{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:52:12Z","timestamp":1791363132312,"version":"4.3.1"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Malnutrition among children is a crucial public health issue. Children in critical care units may suffer from nutritional vulnerability due to their underlying disease or barriers to nutrient delivery. Early detection and management of malnutrition may improve clinical outcomes. To evaluate the nutritional status of critically ill children admitted to the pediatric intensive care unit (PICU) and its prognostic outcome. This observational prospective cohort research entailed 250 children admitted to the PICU. All participants were assessed at admission and weekly thereafter for 28 days. Nutritional status was evaluated using anthropometric measurements and the PYMS and STRONGkids scores. The PRISM score was used to assess illness severity on the day of admission. 59.2% of patients were underweight and\/or stunted at admission and 59% at day 28 of follow-up. PYMS, and STRONGkids scores were significantly higher among underweight and\/or stunted on day 1 and during follow-up (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Multivariable regression analysis demonstrated that admission PRISM score was an independent predictor of mortality (aOR 1.50, 95% CI 1.19\u20131.88,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001), mechanical ventilation requirement (aOR 1.18, 95% CI 1.07\u20131.31,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001), and feeding interruptions (aOR 1.29, 95% CI 1.16\u20131.45,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Socioeconomic status was independently associated with feeding interruptions and length of stay.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0Underweight and\/or stunting was common among PICU patients. PYMS and STRONGkids were effective in identifying nutritional risk. After adjustment for confounding variables, clinical severity rather than baseline malnutrition independently predicted adverse clinical outcomes.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Underweight and\/or stunting were prevalent among children admitted to the PICU and this represent a crucial public health problem.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Both PYMS and STRONGkids were useful screening tools for identifying children at risk of malnutrition.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\u00a0\n                              <jats:italic>This study demonstrated that clinical severity and the need for inotropic support were the primary independent predictors of adverse outcomes.<\/jats:italic>\n                              \u2022\u00a0\n                              <jats:italic>The baseline malnutrition was not independently associated with mortality, mechanical ventilation, feeding interruptions, or length of PICU stay.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07420-5","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:22:21Z","timestamp":1791361341000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of nutritional status of critically Ill pediatric patients and its impact on outcome in a low-and middle-income settings"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8904-6536","authenticated-orcid":false,"given":"Aya Osama","family":"Mohamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0314-1392","authenticated-orcid":false,"given":"Asmaa Farrag El","family":"Sayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina Mohamed","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5943-9083","authenticated-orcid":false,"given":"Shereen A.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"7420_CR1","doi-asserted-by":"publisher","unstructured":"A\u011fin H et al (2023)\u00a0Nutrition in pediatric intensive care units.\u00a0J Pediatr Emerg Intensive Care Med\u00a010:66\u201383. https:\/\/doi.org\/10.4274\/cayd.galenos.2023.49002","DOI":"10.4274\/cayd.galenos.2023.49002"},{"key":"7420_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-077979","author":"J Reignier","year":"2025","unstructured":"Reignier J et al (2025) Nutritional support in the ICU. BMJ. https:\/\/doi.org\/10.1136\/bmj-2023-077979","journal-title":"BMJ"},{"issue":"3","key":"7420_CR3","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1002\/ncp.10828","volume":"37","author":"N Seremet Kurklu","year":"2022","unstructured":"Seremet Kurklu N et al (2022) Comparison of three different nutrition screening tools for pediatric inpatients. Nutr Clin Pract 37(3):698\u2013704","journal-title":"Nutr Clin Pract"},{"issue":"6","key":"7420_CR4","doi-asserted-by":"publisher","first-page":"379","DOI":"10.5005\/jp-journals-10071-24480","volume":"27","author":"S Wali","year":"2023","unstructured":"Wali S, Gutte SH, Gurjar M (2023) Towards achieving nutrition goal in critically ill patients: need a simple yet effective bedside tool. Indian J Crit Care Med 27(6):379","journal-title":"Indian J Crit Care Med"},{"issue":"6","key":"7420_CR5","doi-asserted-by":"publisher","first-page":"251","DOI":"10.58631\/ajhs.v4i6.226","volume":"4","author":"LAS Exposto","year":"2025","unstructured":"Exposto LAS et al (2025) The impact of malnutrition problems on children under 5 years old and its management strategies: a retrospective analysis. Asian J Health Scie 4(6):251\u2013260","journal-title":"Asian J Health Scie"},{"key":"7420_CR6","doi-asserted-by":"publisher","DOI":"10.26719\/2012.18.9.962","author":"A El-Gilany","year":"2012","unstructured":"El-Gilany A, El-Wehady A, El-Wasify M (2012) Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J. https:\/\/doi.org\/10.26719\/2012.18.9.962","journal-title":"East Mediterr Health J"},{"issue":"4","key":"7420_CR7","doi-asserted-by":"publisher","first-page":"511","DOI":"10.29052\/IJEHSR.v9.i4.2021.511-517","volume":"9","author":"H Akhtar","year":"2021","unstructured":"Akhtar H et al (2021) PRISM score as a predictor of mortality among pediatric intensive care units. Int J Endorsing Heal Sci Res 9(4):511\u2013517","journal-title":"Int J Endorsing Heal Sci Res"},{"key":"7420_CR8","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1111\/j.1651-2227.2006.tb02378.x","volume":"95","author":"M de Onis","year":"2006","unstructured":"Group, W.M.G.R.S., de Onis M (2006) WHO child growth standards based on length\/height, weight and age. Acta Paediatr 95:76\u201385","journal-title":"Acta Paediatr"},{"key":"7420_CR9","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.00368","volume":"8","author":"AM El Shafie","year":"2020","unstructured":"El Shafie AM et al (2020) Establishment of Z score reference of growth parameters for Egyptian school children and adolescents aged from 5 to 19 years: a cross sectional study. Front Pediatr 8:368","journal-title":"Front Pediatr"},{"key":"7420_CR10","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.598499","volume":"8","author":"AM El Shafie","year":"2021","unstructured":"El Shafie AM et al (2021) Development of LMS and Z score growth references for Egyptian children from birth up to 5 years. Front Pediatr 8:598499","journal-title":"Front Pediatr"},{"key":"7420_CR11","volume-title":"The UNICEF-WHO-World Bank Joint Child Malnutrition Estimates (JME) standard methodology: tracking progress on SDG Indicators 2.2. 1 on stunting, 2.2. 2 (1) on overweight and 2.2. 2 (2) on wasting","author":"Organization, W.H.","year":"2024","unstructured":"Organization, W.H., U.N.C.s. Fund (2024) The UNICEF-WHO-World Bank Joint Child Malnutrition Estimates (JME) standard methodology: tracking progress on SDG Indicators 2.2. 1 on stunting, 2.2. 2 (1) on overweight and 2.2. 2 (2) on wasting. World Health Organization"},{"key":"7420_CR12","first-page":"492","volume":"17","author":"VA Kumar","year":"2023","unstructured":"Kumar VA et al (2023) Study of PRISM score as predictor of mortality in pediatric intensive care unit (PICU) in a tertiary care hospital. Tirupati Res J Med Sci 17:492\u2013499","journal-title":"Tirupati Res J Med Sci"},{"issue":"8","key":"7420_CR13","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.medin.2020.04.023","volume":"45","author":"M Duyu","year":"2021","unstructured":"Duyu M, Karakaya Z (2021) Viral etiology and outcome of severe lower respiratory tract infections among critically ill children admitted to the PICU. Med Intensiva 45(8):447\u2013458","journal-title":"Med Intensiva"},{"issue":"1","key":"7420_CR14","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1186\/s12887-023-04175-y","volume":"23","author":"D Chen","year":"2023","unstructured":"Chen D, Cao L, Li W (2023) Etiological and clinical characteristics of severe pneumonia in pediatric intensive care unit (PICU). BMC Pediatr 23(1):362","journal-title":"BMC Pediatr"},{"issue":"2","key":"7420_CR15","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1002\/jpen.2116","volume":"46","author":"JC Ventura","year":"2022","unstructured":"Ventura JC et al (2022) Admission factors associated with nutritional status deterioration and prolonged pediatric intensive care unit stay in critically ill children: PICU-ScREEN multicenter study. J Parenter Enter Nutr 46(2):330\u2013338","journal-title":"J Parenter Enter Nutr"},{"issue":"18","key":"7420_CR16","first-page":"2980","volume":"6","author":"MR Nanda","year":"2023","unstructured":"Nanda MR (2023) Malnutrition and pneumonia among under-five children in Sadewa Maternal and Child Hospital, Yogyakarta, Indonesia. Bioscientia Med 6(18):2980\u20132984","journal-title":"Bioscientia Med"},{"issue":"5","key":"7420_CR17","first-page":"3","volume":"20","author":"O Shukla","year":"2017","unstructured":"Shukla O, Dave R, Doshi RP (2017) Clinical and microbiological profile of pneumonia in severe acute malnourished children. Int J Res Med Sci 20(5):3","journal-title":"Int J Res Med Sci"},{"issue":"11","key":"7420_CR18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-007411","volume":"6","author":"A Kirolos","year":"2021","unstructured":"Kirolos A et al (2021) The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis. BMJ Glob Health 6(11):e007411","journal-title":"BMJ Glob Health"},{"issue":"10","key":"7420_CR19","doi-asserted-by":"publisher","first-page":"4583","DOI":"10.1007\/s00431-023-05138-2","volume":"182","author":"Y Gamal","year":"2023","unstructured":"Gamal Y et al (2023) Prevalence and impact of malnutrition on outcomes and mortality of under-five years children with pneumonia: a study from Upper Egypt. Eur J Pediatr 182(10):4583\u20134593","journal-title":"Eur J Pediatr"},{"issue":"2","key":"7420_CR20","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v14.i2.103377","volume":"14","author":"S Jain","year":"2025","unstructured":"Jain S et al (2025) Impact of nutritional status on the outcome of critically ill pediatric patients. World J Clin Pediatr 14(2):103377","journal-title":"World J Clin Pediatr"},{"issue":"12","key":"7420_CR21","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1097\/PCC.0000000000003337","volume":"24","author":"S Campos-Mi\u00f1o","year":"2023","unstructured":"Campos-Mi\u00f1o S et al (2023) Malnutrition and nutrition support in Latin American PICUs: the nutrition in PICU (NutriPIC) study. Pediatr Crit Care Med 24(12):1033\u20131042","journal-title":"Pediatr Crit Care Med"},{"issue":"3","key":"7420_CR22","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1002\/ncp.10200","volume":"34","author":"M Wong Vega","year":"2019","unstructured":"Wong Vega M et al (2019) Malnutrition risk in hospitalized children: a descriptive study of malnutrition-related characteristics and development of a pilot pediatric risk-assessment tool. Nutr Clin Pract 34(3):406\u2013413","journal-title":"Nutr Clin Pract"},{"issue":"7","key":"7420_CR23","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1097\/CM9.0000000000001330","volume":"134","author":"L-Y Wang","year":"2021","unstructured":"Wang L-Y et al (2021) Implementation of STRONGkids for identifying nutritional risk in pediatric intensive care unit: a survey of Chinese practice. Chin Med J 134(7):867\u2013869","journal-title":"Chin Med J"},{"issue":"1","key":"7420_CR24","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s40795-022-00525-8","volume":"8","author":"A Malekiantaghi","year":"2022","unstructured":"Malekiantaghi A et al (2022) Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: a cross-sectional study. BMC Nutr 8(1):33","journal-title":"BMC Nutr"},{"issue":"5","key":"7420_CR25","doi-asserted-by":"publisher","first-page":"2772","DOI":"10.1016\/j.clnu.2021.04.010","volume":"40","author":"S Toh","year":"2021","unstructured":"Toh S et al (2021) Association between admission body mass index and outcomes in critically ill children: a systematic review and meta-analysis. Clin Nutr 40(5):2772\u20132783","journal-title":"Clin Nutr"},{"issue":"8","key":"7420_CR26","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1097\/CCM.0000000000001713","volume":"44","author":"LJ Bechard","year":"2016","unstructured":"Bechard LJ et al (2016) Nutritional status based on body mass index is associated with morbidity and mortality in mechanically ventilated critically ill children in the PICU. Crit Care Med 44(8):1530\u20131537","journal-title":"Crit Care Med"},{"issue":"3","key":"7420_CR27","doi-asserted-by":"publisher","first-page":"110","DOI":"10.4103\/DYPJ.DYPJ_32_22","volume":"10","author":"M Samanta","year":"2022","unstructured":"Samanta M et al (2022) Impact of nutritional status of children admitted in PICU on mortality and morbidity: a prospective observational study. DY Patil J Health Sci 10(3):110\u2013115","journal-title":"DY Patil J Health Sci"},{"issue":"1","key":"7420_CR28","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s43093-020-00032-x","volume":"6","author":"D Ahmad","year":"2020","unstructured":"Ahmad D, Afzal M, Imtiaz A (2020) Effect of socioeconomic factors on malnutrition among children in Pakistan. Future Bus J 6(1):30","journal-title":"Future Bus J"},{"issue":"1","key":"7420_CR29","first-page":"11","volume":"7","author":"A Tadesse","year":"2018","unstructured":"Tadesse A, Hailu D, Bosha T (2018) Nutritional status and associated factors among pastoralist children aged 6\u201323 months in Benna Tsemay Woreda, South Omo zone, Southern Ethiopia. Int J Nutr Food Sci 7(1):11\u201323","journal-title":"Int J Nutr Food Sci"},{"issue":"4","key":"7420_CR30","first-page":"476","volume":"11","author":"M Amoadu","year":"2024","unstructured":"Amoadu M et al (2024) Risk factors of malnutrition among in-school children and adolescents in developing countries: a scoping review. Children (Basel) 11(4):476","journal-title":"Children (Basel)"},{"issue":"1","key":"7420_CR31","doi-asserted-by":"publisher","first-page":"63","DOI":"10.71000\/mhn81y49","volume":"3","author":"I Mugheri","year":"2025","unstructured":"Mugheri I et al (2025) Children with severe acute malnutrition: an evaluation of their hematological parameters: a study conducted in Larkana. Insights-journal of Life and Social Sciences \u0423\u0447pe\u0434\u0438\u0442e\u043b\u0438: Health Res Insights 3(1):63\u201371","journal-title":"Insights-journal of Life and Social Sciences \u0423\u0447pe\u0434\u0438\u0442e\u043b\u0438: Health Res Insights"},{"issue":"1","key":"7420_CR32","first-page":"138","volume":"3","author":"K Isezuo","year":"2021","unstructured":"Isezuo K et al (2021) Complete blood count profile and derived inflammatory markers in children with severe acute malnutrition seen in Sokoto, North-Western Nigeria. Eur J Med Health Sci 3(1):138\u2013142","journal-title":"Eur J Med Health Sci"},{"issue":"1","key":"7420_CR33","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13052-023-01476-x","volume":"49","author":"HM Fouad","year":"2023","unstructured":"Fouad HM et al (2023) Prevalence of malnutrition & anemia in preschool children; a single center study. Ital J Pediatr 49(1):75","journal-title":"Ital J Pediatr"},{"key":"7420_CR34","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/6636043","author":"WW Takele","year":"2021","unstructured":"Takele WW, Baraki AG, Wolde HF, Desyibelew HD, Derseh BT, Dadi AF, Mekonnen EG, Akalu TY (2021) Anemia and contributing factors in severely malnourished infants and children aged between 0 and 59 months admitted to the treatment centers of the Amhara region, Ethiopia: a multicenter chart review study. Anemia. https:\/\/doi.org\/10.1155\/2021\/6636043","journal-title":"Anemia"},{"key":"7420_CR35","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.67657","author":"WC Venigalla","year":"2024","unstructured":"Venigalla WC et al (2024) A study of the prevalence of anemia in children with severe acute malnutrition at a pediatric tertiary care hospital in South India. Cureus. https:\/\/doi.org\/10.7759\/cureus.67657","journal-title":"Cureus"},{"key":"7420_CR36","doi-asserted-by":"publisher","first-page":"245","DOI":"10.21474\/IJAR01\/16414","volume":"11","author":"A Ghmaird","year":"2023","unstructured":"Ghmaird A et al (2023) Iron deficiency anemia and malnutrition in pediatrics in Saudi Arabia: a review article. Int J Adv Res 11:245\u2013250","journal-title":"Int J Adv Res"},{"key":"7420_CR37","doi-asserted-by":"publisher","DOI":"10.2147\/JBM.S284572","author":"S Getawa","year":"2020","unstructured":"Getawa S, Getaneh Z, Melku M (2020) Hematological abnormalities and associated factors among undernourished under-five children attending University of Gondar Specialized Referral Hospital, Northwest Ethiopia. J Blood Med. https:\/\/doi.org\/10.2147\/JBM.S284572","journal-title":"J Blood Med"},{"key":"7420_CR38","unstructured":"Dutta S et al (2024)\u00a0The prevalence of malnutrition in children younger than five years old and its correlation with mortality.\u00a0Chin J Otorhinolaryngol Head Neck Surg 55:1549\u20131557"},{"issue":"1","key":"7420_CR39","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3126\/jngmc.v17i1.25305","volume":"17","author":"R Bora","year":"2019","unstructured":"Bora R (2019) Prediction of mortality by pediatric risk of mortality (PRISM) III score in NGMC pediatric intensive care unit. J Nepalgunj Med Coll 17(1):5\u20139","journal-title":"J Nepalgunj Med Coll"},{"key":"7420_CR40","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.887885","volume":"10","author":"M Ding","year":"2022","unstructured":"Ding M, Yang C, Li Y (2022) Risk factors of readmission to pediatric intensive care unit within 1 year: a case-control study. Front Pediatr 10:887885","journal-title":"Front Pediatr"},{"key":"7420_CR41","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.926686","volume":"10","author":"AS Alkhalifah","year":"2022","unstructured":"Alkhalifah AS, AlSoqati A, Zahraa J (2022) Performance of pediatric risk of mortality III and pediatric index of mortality III scores in tertiary pediatric intensive unit in Saudi Arabia. Front Pediatr 10:926686","journal-title":"Front Pediatr"},{"key":"7420_CR42","unstructured":"Sah VK (2023)\u00a0Effect of weight on mortality and morbidity of patient in pediatric intensive care unit (PICU).\u00a0J Cardiovasc Dis Res 14:1428\u20131435"},{"issue":"7","key":"7420_CR43","doi-asserted-by":"publisher","first-page":"385","DOI":"10.4103\/0972-5229.186218","volume":"20","author":"R Nangalu","year":"2016","unstructured":"Nangalu R et al (2016) Impact of malnutrition on pediatric risk of mortality score and outcome in pediatric intensive care unit. Indian J Crit Care Med 20(7):385","journal-title":"Indian J Crit Care Med"},{"key":"7420_CR44","doi-asserted-by":"publisher","unstructured":"Morales TC et al (2021)\u00a0Survival in critically ill pediatric surgical patients with elevated PYMS and caloric deficit. https:\/\/doi.org\/10.21203\/rs.3.rs-937457\/v1","DOI":"10.21203\/rs.3.rs-937457\/v1"},{"key":"7420_CR45","doi-asserted-by":"publisher","DOI":"10.3390\/children12030390","author":"Y Desai","year":"2025","unstructured":"Desai Y et al (2025) Nutritional status, social determinants of health and clinical outcomes in critically ill children. Children (Basel). https:\/\/doi.org\/10.3390\/children12030390","journal-title":"Children (Basel)"},{"key":"7420_CR46","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.769401","volume":"10","author":"MS Albadi","year":"2022","unstructured":"Albadi MS, Bookari K (2022) Is undernutrition associated with deterioration of outcomes in the pediatric intensive care unit (PICU): systematic and meta-analysis review. Front Pediatr 10:769401","journal-title":"Front Pediatr"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07420-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07420-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07420-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:22:25Z","timestamp":1791361345000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07420-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,11]]}},"alternative-id":["7420"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07420-5","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"30 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study protocol was approved by the Cairo University School of Medicine ethical committee with institutional review board number (N:ms-129\u20132020) and accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. Al author's confirmed that written informed consent was obtained from all participants.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"810"}}