{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:45:12Z","timestamp":1787237112646,"version":"build-2736575974"},"reference-count":20,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"\n Background:<\/jats:title>\n Adult frailty scales rely on performance tests that are rarely feasible in children. Quantitative muscle ultrasound (US) could provide an objective bridge, but its pediatric utility is untested.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n To explore whether US-derived biomarkers Z-scores can cluster into recognizable patterns that serve as preliminary building blocks toward a quantitative definition of pediatric frailty.<\/jats:p>\n <\/jats:sec>\n \n Design and Setting:<\/jats:title>\n Eight-month, single-center exploratory cross-sectional observational study in a pediatric palliative care unit.<\/jats:p>\n <\/jats:sec>\n \n Participants:<\/jats:title>\n Twenty-four consecutively enrolled children (1\u201318 years) with advanced but clinically stable, life-limiting conditions (83.5% neurometabolic, 16.5% oncologic), recruited with parental informed consent.<\/jats:p>\n <\/jats:sec>\n \n Procedures:<\/jats:title>\n Rectus femoris and vastus intermedius were scanned with standardized presets (64 dB gain; 4 cm depth). Age- or weight-adjusted Z-scores for muscle thickness, echo-intensity (EI), and subcutaneous-fat were derived from a published pediatric dataset. Each child was plotted in 3-D \u201chealth cubes\u201d (x = muscle-thickness z, y = EI z, z = subcutaneous-fat z).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n \n \n All patients lay outside the \u00b1 2 SD \u201cnormality cube\u201d for at least one reference set.<\/jats:p>\n <\/jats:list-item>\n \n Median (IQR) muscle-thickness z = \u20134.9 (\u20135.6 to \u20134.1); EI z = +3.7 (+2.1 to +5.8).<\/jats:p>\n <\/jats:list-item>\n \n \n Thickness and EI were inversely correlated (\u03c1 = \u20130.62,\n p<\/jats:italic>\n = 0.002); lower thickness modestly predicted shorter time-to-death (\u03c1 = \u20130.55,\n p<\/jats:italic>\n = 0.01).\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n In this modest, single-center cohort, pediatric palliative patients consistently deviated from normative muscle US ranges, forming a distinct cluster outside the \u201chealthy\u201d 3-D zone. While not diagnostic, these patterns support further, larger, longitudinal studies to develop composite US indices and formal cut-points for pediatric frailty. This visual framework may accelerate that process by highlighting multidimensional outliers at the bedside.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/10966218261420048","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T15:17:37Z","timestamp":1773847057000},"page":"639-645","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Ultrasound-Derived Muscle Biomarkers as a Gateway toward Quantitative Pediatric Frailty in Palliative Care"],"prefix":"10.1177","volume":"29","author":[{"given":"Jos\u00e9 Fern\u00e1ndez-Cuesta","family":"Pe\u00f1afiel","sequence":"first","affiliation":[{"name":"Servicio de Cuidados Paliativos Pediatricos, Hospital Infantil Universitario Ni\u00f1o Jes\u00fas, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro Navarro","family":"Mingorence","sequence":"additional","affiliation":[{"name":"Servicio de Cuidados Paliativos Pediatricos, Hospital Infantil Universitario Ni\u00f1o Jes\u00fas, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica Puertas","family":"Mrt\u00edn","sequence":"additional","affiliation":[{"name":"Servicio de Cuidados Paliativos Pediatricos, Hospital Infantil Universitario Ni\u00f1o Jes\u00fas, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Martino Alba","sequence":"additional","affiliation":[{"name":"Servicio de Cuidados Paliativos Pediatricos, Hospital Infantil Universitario Ni\u00f1o Jes\u00fas, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afy169"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.m146"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00516-4"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.24.2725"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2003-0654-F"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22532"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2008.09.016"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2017.01.014"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S47263"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-011-2099-5"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0148607113501327"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/01617346211029656"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2004.05.013"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.10384"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2015.04.027"},{"key":"e_1_3_7_17_2","unstructured":"Paliativos Sin Fronteras. Bases de los cuidados paliativos pedi\u00e1tricos. Paliativos Sin Fronteras: Girona Spain; 2025. Available from: https:\/\/paliativossinfronteras.org\/wp-content\/uploads\/BASES-DE-LOS-CUIDADOS-PALIATIVOS-PEDIATRICOS.-2025.pdf"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23100"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00583-z"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2024.05.005"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2011.11.036"}],"container-title":["Journal of Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10966218261420048","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10966218261420048","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10966218261420048","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:29:30Z","timestamp":1782271770000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10966218261420048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"alternative-id":["10.1177\/10966218261420048"],"URL":"https:\/\/doi.org\/10.1177\/10966218261420048","relation":{},"ISSN":["1096-6218","1557-7740"],"issn-type":[{"value":"1096-6218","type":"print"},{"value":"1557-7740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]}}}