European Journal of Pediatrics最新文献

Point-of-care ultrasound (POCUS) is increasingly recognized as an essential skill in pediatric emergency medicine (PEM) globally. However, standardized POCUS training is lacking in France, and international curricula cannot be directly applied due to differences in training structures, scope of practice, and resource availability. This study aimed to develop a context-adapted, expert-informed POCUS curriculum for PEM residents in France. A three-round Delphi process was conducted between May and June 2025. Eligible experts were PEM physicians practicing POCUS routinely for at least 2 years. An online survey was created, including 77 items across five domains: ultrasound fundamentals, emergency POCUS, diagnostic POCUS, procedural POCUS, and teaching format. Each item was rated on a four-point Likert scale. Twenty-three of twenty-five experts completed all rounds. Consensus was achieved for 3/3 (100%) ultrasound fundamentals, 10/14 (71.5%) emergency skills, 8/41 (19.5%) diagnostic skills, 2/13 (15.4%) procedural skills, and 4/6 (66.6%) teaching format items. Overall, 20 core learning objectives were identified as essential for PEM residents.

Conclusion:  This national Delphi study provides the first context-adapted POCUS curriculum for pediatric emergency medicine in France. By identifying priority skills and preferred teaching modalities, it offers a structured approach to competency-based POCUS training that may be adapted to other countries facing similar challenges in pediatric emergency education.

What is known: • Point-of-care ultrasound (POCUS) is a core skill in pediatric emergency medicine. In France, however, training remains absent from the resident's curriculum. International programs cannot be directly implemented due to differences in training structures, scope of practice, and available resources.

What is new: • This national Delphi study establishes the first context-adapted POCUS curriculum for pediatric emergency medicine in France, identifying 20 core learning objectives and consensus-based teaching modalities to support structured, competency-based training.

Preterm infants are susceptible to metabolic disruptions due to physiologically immature development, and early metabolic dysregulation may contribute to neurodevelopmental impairments that persist throughout infancy and beyond. This study aims to investigate the associations between preterm birth, neonatal metabolism, and later neurodevelopment, and to explore the potential mediating role of neonatal metabolism. In this prospective birth cohort of 9023 in China, linear regression analyses were employed in discovery and validation sets to identify metabolites associated with preterm birth. Metabolites were then categorized as extremely high (> 90th percentile) or low (< 10th percentile), and their associations with preterm birth were assessed using meta-analysis and logistic regression. Among 2086 infants with neurodevelopmental assessments at 1 year old, we applied restricted cubic splines and linear regression to evaluate associations between extreme metabolite levels and neurodevelopment. Mediation analysis was then performed to assess the potential mediating effects of neonatal metabolism. Preterm birth was associated with extremely low levels of four metabolites and extremely high levels of seven metabolites (e.g., 17-hydroxyprogesterone, alanine, and multiple carnitines/acylcarnitines), indicating perturbed neonatal metabolic profiles. Moreover, extremely high levels of free carnitine (C0) were associated with poorer cognition (β = -0.47; 95% CI -0.75, -0.19) and receptive communication (β = -0.32; 95% CI -0.61, -0.03), with C0 accounting for 10.3% of the relative effect on cognition and 7.2% on receptive communication among preterm infants.

Conclusion:  Preterm infants exhibit metabolic perturbations linked to suboptimal neurodevelopment at 1 year of age, offering compelling evidence for the biological mechanism underlying preterm birth outcomes.

What is known: • Preterm birth is known to disrupt neonatal metabolism and to adversely affect neurodevelopment, but the underlying biological mechanisms remain controversial.

What is new: • Preterm infants are prone to extreme metabolic perturbations, which are associated with subsequent suboptimal neurodevelopmental outcomes. • Free carnitine acted as a potential biomarker of the effects of preterm birth on suboptimal cognition and receptive communication.

Acute mastoiditis (AM) is the most common intratemporal complication of acute otitis media in children. This multicenter study aimed to describe the epidemiological, clinical, microbiological, and radiological features of pediatric AM in four Italian regions and to identify factors associated with radiologic complications. This retrospective, observational cohort study included all patients under 18 years hospitalized with AM in the pediatric departments of Bari, Forlì, Macerata, and Pescara between January 2022 and May 2025. Demographic, clinical, microbiological, imaging, and management data were extracted from medical records using a standardized form and analyzed descriptively. Logistic regression explored associations between clinical variables and radiologic complications. A total of 118 hospitalizations (117 children; median age 4 years, IQR 2-7.8; 56% males) were analyzed. The estimated annual hospitalization rate was approximately 23 per 100 000 children. Otalgia (70%), postauricular swelling (57%), and erythema (56%) were common presenting features. Clinical complications occurred in 25 (21%) patients, and surgery was required in 13 (11%). Microbiological testing was positive in 38 (32%) episodes, most frequently identifying Streptococcus pyogenes or Pseudomonas aeruginosa. Imaging was performed in 70 (59%) episodes, revealing radiologic complications in 20 (17%; 28.5% of imaged). In multivariable analysis, auricular protrusion was independently associated with a lower likelihood of radiologic complications (p = 0.018), whereas no other clinical variable independently predicted radiologic complications.

Conclusion: AM remains a relevant cause of hospitalization in Italian children. Most patients respond well to medical therapy, whereas surgical intervention is required for complicated presentations. The significant protective role of auricular protrusion supports the selective use of imaging and suggests a conservative management approach in most cases.

What is known: • Acute mastoiditis (AM) is the most frequent intratemporal complication of acute otitis media in children. • Despite antibiotic and vaccine advances, AM remains a relevant cause of pediatric hospitalizations. • Most children respond to medical therapy, but some require surgical drainage.

What is new: • This multicenter study provides the first post-pandemic overview of pediatric AM across four Italian regions. • Radiologic complications occurred in 17% of cases; auricular protrusion independently predicted a lower risk of severe imaging findings. • The findings highlight a post-pandemic rebound of AM and support conservative, standardized management.

Congenital heart disease (CHD) is frequently associated with extracardiac abnormalities that can significantly affect prognosis and management. Although abdominal ultrasound is a readily available and noninvasive tool, detailed observational studies on comprehensive screening for neonates with CHD remain lacking. We aimed to evaluate the prevalence of significant abdominal abnormalities detected during early comprehensive ultrasound screening in neonates with CHD. This single-center, retrospective case series included neonates admitted to a tertiary neonatal intensive care unit (NICU) between April 2021 and May 2024 who underwent screening within 14 days of birth. We compared the proportion of neonates with significant abnormalities and the number of abnormalities per patient between those with and without chromosomal abnormalities or malformation syndromes. Among 59 neonates, significant abnormalities were identified in 29 (49.2%). The most common were hydronephrosis (13.6%), hepatomegaly (10.2%), and intestinal malrotation (8.5%). The proportion of significant abnormalities did not differ significantly between the groups with and without chromosomal abnormalities or malformation syndromes (66.7% vs. 39.5%, P = 0.06). However, the number of abnormalities per patient was significantly higher in the former group (1.38 vs. 0.61, P = 0.03).

Conclusion: Early comprehensive abdominal ultrasound screening in hospitalized neonates with CHD revealed significant abnormalities in 49.2% of cases. This screening may improve systemic management of patients with CHD, including perioperative care, and facilitate individualized treatment of CHD‒with or without chromosomal or malformation syndromes‒by enhancing phenotype characterization.

What is known: ・Congenital heart disease (CHD) is frequently associated with extracardiac abnormalities that can affect prognosis and management. ・Detailed observational studies on comprehensive abdominal ultrasound screening for neonates with CHD remain lacking.

What is new: ・Early comprehensive abdominal ultrasound screening in hospitalized neonates with CHD revealed significant abnormalities in 49.2%. ・While abnormalities were more frequent in neonates with chromosomal or malformation syndromes, 39.5% of non-syndromic neonates had significant abnormalities; the screening improves systemic management and individualized treatment.

Emerging studies suggest increased febrile seizures during the Omicron period of SARS-CoV-2. This study compares the incidence of seizures before and during the Omicron variant period to determine if certain variants increase risk. Using PRISMA-P protocol, four databases (PubMed, Embase, Scopus, Web of Science) were searched. Cohort studies reporting febrile seizures in children (up to 18 years of age) with confirmed SARS-CoV-2 infection were included. We provide descriptive summaries of the incidence of febrile seizures across hospital, emergency, and community settings, as well as a meta-analysis between Omicron-predominant and pre-Omicron periods. We included 36 studies comprising 82,591 children with SARS-CoV-2 infection, of whom 2051 experienced febrile seizures. In 29 studies of hospitalized children with SARS-CoV-2, the incidence of febrile seizures varied widely, with a median of 7 per 100 (range 1.06-25.54) children. High heterogeneity was observed, and studies from emergency and community settings were underpowered. Seven studies found that unvaccinated children hospitalized with SARS-CoV-2 had more febrile seizures during the Omicron-predominant (median 11.8 per 100) than during the pre-Omicron period (median 0.7 per 100). The pooled incidence was 11.27 per 100 cases for the Omicron-predominant and 0.66 per 100 for the pre-Omicron period (p < 0.0001).

Conclusion: There was a trend toward more reported febrile seizures among hospitalized children with SARS-CoV-2 during the Omicron-predominant than the pre-Omicron period. However, estimates are limited by small samples and moderate heterogeneity and should not be considered population-based incidences. We hypothesize that SARS-CoV-2 variants may influence febrile seizure risk in children; larger studies are needed to better understand this association. PROSPERO registration: CRD420251054193.

What is known: • Neurological complications, including febrile seizures, occur in children with SARS-CoV-2 infection. • Prior to the Omicron variant, febrile seizures were relatively uncommon in pediatric COVID-19 cases.

What is new: • There was a trend toward more reported febrile seizures among hospitalized children with SARS-CoV-2 during the Omicron-predominant period compared to the pre-Omicron period. • There are potential associations between SARS-CoV-2 variants and febrile seizure risks.

This study evaluates neonatal outcomes following previable preterm premature rupture of membranes (previable PPROM) before 24 weeks' gestation, and identifies factors associated with death or severe comorbidities. A retrospective analysis of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 24 weeks gestation was conducted at the University Hospital of Lille from 2014 to 2019. Maternal and neonatal data until hospital discharge were collected. Among 130 fetuses, 67% were live-born. The rate of medical termination of pregnancy was 8%. Seventy-five percent of those live-born were preterm. About one-third of neonates were admitted to the maternity ward without respiratory failure; 61% of neonates required neonatal intensive care unit admission due to prematurity and/or immediate respiratory failure. Of the live-born infants, 90% were discharged from hospital, 74% with no severe comorbidities. Multivariate analysis identified preterm delivery (relative risk [RR] 3.51, 95% confidence interval [CI]: 1.82-6.76) and short latency from PPROM to delivery (RR 8.47, 95% CI: 1.07-66.67) as risk factors for death or severe comorbidities.

Conclusion:  Parental counseling should consider both current, evolving outcomes, and the unpredictable course of pregnancies complicated by previable PPROM. Prolonging pregnancy through close monitoring and implementation of current guidelines on neonatal management are essential to reduce adverse outcomes.

What is known: • Preterm Premature Rupture of Membranes (PPROM) before 24 weeks' gestation is associated with high rates of neonatal mortality and severe morbidity. • Existing evidence is largely derived from small, heterogeneous cohorts, with substantial variability in obstetric and neonatal management strategies.

What is new: • This large single-center study demonstrates improved neonatal outcomes following previable PPROM, likely reflecting in perinatal practices, compared to the historical cohort. • Short latency between previable PPROM and delivery, as well as lower gestational age at birth, were identified as independent risk factors for death or severe morbidity. • The study provides updated, real-world data to guide parental counseling and clinical decision-making regarding previable PPROM.

This study aimed to compare neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) between asthmatic and healthy children and to investigate the predictive role of PLR and NLR for asthma exacerbation. Web of Science, PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and Medline were systematically searched up to August 2025. The search strategy was described by a combination of relevant medical subheadings (MeSH) and keywords. Eligible English language studies were reviewed, and their quality was appraised. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 13 studies, including 15,250 individuals, met the inclusion criteria. Asthmatic children had significantly higher NLR (SMD 0.852) and PLR (SMD 0.412) than the control group (P-value < 0.05). Exacerbated children had higher NLR (MD 2.5, P-value < 0.05) and PLR (MD 33.62, P-value > 0.05) at presentation compared to after 3 months follow-up. NLR with a cut-off of 1.738 (accuracy of 88%) and PLR with a cut-off of 128.15 (accuracy of 69.8%) can predict exacerbation in asthmatic pediatrics. Also, NLR with a cut-off of 1.335 (accuracy of 76.5%) can distinguish asthmatic from healthy children.

Conclusion: This systematic review discovered that PLR and NLR are increased in asthmatic children, and any changes in clinical situation such as superinfection and exacerbation can change their level. Moreover, NLR and PLR can predict exacerbation, and NLR can even distinguish asthmatic from healthy children.

What is known: • Asthma is diagnosed by classic methods such as spirometry, which cannot be used in younger children and cannot predict exacerbation. • A vital role in the inflammatory orchestra of asthma is played by activation of mast cells, which is mediated by a variety of markers, including neutrophils, platelets, lymphocytes, and macrophages.

What is new: • Mean PLR and NLR are increased in asthmatic children, and any changes in clinical situation such as superinfection and exacerbation can change their level. • NLR and PLR can predict exacerbation, and NLR can even distinguish asthmatic from healthy children.

Bone age assessment in children aged < 3 years is difficult owing to the limited visibility of carpal ossification centres. We aimed to evaluate skeletal maturation patterns in relation to chronological age using humeral ossification on chest radiographs. We retrospectively reviewed the chest radiographs of 187 children aged 0- < 3 years. Three readers independently measured the longitudinal diameter of the humeral head epiphyseal ossification centre. Interobserver agreement was assessed with the intraclass correlation coefficient (ICC). Pearson's correlation and linear regression analyses were performed. Reference ranges (± 1 standard deviation [SD] and ± 2 SD) were established for six 6-month age groups. A strong positive correlation was observed between ossification centre diameter and age (r > 0.88 for all observers). The ICC was 0.96 (p < 0.001), indicating excellent interobserver agreement. Moreover, ± 2 SD reference ranges enabled the identification of deviations in skeletal maturation. A comparison by arm position (raised vs. lowered) revealed no significant difference (p = 0.454), supporting the robustness of the measurement. Additionally, simplified estimation formulas were proposed for practical clinical reference: the longitudinal diameter of the humeral head epiphyseal ossification centre (mm) = 0.5 × age in months + 4 for males and = 0.6 × age in months + 3 for females.

Conclusion: This study presents a simple, reproducible method using routine chest radiographs as a supplementary tool to assess skeletal maturation and to approximate chronological age in children aged < 3 years.

What is known: • Assessment of skeletal maturity and bone age in children aged < 3 years is difficult owing to immature carpal ossification. • Traditional hand-based methods are often unreliable and require extra imaging.

What is new: • A strong linear association between the longitudinal diameter of the humeral head ossification centre and chronological age was demonstrated in children aged < 3 years. • Sex-specific simplified estimation formulas and ± 2 SD reference ranges were established, allowing rapid assessment of skeletal maturation without additional imaging.