European Journal of Pediatrics最新文献

Post-COVID syndrome is widely recognised in children and young people (CYP), where one or more persistent physical symptoms are present 12 weeks after the initial infection that cannot be explained by an alternative cause. We aimed to assess whether an intervention based on narrative therapy and breathing pattern retraining, co-designed with CYP with PCS (12-18 years) was feasible and acceptable within an NHS service. Participants were randomised to standard clinical care or intervention plus standard clinical care. The primary aim was to assess acceptability and feasibility within the study cohort. Intervention effects were evaluated using the Strengths and Difficulties Questionnaire (SDQ) Impact Score,with additional secondary outcomes included the Nijmegen questionnaire, Chandler Fatigue, and EQ-5D-Y, wellness rating, pulmonary function, and exercise testing. Thirty-two CYP were randomised to standard treatment (n = 15) or intervention (n = 17), mean age of 15 years, and 11 (34%) male. Twenty-seven (84%) were diagnosed with breathing pattern disorders. Four intervention groups were offered over 6 months. 14/17 completed the session. Qualitative feedback was positive. There was no statistically significant improvement in the SDQ over time or between groups. Nearly all secondary outcome measures showed statistically significant improvement over time (< 0.001) but not between groups. Conclusions: The intervention was acceptable and feasible to run in an NHS clinic setting for CYP with post-COVID syndrome. Significant improvements seen with time in secondary outcome measures in both groups indicate that post-COVID symptoms improve with time independent of the intervention. What is known - What is new: • Post-COVID syndrome (PCS) affects up to 66.5% of children and young people (CYP) with common persistent or fluctuating symptoms of fatigue, headaches, anxiety, brain fog, breathlessness, and post-exertional malaise and symptom exacerbation. • Few interventions have sought to address both the physical and mental health impact of PCS in adults and the evidence remains limited for CYP. • This novel psychology/physiotherapy co-designed intervention is acceptable and feasible in an NHS clinic setting. • We identified that breathing pattern disorders are common and a predominant cause of breathlessness in teenagers with PCS.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children worldwide. Hypopituitarism (HPPT) has been described as a potential long-term complication following moderate or severe TBI, with widely variable prevalence rates. The aim of this study was to evaluate pituitary function and to estimate the prevalence of hypopituitarism in pediatric patients with moderate or severe TBI followed at two referral centers in Bogotá, Colombia. A total of 53 patients with moderate (n = 23) or severe (n = 30) TBI were included. The mean age was 10.4 ± 5.5 years, and severe TBI was more frequent in males. Baseline pituitary hormone concentrations, including thyroid-stimulating hormone (TSH), free thyroxine (FT4), insulin-like growth factor 1 (IGF-1), morning cortisol, and prolactin, were assessed at least 6 months after the traumatic event. Growth hormone deficiency (GHD) was suspected in patients with IGF-1 levels ≤ - 2 standard deviations and confirmed using dynamic stimulation testing. Hormonal alterations consistent with hypopituitarism were identified in 3 of 53 patients (5.66%), all corresponding to growth hormone deficiency. Two of these patients had experienced severe TBI. No clinically relevant abnormalities were detected in the remaining pituitary axes.

Conclusions:  In this cohort, hypopituitarism was identified in a small proportion of pediatric patients evaluated beyond the acute phase of moderate or severe TBI. These findings support the consideration of targeted endocrine evaluation as part of the long-term multidisciplinary follow-up of this population.

What is known: • Hypopituitarism may develop after moderate or severe traumatic brain injury (TBI) in children and adolescents, with widely variable prevalence rates reported in the literature. • Growth hormone deficiency is the most frequent endocrine alteration during the chronic phase following pediatric TBI.

What is new: • This is the first study conducted in a Colombian pediatric population to systematically evaluate pituitary function after moderate or severe TBI in referral centers. • What is new: A prevalence of hypopituitarism of 5.66%, exclusively due to growth hormone deficiency, was identified at least 6 months after the traumatic event, highlighting the importance of structured pituitary follow-up to reduce morbidity and improve long-term outcomes.

Purpose: The exact pathogenesis of Long COVID remains unclear. Microvascular and endothelial dysfunction, established contributors to SARS-CoV-2-related conditions, appear to play a role in pediatric Long COVID.

Methods: At the Children's University Hospital of LMU Munich, we conducted a comparative cohort study including pediatric Long COVID patients. Microcirculation was assessed using sublingual sidestream dark field (SDF) imaging, analyzing the microvascular flow index (MFI), the total vessel density (TVD), and the proportion of perfused vessels (PPV). Endothelial function and arterial stiffness were evaluated using peripheral arterial tonometry (EndoPAT), measuring reactive hyperemia index (RHI) and augmentation index (AIx@75).

Results: We analyzed 37 pediatric Long COVID patients (13.5 ± 2.6 years; 22 females) with persisting symptoms (> 4 weeks) and 46 healthy controls (12.4 ± 4.8 years; 21 females). Patients exhibited significant microcirculatory alterations, with reduced MFI (2.59 [IQR, 2.38-2.75] vs. 2.83 [IQR, 2.69-2.96]; p = .003), TVD (16.12 [IQR, 15.24-17.86] mm/mm2 vs. 19.38 [IQR, 17.58-20.57] mm/mm2; p < .001), and PPV (13.58 [IQR, 12.72-14.89]% vs. 17.67 [IQR, 16.60-19.32]%; p < .001). Microcirculatory changes varied with clinical phenotype and were most pronounced in patients presenting with dyspnea.We analyzed 37 pediatric Long COVID patients (13.5 ± 2.6 years; 22 females) with persisting symptoms (> 4 weeks) and 46 healthy controls (12.4 ± 4.8 years; 21 females). Patients exhibited significant microcirculatory alterations, with reduced MFI (2.59 [IQR, 2.38-2.75] vs. 2.83 [IQR, 2.69-2.96]; p = .003), TVD (16.12 [IQR, 15.24-17.86] mm/mm2 vs. 19.38 [IQR, 17.58-20.57] mm/mm2; p < .001), and PPV (13.58 [IQR, 12.72-14.89]% vs. 17.67 [IQR, 16.60-19.32]%; p < .001). Microcirculatory changes varied with clinical phenotype and were most pronounced in patients presenting with dyspnea.

Conclusion: We demonstrate measurable vascular alterations in pediatric Long COVID, including microvessel reduction and increased arterial stiffness. Our findings support a role of vascular changes in Long COVID and highlight the importance of integrating cardiovascular monitoring and follow-up into the management of affected children.

What is known: • Microvascular and endothelial dysfunction appear to play a role in SARS-CoV-2-related diseases. • Adults with Long COVID show persistent capillary rarefaction and endothelial impairment supporting a vascular mechanism underlying ongoing symptoms.

What is new: • Pediatric Long COVID is likewise associated with significant microvascular damage and furthermore with increased arterial stiffness. • Children with dyspnea exhibit a distinct vascular phenotype characterized by marked capillary loss, indicating a potential microvascular origin of persistent respiratory symptoms.

Chemerin is a recently identified adipokine implicated in appetite regulation and energy metabolism. This study aimed to investigate the relationship between serum chemerin levels, nutritional status, and appetitive traits in early childhood. This cross-sectional study included 85 children aged 2-9 years. Appetite-related traits were assessed using the Child Eating Behavior Questionnaire (CEBQ). Anthropometric measurements were obtained, and fasting venous blood samples were collected for biochemical analyses, including serum chemerin levels. Based on the CEBQ results, participants with a food approach score below 39.50 and a food avoidant score above 58.50 were classified as having appetite-related undernutrition (n = 44) and the others as normal appetite (n = 41). Biochemical and anthropometric parameters, as well as chemerin levels, were compared between the two groups. In addition, correlation analyses were conducted to examine the relationships between chemerin levels and biochemical parameters, anthropometric measurements, and CEBQ scores. Serum chemerin concentrations were significantly lower in children with appetite-related undernutrition compared with those with normal appetite (median [IQR] 562.4 [12.6-946.6] vs. 1264.9 [976.3-1765.0] ng/L, p < 0.05). Chemerin levels were positively correlated with food approach traits and inversely correlated with food avoidance traits. Moreover, positive associations were observed with LDL cholesterol, total cholesterol, albumin, and calcium levels.

Conclusion:  Serum chemerin levels were significantly lower in children with appetite-related undernutrition and were associated with both anthropometric measures and appetitive traits, suggesting a link between chemerin and nutritional status in early childhood.

What is known: • Chemerin is an adipokine involved in energy metabolism, adipogenesis, and inflammatory processes. • Elevated chemerin levels have been reported in obesity and metabolic disorders, but data on appetite status in children are limited.

What is new: • This is the first study evaluating serum chemerin levels according to appetite status in healthy children. • Children with appetite-related undernutrition had significantly lower chemerin levels, associated with anthropometric and appetite-related traits.

To compare the diagnostic performance of contrast-enhanced voiding ultrasonography (CEVUS) and direct radionuclide cystography (DRC) at physiological bladder filling volumes in pediatric patients with suspected vesicoureteral reflux (VUR). This prospective, comparative study included 22 children with 44 renal units referred for evaluation due to recurrent urinary tract infections (UTIs). Bladder function was assessed as normal through a four-hour voiding observation or uroflowmetry. All patients underwent both DRC and CEVUS on the same day, using a single catheterization. The investigations were performed by blinded radiologists. The primary outcome was VUR detection in relation to bladder filling volumes. Secondary outcomes included adverse effects and clinical outcomes in relation to radiological findings. DRC detected VUR in 72.7% of patients and 50.0% of renal units, while CEVUS detected VUR in 77.3% and 52.3% respectively. Among patients with paired bladder-filling data at first VUR detection, median bladder filling volume was 37.3% (IQR 26.7-82.4) of expected bladder capacity for DRC and 66.7% (IQR 52.9-87.3) for CEVUS (Wilcoxon signed-rank p = 0.158). At patient level, paired detection rates were comparable between modalities (exact McNemar p = 1.00). At the renal unit level, intermodality agreement was moderate (Cohen's κ = 0.59; 95% CI 0.35-0.83). DRC detected VUR in 4 renal units negative on CEVUS, whereas CEVUS detected VUR in 5 renal units negative on DRC.

Conclusion: CEVUS was comparable to DRC in VUR detection with physiological bladder filling volumes. As a radiation-free method providing anatomical detail while minimizing bladder overfilling, CEVUS offers a valuable alternative to VUR imaging.

What is known: • Voiding cystourethrography and direct radionuclide cystography are established imaging modalities for diagnosing vesicoureteral reflux, but both involve ionizing radiation.

What is new: • Radiation-free contrast-enhanced voiding ultrasonography detects vesicoureteral reflux using physiologic bladder filling volumes with detection rates comparable to direct radionuclide cystography.

This study aimed to explore the feasibility of the Eye Movement Desensitization Reprocessing Integrative Group Treatment for Ongoing Traumatic Stress (EMDR-IGTP-OTS) focused on reducing traumatic stress symptoms in parents of children with neurodevelopmental disorders (NDDs). A process-outcome study was conducted, recruiting parents with children diagnosed with NDDs through the collaboration of NDDs family associations in Emilia-Romagna, Italy. 34 Parents experiencing ongoing traumatic symptoms were randomly assigned to the EMDR group intervention (n = 19) or to the control condition (n = 15). Participants were assessed at pre-test, post-test, and 3-month follow-up. Data were gathered through structured questionnaires screening psychological traumatic stress symptoms. Qualitative data were collected through a therapeutic process diary filled out by the participants. Statistical analysis included descriptive statistics, independent sample t-test, non-parametric analysis, and multiple regression. Mann-Whitney test showed significant differences in traumatic stress symptomatology reduction between the groups, Wilcoxon test showed significant reduction in traumatic stress symptoms over time, and multiple regression data showed that the number of sessions attended predicted the intensity of the traumatic stress symptoms reduction. Qualitative thematic analysis showed that the intervention proved to be feasible and resulted in an increase in positive aspects (e.g., body connection, agency, and pleasant emotions) as the intervention progressed.

Conclusion:  The EMDR-IGTP-OTS is a promising intervention for reducing trauma related parental stress symptoms in parents of children with NDDs. Its high feasibility makes it a suitable option for integration into clinical practice to support families facing trauma-related parenting challenges.

What is known: • Parents of children with neurodevelopmental disorders experience high levels of chronic stress and trauma-relatedsymptoms, yet evidence-based psychological interventions specifically targeting caregivers remain limited.

What is new: • This pilot randomized feasibility study provides preliminary evidence that the EMDR-IGTP-OTS group protocol is feasible and may reduce trauma-related stress symptoms in parents of children with neurodevelopmental disorders.

Tracheomalacia (TM), bronchomalacia (BM), and tracheobronchomalacia (TBM) are important causes of dynamic airway collapse in children and are associated with recurrent respiratory symptoms and increased morbidity. The primary aims of this study were to describe anthropometric parameters in pediatric patients with airway malacia diagnosed by flexible fiberoptic bronchoscopy (FFB) and to determine the prevalence of undernutrition at diagnosis. The secondary aim was to examine nutritional status by age group and malacia subtype. This retrospective study included pediatric patients diagnosed with airway malacia by flexible fiberoptic bronchoscopy (FFB) between January 2019 and February 2025. Anthropometric measurements obtained at diagnosis were evaluated using World Health Organization growth standards for children < 2 years and the U.S. Centers for Disease Control and Prevention 2000 growth charts for those ≥ 2 years. Acute malnutrition was defined as weight-for-length or BMI-for-age z-scores <  - 2, and chronic malnutrition as height-for-age z-scores <  - 2. Nutritional status severity was classified according to standard z-score cutoffs. Exploratory analyses compared anthropometric measurements across malacia subtypes within each age group. Among 1,248 pediatric patients who underwent FFB, 129 (10.3%) diagnosed airway malacia: 32 (24.8%) had TM, 51 (39.5%) had BM, and 46 (35.7%) had TBM. Among these patients, the median age was 1.2 years (interquartile range: 0.5-3.2), and 79 (61.2%) were male. Additionally, 31 (24.8%) had acute malnutrition, and 30 (23.3%) had chronic malnutrition. Among patients aged < 2 years, the weight-for-age percentile and z-score were significantly lower among those with TBM than among those with BM (p = 0.040 and p = 0.047, respectively). Among patients aged ≥ 2 years, the height-for-age percentile and z-score were significantly lower among those with TM and TBM than among those with BM (both p = 0.002; TM vs. BM: p = 0.009; TBM vs. BM: p = 0.008). Body mass index and related parameters did not differ significantly between malacia subtypes.Conclusions: Growth impairment is common in pediatric patients with airway malacia, particularly among those with TBM. Anthropometric evaluation should be an integral part of clinical assessment at the time of diagnosis to identify those at risk of growth failure.

Autoantibodies can predict clinical type 1 diabetes, impacting early diagnosis, prevention, and management. While integrating antibody testing into routine practice is debated globally, ethical considerations are often overlooked. This paper explores these ethical concerns through qualitative analysis based on a literature review. A PubMed literature search provided the foundation for a qualitative ethical analysis. Arguments regarding type 1 diabetes screening were extracted from 92 eligible articles and categorized using Beauchamp and Childress's four ethical principles. A thematic and principle-oriented ethical analysis was conducted. Key ethical concerns include decision-making for children, risk determination, screening timepoints, psychological aspects, DKA rates, treatment options, and monetary and personnel aspects. Addressing these issues ensures general population screening aligns with autonomy, beneficence, nonmaleficence, and justice.Conclusions; General population antibody screening for type 1 diabetes presents ethical challenges requiring careful consideration. While early detection offers benefits, risks such as psychological distress, stigmatization, and resource diversion must be taken into consideration. Further research should assess feasibility, including human resource demands, parental and child anxiety, optimal screening timepoints, development of educational material, children's involvement in screening, and expanding options for prevention, including teplizumab approval in the EU. What is Known: • Autoantibodies can identify individuals at risk for Type 1 Diabetes before symptom onset, and population screening is increasingly discussed as a strategy to reduce complications such as diabetic ketoacidosis at diagnosis. What is New: • This study provides a structured ethical analysis of general population antibody screening for Type 1 Diabetes using the four-principle framework of Beauchamp and Childress (autonomy, beneficence, nonmaleficence, justice) • It identifies key ethical domains, including decision-making for children, psychological impact, screening timing, resource allocation, and emerging preventive options such as Teplizumab, that should guide future implementation and research on population screening programs.

The purpose of the study is to assess the number of attempts required to achieve a peripheral venous access during the first 24 h of life and to identify factors associated with increased difficulty. This is a single-center prospective study including newborns admitted to our neonatal unit within the first 24 h of life who required peripheral venous cannulation. Demographic, clinical, and procedural variables were recorded. Logistic regression analyses were performed to identify factors associated with requiring more than one attempt for successful cannulation. A total of 139 newborns were included. First-attempt success was achieved in 58% of cases. Infants who failed the first attempt had significantly lower gestational age and birthweight and a higher prevalence of hypothermia. No differences were observed regarding hypoxemia, umbilical cord pH < 7.10, nursing experience, or shift. In the univariable analysis, lower birthweight (OR 1.24 per 500-g increase; 95% CI 1.03-1.52) and hypothermia (OR 0.44; 95% CI 0.22-0.86) were associated with reduced odds of first-attempt success. In the multivariable model, both variables showed trends toward significance but did not reach statistical thresholds, possibly due to their frequent coexistence.

Conclusion:  Peripheral venous cannulation within the first 24 h of life frequently requires multiple attempts. Lower birthweight and hypothermia on admission reduce first-attempt success. Optimizing thermal management may help minimize unnecessary painful stimuli during early neonatal care.

What is known: • Peripheral venous cannulation is one of the most frequent painful procedures in neonatal care and often requires multiple attempts. Previous studies have mainly focused on operator-related factors or puncture site as factors influencing first-attempt success.

What is new: • In the first 24 h of life, lower birthweight and hypothermia at admission were associated with reduced odds of first-attempt cannulation success. These findings highlight the importance of optimizing thermal management and anticipating vascular access difficulties in low-birthweight newborns to reduce repeated painful procedures during early neonatal care.