{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:44:46Z","timestamp":1790815486310,"version":"4.1.0"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Agence Fran\u00e7aise de D\u00e9veloppement and the Pierre Fabre Foundation","award":["AFD CLB1148 01K"],"award-info":[{"award-number":["AFD CLB1148 01K"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background and Objectives: Congenital abnormalities are a leading cause of neonatal morbidity and mortality and are frequently detectable through prenatal ultrasound. While widely implemented in high-income countries, such screening remains inconsistently applied in low- and middle-income regions. This study aimed to estimate the prevalence of congenital abnormalities identified via prenatal ultrasound in Lebanon and to explore associated maternal, obstetric, and psychosocial factors. Methods: A multicenter retrospective observational study, supplemented by follow-up interviews, was conducted in five Order of Malta medical centers. Pregnant women in their second trimester underwent an obstetric ultrasound, and data were collected through structured questionnaires and follow-up phone interviews. Variables included maternal demographics, obstetric history, anxiety levels (GAD-7 scores), and ultrasound findings. Results: A total of 426 pregnant women were enrolled (mean age: 28.8 \u00b1 5.9 years). The overall prevalence of congenital abnormalities was 13.1%. Growth abnormalities were observed in 8.5% of fetuses and were significantly associated with obstetric complications and the presence of multiple abnormalities. Morphological malformations were found in 10.1% of cases and were more common among women of advanced maternal age, those with a history of anomalies, and those reporting elevated anxiety scores. Combined abnormalities, as well as growth and morphological malformations, were significantly associated with higher parity, prior anomalies, and current pregnancy complications. Conclusions: Prenatal ultrasound is essential for early detection of congenital abnormalities, facilitating timely intervention and improved neonatal outcomes. These findings emphasize the need to integrate systematic screening into prenatal care in Lebanon and for ongoing research to identify context-specific risk factors.<\/jats:p>","DOI":"10.3390\/children12081076","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T16:09:55Z","timestamp":1755274195000},"page":"1076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Obstetric Ultrasound Screening in Lebanon for Fetal Diagnosis and Associated Factors of Congenital Abnormalities"],"prefix":"10.3390","volume":"12","author":[{"given":"Rita","family":"Chebl","sequence":"first","affiliation":[{"name":"Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Nader","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Saba","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecile Z.","family":"Attieh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine &Medical Sciences, University of Balamand, Koura Campus, Tripoli P.O. Box 100, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ogarite","family":"Kattan","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Nohra","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Maria A.","family":"Henaine","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"El Khoury","sequence":"additional","affiliation":[{"name":"Lebanese Association of the Knights of Malta, Order of Malta Lebanon, Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8500-661X","authenticated-orcid":false,"given":"Malek N.","family":"Nassar","sequence":"additional","affiliation":[{"name":"Lebanese Association of the Knights of Malta, Order of Malta Lebanon, Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon"},{"name":"Department of Obstetrics and Reproduction, Hotel-Dieu de France Hospital, Beirut P.O. Box 11-5190, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5550-8671","authenticated-orcid":false,"given":"Pierre","family":"Nakhel","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"},{"name":"Department of Obstetrics & Gynecology, Faculty of Medical Sciences, Lebanese University, Hadath P.O. Box 3, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9chara","family":"El Asmar","sequence":"additional","affiliation":[{"name":"Lebanese Association of the Knights of Malta, Order of Malta Lebanon, Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon"},{"name":"Faculty of Medicine, Saint Joseph University, Beirut P.O. Box 17-5208, Lebanon"},{"name":"Department of Cardiology, Hotel-Dieu de France Hospital, Beirut P.O. Box 11-5190, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6342-413X","authenticated-orcid":false,"given":"Mirna N.","family":"Chahine","sequence":"additional","affiliation":[{"name":"Lebanese Association of the Knights of Malta, Order of Malta Lebanon, Vanlian Bldg, 6th Fl. City Rama Str. Dekwaneh, Beirut P.O. Box 11-4286, Lebanon"},{"name":"Department of Biology, Faculty of Arts & Sciences, University of Balamand, Dekwaneh Campus, Sin-el-Fil P.O. Box 55251, Lebanon"},{"name":"Foundation-Medical Research Institutes (F-MRI<sup>\u00ae<\/sup>), Beirut P.O. Box 166378, Lebanon"},{"name":"Foundation-Medical Research Institutes (F-MRI<sup>\u00ae<\/sup>), 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6015","DOI":"10.1016\/j.vaccine.2016.03.047","article-title":"Congenital anomalies: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data","volume":"34","author":"DeSilva","year":"2016","journal-title":"Vaccine"},{"key":"ref_2","unstructured":"World Health Organization (2023, October 01). Birth Defects: Report by the Secretariat. Sixty-Third World Health Assembly. Available online: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA63\/A63_10-en.pdf."},{"key":"ref_3","unstructured":"World Health Organization (2023, December 01). Congenital Disorders. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/birth-defects."},{"key":"ref_4","unstructured":"World Health Organization (2022). World Birth Defects Day: \u201cMany Birth Defects, One Voice\u201d, World Health Organization. Available online: https:\/\/www.who.int\/southeastasia\/news\/detail\/03-03-2022-world-birth-defects-day-many-birth-defects-one-voice."},{"key":"ref_5","first-page":"117","article-title":"Frequencies of congenital anomalies among newborns admitted in nursery of Ayub Teaching Hospital Abbottabad, Pakistan","volume":"23","author":"Gillani","year":"2011","journal-title":"J. Ayub Med. Coll. Abbottabad"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"651783","DOI":"10.1155\/2014\/651783","article-title":"Major congenital malformations in barbados: The prevalence, the pattern, and the resulting morbidity and mortality","volume":"2014","author":"Singh","year":"2014","journal-title":"ISRN Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.18203\/2320-6012.ijrms20161758","article-title":"A study of incidence of congenital anomalies in newborn: A hospital based study","volume":"4","author":"Prashar","year":"2016","journal-title":"Int. J. Res. Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mashuda, F., Zuechner, A., Chalya, P.L., Kidenya, B.R., and Manyama, M. (2014). Pattern and factors associated with congenital anomalies among young infants admitted at Bugando medical centre, Mwanza, Tanzania. BMC Res. Notes, 7.","DOI":"10.1186\/1756-0500-7-195"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2147\/PHMT.S293285","article-title":"Prevalence and Trends of Congenital Anomalies Among Neonates at Jimma Medical Center, Jimma, Ethiopia: A Three-Year Retrospective Study","volume":"12","author":"Silesh","year":"2021","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Taye, M., Afework, M., Fantaye, W., Diro, E., and Worku, A. (2019). Congenital anomalies prevalence in Addis Ababa and the Amhara region, Ethiopia: A descriptive cross-sectional study. BMC Pediatr., 19.","DOI":"10.1186\/s12887-019-1596-2"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Dessie, M.A., Zeleke, E.G., Workie, S.B., and Berihun, A.W. (2017). Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: Cross-sectional study. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1506-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s10995-023-03591-x","article-title":"Prevalence, Pattern, and Outcome of Congenital Anomalies Admitted to a Neonatal Unit in a Low-Income Country-a Ten-Year Retrospective Study","volume":"27","author":"Opoku","year":"2023","journal-title":"Matern. Child Health J."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Al-Dewik, N., Samara, M., Younes, S., Al-Jurf, R., Nasrallah, G., Al-Obaidly, S., Salama, H., Olukade, T., Hammuda, S., and Marlow, N. (2023). Prevalence, predictors, and outcomes of major congenital anomalies: A population-based register study. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-27935-3"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bhide, P., and Kar, A. (2018). A national estimate of the birth prevalence of congenital anomalies in India: Systematic review and meta-analysis. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1149-0"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.ogc.2019.01.011","article-title":"Benefits and Pitfalls of Ultrasound in Obstetrics and Gynecology","volume":"46","author":"Abinader","year":"2019","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_16","first-page":"CD007058","article-title":"Ultrasound for fetal assessment in early pregnancy","volume":"2015","author":"Whitworth","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.wneu.2020.01.014","article-title":"The Value of Obstetric Ultrasound in Screening Fetal Nervous System Malformation","volume":"138","author":"Zhang","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"f108","DOI":"10.1136\/bmj.f108","article-title":"Maternal and fetal risk factors for stillbirth: Population based study","volume":"346","author":"Gardosi","year":"2013","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.3109\/14767058.2012.703716","article-title":"Detection of congenital heart defects throughout pregnancy; impact of first trimester ultrasound screening for cardiac abnormalities","volume":"25","author":"Eleftheriades","year":"2012","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_20","first-page":"e25367","article-title":"The Lebanese Healthcare Crisis: An Infinite Calamity","volume":"14","author":"Fleifel","year":"2022","journal-title":"Cureus"},{"key":"ref_21","unstructured":"Lebanese Ministry of Public Health (2023, October 01). Health Response Strategy: Maintaining Health Security, Preserving Population Health, and Saving Children\u2019s and Women\u2019s Lives-a New Approach, Available online: https:\/\/www.moph.gov.lb\/userfiles\/files\/HRS%20-%20final%20updated%20Oct%202016.pdf."},{"key":"ref_22","first-page":"62","article-title":"Major anomalies in consecutive births in south of Beirut. A preliminary report about incidence and pattern","volume":"43","author":"Bittar","year":"1995","journal-title":"J. Med. Liban."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/jum.15423","article-title":"Obstetric Ultrasound Screening in a Rural Area of Lebanon One Small Step with a Promising Major Impact","volume":"40","author":"Snaifer","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Abebe, S., Gebru, G., Amenu, D., Mekonnen, Z., and Dube, L. (2021). Risk factors associated with congenital anomalies among newborns in southwestern Ethiopia: A case-control study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0245915"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/uog.11204","article-title":"Fetal growth: A review of terms, concepts and issues relevant to obstetrics","volume":"41","author":"Mayer","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_27","first-page":"310","article-title":"Prevalence of Congenital Malformations among Babies Delivered at a Tertiary Care Hospital","volume":"58","author":"Shrestha","year":"2020","journal-title":"JNMA J. Nepal. Med. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.bpobgyn.2014.01.005","article-title":"The role of ultrasound in the diagnosis of fetal genetic syndromes","volume":"28","author":"Conner","year":"2014","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Appleton, A.A., Lin, B., Holdsworth, E.A., Feingold, B.J., and Schell, L.M. (2021). Prenatal Exposure to Favorable Social and Environmental Neighborhood Conditions Is Associated with Healthy Pregnancy and Infant Outcomes. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18116161"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Workalemahu, T., Grantz, K.L., Grewal, J., Zhang, C., Louis, G.M.B., and Tekola-Ayele, F. (2018). Genetic and Environmental Influences on Fetal Growth Vary during Sensitive Periods in Pregnancy. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-25706-z"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1161\/CIRCULATIONAHA.113.003904","article-title":"Chronic hypertension in pregnancy","volume":"129","author":"Seely","year":"2014","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1161\/HYPERTENSIONAHA.119.14111","article-title":"Conflicting Effects of Fetal Growth Restriction on Blood Pressure Between Human and Rat Offspring: A Meta-Analysis","volume":"75","author":"Kooiman","year":"2020","journal-title":"Hypertension"},{"key":"ref_33","first-page":"289","article-title":"Effect of high parity on occurrence of some fetal growth indices: A cohort study","volume":"4","author":"Brooks","year":"2012","journal-title":"Int. J. Womens Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1471-2458-13-S3-S2","article-title":"The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: A meta-analysis","volume":"13","author":"Kozuki","year":"2013","journal-title":"BMC Public Health"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ameen, S.K., Alalaf, S.K., and Shabila, N.P. (2018). Pattern of congenital anomalies at birth and their correlations with maternal characteristics in the maternity teaching hospital, Erbil city, Iraq. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-2141-2"},{"key":"ref_36","first-page":"e40178","article-title":"Risk Factors Associated with Intrauterine Growth Restriction: A Case-Control Study","volume":"15","author":"Dapkekar","year":"2023","journal-title":"Cureus"},{"key":"ref_37","first-page":"e47044","article-title":"Effects of Prenatal Stress on Behavior, Cognition, and Psychopathology: A Comprehensive Review","volume":"15","author":"Jagtap","year":"2023","journal-title":"Cureus"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kokorudz, C., Radford, B.N., Dean, W., and Hemberger, M. (2022). Advanced Maternal Age Differentially Affects Embryonic Tissues with the Most Severe Impact on the Developing Brain. Cells, 12.","DOI":"10.3390\/cells12010076"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sun, H., Su, X., Liu, Y., Li, G., Liu, X., and Du, Q. (2022). Association between Abortion History and Perinatal and Neonatal Outcomes of Singleton Pregnancies after Assisted Reproductive Technology. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010001"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejogrb.2020.03.016","article-title":"Recurrent miscarriage and fetal congenital malformations: Is there a neglected causal association?","volume":"248","author":"Visconti","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lean, S.C., Heazell, A.E.P., Dilworth, M.R., Mills, T.A., and Jones, R.L. (2017). Placental Dysfunction Underlies Increased Risk of Fetal Growth Restriction and Stillbirth in Advanced Maternal Age Women. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-09814-w"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S745","DOI":"10.1016\/j.ajog.2017.11.577","article-title":"Pathophysiology of placental-derived fetal growth restriction","volume":"218","author":"Burton","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/ppe.12099","article-title":"The association between parity and birthweight in a longitudinal consecutive pregnancy cohort","volume":"28","author":"Hinkle","year":"2014","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e2022349","DOI":"10.1001\/jamanetworkopen.2020.22349","article-title":"Association of Prenatal Maternal Anxiety With Fetal Regional Brain Connectivity","volume":"3","author":"Krishnamurthy","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.psyneuen.2009.07.010","article-title":"High pregnancy anxiety during mid-gestation is associated with decreased gray matter density in 6\u20139-year-old children","volume":"35","author":"Buss","year":"2010","journal-title":"Psychoneuroendocrinology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e229244","DOI":"10.1001\/jamanetworkopen.2022.9244","article-title":"Association of Elevated Maternal Psychological Distress, Altered Fetal Brain, and Offspring Cognitive and Social-Emotional Outcomes at 18 Months","volume":"5","author":"Wu","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Allison, S.J., Stafford, J., and Anumba, D.O. (2011). The effect of stress and anxiety-associated with maternal prenatal diagnosis on feto-maternal attachment. BMC Women\u2019s Health, 11.","DOI":"10.1186\/1472-6874-11-33"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Verma, R.P. (2021). Evaluation and Risk Assessment of Congenital Anomalies in Neonates. Children, 8.","DOI":"10.3390\/children8100862"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.4081\/pr.2013.e5","article-title":"Pattern of congenital anomalies in newborn: A hospital-based study","volume":"5","author":"Lebda","year":"2013","journal-title":"Pediatr. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1186\/s12884-025-07675-0","article-title":"Maternal and gestational factors associated with congenital anomalies among live births: A nationwide population-based study in Brazil from 2012 to 2020","volume":"25","author":"Fernandes","year":"2025","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Xia, L., Sun, L., Wang, X., Yao, M., Xu, F., Cheng, G., Wang, X., and Zhu, C. (2015). Changes in the incidence of congenital anomalies in Henan Province, China, from 1997 to 2011. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0131874"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"131","DOI":"10.4103\/2249-4847.119998","article-title":"Prevalence of congenital anomalies in neonates and associated risk factors in a tertiary care hospital in eastern India","volume":"2","author":"Sarkar","year":"2013","journal-title":"J. Clin. Neonatol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/1076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:28:44Z","timestamp":1760034524000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/1076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,15]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["children12081076"],"URL":"https:\/\/doi.org\/10.3390\/children12081076","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,15]]}}}