Objective Early-onset neonatal pneumonia (EONP) demands rapid recognition, but blood tests are invasive and may be delayed. This study evaluated whether noninvasive salivary pentraxin-3 (PTX3), calprotectin, and interleukin-8 (IL-8) differ between EONP and healthy controls and whether they reflect systemic inflammation. Methods EONP required respiratory distress within 72 h of birth, new infiltrates on chest radiograph and/or lung ultrasound, and ≥1 laboratory or microbiologic criterion: abnormal leukocyte indices (I/T ratio > 0.16 or WBC/differential abnormality), hs-CRP ≥ 10 mg/L, PCT ≥ 0.5 ng/mL, or a positive blood/upper-airway culture with a compatible pathogen. Saliva was collected after definitive EONP diagnosis and immediately before systemic antibiotics in 100 EONP infants and 126 healthy controls. Biomarkers (PTX3, calprotectin, IL-8) were quantified by ELISA. Results EONP infants had higher salivary PTX3 (median 2.11 vs. 0.79 ng/mL), calprotectin (11.65 vs. 3.07 ng/mL), and IL-8 (15.02 vs. 4.67 pg/mL) than healthy controls. After adjustment, calprotectin and IL-8 remained independently associated with EONP, whereas PTX3 did not retain statistical significance. In case—control discrimination, using ROC-derived cut-offs, AUCs were 0.865 (PTX3), 0.967 (calprotectin), and 0.930 (IL-8); a combined three-marker model achieved AUC 0.978. Within EONP, salivary PTX3, calprotectin, and IL-8 correlated with systemic indices and modestly enriched for blood-culture—positive bacteremia (combined model AUC 0.707). Conclusions Noninvasive salivary PTX3, calprotectin, and IL-8 are substantially elevated in early-onset neonatal pneumonia and mirror systemic inflammation. The three-marker panel showed near-excellent discrimination vs. healthy controls and modest enrichment for culture-positive bacteremia, suggesting value as an adjunct to bedside assessment in this case–healthy-control setting. Performance in neonates with non-infectious respiratory distress should be validated in prospective cohorts.

Objective To describe the short-term clinical and echocardiographic effects of a first volume expansion in hypotensive preterm infants during the first 24 h of life. Study design Single-center retrospective observational pilot study including preterm infants ≤31 + 6 weeks of gestation, intubated and mechanically ventilated, presenting arterial hypotension within 24 h of life. All infants received a first volume expansion with modified fluid gelatin (20 mL/kg). Clinical and echocardiographic parameters were compared immediately before and after volume expansion. Results Thirty-one infants were included. Volume expansion was associated with a significant increase in systolic, diastolic and mean arterial pressure (median MAP increase: +4 mmHg; +17%), and a significant decrease in heart rate and capillary refill time. Echocardiographic assessment showed a significant increase in left ventricular end-diastolic diameter and superior vena cava flow (median increase: +19%), suggesting improved preload and systemic blood flow. No immediate clinically apparent adverse events were recorded during the observation period. Conclusion In this exploratory pilot study, a first volume expansion was associated with short-term improvements in clinical and echocardiographic hemodynamic parameters in hypotensive preterm infants. These findings are hypothesis-generating and cannot be generalized to current filling strategies or repeated fluid boluses.

Background The incidence of central precocious puberty (CPP) has reportedly increased worldwide during the coronavirus disease 2019 (COVID-19) pandemic; however, multicenter data from Japan remain limited. This study aimed to evaluate temporal changes in the incidence and clinical characteristics of CPP before, during, and after the pandemic. Methods We conducted a multicenter retrospective observational study across four pediatric endocrinology centers in Kanagawa, Japan. Newly diagnosed CPP cases from 2018 to 2023 were categorized into three periods: pre-pandemic (2018–2019), pandemic (2020–2021), and post-pandemic (2022–2023). Incidence rate ratios (IRRs) were calculated using quasi-Poisson regression, with population size included as an offset. Clinical characteristics—including age at diagnosis, bone age, degree of overweight, and hormone profiles—were compared across periods using the Kruskal–Wallis test. Results A total of 118 children (94 girls and 24 boys) were diagnosed with CPP during the study period. Among girls, CPP incidence increased significantly during the pandemic compared with the pre-pandemic period [IRR 2.47; 95% confidence interval (CI): 1.29–5.03]. In boys, incidence also increased with a statistically significant IRR; however, the estimate was accompanied by wide confidence intervals owing to the small number of cases. Elevated incidence rates in girls persisted into the post-pandemic period. No significant differences were observed across periods in age at diagnosis, degree of bone age advancement, degree of overweight, or basal and stimulated hormone levels. Nevertheless, the cohort consistently exhibited higher degrees of overweight compared with national reference values. Conclusions This multicenter study demonstrates a significant increase in CPP incidence among girls during the COVID-19 pandemic in Japan, with sustained elevation in the post-pandemic period. Although clinical characteristics remained largely unchanged, the consistently higher degree of overweight underscores the need to consider lifestyle and environmental factors that may have been exacerbated during the pandemic. Ongoing surveillance and reevaluation of CPP diagnostic criteria may be warranted to address emerging epidemiological trends.

Background Chronic Non-bacterial Osteomyelitis (CNO) is a rare autoinflammatory bone disease primarily affecting children and adolescents. The disease presents with a wide spectrum of severity, ranging from mild unifocal lesions to severe, recurrent multifocal bone inflammation. Its etiology remains unclear, making diagnosis challenging due to nonspecific symptoms. Methods We report the case of a 14-year-old girl who presented with recurrent swelling and pain in the left clavicle. After multiple admissions, the patient underwent extensive diagnostic workup, including laboratory tests, imaging, and biopsies, which showcased typical imaging and histopathological findings throughout the disease progression, helping to rule out infections and malignancies. Based on clinical findings and the exclusion of other conditions, she was diagnosed with CNO. Treatment included NSAIDs, intravenous antibiotics, and oral medications such as diclofenac sodium, naproxen, methotrexate, and calcitriol. Results During the one-year follow-up after initial treatment, the patient experienced recurrent symptoms, including swelling and pain in the left clavicle. After escalation to intravenous pamidronate and subcutaneous adalimumab, the patient achieved sustained clinical remission. During the subsequent two-year follow-up, no further symptom recurrence was observed. Conclusion CNO is generally diagnosed by exclusion, with MRI being the gold standard for detecting asymptomatic lesions and assessing disease activity. Treatment typically involves NSAIDs, with bisphosphonates and biologics increasingly used in refractory cases. This case underscores the complexity of diagnosing and managing CNO, highlighting the need for a multidisciplinary approach. Further research is essential to establish standardized diagnostic criteria and optimize treatment strategies for this rare condition.

Introduction School bullying has become an important social problem among adolescents, it can influence the growth of individual, yet understanding of the impacts of school bullying is limited. The present study determined to investigate whether and how school bullying can influence adolescent social adaptation. Methods Structural equation modeling was used to assess the hypothesized model. A sample of 434 Chinese adolescents (56.9% females), with an average age of 13.07 years (SD = 0.93), participated the survey. Results The present study combined self-disclosure and school connectedness into a serial mediation model, highlighting the role of individual and environmental factors in the outcomes of school bullying. Discussion These findings suggest that adolescents who engage in bullying are less likely to disclose personal information, which in turn hinders their sense of belonging at school, ultimately impairing their positive social adaptation. The results highlight the interplay between individual (self-disclosure) and environmental (school connectedness) factors in the outcomes of school bullying. Both limitations and implications are discussed in the end.

Background The triglyceride–glucose (TyG) index is widely recognized as a surrogate marker of insulin resistance and poor prognosis in adults. However, the relationship between the TyG index and outcomes in pediatric sepsis patients remains inadequately characterized. Elucidating this association could illuminate the metabolic dimension of sepsis pathophysiology and provide a simple, cost-effective tool for risk stratification in this vulnerable population. This study aims to investigate the relationship between the TyG index and 30-day mortality in pediatric sepsis and to explore its underlying biological significance. Methods We conducted a retrospective cohort study and enrolled 149 children who met the diagnostic criteria for sepsis from the PIC database of the Children's Hospital of Zhejiang University between 2010 and 2018. Participants were stratified by TyG level. The primary outcome was 30-day in-hospital all-cause mortality, and the secondary outcome was 30-day ICU all-cause mortality. Cox regression, restricted cubic splines (RCS), and Kaplan–Meier analyses were used to evaluate the association between the TyG index and 30-day mortality in pediatric sepsis patients. Results Among the 149 children with sepsis, higher TyG index levels were associated with a reduced 30-day mortality rate. In the multivariate Cox regression model, after adjusting for age, gender and key laboratory variables, the TyG index remained independently and negatively correlated with both in-hospital mortality and intensive care unit mortality. Restrictive cubic spline analysis revealed a linear negative correlation between the TyG index and the risk of death. Subgroup analysis indicated that the TyG index had a consistent protective effect across different age groups, genders and treatment subtypes. Although the Kaplan–Meier survival curve observed a trend of higher TyG index being associated with better survival rates, this association did not reach statistical significance in the sample of this study. Conclusions In pediatric patients with sepsis, a higher TyG index was associated with a lower 30-day mortality rate. This finding suggests that the TyG index shows potential for being related to short-term survival rates in children. Future studies need to further explore the interaction between the TyG index and other potential prognostic factors, and verify its value in larger or more diverse populations.

Mucopolysaccharidosis (MPS) represents a group of rare inherited metabolic disorders characterized by abnormal accumulation of glycosaminoglycans (GAGs) due to deficiencies of lysosomal enzymes. Mucopolysaccharidosis type I (MPS I) is caused by biallelic pathogenic variants in the IDUA gene and is inherited in an autosomal recessive pattern. The IDUA gene is located on chromosome 4p16.3 and encodes the lysosomal enzyme α -L-iduronidase, which plays a critical role in the degradation of GAGs, particularly dermatan sulfate and heparan sulfate. Reduced or absent IDUA enzymatic activity leads to the progressive accumulation of undegraded substrates within lysosomes, resulting in multisystem organ involvement. Based on clinical severity, MPS I is traditionally classified into three phenotypic subtypes: the severe form (Hurler syndrome), the intermediate form (Hurler–Scheie syndrome), and the attenuated form (Scheie syndrome, MPS I-S). This report describes a 13-year-old female patient in whom compound heterozygous pathogenic variants in the IDUA gene were identified by genetic testing, and whose clinical manifestations were consistent with the MPS I-S. In addition to typical skeletal and joint abnormalities, the patient also presented with uterine developmental abnormality. Currently, there is no definitive evidence supporting a direct causal relationship between MPS I and uterine developmental abnormalities; however, this case suggests a potential association between MPS I and reproductive system developmental abnormalities. This case may help further expand the phenotypic spectrum of MPS I and enhance clinical awareness of its multisystem involvement.

Introduction Necrotizing enterocolitis (NEC) is a severe gastrointestinal disorder that primarily affects preterm infants, resulting in significant morbidity and mortality. The exact cause of NEC remains unclear, but it is believed to involve a combination of immune dysregulation, intestinal injury, and microbiota imbalance. Methods This scoping review examines existing human and animal studies that explore the role of myeloid cells (neutrophils, monocytes, macrophages, and myeloid-derived suppressor cells (MDSCs) in NEC pathogenesis. Results A reduction in peripheral blood monocytes, along with increased infiltration of proinflammatory monocytes and neutrophils into the intestine, are strongly associated with NEC severity. Immunoregulatory MDSCs may provide protective benefits; however, their activity appears impaired in preterm infants with NEC. Therapies targeting these immune pathways, including transforming growth factor-β2 (TGF-β2) and lactoferrin, show promise in preclinical models for mitigating inflammation and improving outcomes in infants with NEC. Conclusions Targeting myeloid cell immune responses represents a potential therapeutic strategy in NEC. Future research should focus on translating immune-modulating therapies to clinical practice, as such interventions may reduce NEC incidence and severity and offer new hope for vulnerable neonates.