{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:58:17Z","timestamp":1790402297188,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union, Next Generation EU\u2013PNRR M6C2\u2013Investment 2.1 Valorization and enhancement of biomedical research in national health system","award":["PNRR-POC-2022-12375777"],"award-info":[{"award-number":["PNRR-POC-2022-12375777"]}]},{"name":"European Union, Next Generation EU\u2013PNRR M6C2\u2013Investment 2.1 Valorization and enhancement of biomedical research in national health system","award":["CUP C53C22001210007"],"award-info":[{"award-number":["CUP C53C22001210007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Aims: To describe lung ultrasound (LUS) features of Mycoplasma pneumoniae pneumonia and their distribution in pediatric age, and to correlate imaging findings with clinical and laboratory data. Methods: This is a multicenter, prospective, pilot study that involved three hospitals. In total, 35 patients aged 1 month to 17 years, admitted with a diagnosis of Mycoplasma pneumoniae infection, were enrolled. History, clinical, microbiological, and ultrasound data were collected. The LUS examination was performed at admission, recording the following features: presence of subpleural consolidation, bronchograms, B lines, or pleural effusion, and their characteristics. The scans were performed using a standardized approach, in which a composite score was obtained by summing the scores of the different parameters. Results: Consolidations were seen in 97% of children (mostly located in basal, posterior, and lateral fields), and 65% of patients had multiple ones. Non-perilesional B lines were found in 43% of cases, principally in the posterior and basal fields. Pleural effusion was found in 37% of children. The univariate logistic regression showed a correlation between the age of the patient and large-sized consolidations. Moreover, increased lymphocyte count was associated with a lower risk of large-sized consolidations. Conclusions: LUS is a low-cost, non-invasive tool that can reveal findings suggestive of Mycoplasma pneumoniae infection and help physicians better manage children with lower respiratory tract infections, supporting a more personalized diagnostic and therapeutic approach, including antibiotic selection. These preliminary findings also indicate that a larger, comparative study involving other bacterial and viral etiologic agents is warranted to confirm whether LUS patterns are pathogen-specific and whether they can predict clinical outcomes.<\/jats:p>","DOI":"10.3390\/children12121669","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T14:52:24Z","timestamp":1765205544000},"page":"1669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Lung Ultrasound Findings in Pediatric Mycoplasma Pneumoniae Pneumonia: A Prospective Multicenter Pilot Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Mariantonietta","family":"Francavilla","sequence":"first","affiliation":[{"name":"Department of Radiology, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3504-050X","authenticated-orcid":false,"given":"Azzurra","family":"Orlandi","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1160-1456","authenticated-orcid":false,"given":"Anna","family":"Camporesi","sequence":"additional","affiliation":[{"name":"Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children\u2019s Hospital, 20154 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Scarlato","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Rossini","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonello","family":"Sacco","sequence":"additional","affiliation":[{"name":"Department of Radiology, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-1679","authenticated-orcid":false,"given":"Claudio","family":"Cafagno","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste Lidia","family":"Raguseo","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Santoiemma","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Musolino","sequence":"additional","affiliation":[{"name":"Hospital University Pediatrics Clinical Area, Bambin Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2507-8886","authenticated-orcid":false,"given":"Maria Chiara","family":"Supino","sequence":"additional","affiliation":[{"name":"Hospital University Pediatrics Clinical Area, Bambin Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Clemente","sequence":"additional","affiliation":[{"name":"Hospital University Pediatrics Clinical Area, Bambin Ges\u00f9 Children\u2019s Hospital IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Tagliaferri","sequence":"additional","affiliation":[{"name":"UOC Radioterapia Oncologica, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Morello","sequence":"additional","affiliation":[{"name":"Area Pediatrica, Dipartimento di Scienze Della Vita e Sanit\u00e0 Pubblica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giandomenico","family":"Stellacci","sequence":"additional","affiliation":[{"name":"Department of Radiology, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5716-3703","authenticated-orcid":false,"given":"D\u00e9sir\u00e9e","family":"Caselli","sequence":"additional","affiliation":[{"name":"Pediatric Infectious Diseases Unit, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8567-2639","authenticated-orcid":false,"given":"Danilo","family":"Buonsenso","sequence":"additional","affiliation":[{"name":"Area Pediatrica, Dipartimento di Scienze Della Vita e Sanit\u00e0 Pubblica, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1056\/NEJMoa1405870","article-title":"Community-Acquired Pneumonia Requiring Hospitalization among U.S. Children","volume":"372","author":"Jain","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/cid\/ciy419","article-title":"Mycoplasma pneumoniae among children hospitalized with community-acquired pneumonia","volume":"68","author":"Kutty","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1097\/INF.0000000000002171","article-title":"The Art and Science of Diagnosing Mycoplasma pneumoniae Infection","volume":"37","author":"Unger","year":"2018","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_4","unstructured":"(2025, July 04). Mycoplasma Pneumoniae Infections Have Been Increasing. NCIRD|CDC, Available online: https:\/\/www.cdc.gov\/ncird\/whats-new\/mycoplasma-pneumoniae-infections-have-been-increasing.html."},{"key":"ref_5","unstructured":"(2025, July 04). Mycoplasma pneumoniae surveillance in England and Wales, January 2019 to March 2024\u2014GOV.UK, Available online: https:\/\/www.gov.uk\/government\/publications\/mycoplasma-pneumoniae-surveillance-january-2019-to-march-2024\/mycoplasma-pneumoniae-surveillance-in-england-and-wales-january-2019-to-march-2024."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Dungu, K.H.S., Dungu, D., Jarl\u00f8v, M.P., Kristensen, K., Leth, S., Pallesen, S.V., M\u00f8lbak, K., H\u00f8st, B.R., Sch\u00f8nheyder, H.C., and Just, K.D. (2024). Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: A nationwide multicentre population-based cohort study. Lancet Reg. Health Eur., 47.","DOI":"10.1016\/j.lanepe.2024.101103"},{"key":"ref_7","unstructured":"(2025, November 05). Communicable Disease Threats Report, 26 November\u20132 December 2023, Week 48. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/communicable-disease-threats-report-26-november-2-december-2023-week-48."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Meli, M., Bellini, M., Ferraro, G., Gatto, F., Perri, T., Tufano, S., Scarlata, S., Terranova, M., Nardelli, P., and Boccuzzi, E. (2023). The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13091612"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Li, S., Zhang, Q.L., Guo, R.J., Lv, X.Z., and Yang, X. (2021). Quantitative evaluation and significance of ultrasound in bronchoalveolar lavage for lung consolidation in children with severe mycoplasma pneumonia. Transl. Pediatr., 10.","DOI":"10.21037\/tp-21-381"},{"key":"ref_10","first-page":"1301","article-title":"Ultrasound studies on Mycoplasma bronchopneumonia","volume":"5","author":"Clelia","year":"2022","journal-title":"J. Curr. Med. Res. Opin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s40477-021-00600-z","article-title":"Role of lung ultrasound for the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children: A prospective study","volume":"25","author":"Buonsenso","year":"2022","journal-title":"J. Ultrasound"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6343","DOI":"10.2147\/IDR.S387890","article-title":"A Lung Ultrasound-Based Nomogram for the Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Hospitalized Children","volume":"15","author":"Liu","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00134-012-2513-4","article-title":"International evidence-based recommendations for point-of-care lung ultrasound","volume":"38","author":"Volpicelli","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Sun, Y.H., Lin, H.F., Zhu, Z.T., Huang, J., Li, S.Q., Wang, F., Li, T.Y., Wu, Y.H., Wang, Z.R., and Lu, Z.H. (2022). A modified lung ultrasound score to evaluate short-term clinical outcomes of bronchopulmonary dysplasia. BMC Pulm. Med., 22.","DOI":"10.1186\/s12890-022-01885-4"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mongodi, S., Chiumello, D., and Mojoli, F. (2024). Lung ultrasound score for the assessment of lung aeration in ARDS patients: Comparison of two approaches. Ultrasound Int. Open, 10.","DOI":"10.1055\/a-2421-8709"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1002\/jum.15285","article-title":"Proposal for International Standardization of the Use of Lung Ultrasound for Patients With COVID-19","volume":"39","author":"Soldati","year":"2020","journal-title":"J. Ultrasound Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2011-200598","article-title":"British Thoracic Society guidelines for the management of community acquired pneumonia in children: Update 2011","volume":"66","author":"Harris","year":"2011","journal-title":"Thorax"},{"key":"ref_18","first-page":"324","article-title":"Mycoplasma pneumoniae pneumonia. Can radiologic features suggest the etiologic agent?","volume":"86","author":"Severino","year":"1993","journal-title":"Radiol. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Xiao, S., Zeng, S., and Kou, Y. (2025). Clinical value and radiographic features of low dose CT scans compared to X rays in diagnosing mycoplasma pneumonia in children. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-94006-0"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/ppul.25760","article-title":"Pediatric pneumonia (PedPne) lung ultrasound score and inflammatory markers: A pilot study","volume":"57","author":"Ciuca","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Morello, R., Gatto, A., Zattera, D., Longobardi, C., D\u2019Acunzo, R., Del Vecchio, C., Buonsenso, D., Tufano, S., and Valentini, P. (2025). Point-of-care lung ultrasound to differentiate bacterial and viral lower respiratory tract infections in pediatric age: A multicenter prospective observational study. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-19040-4"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Stoicescu, E.R., Gafencu, M., Lupu, R., Luca, C.M., Popescu, M.R., Miron, S.D., and S\u00eerbu, E.A. (2024). Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound\u2014A Prospective Observational Study. Diagnostics, 14.","DOI":"10.3390\/diagnostics14050480"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Xie, W., Ruan, J., Jiang, Q., Zheng, J., Lin, W., and Lyu, G. (2024). Distinguishing types and severity of pediatric pneumonia using modified lung ultrasound score. Front. Pediatr., 12.","DOI":"10.3389\/fped.2024.1411365"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Berce, V., Tomazin, M., Gorenjak, M., Berce, T., and Lovren\u010di\u010d, B. (2019). The Usefulness of Lung Ultrasound for the Aetiological Diagnosis of Community-Acquired Pneumonia in Children. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-54499-y"},{"key":"ref_25","first-page":"2175","article-title":"The value of lung ultrasound in assessing the degree of lesions in children with mycoplasma pneumoniae pneumonia","volume":"15","author":"Guo","year":"2023","journal-title":"Am. J. Transl. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4445","DOI":"10.21037\/qims-24-2167","article-title":"Lung ultrasound for the diagnosis of pulmonary consolidation in children with community-acquired pneumonia","volume":"15","author":"Jia","year":"2025","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Omran, A., Awad, H., Ibrahim, M., El-Sharkawy, S., Elfiky, S., and Rezk, A.R. (2022). Lung Ultrasound and Neutrophil Lymphocyte Ratio in Early Diagnosis and Differentiation between Viral and Bacterial Pneumonia in Young Children. Children, 9.","DOI":"10.3390\/children9101457"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wu, J., Xu, Y., Zhang, R., Li, T., and Ye, D. (2021). The value of lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio in differentiating pneumonia from upper respiratory tract infection (URTI) in children: A cross-sectional study. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-03018-y"},{"key":"ref_29","first-page":"1324","article-title":"Neutrophil\/lymphocyte and C-reactive protein\/mean platelet volume ratios in differentiating between viral and bacterial pneumonias and diagnosing early complications in children","volume":"35","author":"Bekdas","year":"2014","journal-title":"Saudi Med. J."},{"key":"ref_30","first-page":"10","article-title":"Usefulness of early lung ultrasound in acute mild\u2013moderate acute bronchiolitis: A pilot study","volume":"90","year":"2019","journal-title":"An. Pediatr. (Engl. Ed.)"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s00431-019-03335-6","article-title":"Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: A prospective study","volume":"178","author":"Supino","year":"2019","journal-title":"Eur. J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1007\/s00431-011-1461-2","article-title":"Lung ultrasound in bronchiolitis: Comparison with chest X-ray","volume":"170","author":"Caiulo","year":"2011","journal-title":"Eur. J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Basile, V., Di Mauro, A., Scalini, E., Lof\u00f9, I., Pulimeno, L., Ferro, V., Laforgia, N., and Manzoni, P. (2015). Lung ultrasound: A useful tool in diagnosis and management of bronchiolitis. BMC Pediatr., 15.","DOI":"10.1186\/s12887-015-0380-1"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Biagi, C., Ciapponi, P., Dondi, V., D\u2019Andrea, M., Meli, M., Nardelli, P., Nanni, A., Pession, A., and Corsini, I. (2018). Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-018-0750-1"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1016\/j.ultrasmedbio.2020.04.026","article-title":"Lung Ultrasound in Children with COVID-19: Preliminary Findings","volume":"46","author":"Musolino","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Buonsenso, D., Musolino, A.M., Gatto, A., Lazzareschi, I., Curatola, A., and Valentini, P. (2019). Lung ultrasound in infants with bronchiolitis. BMC Pulm. Med., 19.","DOI":"10.1186\/s12890-019-0925-4"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3105","DOI":"10.21608\/ejhm.2022.246903","article-title":"Assessment of Pneumonia in Children with Acute Bronchiolitis Using Lung Ultrasound","volume":"88","author":"Lemine","year":"2022","journal-title":"Egypt. J. Hosp. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Berce, V., Tomazin, M., and Koren, B. (2016). Ultrasound characteristics of community acquired pneumonia in children. Eur. Respir. J., 48.","DOI":"10.1183\/13993003.congress-2016.PA3792"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1080\/17476348.2022.2027757","article-title":"Human neonatal and infant airway epithelial biology: The new frontier for developmental immunology","volume":"16","author":"Nino","year":"2022","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_40","first-page":"2185","article-title":"Peripheral immune cell markers in children with recurrent respiratory infections in the absence of primary immunodeficiency","volume":"18","author":"Munteanu","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.iac.2019.03.005","article-title":"Infant Immune Response to Respiratory Viral Infections","volume":"39","author":"Heinonen","year":"2019","journal-title":"Immunol. Allergy Clin. N. Am."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1669\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T15:19:19Z","timestamp":1765207159000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["children12121669"],"URL":"https:\/\/doi.org\/10.3390\/children12121669","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}