European Journal of Pediatrics最新文献

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.

Proton pump inhibitors (PPIs) represent a class of drugs most prominently known for their use in acid-related disorders. Omeprazole, a drug belonging to this class, is among the top 10 most prescribed drugs in the USA. PPIs have a direct effect on the gastric pH and therefore on the gastric mucosa. This review aims to present the most common adverse effects PPIs have on the gastric mucosa in particular.

Conclusion: PPIs affect the composition of gut and gastric microbiota and will eventually modulate the immune response.

What is known: • Proton-pump inhibitors are amonth the most frequent prescirbed drugs becasue of their well demonstrated efficacy in acid-related disorders. • Because of their mode of action and their metabolism, a large spectrum of adversee effects have been reported.

What is new: • Although the well-known success of PPIs in the wide spectrum of all acid-related conditions should not refrain health care professionals to use them when indicated, insufficient attention is given to the multiple adverse effects reported for this class of drugs. • Well designed prospective trials collecting adverse effects are required, since most studies reporting adverse effects are retrospective, are biassed and have methodological issues.

Respiratory syncytial virus (RSV) is a leading cause of infant morbidity. France has implemented a national campaign using nirsevimab to prevent RSV-related infections in infants. This study assessed its effectiveness in preventing hospitalization due to bronchiolitis in emergency department (ED). This retrospective study was conducted among six pediatric EDs in the Greater Paris area, France, and included infants aged < 3 months with a clinical diagnosis of bronchiolitis during the 2023-2024 RSV epidemic season. The primary outcome was hospitalization after the ED visits. The association with nirsevimab immunization was assessed using a multiple logistic model adjusted for potential confounding factors, with missing data handled using random forest imputation. Secondary analyses examined the risk of admission to the pediatric intensive care unit (PICU), RSV positivity, and subgroup analyses of prematurity, neonates, and deprivation using the FDep index (area-based measure of social deprivation in France). Between October 2 and December 31, 2023, 739 infants were included in the study. A total of 531 (72%) patients had a documented nirsevimab immunization status, and 402 (54%) were hospitalized following a bronchiolitis diagnosis. Nirsevimab showed 53.5% adjusted effectiveness in reducing hospitalizations (95% CI 34.1-67.3). Sensitivity analyses of complete-case data and propensity score matching yielded similar results. Nirsevimab also resulted in 51.1% reduction in PICU admissions (95% CI 10.7-74.3) and 79.6% reduction in RSV positivity (95% CI 68.0-87.1). The protective effect of immunization was consistent for preterm infants, neonates, and deprived groups, though the results were not statistically significant in these smaller subgroups.

Conclusions: Immunization with nirsevimab reduced hospitalization following an ED visit for bronchiolitis among infants aged < 3 months.

What is known: • Nirsevimab reduces the risk of bronchiolitis-related hospitalizations in clinical trials. • Real-world data from the immunization campaign in France remain limited.

What is new: • Nirsevimab showed 53.5% (95% CI 34.1-67.3) adjusted effectiveness in reducing hospitalizations for all-cause bronchiolitis in infants aged < 3 months in emergency departments. • Analyses included social deprivation and highlighted potential disparities in immunization access.

Some individuals experience unexplained, persistent, or newly developed symptoms after coronavirus disease 2019 (COVID-19), known as post-COVID-19 condition (PCC). We explored the age-related prevalence, symptoms, and associated factors for PCC in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This prospective cohort study enrolled children with SARS-CoV-2 infection between December 7, 2022, and January 31, 2023. The participants were assessed via telephone 6 months post-SARS-CoV-2 diagnosis. PCC in children was diagnosed according to the World Health Organization definition. In total, 1084 patients were eligible for matching and follow-up. Eventually, 785 patients (follow-up rate, 72.4%) completed the follow-up. The incidence of PCC among pediatric patients with COVID-19 was 8%. The most common symptom reported by children diagnosed with PCC in all age groups was fatigue. For patients aged 0-2 years, the presence of gastrointestinal symptoms (OR,6.323; 95% CI, 1.549-25.818) and neurological symptoms (OR, 3.816; 95% CI, 1.075-13.545) at the onset of COVID-19 were associated factors for PCC. For patients aged 3-6 years, no associated factors associated with PCC were identified. For patients aged 7-12 years, preexisting comorbidities (OR, 6.869; 95% CI, 2.209-21.360) were associated factors for PCC. For patients aged 13-17 years, female sex (OR, 3.635; 95% CI, 1.164-11.355) and preexisting comorbidities (OR, 6.295; 95% CI, 2.052-19.316) were associated factors for PCC.

Conclusion: The incidence of PCC among pediatric patients with COVID-19 was 8%, with fatigue being the most commonly reported symptom across all age groups. The associated factors for PCC varied according to age groups.

What is known: • Post-COVID-19 condition (PCC) can significantly affect the psychological and physiological health of children. •The characteristics of persistent symptoms and the incidence of PCC varied among children of different age groups.

What is new: • Fatigue is the most common symptom of PCC in children of all age groups. • The associated factors for PCC varied according to age group.

Growth hormone therapy has been shown to be effective in treating a variety of growth-related disorders. This post-marketing study assessed the effectiveness and safety of Cinnatropin®, a biosimilar growth hormone product. The data from the Orchid-Life Registry, which collects long-term effectiveness and safety data from patients receiving Cinnatropin®, was analyzed. A total of 20,465 patients were enrolled in this study, including 405 subjects in the longitudinal analysis. The most common diagnosis was growth hormone deficiency. The mean (SD) height standard deviation score (HSDS) increased from - 1.71 (1.31) to - 1.32 (1.26) in the cross-sectional population and from - 1.84 (1.18) to - 1.49 (1.13) in the longitudinal population over a period of 12 months. The baseline age exhibited an inverse correlation with changes in HSDS, suggesting that older individuals had smaller increments. Over 80% of prepubertal patients reached targeted height velocity after 1 year of treatment. The majority of adverse events were categorized as non-serious, designated as grade one in severity (mild). The most frequently observed adverse events were injection site reaction and headache. Conclusion: The study indicates that Cinnatropin® treatment results in height improvement over 1 year with an acceptable safety profile.