized trial in high-poverty schools
For more than a century, studies have shown that children who grow up in homes with more books achieve higher levels of academic success, yet it remains unclear whether books themselves improve learning or simply reflect broader socioeconomic advantages. Skill-development theory holds that greater access to books directly improves literacy through increased print exposure and reading practice, whereas the cultural capital account suggests books are indicators of broader family resources, including parental education, academic norms, and enrichment opportunities, that promote achievement independently of the books themselves. To provide causal evidence, we conducted a school-level randomized controlled trial of a program that builds children's home libraries. In 2018, we randomly assigned 60 high-poverty public elementary schools to treatment or control groups. Students in 30 treatment schools received four book distributions over 5 y, averaging about seven books per distribution, and prominently including high-interest and culturally relevant titles; students in 30 control schools received none. Tracking students from 2018-19 through 2022-23, we find a statistically significant intention-to-treat impact on reading achievement of d = 0.100 and a larger d = 0.207 advantage for those completing the full 5-y program. These impacts correspond to approximately 25 to 32% and 52 to 65% of a typical year's learning, respectively. The largest benefits are concentrated among students who received books across all distributions, indicating that cumulative exposure drives the strongest impacts. These findings provide evidence supporting skill-development theory and highlight a scalable strategy for improving literacy outcomes in high-poverty urban schools.
26 Apr 2026
Read appraisal →The pharmacogenomics journal
A randomized trial to evaluate attitudes regarding pharmacogenomics among pregnant and pediatric populations: design and baseline characteristics.
Pharmacogenomics (PGx) is a key component of precision medicine, yet most PGx studies exclude pregnant people and children. The VICE (Vanderbilt Integrated Center of Excellence)-MPRINT (Maternal and Pediatric Precision in Therapeutics): Maternal and Pediatric Pharmacogenetics Trial is a single-center, randomized control trial to assess how PGx testing and return of results influence patients' understanding and perceived utility of PGx testing in a pregnancy and pediatric cohort. Pregnant individuals and families or guardians of children with a chronic health condition aged 0-16 were recruited. We assessed participants' knowledge and attitudes regarding PGx testing at baseline and after receiving results with patient-friendly interpretations. Cases received an educational video about PGx testing with return of results. Controls received PGx test results alone. We aimed to determine perspectives regarding PGx in these understudied populations with the goal of promoting research and clinical implementation of PGx for pregnant women and children.
26 Apr 2026
Read appraisal →The British journal of ophthalmology
Two-year outcomes of repeated red light therapy in premyopic children: sustained efficacy and rebound effects
BACKGROUND: To evaluate the long-term prevention effectiveness and rebound effect of repeated red light therapy (RRLT) in children with premyopia over 2 years. METHODS: A total of 108 premyopic children (cycloplegia spherical equivalent refraction (SER): -0.50 to +0.75 D) were enrolled and followed for 24 months. Participants were randomly assigned to the RRLT or control groups. The RRLT was administered two times per day for 3 min per session, with at least 4-hour interval. At the beginning of the second year, participants receiving RRLT were further randomised into continued treatment and washout subgroups. Axial length (AL), SER and subfoveal choroidal thickness (SChT) were measured. RESULTS: Over 2 years, the RRLT group showed significantly smaller AL elongation (0.26 mm; 95% CI 0.18 to 0.35 mm) and SER progression (-0.21 D; 95% CI -0.35 to -0.08 D) compared with the controls (AL: 0.43 mm; 95% CI 0.36 to 0.49 mm; SER: -0.66 D; 95% CI -0.79 to -0.52 D). The RRLT group also demonstrated significantly less SChT thinning (-2.44 µm; 95% CI -16.11 to 11.23 µm) than the controls (-44.12 µm; 95% CI -53.05 to -35.19 µm). After RRLT cessation in the second year, the washout subgroup exhibited significantly faster AL elongation and more SChT thinning than the controls, with no significant difference in SER progression. CONCLUSIONS: The 2-year RRLT intervention effectively retarded AL elongation and SER progression in premyopic children by 0.17 mm and -0.45 D, respectively. Notably, a significant rebound effect was observed in AL growth following 1-year RRLT cessation.
25 Apr 2026
Read appraisal →PloS one
Forecasting under-five stunting in Ethiopia using classical and machine learning time series models
BACKGROUND: The prevalence of under-five stunting in Ethiopia remains above 30%, which, according to World Health Organization (WHO), constitutes a major public health concern. Stunting has long-term consequences for child growth, development, and overall health. Accurate forecasting of its prevalence is therefore essential to guide policymakers and inform targeted interventions. This study aimed to forecast the prevalence of under-five stunting in Ethiopia for the period 2025-2030 using historical data and time series modeling. METHODS: Annual under-five stunting prevalence data for Ethiopia from 2000 to 2024 were retrieved from the WHO Global Health Observatory. Time series forecasting models, including Autoregressive Integrated Moving Average (ARIMA), Exponential Smoothing (ETS), Multilayer Perceptron (MLP), and Long Short-Term Memory (LSTM), were developed and evaluated. Model performance was assessed using time series cross-validation with mean absolute error (MAE), mean absolute percentage error (MAPE), and R² as evaluation metrics. The best-performing model was applied to forecast stunting prevalence for 2025-2030. RESULTS: The ETS model demonstrated the best predictive performance (MAE = 1.09, MAPE = 2.71%, R² = 0.903) and was selected for forecasting. Forecasting indicated a gradual decline in under-five stunting prevalence in Ethiopia from 33.95% in 2025 to 31.95% in 2030. The projected prevalence for 2029 is 32.35% (95% CI: 26.90-37.79%), above the national target of 19%, and the 2030 forecast remains well above the SDG target of ending all forms of malnutrition. CONCLUSION AND RECOMMENDATION: Under-five stunting in Ethiopia is projected to remain above national and SDG targets by 2030, indicating current nutrition efforts are insufficient; national program evaluation and evidence-based policy adjustments are recommended.
24 Apr 2026
Read appraisal →BMJ quality & safety
Sustainability of the de-implementation of low-value care in infants with bronchiolitis: 2-year follow-up of a cluster randomised controlled trial
BACKGROUND: In 2017, the PREDICT (Paediatric Research in Emergency Departments International Collaborative) network conducted a cluster randomised controlled trial (cRCT) at 26 Australian and New Zealand hospitals to improve bronchiolitis care. Findings demonstrated that targeted interventions significantly improved adherence with five evidence-based low-value bronchiolitis practices (no chest radiography, salbutamol, glucocorticoids, antibiotics and epinephrine) in the first 24 hours of hospitalisation (adjusted risk difference, 14.1%; 95% CI: 6.5% to 21.7%; p<0.001). During the intervention year (2017), intervention hospital (n=13) compliance was 85.1% (95% CI: 82.6% to 89.7%). This study aimed to determine if improvements in bronchiolitis management were sustained at intervention hospitals 2 years post-trial completion. METHODS: International, multicentre follow-up study of hospitals in Australia and New Zealand that participated in a cRCT of de-implementation of low-value bronchiolitis practices, 1 year (2018) and 2 years (2019) post-trial completion, obtained retrospectively from medical audits. Sustainability was defined a priori as no more than a <7% decrease to any level of improvement in adherence for all five low-value practices (composite outcome) from the cRCT intervention year. RESULTS: Of the 26 hospitals, 11 intervention and 10 control hospitals agreed to participate in the follow-up study. Data were collected on 3299 infants with bronchiolitis 1 year (intervention and control hospitals) and 1689 infants 2 years post-trial (intervention hospitals). Adherence with no use of the five low-value practices 2 years post-trial completion was 80.9% (adjusted predicted adherence, 80.8%, 95% CI: 77.4% to 84.2%; estimated risk difference from cRCT outcome -3.9%, 95% CI: -8.6% to 0.8%) at intervention hospitals, fulfilling the a priori definition of sustainability. DISCUSSION: Targeted interventions, delivered over one bronchiolitis season, resulted in sustained improvements in bronchiolitis management in infants 2 years later. This follow-up study provides evidence for sustainability in de-implementing low-value care in bronchiolitis management. TRIAL REGISTRATION DETAILS: Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.
23 Apr 2026
Read appraisal →PloS one
An AI-based chatbot to support health-related social needs among pediatric primary care population: Protocol for a pilot randomized controlled trial
Unmet health-related social needs (HRSNs) are major drivers of poor health outcomes in early childhood. Children with unmet HRSNs are at greater risk for developmental delays, caregiver stress, and increased healthcare utilization, yet current screening approaches in pediatric primary care are resource-intensive and inconsistently implemented. AI-powered chatbots (conversational agents or virtual assistants) may offer a private, secure, scalable, and cost-effective alternative for identifying unmet needs and connecting families to services. This protocol describes a pilot randomized controlled trial designed to evaluate the feasibility, acceptability, and usability of DAPHNE, an AI-driven chatbot developed to facilitate the identification of unmet HRSNs and provide personalized community resource referrals. One hundred caregivers of children under two years of age will be recruited from Nationwide Children's Hospital pediatric primary care clinics and randomized to either the standard care (control) group or DAPHNE+ Standard care (intervention) group (n = 50 each arm). Caregivers will complete surveys at baseline, 1 month, 3 months, and 6 months post-intervention (depending on the measure). For the intervention group, participants will receive weekly chatbot prompts and on-demand access throughout the 6-month study period. Primary outcomes include study feasibility (recruitment, retention, and survey completion across both arms), acceptability (caregiver-reported ratings in both arms and intervention-specific ratings), and usability of the DAPHNE chatbot (System Usability Scale among intervention participants). Secondary outcomes includes caregiver-reported outcome measures (caregiver stress, self-efficacy, satisfaction with resource access, quality of life), and electronic health record-derived measures (including documentation of HRSN screening and referrals, adherence to well-child visits, missed appointments, emergency department utilization, and estimated healthcare costs). In addition, ten primary care providers will also participate to assess workflow integration and report on current HRSN practices. Mixed-methods analyses will integrate survey data, chatbot engagement metrics, and qualitative interviews to refine both the intervention and the study protocol. The results of this study will inform the design of a future multi-site trial to evaluate the efficacy and implementation of DAPHNE for addressing HRSNs in pediatric primary care. Trial registration: NCT07168382.
23 Apr 2026
Read appraisal →PloS one
Global folate deficiency among adolescent girls: A systematic review and meta-analysis
INTRODUCTION: Adolescents have higher nutrient requirements than adults, as this stage accounts for approximately 40% of total adult weight gain, 45% of skeletal mass and about 15% of adult height. Adequate micronutrient intake is particularly essential for adolescent girls to support growth, reproductive health, and cognitive development. Adolescent folate deficiency disrupts hematopoiesis, causing megaloblastic anemia, and hinders growth, cognition, and immune function and becoming a major public health concern. OBJECTIVE: This global systematic review and meta-analysis aims to address the gap in comprehensive evidence on the prevalence of adolescent folate deficiency. METHODS: This systematic review was conducted and reported according to PRISMA guidelines. We conducted a systematic literature search in PubMed, HINARI, Science Direct, DOAJ, Google, and Google Scholar for studies reporting the prevalence of folate deficiency among adolescent girls up to August 2025. Study quality was assessed using the Newcastle-Ottawa Scale, and evidence certainty was evaluated using GRADE. Pooled prevalence estimates with 95% confidence intervals were calculated using a random-effects model (DerSimonian-Laird method). Heterogeneity was assessed with Cochrane Q and I² statistics. Publication bias was evaluated through visual inspection of funnel plots and Egger's regression test, and adjusted estimates were calculated using the trim-and-fill method. Meta-regression analyses were conducted to explore potential sources of heterogeneity. Sensitivity analyses were performed to assess the robustness of pooled estimates. RESULTS: The search strategy identified 1,498 records, of which 26 studies met the eligibility criteria and were included in this systematic review and meta-analysis. The pooled global prevalence of folate deficiency among adolescent girls was 26.9%(95% CI: 20.5-33.2), with substantial heterogeneity observed between studies (I² = 99.99%, p < 0.001). On average across included studies, approximately one-quarter of adolescent girls were classified as folate deficient, though the true prevalence varied markedly between settings.. The pooled prevalence of folate deficiency among adolescent girls varied across regions, with the highest rate observed in Africa at 35.5%. CONCLUSION: These findings revealed folate deficiency as a substantial global public health concern among adolescent girls with a disproportionately high burden in low-resource settings. Region-specific strategies are urgently needed to prevent folate deficiency among adolescent girls, particularly in low-resource settings. Implementing targeted nutritional interventions and public health policies is essential to reduce its associated health consequences in this vulnerable population.
22 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Cerebral fuels within the first week of life in very preterm infants: a cohort study
BACKGROUND: Ketones and lactate may contribute towards overall cerebral fuel availability in term infants, yet the availability of such cerebral fuels in very preterm infants is unclear. We undertook a prespecified substudy to explore ketone and lactate concentrations in the first week of life in infants recruited to the REACT trial (real-time continuous glucose monitoring in the newborn): an international multicentre randomised controlled trial of 182 very low birth weight infants investigating the use of continuous glucose monitoring in glycaemic care. METHODS: Ketone and lactate measurements were prospectively collected over the first week of life using the Nova Biomedical point-of-care meter. A longitudinal analysis was undertaken to explore lactate and ketone concentration trends across time and their relationships with blood glucose, baseline demographics, nutritional support and insulin treatment. RESULTS: Data were available for 168 infants (85 females) including 2902 blood glucose, 2084 ketone and 2017 lactate samples. The mean (SD) gestational age was 27.4 (2.0) weeks. Lactate concentrations were higher initially, with mean (SD) 1.72 (1.26) mmol/L on day 2 and lowered to 1.19 (1.1) mmol/L on day 7. Ketone concentrations remained consistently low at 0.1 mmol/L. Neither simultaneous blood glucose concentrations, macronutrient intake nor receipt of insulin was consistently related to ketone or lactate concentrations. CONCLUSION: In this cohort of very preterm infants, there were persistently low concentrations of ketones and relatively higher concentrations of lactate throughout the first week of life. Future research should evaluate changes in these metabolites during episodes of acute hypoglycaemia or hyperglycaemia over more prolonged periods of neonatal intensive care.
20 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Duration of apnoea before start of backup ventilation during nCPAP in extremely preterm infants and time spent within the SpO2 target: a randomised cross-over study
OBJECTIVE: Central apnoea due to immaturity of the respiratory drive constitutes the main cause of frequent and prolonged desaturations in extremely preterm (EPT) infants <28 weeks. We investigated the impact of varying the duration of apnoea before backup ventilation (BUV) on the measures of oxygenation in EPT infants during nasal continuous positive airway pressure (nCPAP) therapy. DESIGN: Single-centre randomised cross-over trial. SETTING: Level 3 neonatal intensive care unit. PATIENTS: 24 EPT infants on nCPAP with BUV. MAIN OUTCOME MEASURES: The primary outcome was the time spent within a predefined oxygen saturation (SpO2) target (88%-95% or ≥88% with fraction of inspired oxygen (FiO2) =0.21) during start of BUV after 4 s of apnoea duration (AD 4) or 16 s of apnoea duration (AD 16) RESULTS: The study was successfully completed in 22 children (median gestational age 24+5 weeks, birth weight 628 g, postnatal age 48 days). Mean time spent within the SpO2 target didn't differ between AD 4 and AD 16 (66.9% vs 67.2%, p=0.88). There were no differences in the time below or above the SpO2 target, prolonged (>30 s, >60 s, >120 s) and severe (<80%, <70%) episodes of hypoxaemias and cerebral tissue oxygenation. Mean FiO2, mean airway pressure, transcutaneous carbon dioxide pressure, heart rate and respiratory frequency did not differ while the rate of BUV was significantly higher during AD 4. CONCLUSION: Reducing the time of apnoea until start of BUV didn't improve the time spent within the SpO2 target in respiratory unstable EPT infants. Our data demand intensified efforts to specify these settings of non-invasive respiratory support that better achieve this important clinical goal. TRIAL REGISTRATION NUMBER: DRKS00031911.
20 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial
OBJECTIVE: To assess the economic consequences of initiating full milk feeds from birth compared with intravenous fluids with gradual feeding in infants born preterm. DESIGN: Within-trial economic evaluation alongside a prospective, multicentre, randomised controlled trial (Fluids Exclusively Enteral from Day 1). A cost-consequence approach was used (revised from the planned cost-effectiveness analysis to avoid double counting length of stay within costs). SETTING: 46 UK National Health Service (NHS) neonatal units. PATIENTS: Preterm infants born at 30+0to 32+6 weeks' gestation. INTERVENTIONS: Infants were allocated to either full milk feeds or gradual feeding with intravenous support within 3 hours of birth. MAIN OUTCOME MEASURE: Resource use and costs were captured from birth to 6 weeks' corrected age. Costs were assessed from an NHS and personal social services perspective. The primary clinical outcome was length of hospital stay. RESULTS: 2088 infants were enrolled. There was no statistically significant difference in mean (95% CI) length of hospital stay between groups (-0.050 days (-0.638 to 0.538)). Mean total costs were £670 lower in the full milk group (95% CI: -£1562 to £223; p=0.141). Subgroup analyses suggested lower costs among infants born at 30 weeks' gestation and those below the 10th birth weight centile; no evidence of interaction was found. CONCLUSIONS: Initiating full milk feeds from birth was associated with a modest reduction in costs compared with gradual feeding. While overall hospital stays and costs were not significantly reduced, early full feeding may offer economic advantages in selected subgroups. Further research is needed to assess long-term outcomes. TRIAL REGISTRATION NUMBER: ISRCTN89654042.
19 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Umbilical cord management strategies and risk of intraventricular haemorrhage in preterm neonates: a systematic review and meta-analysis
OBJECTIVES: To assess the comparative effectiveness of different umbilical cord management strategies for preventing intraventricular haemorrhage (IVH) in preterm neonates. DESIGN: A systematic review and meta-analysis. STUDY SOURCES: PubMed, Scopus and Web of Science were searched from inception to March 2025 for relevant randomised controlled trials. PARTICIPANTS: All preterm neonates born <37+0 weeks of gestation. INTERVENTIONS: All umbilical cord management strategies, including immediate cord clamping (ICC), delayed cord clamping (DCC), intact umbilical cord milking (I-UCM), cut umbilical cord milking (C-UCM), intact cord stabilisation (ICS), physiology-based cord clamping and extrauterine placental perfusion. MAIN OUTCOME MEASURES: Any grade IVH (grades I-IV) and severe IVH (grades III-IV). DATA SYNTHESIS: Random-effects meta-analyses were conducted to calculate risk ratios (RRs) with 95% CIs. Analyses were stratified for very preterm (<32 weeks) and extremely preterm neonates (<28 weeks). RESULTS: Forty-nine studies with 8706 neonates were included. Thirty-five direct comparisons between strategies were made, but no clear evidence of benefit or harm emerged. Certainty of evidence ranged from moderate to very low, often downgraded due to imprecision, risk of bias and inconsistency. The most frequent comparison was DCC versus ICC, with 14 studies (RR 0.90, CI 0.65 to 1.26) for any grade IVH and 11 studies (RR 1.14, CI 0.69 to 1.87) for severe IVH. The second most common comparison, DCC versus I-UCM, showed no benefit: RR 1.03 (CI 0.80 to 1.32; eight studies, 2200 participants) and RR 0.77 (CI 0.35 to 1.66; seven studies, 2032 participants). ICS versus DCC was the only comparison which was rated as moderate certainty of evidence for both, any grade IVH (RR 0.96, CI 0.82 to 1.13) and severe IVH (RR 0.91, CI 0.62 to 1.35). CONCLUSIONS: No umbilical cord management strategy was clearly associated with increased or decreased IVH risk. Evidence certainty was generally low to very low, primarily due to bias and imprecision.
19 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Closed-loop automated oxygen control in preterm ventilated infants: a randomised controlled trial
OBJECTIVE: To compare the duration of mechanical ventilation between preterm infants receiving closed-loop automated oxygen control (CLAC) or manual oxygen control. DESIGN: Randomised controlled trial. SETTING: Tertiary neonatal unit in London, UK. PATIENTS: Infants (n=69) with a median (IQR) gestational age of 27.0 (25.6-29.0) weeks studied at a corrected postmenstrual age of 27.6 (25.9-29.1) weeks. INTERVENTIONS: Infants were randomised to CLAC or manual oxygen control within 48 hours of initiation of mechanical ventilation if less than 7 days of age until successful extubation. MAIN OUTCOME MEASURES: Duration of mechanical ventilation. RESULTS: The CLAC infants (n=34) compared with those who received manual control had a shorter duration of mechanical ventilation (median (range): 11 (1-57) vs 40 (3-134) days, p=0.027), a shorter duration of supplemental oxygen (median (range): 33 (0-100) vs 47 (3-335) days, p=0.031), a lower incidence of bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age (55% vs 83.9%, p=0.015) and fewer required home oxygen (26.5% vs 51.4%, p=0.016). In the CLAC infants, the time spent in the target oxygen range (91%-95%) was increased (p<0.001) and the times spent in hypoxaemia (peripheral oxygen saturation level (SpO2)<85%) and hyperoxaemia (SpO2>95%) were reduced (p<0.001). CONCLUSIONS: Use of CLAC in preterm, ventilated infants was associated with improved achievement of oxygen saturation targets, shorter durations of mechanical ventilation and supplemental oxygen treatment and a lower incidence of BPD. These results need to be replicated in larger multicentre studies before any change in routine practice could be recommended. TRIAL REGISTRATION NUMBER: NCT05030337.
19 Apr 2026
Read appraisal →Archives of disease in childhood. Fetal and neonatal edition
Intermittent hypoxia and caffeine in infants born preterm: the ICAF Randomized Clinical Trial
OBJECTIVE: To determine whether extending caffeine therapy through 43 weeks' postmenstrual age (PMA) decreases intermittent hypoxia (IH) in convalescing preterm infants. Secondary objectives were to assess caffeine effects on changes in inflammation-related plasma biomarkers and brain MRI. DESIGN: Multicentre masked randomised trial. SETTING: 16 US hospitals. PATIENTS: Infants at <30 weeks + 6 days gestational age on caffeine between 32 weeks and 36+5 days PMA in room air with routine caffeine discontinuation prior to 36 weeks +6 days. INTERVENTION: Randomisation to caffeine or placebo and treated through 42 completed weeks. Pulse oximetry was recorded from enrolment through 1 week after stopping study drug. Blood for 12 inflammation-related biomarkers obtained at enrolment and 38 weeks' PMA and brain imaging after enrolment or <3 days of randomisation, and study end. MAIN OUTCOME MEASURE: Seconds/hour of oxygen saturation <90% from randomisation to study end. RESULTS: Randomised 160 subjects, 78 placebo, 82 caffeine. IH was less at every PMA with caffeine treatment from 34 (172.7 (123.4, 241.7); 84.7 (64.4, 111.4, p<0.01) through 41 weeks (73.0 (51.3, 103.7); 26.6 (18.5, 38.2, p<0.001). Adjusted TNF-α levels were 23% lower at follow-up in the caffeine group compared with placebo (p<0.02), without other biomarker differences. Paired brain imaging found no significant differences. CONCLUSIONS: Extended caffeine reduced the burden of IH in very preterm infants and may reduce inflammation. Further study is needed to determine if this effect of caffeine is associated with reduced risk of adverse outcomes. TRIAL REGISTRATION NUMBER: NCT03321734.
19 Apr 2026
Read appraisal →European journal of pediatrics
Effect of intranasal breast milk administration on cerebral oxygenation, vital signs, and transition time to full oral feeding in preterm infants: a randomized controlled study
UNLABELLED: This study examined the effects of intranasal breast milk administration on cerebral oxygenation, vital signs, and time to transition to full oral feeding in preterm infants. This assessor-blinded, randomized controlled trial included 40 preterm infants with gestational ages between 28+0 and 36+6 weeks. Infants in the intervention group received 0.2 mL of fresh breast milk intranasally three times daily for 3 days. The control group continued to receive routine clinical care. During each intervention period, cerebral oxygenation and vital signs were recorded at baseline (T0), 5 (T1), 15 (T2), and 30 (T3) minutes after the intervention. The time required for preterm infants to achieve full oral feeding was monitored until discharge. Cerebral oxygenation levels of preterm infants who received intranasal breast milk were significantly higher than the control group and respiratory rate was lower at some measurement times. No significant differences were found between groups in oxygen saturation, heart rate, time to full oral feeding, length of hospital stay, vomiting frequency and defecation frequency. CONCLUSION: Intranasal breast milk administration has the potential to increase cerebral oxygenation in preterm infants. The maintenance of oxygen saturation and heart rate, along with good tolerance of the procedure, suggests that this intervention may be safe and feasible. TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov on 21 May 2024 (Identifier: NCT06706115). WHAT IS KNOWN: • Intranasal breast milk administration has been reported to have therapeutic potential in improving brain injury in preterm infants. • Intranasal administration of breast milk is known not to cause significant side effects in preterm infants diagnosed with intraventricular hemorrhage. WHAT IS NEW: • Intranasal breast milk administration may increase cerebral rSO₂ in preterm infants. • Intranasal breast milk administration did not affect preterm infants' heart rate, SpO₂ levels, time to transition to full oral feeding, length of hospital stay, daily vomiting, and stooling frequency.
17 Apr 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
Comparison of CATCH, PECARN and CHALICE rules in children with minor head trauma
PURPOSE: The aim of this study is to prospectively compare the diagnostic performance of the PECARN, CATCH, and CHALICE clinical decision rules in pediatric patients presenting with minor head trauma, within a rural secondary-level emergency department characterized by limited resources, high patient volume, and restricted access to specialist physicians. METHODS: The study was designed as a prospective observational study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the patients included in the study, and the data were recorded. The data included in the study were statistically analyzed using the SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL) 27 program. A value of p < 0.05 was considered statistically significant. RESULTS: A total of 1,032 patients were included in the study. The PECARN did not miss any of the 15 patients with pathological brain CT and had 100% sensitivity and 52.1% specificity. CATCH failed to detect pathological brain CT in 1 patient and had 93.3% sensitivity and 53.3% specificity. CHALICE failed to detect pathological brain CT in 2 patients, with 86.7% sensitivity and 87.8% specificity. Overall, PECARN was more successful in detecting pathological brain CT, but it also had a high false-positive brain CT rate. CONCLUSION: PECARN criteria are more sensitive than other criteria in predicting brain CT pathology, but they lead to a large number of brain CT scans. While the CHALICE criteria are beneficial in reducing unnecessary brain CT scans, they may miss positive cases.
16 Apr 2026
Read appraisal →PloS one
Ultra-processed food consumption and the risk of overweight and obesity in adolescents: A systematic review and meta-analysis
INTRODUCTION: Overweight and obesity during early life increase the risk of premature morbidity and mortality. Adolescent obesity raises the likelihood of developing cardiovascular risk factors, including prediabetes, type 2 diabetes, dyslipidemia, hypertension, liver disease, and metabolic syndrome. Sedentary lifestyles and unhealthy diets are major contributors, with one of the fastest-growing unhealthy eating patterns being the consumption of ultra-processed foods (UPFs). No systematic review and meta-analysis has specifically examined the association between UPF consumption and overweight/obesity in adolescents. OBJECTIVE: To systematically review and conduct a meta-analysis of available evidence on the association between UPF consumption and overweight or obesity among adolescents. METHODS: We searched PubMed, ScienceDirect, HINARI, Google, and Google Scholar for primary studies reporting UPF consumption and overweight/obesity outcomes in adolescents, without restrictions on language or study period. Study quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated using Cochrane's Q test and the I² statistic. Publication bias and small-study effects were assessed using Egger's regression test (p < 0.05). A random-effects model estimated pooled associations. RESULTS: Twenty-three studies involving 155,000 adolescents were included. Adolescents with higher UPF consumption had 63% greater odds of overweight or obesity compared with those with lower intake (OR = 1.63; 95% CI: 1.36-1.95). CONCLUSION: High UPF consumption is associated with an increased risk of overweight and obesity among adolescents. Public health strategies targeting reduced UPF intake and promotion of healthier diets should be prioritized to prevent adolescent overweight/obesity and associated health risks.
16 Apr 2026
Read appraisal →European journal of pediatrics
7-days versus 14-days antibiotic therapy in uncomplicated culture proven neonatal sepsis: a randomized control assessor-blinded trial
UNLABELLED: The trial aimed to establish the non-inferiority of a 7-day antibiotic therapy for uncomplicated neonatal sepsis when compared to the standard 14-day therapy. This study was a parallel-group, randomized non-inferiority assessor-blinded trial conducted in a tertiary Neonatal Intensive Care Unit in Central India. Neonates weighing ≥ 1000 g with suspected sepsis were screened and those meeting criteria were enrolled. Exclusions included babies with CNS (central nervous system) infections, septic arthritis, and life-threatening congenital malformations. Participants were observed for 7 days on antibiotics and re-evaluated; those with positive blood cultures were then randomized to receive either 7 or 14 days of antibiotics. The primary outcome was the relapse of sepsis, and a sample size of 70 in each arm was calculated based on a non-inferiority margin. Follow-ups were conducted for 48 h post-antibiotic treatment and weekly for 35 days to monitor any recurrence of illness. During the study, 917 babies with suspected sepsis were admitted, of which 256 had culture-positive sepsis. After excluding those with meningitis, staphylococcus, and fungal infections, 140 babies showed improvement at day 5 and were randomized into two groups: one receiving antibiotics for 7 days and the other for 14 days, each consisting of 70 babies. Klebsiella pneumoniae was the prevalent organism. The 7-day group had a shorter hospital stay (p < 0.05) and less respiratory support (p < 0.05). Outcomes revealed a low incidence of probable relapse in both groups, with no fatalities or definitive relapses recorded. CONCLUSIONS: A 7-day antibiotic regimen for uncomplicated neonatal sepsis is not inferior to a 14-day regimen. WHAT IS KNOWN: • Unregulated use of antibiotics can lead to a myriad of problems, especially in neonates. • There is some evidence that uncomplicated neonatal sepsis can be treated with short-course antibiotics. WHAT IS NEW: • Data is lacking-especially from Central India. • This trial checks if it is possible to reduce the duration of antibiotic therapy in uncomplicated neonatal sepsis.
16 Apr 2026
Read appraisal →The Cochrane database of systematic reviews
Insulin-like growth factor-1 for the prevention or treatment of retinopathy of prematurity
RATIONALE: Retinopathy of prematurity (ROP) is a disorder of the developing retina in which abnormal proliferation of retinal blood vessels may lead to severe visual compromise or retinal detachment in infants born preterm. Insulin-like growth factor-1 (IGF-1) promotes normal retinal vessel growth in utero; however, IGF-1 levels fall substantially following preterm birth. By returning IGF-1 to in utero levels, postnatal treatment with IGF-1 may interrupt ROP pathogenesis, preventing disease or reducing its severity. OBJECTIVES: To compare treatment with IGF-1 to standard care or placebo for the prevention of retinopathy of prematurity or treatment of early retinopathy of prematurity. SEARCH METHODS: We used CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, Issue 3, 2025, in the Cochrane Library, CINAHL Plus with Full Text (EBSCOhost), Epistemonikos, clinical trials registries (US National Library of Medicine Clinicaltrials.gov, World Health Organization's International Trials Registry Platform, and ISRCTN Registry), together with reference checking and citation searching to identify studies that are included in this review. The latest search date was 10 March 2025. ELIGIBILITY CRITERIA: We considered all randomized controlled trials (RCTs), cluster-RCTs, and quasi-RCTs comparing IGF-1 with standard care or placebo for the prevention of ROP or treatment of early ROP in preterm infants. We planned to exclude cross-over randomized trials. OUTCOMES: Our outcomes of interest were: • Development of Type 1 ROP, defined as ROP requiring treatment at any time during the birth hospitalization or outpatient follow-up • Development of ROP ≥ stage 3 at any time during the birth hospitalization or outpatient follow-up • Development of ROP of any severity at any time during the birth hospitalization or outpatient follow-up • Occurrence of one or more serious adverse events (SAEs) at any time during the birth hospitalization • Mortality during the birth hospitalization • Hypoglycemia during the birth hospitalization RISK OF BIAS: We used the original Cochrane Risk of Bias 1 tool (RoB 1) to assess possible bias in the included studies. SYNTHESIS METHODS: Dichotomous data were reported using risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CIs). Where possible, we synthesized results for each outcome using meta-analysis with fixed-effect models. We used GRADE to assess the certainty of evidence for each outcome. INCLUDED STUDIES: We included two studies totaling 140 participants. Both included studies were parallel-group RCTs performed between 2011 and 2016 enrolling extremely preterm infants in well-resourced settings in Europe and North America. The two published primary study references describe a two-center RCT (n = 19) and a 20-center RCT (n = 121) comparing treatment starting on the first day of life with intravenous IGF-1 (as mecasermin rinfabate) to standard care for prevention of ROP in newborn infants at 23 weeks' to 27 weeks plus six days' gestational age with follow-up through 40 weeks' postmenstrual age. SYNTHESIS OF RESULTS: Type 1 ROP/ROP requiring treatment Evidence is very uncertain regarding the effect of treatment with IGF-1 as compared to standard care/placebo for preventing development of Type 1 ROP/ROP requiring treatment (RR 0.94, 95% CI 0.38 to 2.35; P = 0.90; I2 = 0%; 2 RCTs, 116 infants; very low-certainty evidence). ROP ≥ stage 3 Evidence is very uncertain regarding the effect of treatment with IGF-1 as compared to standard care/placebo for preventing development of severe ROP (RR 1.27, 95% CI 0.61 to 2.65; P = 0.52; I2 = 0%; 2 RCTs, 116 infants; very low-certainty evidence). ROP of any severity Evidence is very uncertain regarding the effect of treatment with IGF-1 as compared to standard care/placebo for preventing development of ROP of any severity (RR 1.30, 95% CI 0.94 to 1.80; P = 0.12; I2 = 0%; 2 RCTs, 116 infants; very low-certainty evidence). SAEs during the birth hospitalization Evidence is very uncertain regarding the safety of treatment with IGF-1 as compared to standard care/placebo as reflected by the occurrence of one or more SAEs during the birth hospitalization in preterm infants (RR 1.18, 95% CI 0.94 to 1.47; P = 0.15; I2 = 65%; 2 studies, 140 infants; very low-certainty evidence). Post-hoc sensitivity analysis including only the larger RCT demonstrated an increased risk of experiencing one or more SAEs with IGF-1 compared to controls (RR 1.28, 95% CI 1.01 to 1.62, P = 0.05; RD 0.17, 95% CI 0.01 to 0.33, P = 0.04; number needed to treat for an additional harmful outcome (NNTH) 5.9; I2 = not applicable; 1 RCT, 121 infants; very low-certainty evidence). All-cause mortality during the birth hospitalization Evidence is very uncertain regarding the effect of treatment with IGF-1 as compared to standard care/placebo on all-cause mortality during the birth hospitalization in preterm infants (RR 1.69, 95% CI 0.71 to 3.99; P = 0.23; I2 = not applicable; 1 RCT, 121 infants; very low-certainty evidence). Hypoglycemia during the birth hospitalization Evidence is very uncertain regarding the safety of treatment with IGF-1 as compared to standard care/placebo as reflected by the incidence of hypoglycemia in preterm infants during the birth hospitalization (RR 1.00, 95% CI 0.62 to 1.63; P = 0.99; I2 = 0%; 2 RCTs, 140 infants; very low-certainty evidence). We assessed all results to be of very low certainty due to small total enrollment and substantial risk of bias. Both included studies had a high risk of bias in two domains. In addition, both were funded by industry. AUTHORS' CONCLUSIONS: The available data are of very low certainty, and so we are not able to draw conclusions about the effects of treatment with IGF-1 in preterm infants for preventing or treating ROP, or about its effects on risk of serious adverse events, mortality, or hypoglycemia in this population. FUNDING: This Cochrane review had no dedicated funding. REGISTRATION: Protocol available via DOI: 10.1002/14651858.CD013216.
16 Apr 2026
Read appraisal →European journal of pediatrics
Multi-directional phototherapy vs. unidirectional phototherapy from below for severe neonatal jaundice: a randomized pilot trial in home phototherapy
UNLABELLED: Severe neonatal jaundice is a common problem, carrying a risk of neurologic toxicity. Phototherapy has become the standard treatment for jaundiced infants, eliminating the need for exchange transfusion and the risk of neurotoxicity. We hypothesized that treatment with multi-directional phototherapy would be more rapid than with single-direction, high-intensity treatment from below (unidirectional) in the home setting. We performed a prospective, randomized, pilot trial comparing high-intensity multi-directional phototherapy to high-intensity unidirectional treatment in the home setting. Treatment time was determined from device timers. Serum bilirubin levels were obtained daily and as ordered by the pediatrician, serving as a basis for estimating the bilirubin reduction rates. Eight infants were treated with multi-directional phototherapy; nine were treated with unidirectional phototherapy. Multi-directional treatment was more rapid with treatment time of 15.1 ± 6.4 h vs. 25.1 ± 11.8 h; p = 0.05. The estimated rate of bilirubin reduction was more rapid with multi-directional phototherapy 0.40 ± 0.21 vs. 0.14 ± 0.10 mg/dL/h; p < 0.02. CONCLUSION: Multi-directional phototherapy was more rapid than treatment with unidirectional phototherapy in the home setting. TRIAL REGISTRATION: ISRCTN88608924 29 January 2026, retrospectively registered. WHAT IS KNOWN: •Home phototherapy for hyperbilirubinemia is safe and effective. •Treatment times with fiberoptic and wearable devices in the home setting can be lengthy and complicated by overheating and readmission. WHAT IS NEW: •Home phototherapy with multidirectional illumination is more effective than unidirectional undersurface phototherapy. •Multidirectional home phototherapy can lower bilirubin levels at a rate comparable to hospital devices.
15 Apr 2026
Read appraisal →Journal of chromatography. A
Machine learning-assisted HS-GC-IMS for discrimination and traceability of baby bottles based on volatile fingerprints
Ensuring the safety of food contact materials, particularly baby bottles, is crucial for infant health. In this study, a comprehensive analytical strategy integrating headspace gas chromatography-ion mobility spectrometry (HS-GC-IMS) with machine learning-based chemometrics was developed to profile volatile organic compounds (VOCs) and achieve discrimination and traceability of materials and brands among nine baby bottles. A total of 87 VOCs were identified, with aldehydes, esters, alcohols, ketones being the most diverse groups, and aldehydes exhibiting the highest concentrations. Visual representations were established, clearly illustrating the fingerprint profiles of the various baby bottle samples. Unsupervised models, principal component analysis (PCA) and hierarchical cluster analysis (HCA), revealed distinct clustering patterns. In contrast, supervised models, including Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA), Decision Tree (DT), Random Forest (RF), and Support Vector Machine (SVM), and deep learning models such as Convolutional Neural Network (CNN) and Transformers, were constructed to predict brand classification. Among them, RF was selected as the optimal model due to its superior performance-utility balance. Key discriminant markers were further determined by integrating the Variable Importance in Projection (VIP) scores from OPLS-DA with the feature importance from the RF model, significantly improving classification efficiency. This research proposes an effective and reliable analytical framework for rapid identification and traceability of baby bottles, offering valuable insights for anti-counterfeiting and safety assurance of food-contact materials.
12 Apr 2026
Read appraisal →Journal of speech, language, and hearing research : JSLHR
Rhotic Generalization Is More Rapid in Biofeedback Than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial
PURPOSE: This study examined the effects of visual biofeedback approaches and nonbiofeedback motor-based treatment on generalization outcomes following speech therapy for children with residual speech sound disorders (RSSDs). METHOD: A total of 108 children aged 9-15 years with RSSD affecting American English /ɹ/ were randomly assigned to receive 19 motor-based speech treatment sessions, with or without visual biofeedback (divided into ultrasound or visual-acoustic biofeedback). The treatment included practice designed to implement several motor learning principles, with task difficulty systematically adjusted based on the child's performance. Children's /ɹ/ accuracy on untreated words before and after treatment was rated as correct or incorrect by lay listeners who were blinded to participant characteristics, treatment conditions, and time points. RESULTS: The mixed-effects regression model revealed a statistically significant interaction between treatment type and time point. Specifically, both the biofeedback and nonbiofeedback motor-based treatment groups made progress over time, but the amount of generalization to untreated words was significantly greater in the biofeedback condition than in the motor-based treatment. In a subanalysis comparing biofeedback types, greater generalization was observed following ultrasound biofeedback than visual-acoustic biofeedback, although this effect was strongest at one treatment site. DISCUSSION: This randomized controlled trial found that adding biofeedback to motor-based treatment can increase the rate of accurate production of the American English /ɹ/ in untreated words.
12 Apr 2026
Read appraisal →BMJ paediatrics open
Which healthcare services did children and adolescents use before presentation at specialised outpatient clinics for post-COVID-19 condition? Descriptive findings from the Post-COVID Kids Bavaria study.
OBJECTIVE: Measuring the utilisation of healthcare services in children and adolescents with symptoms suggesting post-COVID-19 condition (PCC) until their presentation at specialised outpatient clinics (SOC). METHODS: 117 patients (aged 4-17 years) with symptoms suggesting PCC were recruited for study participation in SOCs of the comprehensive care network 'Post-COVID Kids Bavaria' for children and adolescents with PCC in Bavaria, Germany. Information on healthcare utilisation from their initial SARS-CoV-2 infection until presentation at an SOC was collected via telephone interviews with parents. RESULTS: Participants had a median of 6.5 physician contacts (Q1-Q3: 3.8-11.5), mainly in person (99.1%, n=116) and rarely used telemedicine (21.4%, n=25). Contacts were mainly with paediatricians (72.6%, n=85), followed by general practitioners (46.2%, n=50). Non-pharmacological measures were used by 56 participants (47.9 %), with therapies by Heilpraktiker and osteopaths being used most commonly (30.8%, n=36). 76 participants (65.0%) were prescribed medications, and 71 (60.7%) used non-prescribed medications or supplements. CONCLUSIONS: Children and adolescents with PCC symptoms frequently consult healthcare services, often self-initiated measures provided by Heilpraktiker and osteopaths, until their presentation at an SOC. This may be due to unclear care pathways. Paediatricians and general practitioners are key providers, making their expertise and strong connections with SOCs essential for early diagnosis and appropriate treatment.
12 Apr 2026
Read appraisal →BMJ paediatrics open
Systematic review of the evidence of cardiac dysfunction and intravenous fluid use among children with severe acute malnutrition and severe dehydration
BACKGROUND: A sizeable proportion of cholera attributed mortality occurs among children with severe acute malnutrition (SAM). International guidelines severely limit the use of intravenous fluids among children with SAM and cholera due to their perceived vulnerability to fluid overload. We reviewed the cardiac function evidence and studies of intravenous fluid use among children with SAM. METHODS: Two systematic reviews of Chinese, English, French and Spanish language papers published after the last Global Task Force for Cholera Control recommendations on the treatment of children with cholera and SAM (2017) were conducted. The first included studies of cardiac function among children presenting to hospital with SAM. The second included studies of intravenous fluid use among children with dehydrating diarrhoea and SAM. RESULTS: Among eight echocardiographic studies of cardiac function in children with SAM at presentation to hospital, all found left ventricular mass to be decreased but none found systolic function to be impaired. Seven of the eight studies assessing diastolic function found some degree of mild-to-moderate impairment. Two echocardiographic studies monitored responsiveness to intravenous fluid resuscitation and found no evidence of fluid overload. Finally, four studies gave intravenous fluids to children with SAM and either shock or dehydration. Collectively, these studies included 251 children with SAM given intravenous fluid. No cases of fluid overload were observed. CONCLUSION: No evidence to support decreased systolic function among children with SAM and no documented cases of fluid overload during intravenous rehydration of these children were identified. These data call into question guidelines that severely restrict intravenous fluids among children with SAM and highly dehydrating conditions such as cholera.
12 Apr 2026
Read appraisal →Vaccine
Increasing HPV vaccine uptake using a "start at 9" strategy: A pilot program
BACKGROUND: Human papillomavirus (HPV) vaccine completion rates by 13 years remain suboptimal. Earlier HPV vaccination may result in improved timely completion rates. We aim to describe the impact of recommending HPV vaccine at 9 years of age on vaccine completion rates. METHODS: We implemented a multi-level program (including policy development, provider and office personnel education, electronic health record changes, and use of vaccine promotional items) to facilitate routine HPV vaccine recommendation at 9 years at 2 pediatric practices. Monthly chart reviews were performed 6 months before through 18 months after program implementation. Outcome measures included rates of HPV vaccination and documentation of HPV vaccine during the visit. Quarterly data (age, HPV vaccination status, gender, race, ethnicity, insurance, and primary care provider type) were obtained from the electronic health records of 9-12-year-olds served by the practice from baseline through 18 months after program implementation. RESULTS: Following program implementation, the median percentage of HPV vaccine uptake among 9-10-year-olds increased from 8% to 41% at the urban practice and from 3% to 23% at the suburban practice. Similarly, HPV vaccine completion rates among 9-12 year olds increased from 9% to 14%, p < 0.001 and from 6% to 16%, p < 0.001, respectively. Documentation of provider vaccine recommendation strongly correlated with HPV vaccination. CONCLUSION: Implementation of a multi-level program to routinely recommend the HPV vaccine at 9 years of age is feasible and effective in increasing in HPV vaccine completion by 13 years of age.
12 Apr 2026
Read appraisal →Microbiology spectrum
PneumoWiki: a pan-genome-based database for the pathogen Streptococcus pneumoniae
UNLABELLED: The Gram-positive bacterium Streptococcus pneumoniae is a major human pathogen that exhibits more than 100 different capsular serotypes and considerable genomic variability. S. pneumoniae is also an important model organism for basic and biomedical research, with a number of strains with different characteristics being used. To address this, we have created the manually curated pan-genome database PneumoWiki (https://pneumowiki.med.uni-greifswald.de) that integrates genomic data of 43 S. pneumoniae strains with various aspects of functional annotation. All data relating to a specific gene and gene product are compiled on a Gene page. In addition to the gene and protein sequences and annotation from NCBI RefSeq, this includes, for example, data on gene expression, protein function, and localization. The information is supplemented with links to the data sources as well as to other databases and relevant literature. The basic concept of PneumoWiki is the interlinked presentation of pan-genome-based and strain-specific information. Therefore, register tabs with strain names at the top of the Gene pages allow switching between orthologous genes and the corresponding pan-genome page. The pan-genome gene pages contain a summary with functional information and the occurrence of the gene, an ortholog table for the 43 S. pneumoniae strains, a multiple-strain genome viewer as well as a protein sequence alignment. PneumoWiki was developed as a user-friendly tool and is available free of charge. The data collected in PneumoWiki are accessible via various download options. Overall, PneumoWiki is a resource for the research community that supports the analysis and interpretation of experimental data and, in particular, enables the integration of the knowledge available for different S. pneumoniae strains. IMPORTANCE: Databases that integrate and curate the large amounts of genomic data and functional information available for well-studied organisms play an increasingly important role in many areas of life sciences, including infection research. Streptococcus pneumoniae is a major human pathogen associated with high morbidity and mortality rates. The species exhibits high variability in its genome sequence, and a number of strains with different characteristics are used in pneumococcal research. We created the wiki-type database PneumoWiki to provide researchers with curated, up-to-date information on a range of pneumococcal genomes, focusing on the individual genes and encoded proteins and their functional annotation. The key feature of PneumoWiki is the pan-genome approach, which allows combining information of individual strains, thereby supporting the analysis of experimental data and comparisons between studies using different strains. In this way, the database becomes a valuable research tool that can contribute to a better understanding of pneumococcal physiology.
10 Apr 2026
Read appraisal →The Tohoku journal of experimental medicine
Age-Specific Trends and Health Status of Children Aged 12-19 Years with Specified Chronic Pediatric Diseases in Japan - Insights from a National Database Study
Japan has a national financial assistance program called the "Specified Chronic Pediatric Diseases of Japan" (SCPDJ; also called "Shouman" in Japanese) for children with chronic diseases designated by the Japanese Ministry of Health, Labour and Welfare. The information of registrants in the system is digitized for research. We utilized the database to clarify the characteristics of children with diseases designated by the SCPDJ program. Analysis was performed with a particular focus on patients aged 12-19 years, which are considered the important ages for transition support from pediatric to adult medical care. The data included 69,061 cases aged 0 to 19 years from April 2016 to March 2017. The number of registrants showed a cumulative increase from 2 years toward adulthood. There were four distribution patterns for registered age and age at onset by disease category: 1) both age and age of onset peaked at age 0; 2) age distribution was mostly flat, while the most common age of onset was age 0; 3) age distribution peaked in older age groups, while age of onset of 0 was most common; and 4) both age and age of onset peaked at older ages. Approximately half of the patients aged 12-19 years were diagnosed after reaching school age. Although the disease condition of most patients remained good, some aged 12-19 years experienced exacerbation. The database was analyzed to provide an overview of children with diseases designated by the SCPDJ program and issues related to transition to adult care systems.
10 Apr 2026
Read appraisal →BMJ paediatrics open
Does osteogenesis imperfecta predispose infants to metaphyseal fractures? A systematic review.
OBJECTIVE: The notion that osteogenesis imperfecta (OI) predisposes children to metaphyseal fractures is controversial. This review aimed to ascertain the prevalence of metaphyseal fractures in children with OI less than 2 years of age. MATERIALS AND METHODS: Medline, CINAHL and Web of Science were searched for studies reporting metaphyseal fractures in children with OI less than 2 years of age. Articles not retrievable, not published in English, or where 'metaphyseal' fracture was not defined/illustrated, were excluded. Article quality was independently assessed using the Critical Appraisal Skills Programme and Case Reports tools. RESULTS: Of 298 retrieved abstracts, 82 were duplicates: 216 articles were screened by title and abstract, excluding 186. Hand search of the remaining 30 articles identified two further articles. Only four articles were included: (1) 4/41 children with OI aged between 1 day and 3 years with 'metaphyseal' fractures; (2) a case series including a 16-month-old boy with three 'metaphyseal' fractures. Abuse concerns remained despite a type IV OI diagnosis (not genetically confirmed); (3) a 7-month-old girl with two 'corner' fractures suspected to have OI and to have been abused; and (4) a pair of siblings with 'metaphyseal' fractures and type XI OI (FKBP10 mutation). CONCLUSIONS: There is limited evidence that OI predisposes infants and young children to metaphyseal fractures. The two diagnoses are not mutually exclusive and until further large studies are conducted, physical abuse should always be considered in infants and young children with metaphyseal fractures, even in those with confirmed OI.
9 Apr 2026
Read appraisal →PloS one
Caregivers' early stimulation behaviors on early child development outcomes in Northern Ghana
Despite the government prioritizing Early Childhood Development (ECD) in Ghana, data on responsive caregiving is limited. This study examined the type and extent of Early Stimulation Activities (ESAs) practiced by mothers, and other caregivers and the associations between ESAs and children's development by caregiver type in Northern Ghana. Data were from a cluster-randomized controlled trial with mother-child dyads that evaluated the impact of an integrated maternal mental health and early childhood intervention program. The primary outcome was measured by the Developmental Milestone Checklist (DMC-II). Covariates included maternal report of ESAs performed by herself, child's father, and other caregivers. Linear regression analyses with cluster-adjusted standard errors were performed. Nearly 15% of mother-participants (n = 313) reported 4 + ESAs in the past 3 days. Within the last 3 days, on average, women reported 2.5 activities for themselves, 1.2 activities by the child's father, and 2 activities by other caregivers. The associations between ESAs and children's development varied by caregiver type. Maternal stimulation was positively associated with children's total development and personal-social development, early stimulation by other caregivers was positively associated with children's total development and language development, and paternal stimulation was not associated with any development domain. Other associations included receipt of postnatal care and presence of household toys. While maternal stimulation seemed particularly important, findings regarding non-primary caregivers suggest that ECD programming could also benefit from their inclusion.
5 Apr 2026
Read appraisal →BMJ global health
Risk and protective factors of depression among caregivers of children with disabilities in rural Rwanda
BACKGROUND: Caregivers of children with disabilities are at increased risk of experiencing poor mental health due to the compound effects of financial and family stressors. This study aims to identify risk and protective factors for poor mental health, particularly depression, among caregivers of young children with disabilities. METHODS: This is a secondary data analysis, including a total of 1518 caregivers who were enrolled at baseline in a cluster randomised trial evaluating the effects of Sugira Muryango, a home-visiting parenting intervention, on early child development and violence prevention outcomes. A total of 309 primary caregivers were identified as having a child aged 12-36 months who screened positive for some form of developmental delay. Associations between key sociodemographic and household characteristics and depression outcomes were explored using multivariable linear regression models. RESULTS: Among the sample of caregivers of children with disabilities, 65% met the clinical cut-off for likely depression. Economic hardship (β=0.158, p<0.001), food insecurity (β=0.009, p<0.01) and caregiver illness (β=0.183, p<0.01) were significant risk factors for depression. In contrast, family unity (β=-0.013, p<0.001) was an important protective factor for depression among these caregivers. Among married/cohabiting caregivers, intimate partner violence (IPV) was associated with higher mean depression scores (β=0.306, p<0.001), though the inclusion of family unity in the full model (inclusive of risk and protective factors) attenuated the impact of IPV on depression. CONCLUSIONS: Programmes targeting children with disabilities should also address the mental health needs of parents. Mental health difficulties are common for caregivers living in poverty, especially those raising a child with a disability or developmental delay. Additionally, parenting programmes that reduce family violence and build family unity should be prioritised by policymakers interested in improving the mental health and well-being of families facing extreme poverty.
5 Apr 2026
Read appraisal →Language, speech, and hearing services in schools
Intervention Efficacy for Children With Mild Bilateral Sensorineural Hearing Loss
PURPOSE: This study aimed to compare the efficacy of hearing aid (HA) and frequency modulation (FM) systems in improving language, articulation, and speech perception outcomes among children with mild bilateral sensorineural hearing loss (MBHL) over a 12-month intervention period. METHOD: A prospective repeated-measures design was employed, enrolling 43 Cantonese-speaking children aged 6-7 years, with a pure-tone average of 26-40 dB HL. Participants were randomly assigned to either the HA group (n = 16) or the FM group (n = 16). A nontreatment control group (n = 11) was formed from children who declined the intervention. The outcome measures included the Hong Kong Cantonese Articulation Test, the Hong Kong Cantonese Oral Language Assessment Scale, and the Cantonese Hearing-in-Noise Test. Assessments were conducted at baseline and 12 months post-intervention. RESULTS: The FM group demonstrated significant improvements in language abilities (p < .01, Cohen's d = 0.53), particularly in word definition, expressive vocabulary, and Cantonese grammar, outperforming both the HA and control groups (p < .05). Articulation improvements were greater in the FM group, with significant gains in consonant production (p < .01). No significant improvements were observed in speech perception across the groups. CONCLUSIONS: FM systems are more effective than HAs in enhancing language and articulation outcomes in children with MBHL, particularly in noisy classroom environments. These findings highlight the importance of individualized intervention strategies and the potential of FM systems to support auditory access and language development. Future research should explore long-term outcomes and the role of contextual factors in intervention efficacy.
5 Apr 2026
Read appraisal →BMJ paediatrics open
Impact of parent education programmes on confidence and self-efficacy in parents of preterm infants: a systematic review
OBJECTIVE: Families of preterm infants can experience high stress during neonatal intensive care unit (NICU) hospitalisation, which interferes with the development of parenting confidence and self-efficacy through active engagement with their infants. Parent NICU support programmes provide guidance and education to build this connection. This systematic review examined the effects of parent education programmes on confidence and self-efficacy among parents of preterm infants. DESIGN: Systematic review in PubMed/Medline, PsycINFO, CINAHL, Google Scholar and Web of Science. SETTING: NICU. PARTICIPANTS: Parents of preterm infants. INTERVENTION: Education programmes offered to parents in the NICU. MAIN OUTCOME MEASURES: Quantitative surveys measuring parent confidence or self-efficacy. RESULTS: 14 studies met inclusion criteria from an initial 220 identified. Five were randomised controlled trials and nine were non-randomised studies. Programmes combining information delivery with opportunities for parent-infant engagement were most effective. Infant access and time to practise skills were key factors in transferring programme knowledge to increase parent confidence and self-efficacy. While 6 of the 14 studies did not show statistically significant differences between groups, all interventions demonstrated improvements in parental confidence or self-efficacy from baseline. Vast variability in duration of intervention, proper descriptions of facilitator trainings, methodological limitations and potential confounding factors reduced the overall quality of evidence to a low level. CONCLUSION: Both unit-specific programmes developed within individual NICUs and commercially available, copyrighted parent education programmes hold value. They are generally effective in building parent confidence and self-efficacy among parents of preterm infants. Integrating either type of programme into standard NICU care may hold promise for strengthening parental competence and promoting family-centred outcomes. Clarity on content/topics of programmes, duration and level of facilitator trainings can strengthen the process of supporting parents in the NICU, even in low resource settings. PROSPERO REGISTRATION NUMBER: CRD42024524063.
4 Apr 2026
Read appraisal →BMJ paediatrics open
Mapping the global prevalence and socioecological drivers of child sexual abuse: a systematic review and synthesis
INTRODUCTION: Child sexual abuse (CSA) is a widespread global health concern with lasting impacts. CSA is multifactorial and layered, and interventions to tackle CSA require an analysis of the key contributing factors. The main objective of this study was to explore global prevalence estimates of CSA and key contributing factors. METHODS: We systematically searched PubMed, Scopus and Web of Science for studies reporting lifetime prevalence of contact (eg, inappropriate touching or sexual acts) and non-contact (eg, exposure to sexual content or ill-intended conversations) CSA. Of 5493 articles screened, 332 met inclusion criteria. Prevalence data were stratified by population, region and abuse type. Risk factors were synthesised thematically using a socioecological framework. RESULTS: Median prevalence of reported non-contact CSA was 57.0% (range: 31.1%-80.0%). Contact CSA prevalence was higher among females (median: 14.9%, range: 2.2%-40.2%) than males (median: 6.0%, range: 0.6%-21.2%). Regional variations were notable, with sub-Saharan Africa reporting the highest contact CSA prevalence (median: 25.5%) and Latin America and the Caribbean the lowest (median: 8.5%). Vulnerable groups, including Indigenous children (median: 39.2%), orphans (37.9%) and the incarcerated (31.1%), faced higher risk. Risk factors spanned individual (shame, stigma), familial (poor supervision, dysfunction), institutional (lack of safeguards) and societal (weak legal frameworks, normalisation of abuse) levels. CONCLUSIONS: Prevalence of CSA was globally high, with 14 in 100 females reporting having experienced CSA. Multilevel interventions, particularly strengthening family supervision and institutional safeguarding, legal accountability and community awareness, are critical for the prevention of CSA.
4 Apr 2026
Read appraisal →Journal of global health
Exposure-response association between outdoor activity time and myopia risk in Chinese children and adolescents: a systematic review and meta-analysis
BACKGROUND: The prevalence of myopia among Chinese children and adolescents has increased sharply over recent decades, raising concern about modifiable environmental risk factors. Although outdoor activity is widely recognised as protective, the quantitative exposure-response relationship within the Chinese educational context remains incompletely defined. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies examining the association between daily outdoor activity time and myopia risk among Chinese youth were identified from major English and Chinese databases (Web of Science, PubMed, CNKI, and Wanfang) through October 2025. Random-effects meta-analysis was conducted to pool odds ratios (ORs). Prespecified subgroup and sensitivity analyses examined exposure thresholds, study design, and geographic latitude. RESULTS: We included 31 studies comprising 380 215 participants. Greater outdoor activity was consistently associated with lower myopia risk (pooled OR = 0.75; 95% confidence interval (CI) = 0.71-0.80), although substantial heterogeneity was observed (I2 = 94%). Compared with <1 hour per day, outdoor exposure of 1-2 hours (OR = 0.85; 95% CI = 0.79-0.92), 2-3 hours (OR = 0.86; 95% CI = 0.78-0.95), and > 3 hours (OR = 0.74; 95% CI = 0.63-0.87) was associated with reduced risk. When dichotomised at two hours, exposure >2 hours yielded an OR of 0.74 (95% CI = 0.69-0.80). Findings were directionally consistent across study designs and latitude strata. CONCLUSIONS: Greater outdoor activity time is associated with lower myopia risk among Chinese children and adolescents. An approximate daily exposure of around two hours appears to represent a pragmatic benchmark under current educational conditions.
4 Apr 2026
Read appraisal →BMJ global health
Impacts of rising food prices on nutritional outcomes and mortality of children in low and middle-income countries: a systematic review
BACKGROUND: Estimates indicate that 45% of mortality among children under 5-year old is linked to nutrition. Increased food prices can reduce access to nutritious foods, increasing nutritional and health risks for children, particularly in low and middle-income countries (LMICs). We synthesised evidence on the relationship of rising food costs with nutritional outcomes and mortality in children in LMICs. METHODS: EMBASE, MEDLINE, Global Health, EconLit, Web of Science and six grey literature sources were searched in September 2023. Searches included key phrases such as 'food price shocks' and 'child malnutrition'. We included any longitudinal study design, with any measure of food price increase and any measure of child malnutrition or mortality as outcomes. Results were analysed narratively with risk of bias assessed using the Newcastle Ottawa Scale. RESULTS: A total of 18 studies were included, covering 104 LMICs. There were 16 repeated cross-sectional or panel studies, one longitudinal cohort study and one quasi-experimental study. Five of these studies were multicountry. 16/18 studies reported a range of adverse nutritional outcomes associated with higher food costs, including mortality (five studies), stunting and low height for age (six studies), and wasting and low weight for height (five studies). Low birth weight, admissions to feeding centres, reduced consumption of rice, fruit, vegetables and animal protein, and reduced haemoglobin concentrations were also associated with higher food prices in one study each. Subgroup analyses were limited although two studies identified larger impacts on children in urban areas, and two studies identified larger impacts where children were exposed to higher food prices at younger ages. DISCUSSION: Rising food prices present a risk to child health and nutrition in LMICs. Policies should prioritise increasing household income alongside structural reforms to mitigate the nutritional impacts of elevated food prices on young children and pregnant women. PROSPERO REGISTRATION NUMBER: CRD42023469198.
4 Apr 2026
Read appraisal →Ann Med
Advancements in artificial intelligence for atopic dermatitis: diagnosis, treatment, and patient management
Atopic dermatitis (AD) is a common and complex skin disease that significantly affects the quality of life of patients. The latest advances in artificial intelligence (AI) technology have introduced new methods for diagnosing, treating, and managing AD. AI has various innovative applications in the diagnosis and treatment of atopic dermatitis, with particular emphasis on its significant benefits in medical diagnosis, treatment monitoring, and patient care. AI algorithms, especially those that use deep learning techniques, demonstrate strong performance in recognizing skin images and effectively distinguishing different types of skin lesions, including common AD manifestations. In addition, artificial intelligence has also shown promise in creating personalized treatment plans, simplifying drug development processes, and managing clinical trials. Despite challenges in data privacy and model transparency, the potential of artificial intelligence in advancing AD care is enormous, bringing the future to precision medicine and improving patient outcomes. This manuscript provides a comprehensive review of the application of AI in the process of AD disease for the first time, aiming to play a key role in the advancement of AI in skin health care and further enhance the clinical diagnosis and treatment of AD.
1 Dec 2025
Read appraisal →Ann Allergy Asthma Immunol
Current updates in the epidemiology and comorbidities of atopic dermatitis
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that affects individuals across the lifespan, with significant implications for both public health and individual well-being. This paper provides an overview of the epidemiology of AD, focusing on its prevalence, incidence, and risk factors across different populations and regions. We evaluate the growing global burden of AD, highlighting trends in both high-income and low- to middle-income countries, and the impact of socioeconomic, environmental, and genetic factors on disease manifestation. The review also explores the variations in disease severity, age of onset, and comorbidities such as asthma and allergic rhinitis. This paper emphasizes the need for more robust epidemiologic studies to further elucidate the complex interactions between genetic predisposition and environmental exposures in the development and progression of AD and explores the potential role of technology (eg, artificial intelligence) in helping to collect robust epidemiologic data. Understanding the epidemiology of AD is crucial for identifying high-risk groups, informing preventive strategies, and optimizing management approaches.
1 Nov 2025
Read appraisal →Nat Med
Feasibility and clinical utility of expanded genomic newborn screening in the Early Check program
Although genomic sequencing presents groundbreaking newborn screening (NBS) opportunities, critical feasibility and utility questions remain. Here we present initial results from the Early Check program-an observational study assessing the feasibility and clinical utility of genomic NBS in North Carolina. Recruitment was statewide through mailed letters with electronic consent. Genome sequencing with analysis of 169 high actionability genes (plus 29 optional lower actionability genes) was performed using residual NBS dried blood spots. In 8 months, 1,979 newborns were screened, with 50 (2.5%) screen positives. Negative results were returned electronically, positive results by genetic counselors. Twenty-eight results (55%) were true positives, all received anticipatory guidance, surveillance and management recommendations, and referral to specialists as appropriate. We report technical feasibility and preliminary clinical utility finding, along with interpretation and follow-up challenges that hinder public health implementation. We propose standardized terminology to facilitate cross-study comparisons and accurate characterization of genomic NBS outcomes.
1 Nov 2025
Read appraisal →Acad Pediatr
Caregiver and Pediatric Clinician Perspectives on Artificial Intelligence for Language Services
OBJECTIVE: Children and caregivers who use languages other than English (LOE) for pediatric health care experience inequities and poorer overall health. Advancement of large language models has raised questions about the future use of artificial intelligence (AI) for language access. This study explored the perspectives of caregivers who use LOE and pediatric clinicians on using AI to address unmet needs in health care translation and interpretation. METHODS: We conducted semistructured individual interviews with caregivers of pediatric patients who use LOE and pediatric clinicians about the use of AI language technologies in health care. A phone interpreter or fluent team member was used for LOE interviews. Recordings were transcribed, translated as needed, coded, and analyzed using inductive thematic analysis. RESULTS: Twenty caregivers using 11 different LOE and 22 clinicians participated. Themes were consistent across participants, though clinicians were more familiar with the concept of AI. Participants reported use of technologies (eg, Google Translate) for written communication and situations where verbal interpretation was perceived to be inadequate. They were concerned about AI accuracy, privacy, and loss of empathy, but hoped it could provide real-time document translation and more convenient verbal communication. Ease of use, validation, and equitable creation and access were critical for use. CONCLUSIONS: Caregivers and clinicians were open to using AI to fill gaps in translation and interpretation; however, robust validation of AI technology and complementary use with human interpreters and translators is needed. Future research, practice, and policy should focus on integrating AI while investing in human translation and interpretation.
1 Jan 2025
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