Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 41 appraisals
Current opinion in pediatrics
Artificial intelligence in pediatric endocrinology: clinical applications, governance, and future directions.
PURPOSE OF REVIEW: Artificial intelligence has transitioned from theoretical promise to practical implementation across medicine including pediatric endocrinology. This review examines artificial intelligence applications across diabetes care, obesity management, thyroid disorders, growth and puberty, and bone age assessment followed by discussion of limitations and future directions. RECENT FINDINGS: Artificial intelligence-driven tools ranging from machine learning algorithms to multimodal large language models enable personalized risk prediction, diagnostic support, and treatment optimization. Human-in-the-Loop frameworks enhance safety by integrating computational efficiency with clinician oversight. In diabetes, artificial intelligence supports glycemic forecasting, automated insulin delivery, complication screening, and digital twin modeling for therapeutic discovery. In obesity, thyroid disease, growth disorders, and bone age assessment, artificial intelligence enhances diagnostic accuracy, risk stratification, and clinical workflow efficiency. However, widespread implementation raises concerns regarding algorithmic bias, data privacy, transparency, regulatory oversight, and health equity. Addressing these limitations through explainable artificial intelligence, federated learning, and continuous performance monitoring is essential. SUMMARY: Artificial intelligence should be viewed as an augmentative tool that enhances clinical judgment in pediatric endocrinology. Preparing the next generation of pediatric endocrinologists will require intentional integration of artificial intelligence literacy into training programs, equipping clinicians to critically evaluate algorithms, interpret outputs responsibly, and participate in the ethical development of future artificial intelligence-enabled tools.
2 Aug 2026
Read appraisal →Journal of the American College of Surgeons
What Is Included in Pediatric Enhanced Recovery After Surgery Protocols and How to Encourage Adoption: A Systematic Review of the Literature
The present systematic review is the first to describe and analyze the breadth of enhanced recovery after surgery (ERAS) elements across various pediatric surgery procedures. The aim of the article is to provide a compendium of ERAS elements that are used in pediatric protocols to identify both gaps and variation. In response to these findings, we then propose a methodology for addressing the gaps and variation we found and furthering the use of ERAS in pediatric surgery.
14 June 2026
Read appraisal →Journal of tropical pediatrics
A randomized controlled trial to evaluate the efficacy and safety of a double-walled incubator compared to a radiant warmer in the care of extremely low-birth-weight infants
This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.
12 June 2026
Read appraisal →Critical care explorations
Linking the Virtual Pediatric System and Pediatric Hospital Information System Databases to Create Novel PICU Research Datasets
BACKGROUND: Lack of a robust, national PICU database hinders epidemiologic and quasi-experimental research of PICU care. Combining the virtual pediatric system (VPS) and pediatric health information system (PHIS) databases would overcome this data gap. However, limits on the use of variables containing protected health information (PHI) have prevented prior large-scale VPS-PHIS linkage. We sought to link VPS and PHIS records from 31 hospitals without using PHI. METHODS: We performed a database linkage study utilizing a sequential direct + probabilistic linkage approach with records from 31 hospitals contributing to VPS and PHIS for patients discharged between January 1, 2017 and December 31, 2022. Using directly linked records as a reference, we assessed the accuracy of probabilistically linked pairs with data from four hospitals by describing the percent of false-negative and false-positive links. We also compared demographic and clinical variables between linked and unlinked records using Cohen's Effect size (CES). RESULTS: We obtained 337,836 VPS and 3,515,595 PHIS records without PHI. In total, we linked 319,955 of 337,836 (94.7%) VPS records. Direct linkage contributed 274,345 of 319,955 (85.7%) of all record linkages. Probabilistic linkage contributed 45,610 of 319,955 (14.3%) of all record linkages. Assessment of the probabilistic linkage found 0.21% false-negative links and no false-positive links. We found negligible imbalance by CES for gender (% female in linked vs. unlinked: 44.8% vs. 43.6%, CES 0.024), age in years (median [interquartile range (IQR)]: 5.1 [1.21-13.22] vs. 5.53 [1.53-13.38], CES 0.054), Pediatric Risk of Mortality 3 score (median [IQR]: 0.44 [0.3-0.9] vs. 0.37 [0.29-1.02], CES 0.096), or days in PICU (median [IQR]: 1.55 [0.8-3.47] vs. 1.33 [0.79-3.45], CES 0.031). CONCLUSIONS: Using a combined direct and probabilistic linkage approach, we created a highly accurate linkage VPS and PHIS database records from 31 hospitals without using PHI. This combined database can be used to create novel datasets for PICU research.
31 May 2026
Read appraisal →Journal of perinatal medicine
Oral adjuvants supplemented to phototherapy as a therapeutic strategy for neonatal hyperbilirubinemia: a systematic review
INTRODUCTION: Neonatal jaundice is a common condition characterized by elevated serum bilirubin levels. Although usually benign, inadequate management may result in severe complications such as bilirubin encephalopathy and kernicterus. Phototherapy is the standard treatment; however, concerns regarding potential short- and long-term adverse effects have motivated the investigation of oral adjuvants as complementary therapies to accelerate bilirubin clearance and reduce phototherapy exposure. CONTENT: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251071886). Randomized controlled trials published between 2010 and 2025 were included, evaluating full-term neonates (35-42 weeks, 2-4 kg) without Rh incompatibility. Searches were conducted in PubMed, Cochrane Central, Embase, and Web of Science. Of 193 identified records, 18 RCTs met eligibility criteria. The oral adjuvants assessed included probiotics, phenobarbital, ursodeoxycholic acid (UDCA), oral calcium, zinc sulfate, fenofibrate, and clofibrate. Lactobacillus reuteri demonstrated greater 24-hour reductions in total serum bilirubin (TSB) compared to controls, whereas Bifidobacterium strains primarily reduced phototherapy duration. Phenobarbital did not outperform phototherapy alone and was associated with longer hospitalization. UDCA showed substantial bilirubin reductions, although findings were heterogeneous. Zinc supplementation did not demonstrate consistent significant benefit. Fenofibrate produced statistically significant decreases in TSB across trials and showed the most consistent efficacy. Clofibrate also reduced bilirubin levels but with methodological variability and limited comparative data. SUMMARY: Oral adjuvants combined with phototherapy may enhance bilirubin reduction in term neonates, particularly fenofibrate. OUTLOOK: However, heterogeneity and potential bias limit definitive conclusions, emphasizing the need for large, multicenter randomized trials.
27 May 2026
Read appraisal →European journal of pediatrics
Safety and efficacy of liposomal iron for iron deficiency anemia in pediatric population: A systematic review and meta-analysis of randomized controlled trials
Iron deficiency anemia (IDA) remains a public health problem in children. Conventional iron therapy is effective but often causes gastrointestinal adverse effects that reduce adherence. Liposomal iron has been developed to enhance absorption and improve tolerability. This systematic review and meta-analysis evaluated the efficacy and safety of liposomal iron compared with conventional iron formulations in pediatric patients with IDA. We searched PubMed, Scopus, Web of Science, and the Cochrane Library up to February 21, 2026 for randomized controlled trials (RCTs) comparing liposomal iron with conventional oral iron in children with IDA. Analyses were performed using R software with the meta package. Continuous outcomes were pooled as mean differences (MDs) and dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses according to follow-up duration. Four RCTs involving 454 children were included. At 6 months, liposomal iron produced a significantly greater increase in hemoglobin compared with conventional iron (MD 0.96 g/dL, 95% CI 0.09-1.82; P = 0.03), although heterogeneity was substantial (I2 = 92.9%). No significant differences were observed at earlier time points. Liposomal iron significantly reduced total iron-binding capacity (MD - 35.52 μg/dL; P < 0.0001) and increased mean corpuscular hemoglobin (MD 1.83 pg; P < 0.0001). Liposomal iron was associated with fewer adverse events (RR 0.29; P = 0.02) and lower risk of constipation (RR 0.56; P = 0.02).Conclusion: Liposomal iron offered better tolerability and was non-inferior to conventional iron for most hematologic outcomes. Evidence remains preliminary and larger RCTs are needed to confirm its efficacy in pediatric IDA.
26 May 2026
Read appraisal →The Cochrane database of systematic reviews
Early erythropoiesis-stimulating agents in preterm or low-birthweight infants
RATIONALE: Preterm and low-birthweight infants are at risk of anemia due to a variety of factors, including low levels of erythropoietin. They may therefore benefit from erythropoiesis-stimulating agents (ESAs). However, controversy remains about their effectiveness and safety, not only in reducing blood transfusions but also in improving clinical outcomes. OBJECTIVES: To assess the benefits and harms of early administration of ESAs in preterm or low-birthweight infants. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Scopus, DOAJ, and trial registries to 31 March 2025, and checked the reference lists of studies and systematic reviews for potentially relevant studies. ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) comparing early (initiated before eight days of life) ESAs (erythropoietin or darbepoetin) to placebo or no intervention among preterm (< 37 weeks' gestation) or low-birthweight (< 2500 g) infants. OUTCOMES: Outcomes included mortality during initial hospital stay (all-cause mortality), moderate to severe neurodevelopmental impairment (NDI) at 18 to 26 months' corrected age, proportion of infants exposed to one or more red blood cell (RBC) transfusions, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (sIVH). RISK OF BIAS: We used the Cochrane RoB 1 tool to assess risk of bias. SYNTHESIS METHODS: We performed data collection and analyses according to the methods of Cochrane Neonatal (fixed-effect meta-analysis using the inverse-variance method). We analyzed categorical data using risk ratio (RR) and continuous data using mean difference (MD), and reported the 95% confidence interval (CI) on all estimates. We used GRADE to assess the certainty of evidence. INCLUDED STUDIES: We included 37 studies (n = 6724), five (n = 3052) of which are new. Two studies (n = 752) investigated darbepoetin, and 35 studies (n = 5972) investigated erythropoietin. SYNTHESIS OF RESULTS: ESAs compared to placebo or no intervention Mortality: ESAs probably result in little to no difference in mortality during initial hospital stay (RR 0.93, 95% CI 0.80 to 1.09; I² = 0%; 24 studies, 5217 participants; moderate-certainty evidence). Subgroup analysis suggests that early use of erythropoietin probably results in little to no difference in mortality (RR 0.91, 95% CI 0.77 to 1.09; I² = 0%; 23 studies, 4505 participants), and early use of darbepoetin probably results in little to no difference in mortality (RR 1.00, 95% CI 0.71 to 1.43; I² = 0%; 2 studies, 712 participants). NDI: ESAs may reduce moderate to severe NDI at 18 to 26 months' corrected age (RR 0.81, 95% CI 0.68 to 0.95; I² = 86%; 3 studies, 1707 participants; low-certainty evidence). Subgroup analysis suggests that early use of erythropoietin may reduce moderate to severe NDI at 18 to 26 months' corrected age (RR 0.79, 95% CI 0.66 to 0.95; I² = 93%; 2 studies, 1239 participants), while early use of darbepoetin may result in little to no difference in moderate to severe NDI at 18 to 26 months' corrected age (RR 0.87, 95% CI 0.59 to 1.28; I² not applicable; 1 study, 468 participants). Transfusions: ESAs may reduce the proportion of infants exposed to one or more RBC transfusions (RR 0.79, 95% CI 0.76 to 0.83; I² = 56%; 21 studies, 3507 participants; low-certainty evidence). Subgroup analysis suggests that erythropoietin may reduce the proportion of infants exposed to one or more RBC transfusions (RR 0.80, 95% CI 0.76 to 0.84; I² = 56%; 20 studies, 2795 participants); darbepoetin may reduce the proportion of infants exposed to one or more RBC transfusions (RR 0.75, 95% CI 0.68 to 0.84; I² = 0%; 2 studies, 712 participants). ROP (any stage): ESAs result in little to no difference in incidence of ROP (RR 0.91, 95% CI 0.83 to 1.00; I² = 0%; 14 studies, 3844 participants; high-certainty evidence). Subgroup analysis suggests the use of either erythropoietin (RR 0.92, 95% CI 0.84 to 1.02; I² = 0%; 13 studies, 3230 participants) or darbepoetin (RR 0.83, 95% CI 0.58 to 1.17; I² = 0%; 2 studies, 614 participants) results in little to no difference in incidence of ROP. NEC (any stage): ESAs probably reduce the incidence of NEC (RR 0.74, 95% CI 0.62 to 0.87; I² = 0%; 20 studies, 5749 participants; moderate-certainty evidence). Subgroup analysis suggests that early use of erythropoietin probably reduces the incidence of NEC (RR 0.72, 95% CI 0.61 to 0.85; I² = 0%; 19 studies, 5041 participants), while early use of darbepoetin probably results in little to no difference in incidence of NEC (RR 1.08, 95% CI 0.54 to 2.15; I² = 0%; 2 studies, 708 participants). sIVH (grade ≥ 3): ESAs probably reduce the incidence of sIVH (RR 0.70, 95% CI 0.56 to 0.89; I² = 43%; 9 studies, 2458 participants; moderate-certainty evidence). Subgroup analysis suggests that early use of erythropoietin probably reduces the incidence of sIVH (RR 0.72, 95% CI 0.57 to 0.91; I² = 47%; 9 studies, 2396 participants), while early use of darbepoetin probably results in little to no difference in incidence of sIVH (RR 0.40, 95% CI 0.11 to 1.41; I² not applicable; 1 study, 62 participants). Of note, the test for subgroup differences between erythropoietin and darbepoetin revealed no evidence of a difference for the outcomes of mortality, moderate to severe NDI, NEC, sIVH, ROP, and the proportion of infants exposed to RBC transfusion. We downgraded the certainty of evidence for inconsistency, imprecision, and high risk of bias in the included studies. AUTHORS' CONCLUSIONS: Early use of ESAs probably results in little to no difference in mortality (moderate-certainty evidence); may reduce moderate to severe NDI at 18 to 26 months' corrected age (low-certainty evidence); has little to no effect on ROP (high-certainty evidence); may reduce the proportion of infants exposed to one or more RBC transfusions (low-certainty evidence); and probably reduces both NEC and sIVH (moderate-certainty evidence). Given the benefits of ESAs, future research should focus on cost-effectiveness, equity, feasibility of implementation, and acceptability to different stakeholders of the routine use of erythropoietin or darbepoetin among preterm or low-birthweight infants. FUNDING: No funding was received for this review. REGISTRATION: Protocol (and previous versions) available via 10.1002/14651858.CD004863; 10.1002/14651858.CD004863.pub2; 10.1002/14651858.CD004863.pub3; 10.1002/14651858.CD004863.pub4; 10.1002/14651858.cd004863.pub5; 10.1002/14651858.CD004863.pub6.
25 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Factors associated with unplanned healthcare encounters in pediatric cancer patients.
INTRODUCTION: Pediatric cancer therapies can cause complications that drive unplanned healthcare encounters (e.g., emergency visits and unplanned admissions). Characterizing their frequency and risk factors is important for resource planning, family counseling, and targeted mitigation strategies. In a secondary analysis of data from a cluster-randomized controlled trial of symptom monitoring in pediatric cancer patients, the primary objective was to describe the characteristics of unplanned healthcare encounters. The secondary objective was to identify risk factors associated with unplanned healthcare encounters. METHODS: This was a sub-analysis of a cluster-randomized trial of 10 sites randomized to symptom screening and 10 sites randomized to usual care. We included English- or Spanish-speaking pediatric patients newly diagnosed with cancer who were 8-18 years of age receiving any cancer treatment. At symptom screening sites, enrolled participants were reminded to complete symptom screening with Symptom Screening in Pediatrics Tool (SSPedi), a validated symptom screening and assessment, three times weekly for 8 weeks. The healthcare team was notified for severely bothersome symptoms. Emergency department visits, and unplanned clinic visits and admissions were determined from families and charts. Encounter documentation was reviewed to determine if the unplanned encounter was related to SSPedi symptoms. RESULTS: Among the 444 participants from 20 participating sites, there were 652 unplanned encounters and the most common were emergency room visits (n = 269) followed by unplanned clinic visits (n = 143) and unplanned admissions (n = 240). Pain was the primary reason for emergency room visits (59, 13.3%), unplanned clinic visits (52, 11.7%), and unplanned admissions (19, 4.3%). Nausea/vomiting was the next most common symptom for emergency room visits (40, 9.0%), unplanned clinic visits (4, 0.9%), and unplanned admissions (14, 3.2%). In multivariable analysis, leukemia diagnosis (P = 0.0003), site randomization (P = 0.018), and increasing physician full-time equivalents per 100 new cancer diagnoses (P = 0.032) were associated with more unplanned encounters. CONCLUSIONS: Unplanned healthcare utilization is common among newly diagnosed pediatric cancer patients. The association between unplanned healthcare utilization and standardized symptom screening and increasing physical full-time equivalents warrant further investigation. Key aspects to the implementation of routine symptom screening among pediatric patients with cancer will be resource allocation to prevent and manage common symptoms including those that may lead to unplanned healthcare visits.
22 May 2026
Read appraisal →European journal of pediatrics
The effect of virtual reality glasses used during inhaler treatment on anxiety, fear and vital signs in children: a randomized controlled trial
UNLABELLED: This study aimed to determine the effect of virtual reality (VR) glasses used during inhaler treatment on anxiety, fear and vital signs in children. The study had an experimental, randomized controlled design. Participants were assigned to groups using a lottery method based on simple randomization. The random sequence was generated by physically mixing up 30 red (experimental) and 30 white (control) cards. All the data were collected and finalized by two trained researchers (Yasemin Özyer Güvener, a nurse researcher, and Şeyma Şimşirgil Kara, a pediatrician). Participants were recruited using a convenience sampling method from among individuals who met the inclusion criteria. In terms of baseline measurements, the experimental group had significantly higher mean pulse rate, fear scores, and anxiety scores (130.23 ± 14.64, 2.77 ± 1.25, and 4.60 ± 2.04, respectively) compared to the control group (118.83 ± 17.10, 2.07 ± 1.26, and 2.80 ± 2.07, respectively) (p = 0.007, p = 0.035, and p = 0.001, respectively). For post-intervention measurements, the experimental group had significantly lower mean fear and anxiety scores (0.443 ± 0.16 and 0.703 ± 0.22, respectively) compared to the control group (2.39 ± 0.16 and 3.197 ± 0.22, respectively) (p < 0.001 and p = 0.001, respectively). CONCLUSION: It was determined that VR glasses reduced anxiety and fear, increased oxygen saturation, and reduced respiratory and pulse rates. They can thus be used as an alternative method to reduce fear and anxiety levels and balance vital signs during inhalation therapy in children. WHAT IS KNOWN: • Virtual reality (VR) is an effective non-pharmacological method for reducing pain, anxiety, and fear in pediatric patients during various medical procedures. • VR applications create a sense of presence in a virtual world, limiting the impact of anxiety and fear in clinical settings. WHAT IS NEW: • Using VR glasses during the administration of inhaled medication significantly reduces anxiety and fear levels in children compared to traditional methods. • While evidence for VR use during inhalation therapy was previously limited, this study demonstrates its effectiveness as a promising alternative to improve treatment compliance and physiological responses in pediatric patients.
21 May 2026
Read appraisal →JMIR formative research
Application of an AI-Based Pediatric Early Warning Score in the Pediatric Emergency Department: Cross-Sectional Study
BACKGROUND: Pediatric emergency departments see a high volume of patients. Given that children often cannot describe their condition and there is a shortage of nursing staff, it is essential to identify the early warning signs of adverse conditions among children as quickly as possible. Current targeted care needs to be improved. OBJECTIVE: This study aimed to investigate the application of an artificial intelligence (AI)-based version of the Pediatric Early Warning Score (PEWS) in a pediatric emergency observation unit, analyze the relationship between PEWS and disease severity, and assess its impact on the length of hospital stay and hospitalization costs after admission, thereby providing a reference for targeted nursing care. METHODS: We performed a retrospective study. A total of 1233 pediatric patients admitted via the pediatric emergency department of a tertiary specialty hospital in Guangzhou from September 2023 to March 2024 were included. The patients were divided according to whether they triggered a PEWS early warning into an early warning group (PEWS ≥1) and a non-early warning group (PEWS=0) during emergency observation. Length of stay and hospitalization costs were compared between the early warning group and the non-early warning group. Differences between groups were assessed using the Mann-Whitney U test. We performed multivariable logistic regression to discuss the association of resource use metrics and PEWS status, adjusted by age, sex, and disease category (respiratory, neurological, and hematologic). RESULTS: Of 1233 patients, 597 (48.4%) triggered the PEWS early warning (mean score 2.44, SD 1.41), and 636 (51.6%) did not. In the early warning group, 68 children were transferred to the intensive care unit, with a mean PEWS of 3.32 (SD 1.73). Compared with the non-early warning group, the early warning group had a longer hospital stay (z=-5.180; P<.001) and higher hospitalization costs (z=-6.500; P<.001), and the differences between groups were statistically significant (P<.001). Among the top 3 admission categories-respiratory, neurological, and hematologic diseases-children in the early warning group had significantly longer hospital stays and higher hospitalization costs (all P<.01). The β coefficient for length of hospital stay was 0.053 (SE 0.010; Wald χ²1=5.533; odds ratio 1.055, 95% CI 1.035-1.075), while the β coefficient for hospitalization costs was 0.001 (SE 0.000; Wald χ²1=6.075; odds ratio 1.001, 95% CI 1.001-1.001). CONCLUSIONS: Compared with the non-early warning group, the early warning group had significantly longer hospital stays and higher hospitalization costs (P<.001); similar patterns were observed within respiratory, neurological, and hematologic disease categories (all P<.01). These findings show differences between children who triggered the warning and children who did not, providing a reference for identifying critically ill children for targeted care.
21 May 2026
Read appraisal →Science advances
Wireless, skin-interfaced multimodal sensing system for continuous psychophysiological monitoring-A wearable polygraph device
Accurate, continuous monitoring of psychophysiological states is central to understanding stress and autonomic dysfunction across diverse medical contexts. Current approaches such as polygraphy and polysomnography rely on cumbersome, wired sensors that limit real-world utility and burden patients, particularly vulnerable populations such as infants. Here, we introduce a wireless, skin-interfaced multimodal sensing system capable of simultaneously recording cardiac, respiratory, electrodermal, and thermal signals in a time-synchronized manner. Leveraging compact and soft designs, the technology enables unobtrusive monitoring across controlled, clinical, and naturalistic settings. Validation studies performed in parallel with gold standard systems demonstrate high fidelity in quantifying stress responses during polygraph interviews, cognitive load tasks, and cold pressor tests. In pediatric sleep studies, the data reliably identify arousals, hypopnea, and apnea while revealing disease-specific autonomic signatures in infants with Down syndrome. Real-world deployment during emergency simulation training shows that multimodal stress signatures correlate inversely with performance, underscoring translational value in medical education. Machine learning analyses across all studies confirm that multimodal features outperform single-signal approaches in detecting stress and clinical events with high sensitivity and specificity. Collectively, these findings establish the technology as a next-generation wearable platform that bridges engineering innovation and clinical practice, offering mechanistic insight and diagnostic potential in stress medicine, sleep medicine, and beyond.
18 May 2026
Read appraisal →PloS one
Comparing machine and deep learning models for pediatric anxiety classification using structured EHRs and area-based measures of health data
OBJECTIVE: This retrospective, case-control study with internal validation evaluates the performance of machine learning (ML) and deep learning (DL) models in classifying pediatric patients at risk for anxiety disorders using structured electronic health records (EHRs) and area-based measures of health (ABMH). The aim is to enable proactive care by monitoring potential anxiety onset across developmental stages. METHODS: We trained a series of ML models (Logistic Regression, Decision Tree, Random Forest, K-Nearest Neighbors, XGBoost) and DL models (LSTM, GRU, RETAIN, Dipole) using structured EHR data from 30-day windows prior to diagnosis. Two datasets were used per age group: one with structured EHR data only, and another including both EHR and ABMH data. ML models were trained using short-term cross-sectional features, while DL models leveraged full longitudinal patient histories. Performance was assessed using AUROC, AUPRC, PPV, NPV, F1 score, and accuracy. Due to differences in input scope, model performance reflects both algorithmic and temporal design differences and is not intended as a direct comparison between ML and DL. RESULTS: ML models offered strong baseline performance, with XGBoost achieving AUROC scores of 0.817 (EHR) and 0.816 (EHR+ABMH) for 8-year-olds. Adding ABMH features did not significantly improve performance. DL models, particularly RETAIN and Dipole, achieved the highest AUROC values (e.g., Dipole: 0.853 with EHR, 0.857 with EHR+ABMH for 8-year-olds), outperforming other DL and ML models within their respective design constraints. CONCLUSION: Both ML and DL models successfully identified likely anxiety onset using structured EHR data. DL models using longitudinal data achieved the highest performance, while XGBoost provided a robust ML baseline. The minimal impact of ABMH features highlights integration challenges, and performance variation across ages emphasizes the need for age-stratified modeling approaches.
14 May 2026
Read appraisal →European journal of pediatrics
Wheeze detection in real-world pediatric care: AI applied to smartphone lung auscultation.
UNLABELLED: Smartphone-based lung auscultation, combined with artificial intelligence (AI), may offer a promising alternative for pediatric respiratory telemonitoring. The aim of our study was to evaluate the performance of an AI model on wheeze detection from pediatric respiratory sounds recorded via smartphone. An observational cross-sectional study was conducted at the Pediatric Department of a Portuguese tertiary hospital, including children aged 0-17 years (pre-school, school-aged, and adolescent), with or without respiratory disease. Respiratory sounds were recorded at four locations using smartphone microphones and independently classified by at least 2 blinded annotators for quality and presence of wheezes. A hybrid convolutional-recurrent neural network (CNN + LSTM) trained on public electronic stethoscope databases was used to detect wheezes. AI model performance was assessed using positive predictive value, sensitivity, specificity, accuracy, and F1-score. A total of 217 children (59.9% male; median 10 [Q1-Q3 4.5-13] years) were included. From 2020 respiratory sound recordings, 1500 (74.3%) met quality criteria. Manual annotation identified 271 recordings with wheezes, whereas AI detected 217, most frequently in pre-school children (64.5% AI; 53.9% manual). The model achieved an overall accuracy of 87% (95% CI 86-89) and an F1-score of 61% (95% CI 56-66). The best accuracy was found in adolescents (92%, 95% CI 90-94) and the best global F1-score in pre-school children recordings (64%, 95% CI 58-71). CONCLUSION: This study supports the feasibility of AI-assisted analysis of smartphone-recorded pediatric respiratory sounds in real-world settings. Future multicenter studies with larger datasets and model fine-tuning using smartphone recordings are expected to improve AI model performance and generalizability. WHAT IS KNOWN: • Continuous monitoring of pediatric respiratory diseases is essential to improve outcomes and reduce healthcare and family burden. • Smartphone lung auscultation is feasible in children but AI wheeze detection models have only been applied to recordings from electronic stethoscopes. WHAT IS NEW: • First study applying an AI model to detect wheezes in smartphone-recorded lung sounds. • Quality recordings were obtained across all pediatric age groups and the AI model performance showed promising results, comparable to studies using electronic stethoscopes.
14 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Open versus laparoscopic repair in pediatric incarcerated inguinal hernia: a systematic review and meta-analysis
PURPOSE: The optimal surgical approach for pediatric incarcerated inguinal hernia remains controversial. This study aimed to systematically compare the clinical outcomes of laparoscopic repair (LH) and open repair (OH) in children with incarcerated inguinal hernia through a systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from database inception to March 2026. Comparative studies evaluating LH versus OH in pediatric incarcerated inguinal hernia were included. Primary outcomes included operative time, intraoperative blood loss, and length of hospital stay. Secondary outcomes included intraoperative injury, wound infection, testicular atrophy, and recurrence. Pooled mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using Review Manager 5.4. RESULTS: Nine studies involving 584 pediatric patients were included in the meta-analysis. Compared with OH, LH was associated with significantly shorter operative time and reduced intraoperative blood loss. The length of hospital stay was also significantly shorter in the LH group. In addition, LH showed a significantly lower risk of intraoperative injury and recurrence. No statistically significant differences were observed between the two groups in terms of wound infection or testicular atrophy. CONCLUSIONS: Laparoscopic repair appears to be a safe and effective alternative to open repair for pediatric incarcerated inguinal hernia. Further high-quality prospective studies are warranted to confirm these findings.
14 May 2026
Read appraisal →Pediatric surgery international
Selective non-operative management of post-appendectomy abscesses in children: a comprehensive systematic review and pairwise meta-analysis
Post-appendectomy intra-abdominal abscess remains a common complication following pediatric appendicitis. Although drainage has traditionally been considered standard treatment, increasing evidence suggests selected patients may be successfully managed with antibiotics alone. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251075191). PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 20, 2025. Eligible studies included pediatric patients (0-18 years) with post-appendectomy abscess managed with antibiotic vs. invasive drainage. The primary outcome was failure of first-line treatment requiring escalation. Secondary outcomes included recurrence and length of hospital stay. Ten observational studies involving 363 pediatric patients were included (152 drainage, 211 conservative). Treatment success was 80.9% with drainage and 89.1% with antibiotics. Pooled analysis demonstrated no statistically significant difference in treatment success (RR 1.00; 95% CI 0.95-1.05) or recurrence (RR 0.99; 95% CI 0.57-1.74). Drainage was associated with longer hospital stays (MD 3.40 days; 95% CI 0.65-6.14; p = 0.02). Subgroup analyses demonstrated consistent findings. All included studies demonstrated a serious risk of bias due to confounding by indication. An antibiotics-first approach appears viable for clinically stable pediatric patients, achieving comparable outcomes with shorter hospitalization.
13 May 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Postoperative raised ICP after minimally invasive surgery for monosutural craniosynostosis
INTRODUCTION: Minimally invasive craniectomies (MIC) for monosutural craniosynostosis are more and more used. Their results are usually investigated in terms of surgical, esthetic, and neuropsychological outcomes but not specifically about the risk of postoperative raised intracranial pressure (ICP). The goal of this article is to review the literature and the personal experience looking for the possible risk of postoperative raised ICP after MIC. METHODS: A systematic review adhering to PRISMA guidelines was realized. In parallel, the personal experience concerning scaphocephalic children consecutively operated on between 2010 and 2013 by MIC was analyzed. Children operated on by open cranial vault remodeling (OCVR) in the same period were considered as controls. RESULTS: Overall, 3048 patients from 14 studies were included, 5% of them requiring a reoperation after a 59.9-month mean follow-up. A total of 2297 children were treated by MIC: 2.8% (65 cases) showed postoperative raised ICP, the rate of reoperation was 4.4% (102 cases). The risk of reoperation varies across the techniques, being higher in modified or spring-assisted strip craniectomies (2.4-14.6%) than in endoscopy-assisted craniectomies (2.4%). Among 751 cases treated by OCVR, this risk varied from 0.95 to 7.1%. Also in the personal experience, no significant differences were found between MIC (1.5% of reoperation for raised ICP) and OCVR (0.8%). CONCLUSIONS: The risk of postoperative raised ICP seems to be relatively low after surgery for monosutural synostosis without a significant difference between MIC and OCVR. Missing standardized methods for postoperative screening, missing information about the reason of reoperation in some studies, and the retrospective analysis methods in most of them are the main limitations of this study.
13 May 2026
Read appraisal →European journal of pediatrics
Diagnostic accuracy of artificial intelligence versus 263 pediatric clinicians for childhood exanthems
Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents (P = .001; ε2 = 0.13).Conclusions: AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight.
12 May 2026
Read appraisal →Sleep & breathing = Schlaf & Atmung
Efficacy of the twin-block appliance for pediatric obstructive sleep apnea: an updated systematic review and meta-analysis
OBJECTIVE: To provide an updated and robust assessment of the efficacy of the Twin-Block appliance in the treatment of pediatric obstructive sleep apnea (OSA). A previous meta-analysis indicated a potential benefit, but was limited by the quality of available evidence and is now outdated. This study aims to synthesize all current evidence, including recent high-quality randomized controlled trials (RCTs). METHODS: This systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was performed up to October 2025. We included RCTs, non-randomized controlled trials (NRCTs), and case series evaluating the effect of the Twin-Block appliance on respiratory parameters in children (< 18 years) with OSA. The primary outcome was the change in the Apnea-Hypopnea Index (AHI). A random-effects model was used to calculate the pooled Mean Difference (MD) and 95% Confidence Intervals (CIs). Sensitivity analyses were performed, and the risk of bias was assessed using design-specific tools (RoB 2, ROBINS-I, and the JBI Critical Appraisal Checklist). RESULTS: Eight studies, comprising a total of 259 patients, were included in the systematic review. The meta-analysis of seven studies (n = 219) demonstrated that Twin-Block therapy resulted in a statistically significant and clinically meaningful reduction in AHI (pooled MD: -6.68, 95% CI: -8.76 to -4.60; p < 0.0001). Significant heterogeneity was observed across studies (I² = 89.1%). A recent high-quality RCT, while not poolable due to a different outcome measure, provided mechanistic evidence by showing a significant increase in oropharyngeal airway volume with Twin-Block treatment compared to a control group. The findings remained robust in sensitivity and leave-one-out analyses. CONCLUSION: This updated meta-analysis provides strengthened evidence that the Twin-Block appliance is an effective treatment for reducing the severity of OSA in appropriately selected children. The therapeutic effect is likely mediated by structural enlargement of the upper airway. Despite the heterogeneity and limitations in the primary literature, these findings support the consideration of the Twin-Block appliance as a viable non-surgical intervention for pediatric OSA, particularly in patients with mandibular retrognathia. Future large-scale RCTs are warranted to confirm these findings and establish long-term effectiveness.
12 May 2026
Read appraisal →European journal of pediatrics
Post-asphyxia acute kidney injury in neonates: a systematic review
UNLABELLED: Perinatal asphyxia is a major cause of neonatal morbidity and mortality globally. It affects multi-systems and has significant renal consequences. Acute kidney injury (AKI) is a frequent complication of perinatal asphyxia; however, its burden, diagnosis, and outcomes remain variably characterized. This study employed a scoping review approach to map and synthesize the existing evidence on post-asphyxia AKI in neonates. A total of 30 studies published between 1995 and 2025 were included, encompassing different geographic regions, study designs, and diagnostic criteria. The review demonstrates a clear growth in scholarly attention to post-asphyxia AKI, particularly in the last 25 years, coinciding with the introduction of neonatal-modified KDIGO definitions and advances in neonatal nephrology. Reported incidence of AKI varied widely, ranging from 20% to over 60%, reflecting non-homogeneity in study populations, differing case definitions of acute kidney injury in neonates, the severities of hypoxic-ischemic encephalopathy, and varied methodological approaches. Findings consistently indicate that AKI is strongly associated with severe forms of perinatal asphyxia, the presence of multi-organ dysfunction, prolonged neonatal intensive care stay, and mortality. CONCLUSION: Despite emerging interest in novel biomarkers and standard definitions, important gaps persist in early detection, long-term renal outcome data, and evidence from low- and middle-income countries. Addressing these gaps through standardized monitoring, biomarker validation, and longitudinal follow-up will improve renal survival in neonates affected by perinatal asphyxia. WHAT IS KNOWN: • The newborn kidneys are susceptible to the hemodynamic changes that follow ischemia/asphyxia due to a poor functioning capacity and oftentimes an inadequate structural potential. • Neonatal AKI is closely linked to severe forms of asphyxia, increased length of hospital stay and increased mortality. its reported incidence is widely varied. WHAT IS NEW: • The emergence of novel biomarkers in the identification and diagnosis of neonatal AKI, and the uptake and application of standard definitions (modified neonatal KDIGO) in the identification of neonatal AKI. • The availabiltiy of specialized kidney support therapy (continuous kidney replacement therapy; the carpadiem) in the management of neonatal AKI.
11 May 2026
Read appraisal →European journal of pediatrics
Oral dextrose gel vs standard care for the treatment of hypoglycemia in high-risk neonates: an open-label randomized controlled trial
UNLABELLED: To determine whether 40% dextrose gel with oral feeds reduces NICU admission for asymptomatic hypoglycemia compared with standard care with oral feeds in at-risk neonates within 48 h of life. Secondary objectives were to assess rebound and recurrent hypoglycemia, hyperglycemia, and exclusive breastfeeding at discharge and at 6 weeks. Open-label randomized controlled trial conducted at a tertiary hospital in South India between April 2023 and May 2024. Neonates born at ≥ 35 weeks of gestation with asymptomatic hypoglycemia within the first 48 h of life were randomly assigned to receive either 200 mg/kg of oral 40% dextrose gel with oral feeds or standard care with oral feeds alone. The primary outcome was NICU admission for hypoglycemia. A total of 193 neonates were enrolled, with 98 in the standard care group and 95 in the gel group. Baseline characteristics were comparable. NICU admission for hypoglycemia occurred in 4.2% in gel group and 12.2% in standard care group (RR 0.34, 95% CI 0.11-1.03; p = 0.06), with a number needed to treat of 13. Exclusive breastfeeding was higher in gel group at discharge (97% vs 76%; p < 0.001) and at 6 weeks (90% vs 69%; p < 0.001). Rebound hypoglycemia, recurrent hypoglycemia, and hyperglycemia were similar between groups. CONCLUSION: Oral dextrose gel was associated with fewer NICU admissions, but the primary outcome did not reach statistical significance. Improved breastfeeding rates were observed as secondary outcomes. These findings should be interpreted cautiously and confirmed in adequately powered studies. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/02/050027). WHAT'S KNOWN: • Oral 40% dextrose gel is an eff ective fi rst-line treatment for neonatal hypoglycemia and has been shown to reduce treatment failure and intravenous glucose use in previous trials. • Existing evidence is predominantly from high-income settings, with limited randomized data from low- and middle-income countries assessing pragmatic outcomes such as NICU admission. WHAT IS NEW: • In this open-label randomized controlled trial, oral dextrose gel was associated with fewer NICU admissions for hypoglycemia (4.2% vs 12.2%) and higher exclusive breastfeeding rates at discharge and 6 weeks compared with standard care. • These fi ndings support the potential utility of dextrose gel as a simple, low-cost intervention for managing neonatal hypoglycemia in resource-limited settings.
11 May 2026
Read appraisal →European journal of pediatrics
Impact of protocolized restrictive versus liberal/usual maintenance fluid strategy on fluid overload among mechanically ventilated children: an open-label randomized trial (ReLiSCh-II trial)
UNLABELLED: Fluid overload (FO) is associated with poor clinical outcomes among critically ill children. The objective of this trial was to assess the impact of a protocolized restrictive maintenance fluid strategy on FO among mechanically ventilated children. This open-label randomized controlled trial was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in North India over 13 months (November 2023-November 2024). Hemodynamically stable mechanically ventilated children were randomized to protocolized restrictive (n = 64) (40-50% of maintenance fluids with diuretic infusion if FO% > 10%); and liberal/usual (n = 66) (70-80% of maintenance fluid) groups. The primary outcome was the proportion of children with cumulative FO% > 10% through day 5. Secondary outcomes were daily cumulative FO%; inferior vena cava variability index (∆IVC) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at 48 h; safety parameters (requirement of fluid boluses or vasoactive drugs); 28-day ventilator and PICU-free days (VFDs and PFDs), and mortality. Significantly fewer children in the protocolized restrictive group had cumulative FO% > 10% than in the liberal/usual group (22% vs. 47%, p = 0.003). Also, the restrictive group had significantly lower daily cumulative FO% on the first 5 days. ∆IVC and NT-proBNP levels at 48 h, as well as safety parameters, were similar between the two groups. Protocolized restrictive and liberal/usual groups had similar VFDs [20 (8-24) vs. 16 (0-23), p = 0.076], PFDs [16 (3-21) vs. 13 (0-19), p = 0.071], and mortality (14% vs. 24%, p = 0.14). CONCLUSION: A protocolized restrictive maintenance fluid strategy resulted in significantly lower FO among hemodynamically stable, mechanically ventilated children without a measurable impact on short-term clinical outcomes. WHAT IS KNOWN: • Fluid overload (FO) is associated with poor clinical outcomes among critically ill mechanically ventilated children. WHAT IS NEW: • Among hemodynamically stable, mechanically ventilated children, a restrictive maintenance fluid strategy may be a useful intervention to limit FO and improve clinical outcomes in LMICs.
10 May 2026
Read appraisal →Pediatric surgery international
Total versus partial fundoplication in children with gastroesophageal reflux disease: a systematic review and comparative meta-analysis of 2633 patients highlighting the trade-off between reflux control and postoperative dysphagia
INTRODUCTION: Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. METHODS: A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. RESULTS: Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. CONCLUSIONS: Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.
10 May 2026
Read appraisal →The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
The effect of maternal scent-infused blanket on the stress level, crying duration and physiological parameters of premature newborns
BACKGROUND: Olfactory cues from the mother may soothe distress in premature infants in the Neonatal Intensive Care Unit (NICU). This study evaluated the effect of a maternal scent-infused blanket on stress, crying duration, and physiological parameters in premature newborns. METHODS: This double-blind randomized clinical trial included 69 premature infants who were randomly assigned to one of three groups: maternal scent-infused blanket, unscented blanket, or control (no blanket) group. Infants were covered with the assigned blanket for 60 min daily for 3 consecutive days. The maternal scent was obtained by placing a clean blanket in contact with the mother's bare chest overnight prior to each day's exposure, with fragrance-free cleansing products used and a new blanket for each session. Primary outcomes were stress level (Newborn Stress Scale, NSS), crying duration (chronometer), and Secondary outcomes were physiological parameters (heart rate, respiratory rate, oxygen saturation, and body temperature). Measurements were collected at 5 min before intervention, immediately after, and at 15, 30, 45, and 60 min during intervention, plus 5 min after intervention, each day for three consecutive days. Data were analyzed using one-way ANOVA and ANCOVA adjusting for baseline values; p < 0.05 denoted significance. RESULTS: Stress scores and crying duration differed significantly among groups during the intervention, with the maternal scent-infused blanket group showing lower NSS scores and shorter crying times than the unscented and no-blanket groups (p < 0.001). During exposure, heart rate, oxygen saturation, and body temperature differed among groups (significant at multiple time points, p < 0.001); by contrast, respiratory rate did not differ significantly (p > 0.05). Differences were not observed at baseline or immediately after the intervention for these physiological measures. CONCLUSION: The maternal scent-infused blanket may reduce stress and crying duration, with transient improvements in some physiological parameters during exposure. Maternal olfactory cues could serve as a feasible non-pharmacological adjunct to support comfort and well-being in vulnerable newborns, emphasizing parental involvement in neonatal care.
10 May 2026
Read appraisal →European journal of pediatrics
Metaphorical perceptions of secondary school students regarding the concept of generative artificial intelligence
UNLABELLED: The rapid integration of generative artificial intelligence (GenAI) tools, such as ChatGPT, into educational contexts has raised important questions regarding how adolescents conceptualize and make sense of these technologies. Understanding students' perceptions is essential for developing age-appropriate, ethical, and pedagogically sound approaches to AI use in secondary education. This descriptive qualitative study employed a phenomenological approach and metaphor analysis to explore secondary school students' perceptions of generative artificial intelligence. The study sample consisted of 332 students aged 14-18 years from four secondary schools in Türkiye. Data were collected using an open-ended prompt ("Generative artificial intelligence is like … because …") and analyzed through content analysis. Metaphors were categorized based on shared semantic and conceptual features, and inter-rater reliability was established using Cohen's kappa (κ = 0.92). Analysis revealed ten metaphor categories clustered under five overarching themes: generative artificial intelligence as (1) a source of knowledge, (2) a teaching and guiding entity, (3) a supportive and assisting tool, (4) a reflection of human intelligence, and (5) a dual-purpose (beneficial-risky) technology. Students most frequently conceptualized GenAI as a comprehensive knowledge source (e.g., book, encyclopedia) and as a human-like cognitive entity (e.g., brain, wise person). At the same time, metaphors reflecting ethical awareness and potential risks, such as misuse and overreliance, were also identified. The findings indicate that secondary school students hold multifaceted and nuanced perceptions of generative artificial intelligence, encompassing both educational opportunities and ethical concerns. These results highlight the importance of integrating AI literacy into secondary education in ways that promote critical thinking, responsible use, and awareness of GenAI's limitations alongside its potential benefits. CONCLUSION: It was determined that secondary school students perceive generative artificial intelligence ambivalently as both a useful tool and a source of ethical and emotional concern, highlighting the need for developmentally appropriate artificial intelligence literacy approaches. WHAT IS KNOWN: • GenAI tools such as ChatGPT are increasingly integrated into educational contexts and have the potential to support personalized learning, information access, and student engagement. • Existing research has primarily focused on educators' perspectives or higher education settings, while studies examining adolescents' perceptions of GenAI remain limited. WHAT IS NEW: • This study provides empirical evidence on secondary school students' metaphorical perceptions of generative artificial intelligence within a K-12 context. • Findings reveal that adolescents conceptualize GenAI in multifaceted ways, including as a knowledge source, teaching and guiding entity, supportive tool, reflection of human intelligence, and a dual-purpose (beneficial-risky) technology.
10 May 2026
Read appraisal →IEEE transactions on bio-medical engineering
Multi-Stage Respiratory Sound Analysis: Confidence-Driven Wheeze and Crackle Detection
OBJECTIVE: Accurate detection of adventitious respiratory sounds, such as wheezes and crackles, is essential for diagnosing and managing respiratory conditions. This study introduces a multi-stage, confidence-driven framework for automated pediatric auscultation analysis, performing a three-way classification of normal, wheeze, and crackle sounds to improve diagnostic accuracy. METHODS: We develop a comprehensive pipeline integrating anomaly-specific segment selection, segment-level classification, and confidence-based fusion. Our contrastive variational recurrent neural network (CVRNN) enhances feature extraction, while a confidence-weighted aggregation strategy refines final predictions. The system is validated using a diverse pediatric dataset from 742 subjects (aged 1-59 months) from seven countries. RESULTS: The multi-level framework is evaluated across three stages. The anomaly-specific segment selection achieves 98.47 $\%$ recall, identifying adventitious regions. Next, segment-level classifiers improve sensitivity, achieving balanced accuracies of 72.15 $\%$ (wheeze) and 68.1 $\%$ (crackle). This performance surpasses state of the art systems on the same dataset and demonstrates enhanced balanced performance in detecting both crackle and wheeze sounds, which present different challenges to automated systems given their markedly different acoustic profiles. Finally, the confidence-driven fusion outperforms traditional aggregation methods, yielding a final three-way classification of 62.12 $\%$. CONCLUSION: Our confidence-based multi-stage approach enhances automated respiratory sound classification by prioritizing high-certainty segment predictions, aligning with expert physician annotations. SIGNIFICANCE: This framework advances computer-aided respiratory diagnostics, improving early detection and monitoring of pediatric respiratory conditions. By integrating expert-inspired segmentation with machine learning-driven confidence estimation, it has potential to enhance clinical workflows and screening for pulmonary diseases, particularly in resource-limited settings.
4 May 2026
Read appraisal →JMIR formative research
Exploring User Experiences of an Augmented Reality Smartphone App Prescribing Exercise for Children and Young People With Cancer: Results From a Qualitative Study
BACKGROUND: Mobile health (mHealth), and specifically smartphone apps, have grown exponentially in both functionality and accessibility and are becoming an important component of health care. Research exploring the use of mHealth for managing or treating chronic diseases, such as cancer, has shown promising effects. Yet, comparatively little work has examined how such technologies can enhance exercise interventions for young people with cancer. To optimize the effectiveness of mHealth in these contexts, it is essential to build a stronger evidence base on user experience. OBJECTIVE: This study aimed to investigate how healthy children and young people engaged with an augmented reality (AR) app developed specifically for children and young people undergoing cancer treatment, and to identify design features that may support engagement and behavior change in the intended clinical population. METHODS: School and university students, aged 8-21 years, were eligible to participate in the study. Practical workshops allowed participants to engage with the AR exercise app before taking part in focus groups to explore user experiences. Data were analyzed using qualitative content analysis, which also involved a critical friend approach using 2 researchers (HM and KS). Suggested improvements were mapped against the motivational affordances' taxonomy. RESULTS: A total of 39 participants aged 8-21 years took part in the focus group study. Participants found the demonstrations and varied exercises useful but expressed some concerns regarding data safety and functionality of the novel AR avatar. It was proposed that additional educational components, challenges, and rewards, as well as a customizable avatar, social support features, and audio instructions for a more inclusive design would be desirable and could enhance user experience. When mapped against the motivational affordances taxonomy, the suggested improvements aligned primarily with mechanisms of user education, challenges, feedback, cooperation, and comparison. CONCLUSIONS: This study provides an understanding of how apps that prescribe exercise can be optimized to enhance motivation and user experience. By assessing feedback and suggestions for improvements, the findings highlight key design features that may support engagement. While this initial work focused on healthy, age-matched participants, further evidence specifically in children and young people with a childhood cancer diagnosis is needed.
26 Apr 2026
Read appraisal →European journal of pediatrics
Different doses of vitamin A supplementation as adjuvant treatment for pneumonia in children: a network meta-analysis of randomized controlled trials
UNLABELLED: While previous meta-analyses have established a link between vitamin A supplementation and outcomes in children with pneumonia, the efficacy and safety of different dosing regimens remain unclear. Existing evidence is predominantly based on single-dose trials, creating a critical knowledge gap. We systematically searched PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP databases from their inception to December 2025. Study searches were independently carried out in December 2025 by two reviewers. Two researchers used the Cochrane risk of bias tool to independently assess the quality of the included studies. Data analysis was conducted through the "netmeta" package in R software (version 4.3.3). Twenty-five trials involving 3116 patients were included. Network meta-analysis revealed that medium-dose vitamin A supplementation was most effective in reducing the duration of fever and cough. Low-to-medium doses were consistently associated with better clinical outcomes than high-dose regimens. However, evidence regarding safety outcomes remained limited and inconclusive. CONCLUSION: Low-to-medium dose vitamin A supplementation appears superior to high-dose regimens for alleviating clinical symptoms in children with pneumonia. However, the evidence is limited by high heterogeneity, indirect comparisons between dose groups, and poor reporting of adverse events. Future trials should prioritize direct dose-comparisons and rigorous safety monitoring to refine dosing guidelines. WHAT IS KNOWN: • Pneumonia poses a significant threat to the health and lives of children. Vitamin A supplementation plays an adjuvant role in the treatment of pneumonia in children. • There are currently divergent conclusions in the research regarding the optimal dosage of vitamin A, particularly with regard to the safety of high-dose supplementation and the effectiveness of low-dose supplementation. WHAT IS NEW: • This study revealed that medium-to-low-dose vitamin A supplementation appears to be more effective than high-dose therapy in alleviating the primary symptoms of childhood pneumonia. • This study also suggests that children in developed regions have higher baseline serum retinol levels, which may diminish the marginal benefits of high-dose supplementation and may even predispose them to its immunosuppressive effects.
22 Apr 2026
Read appraisal →Medicine
Safety assessment of intravenous immunoglobulins in pediatric population: A systematic review of adverse events
BACKGROUND: Intravenous immunoglobulin (IVIG) is a therapeutic intervention utilized in various disorders due to its antimicrobial, antiinflammatory, and immunomodulatory properties. The market offers a range of IVIG products, leading to variations in efficacy and safety profiles. This study aimed to systematically evaluate the safety profile of IVIG administration in pediatric patients. METHODS: A systematic search was conducted on PubMed, Embase, and Cochrane databases using predetermined MeSH terms, covering the period from January 1, 2000, to October 15, 2022. Two independent reviewers performed relevance screening. Inclusion criteria encompassed English-language studies involving patients below 18 years of age who received IVIG treatment. Included studies were limited to peer-reviewed full-text publications with a minimum of 5 patients. A total of 8 studies met the inclusion criteria, encompassing 1088 pediatric patients. RESULTS: Eight studies met the inclusion criteria (total 1088 pediatric patients). Five studies reported patient-level adverse event data suitable for pooling (688 patients). Among these 688 patients, 267 (38.8%) experienced adverse events (AEs). Among reported AEs, the most frequent were headache 68/267 (25.5%) and fever 47/267 (17.6%). Less common AEs included nausea 12/267 (4.5%) and fatigue 12/267 (4.5%). Four studies recorded a total of 2960 IVIG infusions, with 12.6% of infusions accompanied by AEs. The predominant AEs during infusions were headache (54.3%) and fever (29.4%). Cough (0.8%) and nausea (1.6%) were the least commonly observed AEs. Other AEs such as rash, vomiting, and abdominal pain were also reported. Of the 23 full-text articles reviewed, 8 were included. The remaining 15 were excluded due to the following reasons: 6 for duplicate data, 4 for inappropriate study design, 3 for not meeting the minimum number of patients, and 2 for incomplete adverse event reporting. These reasons are now detailed in the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. CONCLUSION: IVIG therapy demonstrates good tolerability in pediatric patients, with an overall favorable safety profile, aside from mild AEs associated with its administration. Serious AEs were infrequent and mainly observed in high-risk patients. Headache was the most prevalent AE, which seldom required hospitalization and could be effectively managed with acetaminophen. Other AEs were generally mild systemic reactions. Notably, AEs appear to be more frequent during the initial exposure to IVIG.
19 Apr 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Surgical management of anterior sacral meningoceles: a case series and systematic review
PURPOSE: Anterior sacral meningoceles (ASMs) are rare forms of spinal dysraphism caused by anterior herniation of meninges through a sacral defect. Surgical management is the treatment of choice, yet the optimal approach remains debated. This study compares outcomes of three main surgical approaches-anterior transabdominal, posterior transsacral, posterior sagittal (PSARP-type)-focusing on the efficacy and safety of the PSARP-type. METHODS: A retrospective single-center analysis was conducted on eight patients treated for ASM between 2008 and 2025. Demographic, clinical, radiological, functional data were reviewed. Outcomes included recurrence, reoperation, sac size reduction, bladder function; complications were categorized as early or late. A systematic literature review was performed according to PRISMA guidelines. RESULTS: Eight patients (6 females, 2 males; mean age 19.4 years) underwent surgery (five anterior Pfannenstiel incision, two posterior sagittal, one posterior transsacral). All were symptomatic, 87.5% had associated malformations. Sac reduction was achieved in 87.5% of cases, with no new neurological deficits. Complications were mild and self-limiting, including transient urinary retention and cerebrospinal fluid fistula managed with lumboperitoneal shunt. The literature review (49 studies, 68 patients) confirmed female predominance (81%), association with Marfan and Currarino syndromes (35%), preference for posterior approaches (70%), which showed lower morbidity and recurrence rates. One postoperative death (1.4%) was reported. CONCLUSIONS: Posterior approaches-particularly the PSARP-type-provide safe, effective, and functionally favorable alternatives to anterior surgery for ASM, offering optimal exposure, precise dural closure, superior cosmetic outcomes with minimal morbidity. The anterior route should be reserved for large or high-lying lesions. Further multicenter studies with longer follow-up are warranted.
17 Apr 2026
Read appraisal →Journal of the American College of Surgeons
Effect of Adhesion Barrier Use During Ladd Procedure for Intestinal Malrotation on Postoperative Midgut Volvulus and Postoperative Small-Bowel Obstruction: A Retrospective Cohort Study Using a National Inpatient Database
BACKGROUND: Postoperative midgut volvulus is a life-threatening complication after the Ladd procedure. An adhesion barrier to prevent postoperative small-bowel obstruction could increase postoperative midgut volvulus incidence due to reduced adhesions. We aimed to examine the effect of adhesion barrier use during Ladd procedures on postoperative midgut volvulus and postoperative small-bowel obstruction. STUDY DESIGN: We retrospectively identified patients younger than 18 years who underwent the Ladd procedure between July 2010 and March 2021, using a Japanese nationwide inpatient database. We used propensity score overlap-weighting analyses to compare reoperation for midgut volvulus, rehospitalization, and operation for small-bowel obstruction, mortality, total rehospitalization length, and total rehospitalization cost within 1 year after the Ladd procedure between patients in whom adhesion barrier was used (barrier group) and patients in whom it was not used (nonbarrier group). RESULTS: Of the 1,159 eligible patients, adhesion barrier was used in 314 and not used in 845 patients. The proportion of reoperations for midgut volvulus did not differ between the barrier and nonbarrier groups (3.5% vs 2.7%; risk difference 0.8%, 95% CI -1.9 to 3.5). The proportion of rehospitalization due to small-bowel obstruction was lower in the barrier group than in the nonbarrier group (2.6% vs 6.3%; risk difference -3.6%, 95% CI -6.6 to -0.8). No significant differences were observed in operation for small-bowel obstruction, mortality, and total length and cost of rehospitalization. CONCLUSIONS: The use of adhesion barrier during the Ladd procedure can prevent rehospitalization due to postoperative small-bowel obstruction without increasing the incidence of postoperative midgut volvulus.
17 Apr 2026
Read appraisal →Global health action
Impact of climate change on pediatric health outcomes
Climate change has become one of the most critical health issues globally in the twenty-first century with children bearing the disproportionate burden of the burden since they are more vulnerable than adults because of their physiological, behavioral, and developmental capacities. It is a systematic review that rates the evidence of the relationship between climatic exposures such as heat, air-pollution, and extreme weather events and pediatric health outcomes. The number of peer-reviewed studies involved was 23 published in 2000-2025, which represented different geographic areas and study designs and assessed acute and chronic health outcomes. The Newcastle-Ottawa Scale and the ROBINS-I tool were used to evaluate the methodological quality, and the majority of the studies had low to moderate risks of bias. The narrative synthesis shows that there are always links between air pollutants especially PM2.5, NO2 and O3 and respiratory morbidity, prevalence of asthma and hospitalization of children. Amplified temperatures as well as heat waves were associated with increased cases of heat illness, dehydration, and febrile state in infants and young children. There were elevated cases of diarrheal and vector-related infections, especially in low-resource settings, which were linked to extreme weather events especially floods. Although the overall results were similar, significant differences in the regions and methods were found, and low-income countries show little evidence. In addition, exposures as analyzed in most studies were usually considered individually, which may have underestimated the cumulative or compound climate risks. Main findings: This review shows that rising temperatures, air pollutants, and extreme weather events are consistently linked with higher rates of respiratory illness, heat-related illness, and infectious diseases among children.Added knowledge: The synthesis brings together two decades of evidence showing that children across multiple continents experience similar health vulnerabilities when exposed to climate-related environmental conditions.Global health impact for policy and action: The findings highlight an urgent need for stronger climate-responsive child health policies and early warning systems to protect children from worsening environmental threats worldwide.
16 Apr 2026
Read appraisal →Journal of investigational allergology & clinical immunology
Dupilumab in Eosinophilic Gastrointestinal Disorders With Extraesophageal Involvement: A Pediatric Case Series and Systematic Review
Dupilumab has proven effective in the treatment of eosinophilic esophagitis (EoE) in randomized controlled trials. Its efficacy in other, less common and generally more severe eosinophilic gastrointestinal disorders (EGIDs) is scientifically plausible, although it has not been studied to date. Our objective was to describe published and our experience on the empirical use of dupilumab in patients affected by EGIDs with extraesophageal involvement. We retrospectively analyzed the medical charts of children diagnosed with extraesophageal EGIDs treated with dupilumab at our tertiary medical center. The Medline, Embase, and Cochrane databases were searched up to January 2025 for articles describing the use of dupilumab in patients with diagnosed or suspected extraesophageal EGID. Our cohort included 8 patients with a clinical and histological diagnosis of EGID and extraesophageal involvement. All of them had recurrent gastrointestinal symptoms refractory to standard treatments. Three patients had growth retardation. In all patients, symptoms and macroscopic and histological abnormalities, including eosinophilic infiltration, quickly improved after initiation of dupilumab. The systematic review identified 11 case reports (n=29 patients) of pediatric and adult patients with extraesophageal EGIDs treated with dupilumab. All 11 reports described significant clinical and histological improvement following therapy. Clinical experience suggests that dupilumab is effective in treating pediatric EGIDs with extraesophageal features. Given the rarity and high morbidity of these disorders, dupilumab could be considered a reasonable option while waiting for high-quality evidence from ongoing randomized controlled trials.
16 Apr 2026
Read appraisal →Journal of medical Internet research
A Health-Related Digital Ecological Momentary Assessment in Children (Aged 5-11 Years): Systematic Review
BACKGROUND: Digital ecological momentary assessment (EMA) collects data on experiences as they occur in daily life, capturing dynamic, context-sensitive experiences often missed by retrospective reporting. While EMA shows promise for pediatric health research, preadolescents have distinct socioemotional and cognitive characteristics likely to affect engagement. Existing reviews have not focused on the acceptability and feasibility of EMA protocols for this age group. OBJECTIVE: This review aimed to examine digital EMA protocols used with children aged 5-11 years across health domains, focusing on protocol characteristics, acceptability, and feasibility. We address 3 research questions (RQs)-RQ1: What are the characteristics of these protocols? RQ2: What is the feasibility and acceptability of these protocols? RQ3: What are the characteristics of high and low response rate protocols? METHODS: We searched 10 databases (CINAHL, Embase, ACM Digital Library, IEEE Xplore, Cochrane Library, PsycINFO, Web of Science, PubMed, Scopus, and MEDLINE) for peer-reviewed studies published up to October 2025. Eligible studies used EMA with children aged 5-11 years to collect health data via digital devices. Two researchers independently screened studies (SC and LT); one (SC) conducted quality assessment and data extraction. Findings were narratively synthesized. RESULTS: We identified 17 protocols across 37 studies. Most targeted nonclinical populations, used handheld devices, spanned 3-28 days, and applied interval-contingent prompting (RQ1). Response rates were available or calculable for 15 of 17 protocols, ranging from 48% to 92% (RQ2). Six protocols reported response rates of ≥80%. However, key data required for pooling (eg, raw counts for planned vs completed prompts) were missing or selectively reported. This contributed to 13 of 17 protocols being rated at critical risk of bias (ROBINS-I, v2). As a result, the strength of evidence was limited by poor reporting and high risk of bias. Facilitators included uncomplicated, engaging technology, reminders, and caregiver involvement. Barriers included device burden, restricted device access, difficulty with accurate reporting, stigma, limited device awareness, and insufficient caregiver support. High-response protocols (≥80%) often involved older children or clinical groups, ≥3-week duration, fixed schedules (≥20 items per prompt, 3 or 4 times per day), timing customization, and incentives (RQ3). CONCLUSIONS: This review provides the first systematic synthesis on preadolescents, offering insight into EMA protocol design beyond prior work treating children as a single group. By examining 17 EMA protocols, the review identifies gaps in developmental appropriateness and reporting quality, highlighting where the evidence may differ from adolescent and adult EMA research. The results suggest that digital EMA for preadolescents requires greater focus on child-centered design to increase acceptability and adherence, alongside improved reporting standards, so protocols can be meaningfully compared. With these advances, EMA could be more effectively integrated into pediatric health monitoring, tailored to the needs of different age groups.
16 Apr 2026
Read appraisal →Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
The role of age and Galassi type in management and surgical outcomes of pediatric middle fossa arachnoid cysts: a systematic review and meta-analysis
PURPOSE: Arachnoid cysts are found in approximately 2.6% of the pediatric population, mostly asymptomatic, incidental findings. However, those with mass effect symptoms from cyst growth may require surgery. Because of the variability in progression, we investigated the interaction of patient age with middle fossa arachnoid cyst (MFAC) clinical outcomes. METHODS: A systematic review using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles detailing pediatric MFACs. RESULTS: Sixty articles meeting the inclusion criteria, totaling 1024 patients, were included. Signs of elevated ICP (194/873, prevalence: 22.2%, 95% CI: 19.5-25.0%) and primary headaches (263/873, prevalence: 30.1%, 95% CI: 27.1-33.2%) were the most common presenting symptoms. In the evaluation of the hemispheric location of MFACs, younger ages at presentation were more likely to present with bilateral MFACs (OR: 0.71, 95% CI: 0.52-0.98, p = 0.034). Most MFACs in the retrospective studies had left laterality (421/677, prevalence: 62.2%, 95% CI: 58.6-65.1%) and were singular (791/817, prevalence:96.8%, 95% CI: 95.6-98.2%). A higher proportion of younger patients required a second operation (OR: 0.82, 95% CI: 0.72-0.93, p = 0.002) and cerebrospinal fluid shunting (OR: 0.88, 95% CI: 0.79-0.97, p = 0.011) across the case reports. There was no significant difference in complications when comparing older children (5-18 years) to young children (≤ 4 years) (p = 0.737) or Galassi type (p = 0.736), but Galassi type 1 was associated with management through observation (p = 0.019). CONCLUSION: Younger patients presented with a higher rate of bilateral MFACs and required more invasive treatment methods and repeat operations more frequently, suggesting that infants and young children with MFACs may require greater surveillance during and after management to minimize complications.
14 Apr 2026
Read appraisal →JMIR formative research
Real-World Data From a Group Parent Management Training Program Enhanced Using Artificial Intelligence: Qualitative Study
BACKGROUND: Parent management training (PMT) is an evidence-based intervention for children with disruptive behavior problems. However, access to care is often limited by cost, availability of clinicians, scheduling, and transportation barriers. Integrating artificial intelligence (AI) into group PMT may improve accessibility, personalization, and adherence, while preserving therapeutic quality. OBJECTIVE: This study explored caregivers' experiences with a hybrid PMT program that combined live therapist-led group sessions with asynchronous support from Pat, an AI conversational agent designed to augment the therapists' support to caregivers. METHODS: A total of 88 caregivers of children aged 3-14 years (mean 7.98, SD 2.45 years) from Argentina and Paraguay participated in eight weekly online group sessions led by human therapists and supplemented by Pat. Caregivers were asked to provide the net promoter score (NPS) and their perceived contribution of their experience in remote group sessions and with Pat. Caregiver perspectives were analyzed using thematic analysis by multiple coders with consensus and interrater reliability assessment. RESULTS: The average NPS was 76.92, indicating excellent satisfaction. Regarding participants' perceptions of the overall program, the most frequent theme was useful strategies (73/202, 36.1%), reflecting the value placed on clear, structured, and practical tools to address everyday parenting challenges. Most comments about Pat were positive (156/164, 95.1%), particularly highlighting its 24/7 accessibility and constant availability (69/164, 42.1%). Recommendations for improvement mainly focused on enhancing the user experience and incorporating additional functionalities. Regarding perceived contribution to progress, caregivers attributed, on average, 61% to Pat and 46% to the group sessions. CONCLUSIONS: Combining therapist-led PMT group sessions with AI support appears feasible, acceptable, and valued by caregivers and may expand reach without sacrificing quality. Overall, caregivers valued the useful strategies and the professional and peer support and reported positive changes. Regarding Pat, the most valued aspect is the constant and immediate support. This model integrates human expertise with the accessibility and continuity provided by AI, reducing barriers, such as time, cost, and clinician availability.
8 Apr 2026
Read appraisal →Pediatric radiology
Data mining in pediatric radiology in the era of artificial intelligence
Data mining is the systematic process of extracting useful knowledge from large multimodal datasets and is increasingly enabled by artificial intelligence (AI) methods. Pediatric radiology is a natural field for data mining because multimodal data sources, including images, reports, metadata, and electronic health records, together capture rich information on anatomy, disease, treatment, and outcomes. In the current era, the boundaries between data mining and AI are increasingly blurred. AI assists in key steps of the mining workflow through automated labeling, information extraction, and representation learning, while data mining provides the high-quality curated datasets that underpin model performance, generalizability, and safety. This review, therefore, examines both domains together, emphasizing their interdependence in the pediatric context. We describe core concepts and workflows of data mining in pediatric radiology, including data collection, linkage, annotation, analysis, validation, and governance, and outline how modern AI tools such as deep learning, large language models, multimodal fusion, and federated learning support advanced pattern discovery across limited and heterogeneous pediatric datasets. We summarize current and emerging clinical applications across diagnosis, prognosis, radiation dose monitoring, operational analytics, reporting safety nets, and continual learning. We then discuss current challenges related to data quality and standardization, ethics, regulation, workflow integration, resource disparities, sustainability, and explainability. Finally, we highlight future perspectives, including synthetic data generation, foundation models, structured reporting, and pediatric-focused ethical frameworks that aim to enable safe, transparent, and equitable integration of AI-driven data mining to improve outcomes in children.
4 Apr 2026
Read appraisal →European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
Latest Developments in Artificial Intelligence and Machine Learning Models in General Pediatric Surgery
Artificial intelligence (AI) and machine learning (ML) models rapidly transform health care with applications ranging from diagnostic image interpretation, predictive modeling, personalized treatment planning, real-time intraoperative guidance, and outcome prediction. However, their implementation in general pediatric surgery remains limited due to the rarity and complexity of pediatric surgical conditions, small and heterogeneous datasets, and a lack of formal AI training and competencies among pediatric surgeons.This narrative review explores the current landscape of AI and ML applications in general pediatric surgery, focusing on five key conditions: appendicitis, necrotizing enterocolitis, Hirschsprung's disease, congenital diaphragmatic hernia, and biliary atresia. For each, we summarize recent developments, including the use of AI in image analysis, diagnostic support, prediction of disease severity and outcome, postoperative monitoring, and histopathological evaluation. We also highlight novel tools such as explainable AI models, natural language processing, and wearable technologies.Recent findings demonstrate promising diagnostic and prognostic capabilities across multiple conditions. However, most AI/ML models still require external validation and standardization. The review underscores the importance of collaborative, multicenter research based on joint datasets as well as targeted AI education for pediatric surgeons to fully explore the benefits of these technologies in clinical practice.AI and ML offer significant potential to improve pediatric surgical care, but broader implementation will require multicenter collaboration, a robust dataset, and targeted AI education for pediatric surgeons.
4 Apr 2026
Read appraisal →Journal of telemedicine and telecare
Telemedicine and digital health for chronic conditions in pediatrics: A systematic review
BackgroundThe prevalence of chronic diseases in children and adolescents has significantly increased. The COVID-19 pandemic accelerated telemedicine adoption, leading to improved healthcare access and outcomes. Despite its benefits, telemedicine is still not fully integrated into standard care. Previous reviews have been limited in scope. This systematic review aims to provide a comprehensive overview of recent trials on web or app-based telemedicine for chronically ill children and adolescents, identifying interventions and outcomes for future healthcare strategies.MethodsA comprehensive search was conducted on PubMed on November 21, 2023, and updated on January 9, 2025. Results were filtered to include prospective intervention studies involving children and adolescents with chronic conditions and limited to publications from 2017 onwards. A total of 8699 results were retrieved, and 1506 titles were screened for eligibility, resulting in 116 studies included in the review.ResultsThese studies covered 45 different conditions, with the highest numbers for diabetes, asthma, and obesity. Telemedicine interventions varied, including gamification, video meetings, integrated devices, psychological components, symptom tracking, and educational content. Most studies reported high feasibility and patient satisfaction. Clinical outcomes improved in some cases, and none were worse than standard care. The heterogeneity limited direct comparisons and meta-analysis, and small sample sizes in many studies affected the generalizability and statistical significance of the findings.ConclusionsOur study highlights the potential of telemedicine in managing chronic illnesses among children, emphasizing the need for standardized methodologies, larger sample sizes, and continued investment in infrastructure and equitable policies to fully realize its benefits in improving accessibility, convenience, cost savings, and overall health outcomes.
4 Apr 2026
Read appraisal →Curr Opin Pulm Med
Foreign body removal
PURPOSE OF REVIEW: Airway foreign body aspiration remains a potentially life-threatening emergency, predominantly affecting children under 5 years and adults over 65 years. This review synthesizes current evidence on diagnostic strategies, bronchoscopic extraction techniques, procedural outcomes, complication management, and emerging technologies in airway foreign body management. RECENT FINDINGS: Multidetector computed tomography with three-dimensional reconstruction has significantly improved diagnostic accuracy, achieving sensitivity of 98-99% for radiopaque objects and 85-92% for radiolucent materials. Flexible bronchoscopy has evolved from a diagnostic tool to a first-line therapeutic modality, with recent pediatric meta-analyses demonstrating 87% success rates and adult series showing comparable outcomes to rigid bronchoscopy for appropriately selected cases. Rigid bronchoscopy maintains superiority in asphyxiating presentations, and for large (>1.5 cm), sharp, or severely impacted foreign bodies. Technological innovations including robotic-assisted bronchoscopy, electromagnetic navigation systems, and artificial intelligence-powered imaging analysis are enhancing procedural precision and safety. SUMMARY: Successful airway foreign body management requires individualized, multidisciplinary approaches integrating patient clinical status, foreign body characteristics, and institutional expertise. Success depends on appropriate bronchoscopic modality selection, comprehensive preprocedural planning, availability of specialized retrieval instruments, and readiness to manage potential complications. Integration of advanced imaging, simulation-based training protocols, and telemedicine consultation are becoming essential components of contemporary practice.
1 Jan 2026
Read appraisal →Curr Opin Pediatr
Artificial intelligence supported facial feature analysis in medical genetics
PURPOSE OF REVIEW: This review highlights recent developments in the use of machine learning supported facial feature analysis in the context of genetic and syndromic conditions. The review focusses on 2D image-based tools. The 2D images are easily obtained using handheld devices such as mobile phones and are more relevant to general practice than 3D image based systems. RECENT FINDINGS: Different algorithms are used widely in pediatric clinics, medical genetics clinics, for gene variant analysis and in research. Integrated systems combining next-generation phenotyping with next-generation genotyping support a shortened diagnostic odyssey for patients. SUMMARY: Future integration of phenotyping using data available in electronic medical records with genotyping data will likely result in earlier identification of possible genetic conditions.
1 Dec 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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