European Journal of Pediatrics最新文献

Chemotherapy can alter body composition, including loss of skeletal muscle mass and density changes, which are linked to negative outcomes. This study investigates body composition changes in children and adolescents with lymphoma, focusing on the impact of chemotherapy protocols and diagnoses. A retrospective observational study included 49 lymphoma patients (ages 6-18) who underwent chemotherapy from 2017 to 2021, excluding palliative care cases. Data on disease, treatment, weight, and height were collected, and anthropometric indices, Body Mass Index by Age (BMI/A) and height by age (H/A) were calculated. Body composition was analyzed using Computed tomography (CT) at the third lumbar vertebra region (L3) with Slice-O-Matic 5.0 software, measuring skeletal muscle area (SMA), skeletal muscle density (SMD) measured in Hounsfield units (HU), total psoas muscle area (PMA), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT). Paired t-tests compared variables before and after treatment, and the delta of body composition parameters was stratified by chemotherapy protocols and diagnoses (Kruskal-Wallis Test), considering p < 0.05 as significant. Forty-nine patients were included (mean age 13.24 years, 49% male). After chemotherapy, there was an increase in SAT, VAT, IMAT, and SMA (p < 0.001), while SMD decreased from 41 HU to 35.27 HU (p < 0.001). The EURONET protocol and Hodgkin lymphoma were associated with increases in SAT (∆ = 78.28 cm²/73.92 cm²) and VAT (∆ = 27.44 cm²/26.36 cm²).

Conclusions: Significant adipose tissue gains were observed in the EURONET protocol and Hodgkin lymphoma, highlighting the impact of chemotherapy on body composition.

What is known: • Computed tomography is used to assess body composition, including muscle, adipose tissue and muscle density in adults. • Chemotherapy treatment negatively affects body composition, reducing muscle mass in adults with cancer.

What is new: • Computed tomography can also be used to assess body composition in children and adolescents with cancer. • In pediatrics, chemotherapy can also impact body composition, with changes varying according to the administered protocol.

Although the administration of antenatal corticosteroids (ACS) is generally recognized as cost-effective and beneficial, recent studies have indicated potential long-term adverse effects on neurodevelopment, particularly for term-born infants. However, limited research has explored the association between the timing of ACS exposure, gestational age (GA) at birth, and their potential implications for mental and behavioral outcomes in offspring compared to non-exposed infants. This study aimed to examine the association between the timing of antenatal corticosteroid (ACS) exposure for threatened preterm labor and childhood mental disorders among early-term and full-term births. All eligible term infants born between 2010 to 2014 were included in this nationwide study and followed until the end of 2021. The primary outcome was any childhood mentaldisorders, with secondary outcomes being attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental delay (DD). Compared to unexposed infants, ACS exposure before 34 weeks of GA increased the risk of developing mental behavior disorders. Exposure to ACS before 34 weeks was significantly associated with an increased risk of ADHD and DD; however, this association was observed only in early-term births but not in those born at full-term.

Conclusion: Our finding suggests a need for further investigation into the influence of GA at birth on these disorders and supports that the risk of childhood mental disorders in term infants varied among different ACS exposure timing.

What is known: • While administration of antenatal corticosteroids (ACS) for preterm birth threats is widely acknowledged as both cost-effective and beneficial, recent studies have raised concerns about potential long-term adverse effects on neurodevelopment, particularly in term-born infants. • Previous studies have found that early-term birth is associated with lower intelligence, ADHD, and poorer school performance compared to full-term birth.

What is new: • There is an interaction between the timing of ACS treatment and gestational age at birth with respect to the likelihood of neurodevelopmental outcomes in term-born infants. • Exposure to ACS before 34 weeks is associated with an increased risk of any childhood mental disorders, specifically ADHD and DD, among early-term births, whereas this association was not observed in infants who reached full-term gestation.

Central venous access devices (CVADs) are vital instruments in pediatric healthcare, enabling the administration of critical treatments such as chemotherapy and parenteral nutrition. However, despite their advantages, CVADs carry a significant risk of complications, including infections, mechanical failures, and thrombotic events. From the current literature, it is unknown whether previous CVAD placements lead to an increased risk for complications in subsequent CVAD placements. We retrospectively analyzed data regarding tunneled, surgically implanted CVADs in children over a period of 2 years at a single tertiary pediatric center regarding their complications. Between 2021 and 2022, 328 CVAD implantations were performed in 313 children. The average age at implantation was 6.6 ± 5.5 years, while most of the patients were younger than 5 years old. During the study period, a total of 102 complications occurred in 96 patients. Most frequent complications were infections (18.29% of all implantations), followed by dislocation of the catheter tip (6.4 0%) and mechanical dysfunctions (4.27%). No patient died from a complication. The choice of catheter type (Port versus Broviac) showed a significant influence on the occurrence of complications (hazard ratio of 3.964 (95% CI 1.993-7.886; p < 0.001). The risk of infection and dislodgement was also higher when comparing Broviac with Ports implantations (infection: HR = 3.236; 95% CI 1.239-8.454; p = 0.017; dislodgement: HR = 5.781; 95% CI 1.229-27.193; p = 0.026). Cox regression showed a statistically significant higher risk of complications (especially infections) when the catheter was inserted via venous cutdown instead of percutaneous puncture technique (complications: HR = 6.709; 95% CI 1.776-25.337; p = 0.005; infections: HR = 7.28; 95% CI 1.096-48.379; p = 0.04). Cox regression did not show a statistically significant influence on complications for neither of the following factors: age, gender, weight, and oncological/non-oncological diagnosis. The complication rate for patients with previous CVAD was nearly the same as for patients who received a CVAD for the first time (previous CVAD: 29.17%; no previous CVAD: 30.74%).

Conclusion: Our study challenges conventional assumptions regarding the impact of previous CVAD placements on complication rates. Nevertheless, ongoing vigilance and adherence to standardized protocols remain crucial in mitigating risks and improving outcomes in pediatric CVAD management.

What is known: • Risk factors predisposing for CVAD-related complications remain insufficiently understood. • It is unknown whether previous CVAD placements lead to an increased risk for complications in subsequent CVAD placements.

What is new: • The complication rate for patients with previous CVAD appears to be the same as for patients who receive a CVAD for the first time.

There are conflicting results on the association between maternal vitamin D concentrations during pregnancy and respiratory outcomes for their offspring. However, published studies have mainly focused on the second and third trimesters of pregnancy or on high-risk population. The main objective of this study was to evaluate the association between vitamin D plasma concentrations in the first trimester (T1) of pregnancy and effective specific airway resistance (sR_eff) for children aged 5 to 6. Secondary objectives were to evaluate this association in the third trimester (T3) and in cord blood as well as the association between vitamin D plasma concentration and interrupter resistance (Rint), bronchiolitis, asthma, and allergen sensitization at the same time points. This multicenter study included 140 children born from women enrolled in the FEPED cohort. Associations between sR_eff and maternal vitamin D plasma concentration at T1, T3 of pregnancy, and in cord blood were assessed. sR_eff was analyzed according to in-utero and postnatal exposure to tobacco smoke and the occurrence of an episode of bronchiolitis before 6 months of age. The impact of maternal vitamin D status on the secondary outcomes was similarly assessed. sR_eff values were not associated with the maternal vitamin D status at T1 and T3, nor asthma status or allergen sensitization.

Conclusion: In a cohort of young children, airway resistance and asthma were not associated with early vitamin D deficiency during pregnancy.

Trial registration: This study is registered with the ClinicalTrials.gov identifier NCT03229317.

What is known: • There are conflicting results on the association between maternal vitamin D concentrations during pregnancy and respiratory outcomes for their offspring. However, published studies have mainly focused on the second and third trimesters of pregnancy or on high-risk population.

What is new: • In a cohort of 5- to 6-year-old children assessed prospectively, there was no significant difference in sReff or any other lung function measurements depending on maternal vitamin D status during the first trimester of pregnancy.

The aim of this study is to examine the association between insufficient sleep and astigmatism, as well as its related refractive components, in preschool children. Preschool children aged 3 to 6 from two kindergartens in Shanghai participated in this study. Non-cycloplegic refraction was assessed using an auto-refractor (Topcon KR-800, Tokyo, Japan), and biometric parameters were measured with the IOL Master 700 (Carl Zeiss, Jena, Germany). Sleep duration and lifestyle information were collected via questionnaires. Total Astigmatism (TA), Anterior Corneal Astigmatism (ACA), Internal Astigmatism (IA), and Compensation Factor (CF) were calculated from vector components J₀ and J₄₅. A total of 451 preschool children (55% males, mean age 5.20 ± 0.84 years) were included, with 5.8% experiencing astigmatism. Insufficient sleep was associated with higher astigmatism prevalence (OR = 2.932, 95% CI: 1.121 to 7.669) and increased cylinder power (β = 0.155, 95% CI: 0.024 to 0.286). Total sleep duration showed an inverse association with cylinder power (β = -0.049, 95% CI: -0.092 to -0.007). Insufficient sleep correlated significantly with J_0t (β = 0.123, 95% CI: 0.032-0.215) and J_0i (β = 0.170, 95% CI: 0.072-0.269), and CF₀ (Adjusted OR = 1.731, 95% CI: 1.005 - 2.981). Sleep duration was also significantly associated with J_0t, J_0i and CF₀. Insufficient sleep is significantly associated with astigmatism in preschool children, primarily through internal astigmatism. These findings emphasize the need for vision screening in children with insufficient sleep to identify and address refractive issues early. What is Known: • Refractive errors, including astigmatism, are common in preschool children and influenced by both environmental and genetic factors. • Insufficient sleep is significantly associated with refractive errors, particularly myopia, and is known to affect visual health and ocular conditions. What is New: • Insufficient sleep is significantly associated with astigmatism in preschool children. • This association may primarily stem from internal compensation mechanisms.

This study aimed to assess the risk factors for complications post-Tenckhoff catheter implantation in paediatric patients. All records of children who underwent the procedure from 2002 to 2022 at the University Medical Centre of Hamburg were analyzed. The demographic and anthropometric characteristics were scrutinized, with particular attention given to complications such as catheter leakage, occlusions, and peritonitis. Univariate and multivariate analyses were employed to determine the hazard ratios for complications. In total, 299 implantations were performed in 116 females and 130 males; 67% were under 5 years old, and 85% had renal disease. Fifty-one percent needed an acute catheter insertion, 26% of the patient's required revision, and 24% of the patients experienced peritonitis. Neonates had a 22% mortality rate, and infants had a 37% reimplantation rate. Compared with the other subgroups, a glomerular filtration rate of 15-29 ml/kg/1.7 3m² was associated with a 10.7-fold higher risk of peritonitis. Male patients had a threefold greater chance of reimplantation or inguinal hernia. Omentectomy revealed no increased risk of peritonitis, and only two catheter occlusions were observed. Patients with inguinal hernias or gastric tubes had higher odds of complications (HR = 3.60, p = 0.003 and OR = 2.47, p = 0.014). Neither the implantation side nor acute insertion was correlated with complications.

Conclusion: Infants, male patients with kidney disease, prolonged use of catheter, and those with a GFR of 15-29 ml/kg/1.73 m² were at increased risk. The presence of peritonitis, inguinal hernia, and gastric tubes were adverse prognostic factors.

What is known: • Omentectomy can serve as a protective factor and correlates with a lower incidence of catheter malfunction. • The insertion of gastric tubes is commonly associated with complications but has lower risk of complications if inserted prior to the initiation of peritoneal dialysis.

What is new: • Males have been found to have a 2.14 hazard ratio for revision in both acute and chronic peritoneal dialysis groups. • The incidence of revisions seems to be greater in the first 36 months, while the incidence of peritonitis rises by 7% for each additional year of age.

Motor behavior alterations are common in neurodevelopmental disorders (NDDs), including autism, developmental coordination disorder (DCD), and attention deficit hyperactivity disorder (ADHD), but the extent of motor impairment remains unclear. In autism and ADHD, motor difficulties may be linked to co-occurring DCD, which often goes unrecognized. We aimed to map the prevalence of DCD in autism and ADHD, and to explore motor skill difficulties using the Movement Assessment Battery for Children-2 (MABC-2), by comparing children with typical motor development (TMD) with those who have NDDs, and by identifying specific profiles among NDDs. A combined sample of participants (n = 215), including autistic children with(out) intellectual disability (ID) and children with ADHD, DCD, and TMD, performed the MABC-2. Depending on co-occurring DCD/ID, subgroups were composed: autism-only (n = 17), autism + ID (n = 17), autism + DCD (n = 40), ADHD-only (n = 14), ADHD + DCD (n = 12), DCD (n = 25), and TMD (n = 59). MABC-2 differences between TMD/NDDs (Mann-Whitney U test) and among NDDs (Kruskal-Wallis test) were assessed. DCD occurred in 70.2% of the autistic children without ID and in 46.2% of those with ADHD. Children with NDDs performed significantly worse than the TMD (p < 0.001). Manual dexterity skills, aiming and catching, and balance were significantly different across the NDD subgroups (p ≤ 0.001). Particularly children with ( +)DCD and autism + ID performed worse on manual dexterity skills. Children with ( +)DCD were outperformed on aiming and catching. All subgroups, except the ADHD-only group, performed poorly on balance.

Conclusion: Distinct motor difficulties were identified across various NDDs. Children with co-occurring ID or DCD exhibit unique challenges, stressing the importance of motor profile subgrouping.

What is known: • Despite the common occurrence of motor behavior in neurodevelopmental disorders, the extent of motor impairment remains unclear. • Motor difficulties in autism and ADHD may be linked to co-occurring DCD, which often goes unrecognized.

What is new: • DCD occurred in 70% of the autistic children without ID and in 46% of those with ADHD. • Children with co-occurring ID or DCD exhibit unique challenges, stressing the importance of motor profile subgrouping.

Polycythemia vera (PV) and essential thrombocythemia (ET) are rare myeloproliferative neoplasms (MPN) in children, adolescents and young adults. No recommendations are available concerning these patients' management. Transposing to children the knowledge established in adult patients is not acceptable. For a better understanding of difficulties encountered by pediatricians and adult hematologists, we conducted a national practice analysis concerning follow-up of patients under 18 diagnosed with ET or PV, in France. Then, we present data from a multicentric, descriptive, retrospective study, including 17 patients with ET or PV, diagnosed under 18, coming from 7 hematopediatric departments in France. Interviewed physicians reported a lack of expertise and theoretical training in the hematological field to diagnose and follow children with MPNs. Data from 17 patients (15 ET, 2 PV) confirmed a high proportion of asymptomatic patients at the time of diagnosis (41%). Proportion of "triple-negative" patients (59%) was higher than in adult cohorts. 60% of patients underwent a bone marrow biopsy and 31% of cases were discussed during a multi-disciplinary staff meeting. 76.5% patients were treated, with a high frequency of antithrombotic and cytoreductive drugs. No complications were observed during the 45 months of median follow-up.

Conclusion: Physicians insisted on the need for training. Only the accumulation of descriptions of MPNs in children will lead to a better management of these diseases. Considering the small proportion of pediatric patients with complications after diagnosis, rapid therapeutic de-escalation seems essential to consider during the follow-up in a close collaboration with adult hematologists.

What is known: • Myeloproliferativ neoplams are rare and chronic deseases, most of the time affecting adults but also found in few pediatric patients. • There are no recommendations for the diagnosis, therapeutic management or follow-up of children with polycythemia vera or essential thrombocythemia.

What is new: • Find out how adult haematologists and paediatricians feel about the management and follow-up of paediatric patients with myeloproliferative syndrome through a national practice analysis. • Description of the "real life" follow-up of children with polycythemia vera or essential thrombocythemia in France.

This study aims to analyze the demographics, therapeutic approaches, and outcomes of pediatric sarcomas of the head and neck treated at a single tertiary referral center. We retrospectively reviewed the medical charts of all pediatric patients diagnosed with head and neck sarcomas treated at the Tel Aviv Sourasky Medical Center during 2002-2021. Clinical data, oncologic and surgical treatments, and outcome measures were retrieved from electronic medical files. A total of 52 patients met the inclusion criteria. The mean age at diagnosis was 7.25 ± 6.04 years (range 2 months to 20 years), and the male-to-female ratio was 1.4: 1. The leading histological subtypes were rhabdomyosarcoma (RMS) (50%) followed by Ewing sarcoma (23%). The vast majority (96%) of patients were treated with multimodal therapy that included chemotherapy, surgical resection, and/or radiation therapy. Twenty-nine (55.8%) patients underwent surgical resection. The average follow-up was 4.75 years (range 5 months to 13.5 years). The 1-, 5-, and 10-year overall survival rates were 89.5%, 81.3%, and 62.5%, respectively. Male sex, Ewing sarcoma, and non-metastatic disease at diagnosis were associated with better disease-free survival (DFS) (p = 0.008, p = 0.048, and p = 0.038, respectively). Patients with sarcomas suitable for surgical resection and those who received adjuvant therapy had significantly better DFS (p = 0.003 and p = 0.025, respectively).

Conclusions: Head and neck sarcomas in the pediatric population are best managed by a multidisciplinary team. Surgical resection and the integration of adjuvant therapy in selected patients confer survival benefit.

What is known: • Head and neck sarcomas pose a considerable challenge to physicians due to their rarity, their heterogenic presentation, and their proximity to vital structures.

What is new: • A multimodal therapeutic approach that includes chemotherapy, radiotherapy, and surgical resection when feasible should be provided to these patients in order to optimize survival outcomes. Surgical resection and the integration of adjuvant therapy in selected patients confer survival benefit.

Bronchiolitis is one of the leading reasons for paediatric emergency department (PED) visits. France was one of the few countries in the world to implement nirsevimab during winter 2023-2024 in order to reduce the burden of bronchiolitis each year. We conducted a test-negative design study, including all infants younger than 1, diagnosed with a first episode of bronchiolitis. We included all cases presenting to the PED of five university hospitals across France, between October 1, 2023, and February 29, 2024, and undergoing a nasopharyngeal sample for RSV testing. Case patients were the RSV-positive bronchiolitis and control patients the RSV-negative. As a follow-up, all parents were contacted by e-mail 15 days after inclusion. We included 383 bronchiolitis patients, of which 274 tested positive for RSV (75.2%). Among case patients, 27/274 (9.8%) received nirsevimab, compared to 50/109 (46.2%) among control patients. Nirsevimab had an adjusted estimated effectiveness of 82.5% (95% CI [68.0-90.8]) at PEDs. Sensitivity analyses found similar results. At 15-day follow-up, characteristics were similar between children immunized by nirsevimab or not.

Conclusion: Our findings advocate for nirsevimab widespread adoption to alleviate the burden of RSV bronchiolitis in paediatric emergency departments.

Trial registration: NCT04743609 (date of registration: February 4, 2021).

What is known: • Each year, RSV-bronchiolitis places significant pressure on pediatric emergency services. • France is one of the first countries in the world to have implemented nirsevimab in septembre 2023.

What is new: • Nirsevimab effectiveness on pediatric emergency visits for RSV-bronchiolitis has been estimated to 82.5% (95% CI [68.0-90.8]) in our study. • The effectiveness was as strong to prevent hospitalizations and sever illnesses.