European Journal of Pediatrics最新文献

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.

Extracorporeal membrane oxygenation (ECMO) has been used since 1975 to provide temporary cardiorespiratory support in neonates, children, and adults with severe cardiopulmonary conditions unresponsive to conventional therapy. Initially focused on neonatal respiratory failure, ECMO indications have expanded to include older children with cardiac failure or post-cardiopulmonary arrest. Epidemiological data indicate a decline in neonatal respiratory ECMO cases over the recent decades, largely due to advances in conventional therapies. Conversely, neonatal cardiac ECMO has shown a more variable trend, often used perioperatively in congenital heart disease or for myocarditis, cardiomyopathy, and refractory arrhythmias. Survival rates remain relatively stable, although outcomes vary with underlying pathology and disease severity. Long-term follow-up of survivors reveals persistent respiratory, neurodevelopmental, and motor sequelae, particularly in patients with complex or chronic conditions such as congenital diaphragmatic hernia or hypoxic-ischemic encephalopathy. Pulmonary function deficits, cognitive impairments, hearing loss, and motor delays are frequently reported, with earlier rehabilitation and structured follow-up programs shown to improve functional recovery. Multicenter registries highlight the need for standardized assessment protocols to track long-term outcomes and guide interventions.

Conclusion: While neonatal ECMO has become a life-saving intervention for increasingly complex cases, ongoing efforts to refine patient selection, improve management strategies, and implement structured long-term follow-up are essential to minimize morbidity and maximize functional recovery in this vulnerable population.

What is known: • Neonatal ECMO provides life-saving support for infants with severe cardiopulmonary failure when conventional therapies fail. • Survival rates vary depending on the underlying diagnosis, with respiratory ECMO generally showing higher survival than cardiac or extracorporeal cardiopulmonary resuscitation cases.

What is new: • The neonatal ECMO population has become more complex, with higher-risk patients and more prolonged support requirements. • Long-term follow-up reveals that many ECMO survivors continue to face respiratory, neurological, or developmental sequelae.

Few studies have analyzed preschoolers' screen exposure patterns, especially combined screen time and content, and the associations with neurodevelopment. This study aims to identify the screen exposure patterns in preschoolers by intelligent technology and to examine their associations with their neurodevelopment. This cross-sectional study enrolled preschool children from two kindergartens in Shanghai. Data were collected from March 2023 to July 2023. Screen time and content types were monitored over 7 consecutive days using an intelligent monitoring technology validated by the 24-h diary method (κ = 0.61). Neurodevelopmental outcomes were assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3); developmental abnormality was defined as a score < 1 SD from the mean in each domain. K-means clustering analysis identified screen exposure patterns, and binary logistic regression was applied to examine associations between screen exposure patterns and neurodevelopmental outcomes. Of 355 preschool children included, 204 were males (57.5%) and 251 (70.7%) were aged between 34.5 months and 50.5 months. K-means cluster analysis yielded 4 screen exposure patterns: restrictive use, moderately educational, noneducational, and educational-dominant pattern. Binary logistic regression showed the moderately educational pattern was associated with gross motor abnormalities (OR = 2.530, 95% CI: 1.089-5.875, P = 0.031), and non-educational pattern with fine motor abnormalities (OR = 3.172, 95% CI: 1.122-8.968, P = 0.029).

Conclusion: This monitoring study identified heterogeneous screen exposure patterns in preschool-aged children, revealing that excessive use of moderately educational content and noneducational content was associated with lower gross motor and fine motor skills. When limiting total screen time, parents should focus on content selection for preschool-aged children. Future research should focus on the objective measurement of different types of screen content and utilize the intelligent monitoring system to conduct cohort studies, aiming to explore the causal associations between screen exposure content and children's development.

What is known: • Few studies have analyzed preschoolers' screen exposure patterns (especially combined time and content) or the associations with neurodevelopment, with scarce research using objective measures of both.

What is new: • Using validated intelligent monitoring, we identified heterogeneous patterns and found excessive moderately educational/noneducational content linked to lower motor skills.

Epilepsy is a common neurological disorder in childhood, and levetiracetam, a newer anti-seizure medication (ASM), is widely used due to its efficacy and safety. Recent attention has focused on the effects of anti-seizure medication (ASM) on thyroid function. This study aimed to evaluate changes in thyroid function and thyroid volume in children receiving levetiracetam monotherapy. It is the first study to assess both thyroid function tests and ultrasonographic thyroid volume in this context. In this single-center, prospective study, 40 children aged 3 months to 18 years with epilepsy who began levetiracetam monotherapy at Dr. Behçet Uz Children's Hospital between January and June 2024 were included. Thyroid function tests (fT3, fT4, TSH, Anti-TPO, Anti-Tg) and thyroid volume (via ultrasound) were measured before treatment and at the 6th month, and analyzed using age-adjusted standard deviation scores (SDS). No statistically significant differences were found between baseline and 6th-month values for fT3 (p = 0.678), fT4 (p = 0.604), TSH (p = 0.210), Anti-TPO (p = 0.923), or Anti-Tg (p = 0.843). Thyroid volume showed no significant change (p = 0.159), but thyroid volume SDS decreased significantly (p = 0.018).

Conclusion: Levetiracetam monotherapy over six months did not significantly affect thyroid hormone levels, autoantibodies, or absolute thyroid volume, although a decrease in thyroid volume SDS was noted. This may be due to measurement variability. Overall, short-term levetiracetam use appears safe in terms of thyroid function.

What is known: • Levetiracetam is widely used in pediatric epilepsy and is considered to have a favorable safety profile with respect to endocrine function. • Previous studies suggest that levetiracetam has minimal effects on thyroid function in children, although the available data are limited.

What is new: • This prospective study evaluates both thyroid function tests and ultrasonographic thyroid volume in children receiving levetiracetam monotherapy. • Over a six-month follow-up period, thyroid hormone levels and autoantibody profiles remained stable, with no clinically relevant change in absolute thyroid volume, although a mild decrease in thyroid volume standard deviation score was observed.

Idiopathic ventricular arrhythmias (VAs) in children are often benign, with a known potential for spontaneous resolution. However, the ability to predict which patients will experience resolution remains challenging, leading to uncertainties in management, including the timing of intervention. This study aimed to identify independent clinical predictors of spontaneous VA resolution in children and to develop a practical scoring system for risk stratification. We conducted a retrospective single-center cohort study of 392 children (median age 13.0 [IQR 9.0-15.0] years; 56.6% male) with idiopathic VAs, confirmed after comprehensive exclusion of structural heart disease and channelopathies. Spontaneous resolution was defined as the complete absence of the baseline VA morphology on follow-up ECG and Holter monitoring. Clinical and electrocardiographic parameters were compared between patients with and without resolution. Multivariable Cox regression analysis was used to identify independent predictors, which were then incorporated into a probability-based scoring system. Over a median follow-up of 32.5 [18.0-58.5] months, spontaneous resolution occurred in 97 patients (24.7%). Multivariable analysis identified four independent predictors of resolution: age < 12 years (adjusted HR 1.88; 95% CI: 1.19-2.96; p = 0.007), isolated premature ventricular complexes (PVCs) without ventricular tachycardia (adjusted HR 3.14; 95% CI: 1.81-5.43; p < 0.001), right-sided origin of ectopy (adjusted HR 1.96; 95% CI: 1.10-3.49; p = 0.023), and a 24-h PVC burden < 20% (adjusted HR 1.76; 95% CI: 1.15-2.70; p = 0.010). A scoring system (range 0-4.5 points) based on these factors demonstrated good discriminatory ability (AUC 0.81; 95% CI: 0.76-0.86; p < 0.001) and effectively stratified patients into high-, intermediate-, and low-probability groups for spontaneous resolution.

Conclusion: We identified key predictors of spontaneous resolution of idiopathic VAs in children. The proposed scoring system provides a practical tool for clinical decision-making, potentially helping to identify children who are most likely to benefit from conservative management and avoid unnecessary invasive procedures.

What is known: •Long-term follow-up demonstrates a substantial reduction or complete disappearance of idiopathic ectopy in children. •Complete resolution of ventricular arrhythmias was observed in in almost half of the cases.

What is new: •Multivariable analysis identified four independent predictors of resolution of ventricular arrhythmias: -age < 12 years at the time of the onset of ventricular arrhythmia -isolated premature ventricular complexes (PVCs) without ventricular tachycardia -right-sided origin of ectopy -24-h PVC burden < 20.

Medical care might be highly resource-intensive, with a significant contribution to greenhouse gas emissions and waste generation. This narrative review aims to provide a synopsis of the current evidence and strategies to promote a "green" pediatric gastroenterology practice. We conducted a narrative review of current literature, international guidelines, and policy recommendations from global health and gastroenterology organizations. Evidence on sustainable strategies, including hygiene, nutrition, vaccination, diagnostic methods, therapies, telemedicine, and digital health, was synthesized to provide an overview of "green" pediatric gastroenterology. Preventive measures such as breastfeeding, sustainable diets, and vaccination decrease gastrointestinal disease burden and environmental impact. Diagnostic sustainability involves avoiding unnecessary tests, using non-invasive biomarkers, and adopting green endoscopy principles. Treatment innovations, dietary approaches, home-based care, and environmentally conscious drug production should promote eco-friendly management. During follow-up, telemedicine, electronic health records, and non-invasive monitoring minimize waste and emissions.

Conclusion:  Preventive strategies, diagnostic tools, treatment options, and follow-up methods will facilitate and promote a more sustainable pediatric gastroenterology. A "green" approach simultaneously advances planetary and child health, aligning with the pediatric mission to safeguard long-term well-being for future generations.

What is known: • Hospitals contribute substantially to healthcare's environmental footprint through energy use, waste, and high-impact procedures. • Evidence-based measures already reduce impact without compromising care: prevention (vaccination, breastfeeding, hygiene), rational diagnostics, and telemedicine can lower emissions and waste.

What is new: • This review integrates sustainability across prevention, diagnosis, treatment, and follow-up, highlighting practical actions such as endoscopy optimization, selective biopsy, eco-friendlier imaging, and medication stewardship • Diet-forward strategies, recyclable packaging innovations, and structured telemedicine/remote monitoring could reduce emissions while maintaining clinical effectiveness.

The variety of genes associated with Noonan syndrome spectrum disorders (NSSD) is expanding, and real-life experience with its management is increasing; however, phenotypic differences among genotypes remain poorly defined. We aimed to assess clinical characteristics and response to growth hormone (GH) therapy in a genetically confirmed, single-country multicentre NSSD cohort. We included 101 patients with NSSD (56 males) from six centres: 76 with (likely) pathogenic PTPN11 variants, 7 with SOS1 variants, and 18 with other gene variations. All completed at least one year of GH therapy; 23 reached final height. Parental heights were below average (fathers: - 0.33 SDS [- 1.19; 0.39], p < 0.01; mothers: - 0.68 SDS [- 1.47; 0.12], p < 0.001; medians [IQR]). SOS1-NS patients were born earlier (gestational week 36 [31; 37]) compared to PTPN11-NS. Birth length (- 1.23 SDS [- 1.74; - 0.57]) was more reduced than weight (- 0.29 SDS [- 1.10; 0.54]; p < 0.0001); PTPN11-NS/SOS1-NS had the lowest birth weights (p < 0.05). GH was started at 6.4 years (3.8; 9.5), with baseline height-SDS - 2.92 (- 3.64; - 2.47). Median annual height-SDS increments were similar across genotypes: 0.61 (year 1; n = 101), 0.28 (year 2; n = 92), 0.21 (year 3; n = 77), 0.07 (year 4; n = 63), and 0.09 (year 5; n = 41), leading to height-SDS - 1.97 (- 2.81; - 1.42) after 5 years. Menarche occurred at age 15.7 (13.8; 17.2) years (n = 13), and final height-SDS (available in 23 patients) reached - 1.68 (- 2.65; - 0.41). Conclusions Growth restriction in NSSD begins prenatally, especially in PTPN11-NS and SOS1-NS. GH therapy was associated with improved height SDS, with the largest height gains observed before puberty. Earlier treatment initiation may therefore be beneficial for growth outcomes. What is Known: • Noonan syndrome spectrum disorders (NSSD) are genetically heterogeneous, with pathogenic variants in the PTPN11 and SOS1 genes being most prevalent. Phenotypic differences among genotypes remain poorly defined. • Short stature is a key NSSD feature. Growth hormone (GH) therapy is beneficial, but prior studies lacked genetic justification or had limited sample sizes. What is New: • We analysed perinatal data and real-life GH outcomes in 101 genetically confirmed NSSD cases. • SOS1-NS was linked to prematurity. Birth length was more reduced than weight across genotypes; PTPN11/SOS1 cases had the lowest birth weights. GH therapy was associated with an increase in height SDS from - 2.92 to - 1.97 (median) following 5 years, and to - 1.68 in those with final height.

There is a growing interest for bioelectrical impedance analysis (BIA)-derived raw variables such as phase angle (PhA) and impedance-Z ratio, since they are considered proxy indicators of body cell mass and muscle structure. So far, limited information is available on the trajectories of PhA and IR during the first two decades of life. Anthropometry was measured with standardized procedures. For the whole body, PhA was measured at 50 kHz, while IR was calculated as the ratio of Z at 250 kHz/Z to that 5 kHz. Fat-free mass (FFM) and percentage body fat (%BF) were estimated by BIA. Segmented linear regression was applied to assess whether the relationships between PhA or IR and age showed discontinuities with time. Healthy children and adolescents were enrolled (302 boys and 278 girls aged 6-16 yrs). Independent predictors of PhA were body weight, height, FFM and %BF in boys and age, body weight, height and FFM in girls. Similar findings were observed for IR. PhA increased similarly in both sexes from 6 to 11 yrs. In the second decade the slope was ten times steeper in boys and three times in girls, with a breakpoint around 12 yrs in both sexes. A breakpoint was also detected for IR which was significant in boys only. This study provides a comprehensive description of the trajectories of PhA and IR in healthy children and adolescents. Changes of both variables were associated with age, with breakpoints observed around 11-12 yrs of age, followed by more marked variations with time. What is known: • In children and adolescents, BIA-derived raw variables, such as phase angle and impedance ratio, have been related to muscle strength and cardiorespiratory fitness and were considered as a marker of outcome in hospitalized paediatric patients. • A limited number of papers described the trajectory of these variables in paediatric population. What is new: • There are very clear age-related differences in BIA-derived variables over the first two decades of life, with a variability related to variation in fat-free mass. • For both variables, breakpoints were observed particularly in boys around 12 yrs of age.

This study evaluated the impact of perioperative levosimendan on in-hospital outcomes in children undergoing surgery for complex congenital heart disease. A retrospective cohort of 120 neonates and infants undergoing Norwood operation, arterial switch operation, or truncus arteriosus repair was analyzed. Median age at surgery was 29.5 days, and median weight was 4.0 kg. In-hospital mortality was higher in female patients, who exhibited a 2.64-fold greater mortality rate compared with males (33.3% vs. 12.6%). Levosimendan use was not significantly associated with a significant reduction in in-hospital mortality (aOR 0.76; 95% CI 0.07-1.46), major complications (aOR 0.87; 95% CI 0.44-1.30), or length of stay (aOR 0.76; 95% CI 0.36-1.16). However, treatment allocation was clinically based, introducing selection bias and confounding by indication, therefore still leaving the question of potential levosimendan efficacy in the CHD postoperative context unanswered. Thus, further studies are warranted.

Conclusion:  In this retrospective cohort of high-risk pediatric patients undergoing complex congenital heart surgery, perioperative levosimendan was not associated with significant differences in in-hospital mortality, postoperative length of stay, or major complications.

What is known: • Vasoactive support is central after complex pediatric cardiac surgery; levosimendan is a calcium-sensitizer/inodilator used perioperatively. • Pediatric evidence is mixed: some reports suggest fewer LCOS events, but no consistent reduction in in-hospital mortality, AKI, ventilation duration, or LOS.

What is new: • In a national referral cohort from a middle-income country, perioperative levosimendan showed no significant difference in mortality, LOS, or major complications versus no levosimendan in complex congenital heart surgery (Norwood procedure, Arterial switch operation and  truncus arteriosus repair). • Among postoperative ECMO patients, LOS was numerically shorter with levosimendan but not statistically significant (exploratory).