European Journal of Pediatrics最新文献

Anisocoria often raises concerns about potential underlying conditions such as intracranial hemorrhage, brain tumor, or Horner syndrome. However, iatrogenic exposures may also lead to unilateral mydriasis. A six-month-old infant was hospitalized due to acute bronchiolitis with a history of prematurity, bronchopulmonary dysplasia, and periventricular leukomalacia (PVL). He received non-invasive respiratory support, salbutamol, and ipratropium bromide by inhalation. Four days after admission, the infant exhibited an episode of sudden unilateral mydriasis with no other new signs or symptoms. Ophthalmological examination disclosed no abnormalities besides the dilated pupil, and brain CT scan showed PVL similar to the previous imaging without new pathological findings. There are several case reports of ipratropium bromide given by inhalation causing mydriasis by leakage through the inhalation mask. Ipratropium bromide is an antagonist of the muscarinic receptors. It induces bronchodilation and inhibits mucus production. One of the possible side effects of antimuscarinic drugs is mydriasis. Our patient did not exhibit any systemic signs, thus suggesting a local effect by direct contact between the eye and the offending agent. Treatment with ipratropium bromide was stopped, and within 24 h, the pupil size returned to normal.

Conclusion: This case underscores the importance of recognizing the side effects of medications, particularly in young patients with complex medical conditions.

What is known: • Unilateral mydriasis refers to unequal pupil sizes, where the abnormal pupil is dilated. • Unilateral mydriasis can result from a variety of causes, ranging from benign to serious conditions, including iatrogenic factors such as medications.

What is new: • The occurrence of unilateral mydriasis induced by ipratropium bromide has been rarely reported in pediatric patients. • If unilateral mydriasis is an isolated abnormal finding and there is a history of ipratropium bromide exposure, themydriasis could be due to the ipratropium exposure.

In this brief report, we present the findings of a survey which explores the learning curve that was achieved during the 'Serial Lung Ultrasound in predicting the need for surfactant and Respiratory course in Preterm infants' (SLURP) study. The aim of this survey was to evaluate the training lung ultrasound operators received in order to scan patients who were recruited into the SLURP study. The aim of the SLURP study was to validate the optimal lung ultrasound (LU) 'cut off' score using standard and extended LU zones that predict surfactant need in babies born ≤ 34 weeks on non-invasive respiratory support when clinicians had various levels of experience in LU. The study was a prospective observational study conducted between May 2023 to June 2024 in 3 neonatal intensive care units (NICUs) across the UK. A standardised lung ultrasound training programme was delivered across the 3 sites before starting the SLURP study which included an online module and 1 day of didactic lectures with face-to-face hands-on training. We performed a survey towards the end of the SLURP study to evaluate the learning curve of a significant number of inexperienced lung ultrasound operators participating in this study. The results of the survey showed that a structured training package alongside supervision developed clinicians' ability to recognise common lung pathologies, perform scans independently and improve their scanning speed.

Conclusion:  The SLURP study was a major driving force in upskilling clinicians in LU across 3 UK NICUs. The study was unique in that it was the first prospective LU study in the UK, and it utilised a large proportion of staff with no prior LU experience. This survey demonstrates that the implementation of a structured training package and supervision led to a rapid learning curve for basic LU skills which can be replicated on a larger scale across the UK.

What is known: • Training and implementation of neonatal lung ultrasound (LU) remains inconsistent across neonatal units. • The effectiveness of neonatal LU training is infrequently evaluated and reported in the literature.

What is new: • Novice neonatal LU operators can be trained within a short time frame through a structured training programme. • This training enabled the operators to perform high-quality scans, with reduced scanning time and differentiate between various neonatal lung pathologies.

This study aimed to explore the developmental outcomes of children with biotinidase deficiency (BD) and the psychological well-being of their parents. The cohort comprised 61 children diagnosed with BD who were followed at the Department of Pediatric Metabolism of Başakşehir Çam and Sakura City Hospital in Istanbul, along with their parents. The control group comprised 49 children who were admitted to the pediatric outpatient clinic during the same period and did not have any chronic physical diseases or previous psychiatric admissions, and their parents. The current findings indicated that children with BD did not show significant developmental delays compared to the control group, with no notable differences in intelligence scores between the groups. Interestingly, parents of children with BD reported lower levels of state anxiety than those of the control group, although no significant differences were observed for other mental health metrics.

Conclusion:  These findings imply that early diagnosis and intervention through newborn screening could help alleviate developmental and psychological challenges for children and their parents.

What is known: • Children who receive biotin supplementation before the onset of symptoms generally develop, while those who are untreated may exhibit developmental delays. • Having a child with a metabolic disease can adversely affect a parent's psychological well-being.

What is new: • Children diagnosed with BD through newborn screening did not show significant developmental delays compared to the control group, with no notable differences in intelligence scores between the groups. • Parents of children with BD reported lower levels of state anxiety than those of the control group, although no significant differences were observed for other mental health metrics.

Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment and enabled the treatment of those who could not be treated using interferon. The aim of this work was to assess the efficacy and safety of oral DAAs in HCV-infected children with associated comorbidities. This analytical retrospective study included children with HCV mono-infection versus those with associated comorbidities. The study included 187 HCV-infected children aged 6-18 years; 114 patients (61%) had associated comorbidities. The most frequent comorbidities were hematological disorders (30.7%), followed by renal and cardiac diseases. Baseline total bilirubin, aspartate aminotransferase, and gamma glutamyl transpeptidase were significantly more elevated in patients with comorbidities. Sustained virologic response (SVR) was achieved in 100% of patients with HCV mono-infection versus 98.2% of patients with comorbidities. The most frequently reported treatment adverse effects were headache, asthenia, and irritability. All side effects were transient and did not necessitate treatment discontinuation.

Conclusion: DAAs allowed treatment of HCV-infected children with comorbidities with high SVR and excellent safety profile. Treatment with sofosbuvir/ledipasvir achieved an SVR of 98.9% in HCV-infected children with comorbidities. Treatment was safe and well tolerated with mild transient adverse events.

What is known: • The novel DAAs have revolutionized the landscape of HCV treatment and enabled the treatment of those who could not be treated using IFN. • When treating HCV, clinicians should take into consideration the presence of other comorbid conditions. In the IFN-RBV era, many HCV patients with comorbidities were ineligible for therapy.

What is new: • There are limited data in the literature about the efficacy and tolerability of DAAs in children with comorbidities. • We reported in the current study that DAAs allowed treatment of HCV-infected children with comorbidities with high SVR and excellent safety profile. These patients should be offered treatment with oral DAAs to help decrease the infectious pool and hence reach the ambitious final goal of global eradication.

Although cesarean delivery (CD) has been linked to long-term health risks in singleton infants, the impact of delivery mode on long-term health outcomes in preterm twins remains underexplored. A retrospective cohort study was conducted at a tertiary medical center in Israel from 1991 to 2021, comparing preterm twins vaginally delivered (VD) versus cesarean section, excluding cases with congenital malformations or perinatal deaths. Kaplan-Meier survival curves were used to compare the cumulative incidence, and Cox proportional hazards models were applied to adjust for potential confounders. Four thousand twenty-eight preterm twin offspring were included, with 1703 (42%) VD and 2325 (58%) by CD. Preterm twins delivered by CD had a higher incidence of respiratory morbidities (42% vs. 35% in the VD group, p < 0.001), with an adjusted Hazard Ratio (aHR) of 1.15 (95%CI 1.02-1.30). CD was associated with an increased incidence of neurologic morbidities (22% vs. 17% in the VD group, p < 0.001), with an aHR of 1.16 (95%CI 1.02-1.36). CD was associated with a higher incidence of infectious morbidities (69% vs. 62%, p < 0.001), with an aHR of 1.10 (95%CI 1.01-1.21). Gastrointestinal morbidities were more pronounced in the CD group (29% vs. 25%, p < 0.001), but the multivariable analysis did not reach significance (aHR = 1.10, 95%CI 0.95-1.27). Sub-analyses of elective-uncomplicated deliveries showed consistent results for most morbidities.

Conclusions: Cesarean delivery in preterm twins is associated with long-term respiratory, neurologic, infectious and gastrointestinal morbidities of the offspring. The findings suggest the potential benefits of vaginal over cesarean deliveries regarding offspring long-term health complications.

What is known: • Studies on singleton births show that cesarean delivery may increase respiratory, infectious, neurological and gastrointestinal outcomes remains inconsistent across term and preterm deliveries. • Cesarean delivery rates remain high despite recommendations to reduce their frequency, yet data on the association between cesarean delivery and morbidity among twins, particularly in small for gestational age twins, is limited.

What is new: • This is the first large-scale study demonstrating that cesarean delivery in preterm twins increases the odds of respiratory, neurologic, infectious and gastrointestinal long-term morbidities up to age 18. • The higher rates of respiratory, neurologic, infectious, and gastrointestinal complications persist even in uncomplicated cesarean deliveries.

Staphylococcus aureus (SA) is an important pathogen in the pediatric population. Community-acquired SA bacteremia (SAB) may also occur in healthy individuals, yet literature on this matter is scarce. Our study aims to describe patient characteristics, clinical course, and outcomes of healthy children with SAB. This retrospective cohort study included all healthy patients aged 3 months-18 years, with a positive SA blood culture taken during the first 72 hours of hospitalization between 2009 and 2021. Demographic, laboratory, and clinical data were collected. Analysis was performed to assess factors associated with complicated disease. Fifty-seven patients aged 8.5 ± 4.5 years were included. Forty-one (71.9%) were males and 18 (31.6%) reported trauma before onset. Thirty-four (59.6%) were diagnosed with osteomyelitis, 14 (24.6%) with abscesses, 7 (12.3%) with isolated SAB, and 7 (12.3%) suffered from complex SAB. Factors associated with abscess formation were age ≥ 13 years and groin pain; OR 3.857 (p-value 0.01) and 20.0 (p-value 0.01), respectively. A CRP ≥ 13 mg/dL upon admission was found to be a predictor of complex disease (AUC of 0.765; 95% CI 0.559-0.971 (p-value 0.024)). Higher odds for complex SAB were seen in persistent bacteremia, prolonged time to eradication, and time to targeted therapy; OR 5.833 (p-value 0.048), OR 1.810 (p-value 0.017), and OR 3.214 (p-value 0.015), respectively. There were no cases of mortality.

Conclusion: This study describes various aspects of SAB in healthy children and could help to better recognize the signs and symptoms of the disease. Moreover, we report several indicators that may assist clinicians in identifying at-risk patients for a complicated disease.

What is known: •SAB is an important pediatric disease that can cause severe complications and mortality. •SAB is well described as a nosocomial infection and in high-risk populations such as premature babies, children with intravascular devices, immunodeficient individuals, and other major chronic illnesses. However, data regarding community-acquired SAB in healthy children is lacking.

What is new: •This is the first study to exclusively include previously healthy children with community-acquired SAB. •Higher CRP upon admission, persistent bacteremia, and longer time to targeted therapy are all in correlation with complications such as multifocal disease, sepsis, ICU admission, and endocarditis.

Vulvar Lichen Sclerosus(VLS) is an uncommon, often misdiagnosed condition with a chronic course. Children presenting with VLS may have a wide variety of complaints, which complicates diagnosis. The differentiation of symptoms in the course of VLS causes great diagnostic difficulties. Delayed diagnosis may have an impact on vulvar architecture and long-term sexual health, and can often lead to frustration for both the patient and her parents. The aim of this study was to determine the reasons for delayed diagnosis of VLS in girls and adolescents and to investigate the number of different doctors and specialists consulted before the diagnosis of VLS, the symptoms reported, and the clinical presentation at time of diagnosis. We conducted a retrospective descriptive unicentric cohort study by reviewing medical charts of paediatric and adolescent girls diagnosed with VLS in a tertiary Swiss Centre. The average delay from first symptoms to VLS diagnosis was three years. Many symptoms went unrecognised despite consultations with a wide range of specialists. Once topical corticosteroids were prescribed, relief of symptoms was very quick, usually within one month.

Conclusion: Even for a wealthy country such as Switzerland, with ample access to healthcare and specialists, it still takes a long time to arrive at the correct diagnosis and treatment of VLS. Improving knowledge and understanding of VLS disease among paediatricians and healthcare providers could lead to earlier diagnosis and treatment, and thereby significantly improve patient outcomes.

What is known: •  VLS is a chronic, often misdiagnosed condition with a variety of symptoms in children. •  Delayed diagnosis can impact vulvar anatomy and long-term sexual health.

What is new: •  In Switzerland (Canton od Geneva), the average delay from symptoms to diagnosis is three years, despite specialist access. • Many patients see multiple doctors before diagnosis, highlighting the need for better awareness among healthcare providers.

Central nervous system (CNS) disorders, including seizures, status epilepticus (SE), and altered mental status, constitute a significant proportion of cases presenting in the pediatric emergency department. EEG is essential for diagnosing nonconvulsive SE, but standard EEG is often unavailable due to resource constraints. Point-of-care EEG (pocEEG) has emerged as a viable alternative, offering rapid bedside assessment. This systematic review synthesizes existing data on the use of pocEEG in pediatric emergencies and highlights research gaps. A comprehensive search of PubMed, CINAHL, and EMBASE identified six studies on pediatric populations using simplified EEG montages, with cohort sizes ranging from 20 to 242 patients. The findings indicate that pocEEG is feasible in acute pediatric care, effectively aiding in the detection of nonconvulsive SE and other critical neurological conditions. The studies varied in electrode placement strategies, ranging from neonatal to subhairline montages.

Conclusion: Despite some implementation challenges, pocEEG has shown sufficient accuracy for clinical use. Further research should focus on optimizing EEG montages, refining interpretation, and assessing its impact on patient outcomes. This review underscores the potential of pocEEG to address critical care needs in pediatric emergency departments and calls for larger, standardized studies.

What is known: •  Central nervous system (CNS) disorders, such as seizures and altered mental status, are common and critical conditions encountered in pediatric emergency resuscitation bays. •  EEG is essential for diagnosing nonconvulsive status epilepticus, but standard EEG is often unavailable in emergency departments due to logistical challenges, limited resources, and the need for specialized interpretation.

What is new: •  Reduced-lead, point-of-care EEG (pocEEG) is a feasible alternative for real-time bedside CNS monitoring in pediatric emergency settings, aiding in the diagnosis of nonconvulsive status epilepticus and guiding the management of convulsive status epilepticus. • This systematic review highlights the feasibility and clinical potential of pocEEG in pediatric emergency departments and identifies key areas for further research, including the development of standardized pocEEG protocols and the integration of automated EEG analysis.

The aim of the study is to elucidate demographic characteristics, risk factors, clinical presentations, causative agents, and management approaches pertaining to drug-related anaphylaxis in the paediatric population. This study is a multicenter retrospective study that included paediatric patients aged between 1 month and 18 years, who were admitted to the Pediatric Allergy and Immunology outpatient clinics of 11 participating centres with a presumptive diagnosis of drug-induced anaphylaxis, that fulfilled the standardised criteria for anaphylaxis, between January 2017 and December 2022. A total of 293 anaphylactic episodes presented among 265 patients, of which 48.1% (n 141) were female, were included. The median age of patients during the index episode was 107 months (IQR 56.5-161.5). Anaphylaxis occurred most frequently within hospital settings (62.1%, n 182) compared to home environments (34.1%, n 100). The administration were peroral in 40.3% (n 118), parenteral in 59.7% (n 175) of the cases. While antibiotics (56.7%), non-steroidal anti-inflammatory drugs (25.7%), and chemotherapeutics (3.4%) were the most commonly suspected drug groups, the cephalosporin group, and especially ceftriaxone (27.5% [n 80]) were the leading culprits among antibiotics. The anaphylaxis severity was severe in 39.6% (n 116), and moderate in 54.9% (n 161) of episodes. A biphasic reaction occurred in five patients. Only 72% (n 213) of patients were given adrenaline treatment. There were no fatalities. Diagnostic tests (n 64), including skin prick, intradermal, and drug provocation tests, which were performed between 1 and 120 months after the index reaction, yielded positive results in 23.4% (n 15), 17.2% (n 11), and 20.3% (n 13) of cases respectively, giving a total confirmation of 39 patients. Four patients underwent suspected drug desensitisation protocols. There were no fatalities.Conclusions: Antibiotics, particularly ceftriaxone, were the most commonly implicated agents in paediatric drug-induced anaphylaxis. Non-steroidal anti-inflammatory drugs, particularly ibuprofen, constituted the second most frequently implicated drug group. Paediatric patients experiencing drug-related anaphylaxis warrant algorithmic evaluation to ensure accurate diagnosis, prevent recurrence, and identify safe alternative treatments.

Sudden unexpected death in infants (SUDI) and children (SUDC) requires thorough investigation to identify causes and prevention strategies. In the Netherlands, these deaths are investigated using the standardized postmortem evaluation of sudden unexpected death in infants and children (PESUDIC) procedure. This study examines the use of various diagnostic tests within PESUDIC and their effectiveness in determining causes of death. This observational study included infants and children who died suddenly and underwent the PESUDIC procedure from 2016 to 2022. Standardized data on medical history, postmortem examinations, and diagnostic outcomes were collected. Findings were classified by consensus of two experts as "contributory" if they supported the cause of death and "decisive" if they were leading for determination. A total of 275 cases were included. Median age was 13 months (IQR 3.5-73.3). Fifty-nine percent were boys. Over 95% of cases had a medical history, postmortem physical examination, biochemical, and microbiological testing available. Total body postmortem CT and/or MRI was done in 93% (n = 255) and autopsy in 62% (n = 171). The cause of death was determined in 193 (70%). History, imaging, and autopsy provided contributory results in 50% (n = 137/275), 40% (n = 103/255), and 67% (n = 115/171) of applicable cases, respectively. More than two different tests showed contributory findings in 52% of diagnosed cases. Autopsy and microbiological testing had decisive findings most often: in 83/171 and 44/265 cases respectively.

Conclusion: A routinely performed wide array of postmortem investigations has additional value to an autopsy for identifying the cause of death in SUDI and SUDC. A thorough SUDY investigation should therefore minimally include an autopsy, microbiological testing, and whole-body imaging.

What is known: • A thorough postmortem investigation into the cause of sudden death in infants and children can provide an explanation of the death and identify potential preventable causes.

What is new: • A thorough postmortem investigation for sudden unexpected death in infants and children should minimally include an autopsy, microbiological testing and whole-body imaging.