European Journal of Pediatrics最新文献

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.

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.