Introduction. Mechanical ventilation (MV) is a common intensive care intervention associated with increased resource use and a risk of complications. Therefore, this study aimed to characterize ventilated patients with acute hypoxemic respiratory failure (AHRF) and pediatric acute respiratory distress syndrome (PARDS). Population and Methods. We conducted a prospective cohort study in the pediatric intensive care unit of a high-complexity hospital between June 2021 and August 2022. The study analyzed the outcomes of patients with MV, the incidence of AHRF and PARDS, and their respective outcomes. Results. The study recorded 1354 admissions; 273 required mechanical ventilation (306 cycles). 19.4% had AHRF and 6.6% had PARDS. Morbidity upon discharge from the intensive care unit was 18.7%, and mortality was 12.1%. In-hospital mortality was 13.2%; 10.2% required a tracheostomy. In the univariate analysis, PIM-2, failed and unscheduled extubations, tracheostomy, days on mechanical ventilation and length of hospital stay, AHRF, and PARDS were associated with morbidity and mortality. In the multivariate analysis, PIM-2 and tracheostomy remained significant. Conclusion. One in five patients admitted to the pediatric intensive care unit required mechanical ventilation, and approximately seven out of ten ventilated patients survived without acquired morbidity. AHRF was associated with longer duration of mechanical ventilation and hospital stay, a higher likelihood of tracheostomy, and higher morbidity and mortality. The results for patients with PARDS show a trend toward more days on a ventilator, longer hospital stays, and higher mortality.

Introduction. Argentina introduced maternal vaccination against respiratory syncytial virus (RSV) in 2024 to prevent severe respiratory infections in infants. To ensure satisfactory vaccination rates, it is important to identify barriers to its implementation. Objective. To identify barriers to RSV vaccination among pregnant women. We estimated RSV vaccination coverage and the potential association between coverage and barriers. Population and methods. A cross-sectional study based on a survey of mothers who were eligible to receive the RSV vaccine. We developed and validated a tool to identify structural, informational, emotional, and social barriers. We used logistic regression for univariate and multivariate analyses. Results. We surveyed 216 mothers. RSV vaccine coverage was 43.7%. In the univariate analysis, fewer than 5 prenatal visits and not receiving clear information were associated with lower vaccination rates. In the multivariate analysis, knowledge of the RSV vaccine was the only factor independently associated with vaccination coverage (adjusted OR: 3.4; 95% CI: 1.9-6.2; p <0.001). Conclusion. RSV vaccination coverage among pregnant women was lower than that for other vaccines recommended during pregnancy. We identified limited vaccine availability and limited knowledge about the vaccine as factors associated with non-vaccination. Strengthening information and recommendations during prenatal care could help improve vaccination coverage. This study provides a validated tool for assessing barriers to vaccination among pregnant women.

Posterior nutcracker syndrome results from compression of the left renal vein between the aorta and the spine, secondary to an anomalous and rare anatomical location of the vein. The typical clinical presentation includes hematuria and chronic pain. We present the case of a 14-year-old female patient with a 20-day history of heavy uterine bleeding requiring a red blood cell transfusion. An abdominal ultrasound was performed, revealing dilation of the left gonadal and ovarian veins. CT angiography and phlebography confirmed ovarian varices and dilation of the left gonadal and renal veins, revealing a posterior left renal vein location suggestive of posterior nutcracker syndrome. We performed surgical correction by transposing the left renal vein, with a favorable medium-term outcome.

Inflammatory myofibroblastic tumor is a rare neoplasm. Its preferred location is intrathoracic; there are few reports of intra-abdominal involvement, where it may affect the mesentery and retroperitoneum. A 7-year-old girl was brought in for evaluation due to fever, nonspecific lower abdominal pain, fatigue, and progressive weight loss. Laboratory tests revealed anemia, thrombocytosis, and elevated CRP. An abdominal ultrasound showed a hypoechoic mass with well-defined borders and heterogeneous content, measuring approximately 67 × 52 × 79 mm. Complete excision was performed via laparotomy. Its low incidence, varied location, nonspecific histology, and clinical heterogeneity make diagnosis extremely difficult. Only histopathology allows for a definitive diagnosis, and the cornerstone of treatment remains complete removal of the tumor. This rare condition should be included in the pediatric differential diagnosis because of its nonspecific clinical presentation, intra-abdominal mass, and high recurrence rate after incomplete resection.

Introduction. Neck circumference is a useful anthropometric measure for identifying adiposity in children; however, few percentiles are available for school-aged children in northwestern Mexico. Objectives. To estimate smoothed percentiles of neck circumference by age and sex, and to evaluate their association with anthropometric and adiposity indicators in schoolchildren aged 7 to 12 years in northwestern Mexico. Population and methods. We conducted a cross-sectional study among 319 schoolchildren aged 7 to 12 years from four elementary schools in Ciudad Obregón, Sonora. Weight, height, neck circumference, waist circumference, triceps skinfold thickness, and body fat percentage (measured by electrical bioimpedance) were measured. We estimated smoothed percentiles using the LMS method. Results. We included 174 girls and 145 boys. Smoothed percentiles (P10, P25, P50, P75, and P90) were estimated by age and sex. Neck circumference was positively correlated with age-adjusted body mass index (BMI), waist circumference, body fat percentage, and triceps skinfold thickness. Conclusion. Neck circumference showed a positive association with anthropometric and adiposity indicators, suggesting that it could serve as a complementary anthropometric measure for assessing adiposity in this population.

Introduction. Vaccination is an effective public health intervention, although it can be painful. Breastfeeding during vaccination reduces infants' pain perception, but vaccination services do not systematically incorporate this practice. Objective. To describe the development, application, and results of a protocol for the implementation of nonpharmacological analgesia through breastfeeding during vaccination of infants up to six months of age in a public hospital. Population and methods. We conducted an implementation study with a before-and-after evaluation based on the model developed by Grol and Wensing, carried out in both inpatient and vaccination settings. It included a diagnostic phase with surveys of mothers and interviews with vaccinators; planning and designation of a point person; awareness-raising activities; and active implementation with follow-up. Evaluations were conducted at one month and six months using surveys and interviews. Implementation indicators were analyzed. Results. The project ran from April 2024 to November 2025. The diagnostic phase included 199 surveys, and 71 were included in each subsequent evaluation. The proportion of infants who were breastfed during vaccination was 15% at baseline, 78% at one month, and 68% at six months. Mothers and healthcare workers accepted the strategy well, and it became an institutional practice. Conclusion. Using breastfeeding as a pain-relief strategy during vaccination proved to be a simple, feasible, and widely accepted intervention for both families and the healthcare team.

Diabetes is a chronic disease characterized by hyperglycemia resulting from insulin deficiency or resistance to insulin action. Its onset may result from polygenic or monogenic mechanisms. The liver plays a central role in glucose metabolism and can be affected by various conditions. In poorly controlled type 1 diabetes, glycogenic liver disease presents with hepatomegaly and elevated liver enzymes, which is reversible with good metabolic control. Autoimmune hepatitis may coexist with type 1 diabetes due to shared immunological mechanisms or may develop during treatment with corticosteroids. In type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD) is common and can progress to severe forms. Monogenic forms may be associated with structural abnormalities of the liver and biliary tract. Early recognition of liver involvement and a multidisciplinary approach are essential for preventing long-term complications.

Adolescent health care has been structured around present-focused approaches: rights, holistic health, risk, and gender. These frameworks have led to substantial progress, but they share a limitation: they describe the adolescent's current state without offering a systematic way to project their future trajectory. We present the prospective-dynamic approach, a conceptual framework that integrates these frameworks with an explicit temporal orientation and draws on self-determination theory, motivational interviewing, the future-oriented perspective on adolescent development, the life-course perspective, and positive adolescent development. The prospective-dynamic approach is organized into five operational components-comprehensive assessment with a temporal perspective, exploration of desires and purpose, construction of trajectories and scenarios, definition of microgoals, and periodic follow-up checkpoints-which can be incorporated into routine consultations without replacing current approaches. This article discusses its rationale, clinical application, and limitations.

Introduction. Cyber addiction is the excessive and uncontrolled use of the Internet, computer games, social media, and digital devices in ways that negatively affect children's daily lives. With the rapid proliferation of digital technologies, cyber addiction has become a significant public health issue among adolescents and has contributed to psychological, social, and academic problems among them. This study investigated the effectiveness of a parent-based digital detox education program in reducing cyber addiction among adolescents aged 12-17 years by improving parental awareness and guidance on the subject. Population and methods. Between June and December 2025, parents of adolescents aged 12-17 years living in a province in eastern Türkiye participated in this quasi-experimental study. The intervention group attended a four-week online parent education program, whereas the control group received no intervention. Data were collected before and after the intervention using the Introduction Form and the Family Child Internet Addiction Scale. Results. A total of 81 parents were included; in the intervention group (n = 40), post-test scores for social isolation, dysfunction, withdrawal, loss of control, and total internet addiction decreased significantly compared with pre-test scores (p <0.05). No significant pre- or post-test differences were observed in the control group. Baseline comparisons indicated that the groups were comparable before intervention. Conclusions. A parent-based digital detox education program was associated with reduced cyber addiction in adolescents aged 12-17 years. However, because no significant post-test differences were found between the intervention and control groups, the findings should be interpreted with caution. Larger randomized controlled trials are required to confirm the effectiveness of this intervention.

Introduction. Classifying stool consistency in infants is essential in pediatric gastroenterology. The Brussels Infant and Toddler Stool Scale (BITSS) is the visual standard, but it exhibits interobserver variability. Artificial intelligence (AI) offers an objective alternative to reduce subjectivity. Objective. To evaluate the agreement between an AI model and the classification performed by pediatric gastroenterologists using BITSS. Population and methods. An observational, cross-sectional, retrospective study based on a photo database of stool samples from infants under 12 months of age in diapers. We selected 1100 images that met quality criteria; a majority of three gastroenterologists agreed on 896, which we used as the reference set. The images were organized into seven BITSS categories and a grouped version. We trained 20 AI models using an 85/15 split for training and validation. We evaluated performance using exactness, sensitivity, specificity, precision, and F1 score. Inter-specialist agreement was assessed using Fleiss's Kappa, and AI-reference agreement was assessed using weighted Kappa. Results. The specialists showed 24.7% complete agreement and 75.3% partial agreement, with a Fleiss Kappa of 0.24. The best model for seven categories achieved an overall accuracy of 0.56, with Kappa values of 0.59 (linear) and 0.75 (quadratic). In the grouped version, accuracy reached 0.76, with coefficients of 0.69 and 0.78, respectively. Conclusion. The AI showed moderate to substantial agreement with the reference classification, particularly in the grouped categories. The findings support the approach's feasibility and warrant external validation studies.

Hypomagnesemia secondary to cisplatin-induced nephrotoxicity is caused by a tubular defect that results in renal loss of magnesium. The objective was to evaluate the effect of amiloride in patients with cisplatin-induced hypomagnesemia. To this end, we included nine cancer patients who were evaluated sequentially in three stages: without corrective treatment, with magnesium supplementation, and with combined treatment of magnesium plus amiloride. Magnesium supplementation increased serum magnesium levels compared with no treatment (1.22 ± 0.07 vs. 1.01 ± 0.13 mg/dl; p < 0.01), without reducing urinary magnesium excretion. The addition of amiloride produced a further increase in serum magnesium levels (1.38 ± 0.17 mg/dl; p <0.05) and was associated with a significant decrease in magnesium excretion and fractional magnesium excretion (p <0.01). No episodes of hyperkalemia were observed. Amiloride reduced hypermagnesuria and increased serum magnesium levels in patients with cisplatin-induced nephrotoxicity.

Introduction. Acute viral myositis is an inflammatory condition caused by respiratory viruses, characterized by lower-extremity pain and difficulty walking. It is a benign, self-limiting condition; complications such as rhabdomyolysis or acute kidney injury are rare. The objective of this study is to analyze the clinical course and treatment of patients seen in a pediatric emergency department (PED). Population and methods. Retrospective observational study with exploratory analysis of associations. Patients diagnosed with acute viral myositis between January 2018 and March 2023 at the PED were analyzed. Demographic, clinical, and laboratory data were collected and analyzed using means, standard deviations, and bivariate analysis (Student's t-test or chi-square test), as well as correlations (Pearson or Spearman). Results. Forty patients were included, with a mean age of 6.75 years (SD 2.59). Blood tests were performed in 30 of 40 patients (75.0%; 95% CI: 59.8-85.8). Eleven of 40 patients (27.5%; 95% CI: 16.1-42.8) met the criteria for rhabdomyolysis. No cases of renal failure or other complications were observed. Exploratory analysis revealed that creatine phosphokinase (CPK) levels were higher in males than in females and were associated with age, the AST/ALT ratio, lactate dehydrogenase (LDH), and the need for hospitalization and intravenous fluid therapy. Conclusion. Acute viral myositis in this pediatric series had a favorable clinical course. A proportion of patients presented with markedly elevated CPK levels and criteria for rhabdomyolysis, with no cases of acute renal failure.

Erythromelalgia is a rare acral clinical syndrome characterized by episodes of burning pain, erythema, and increased skin temperature in the extremities. Its occurrence in children is exceptional. It may occur as a primary form or secondary to an underlying organic disorder; type 1 diabetes mellitus is an uncommon cause. Diagnosis is clinical and is established after other etiologies have been excluded. Treatment is aimed at alleviating symptoms and managing the underlying condition. We present a pediatric case of erythromelalgia secondary to type 1 diabetes mellitus.

Congenital portosystemic shunts (CPS) are rare vascular malformations associated with hepatic and extrahepatic complications, including hepatopulmonary syndrome (HPS). We present a 16-year-old adolescent with no relevant medical history who presented with episodes of abdominal pain, jaundice, and dark urine. Ultrasound revealed a heterogeneous liver with multiple hyperechoic nodules and no visualization of the intrahepatic portal vein. Angiography demonstrated an extrahepatic portocaval shunt at the level of the portal trunk, with no opacification of the intrahepatic portal tree and low portal pressures; liver biopsy revealed regenerative nodular hyperplasia. Subsequently, he developed hypoxemia with orthodeoxygenation and required home oxygen therapy. He was placed on the waiting list and received an orthotopic liver transplant from a deceased donor. This case highlights the need for timely diagnosis, proper anatomical characterization, and individualized treatment planning in CPS associated with HPS.