European Journal of Pediatrics最新文献

Obesity is a public health challenge, especially in adolescence, a stage characterized by physiological and behavioral changes that may influence energy balance, lifestyle choices, and long-term health trajectories. Although self-image place a significant role on weight perception, there is no consensus on the impact of self-perceived weight on actual weight development. While some studies suggest that underestimating weight may contribute to subsequent weight gain, others suggest the contrary. The aim of this study was to analyze the influence of weight perception on the evolution of body composition in adolescents followed in an Adolescent Obesity Clinic. An exploratory, longitudinal, retrospective study was carried out, analyzing data from 131 adolescents with obesity (BMI Z-Score ≥ 2.0), with valid data from at least two obesity appointments. 44.3% of the participants had a correct perception of their weight evolution; 41.4% perceived an increase, with real weight loss and 7.1% reported having no perception at all of their weight evolution. Lack of perception of weight evolution was associated with an increase in hip circumference (β = 1.021; 95%CI: 0.791 to 1.318; R² = 31.6%; p = .012). The correct perception of weight gain, compared to the wrong perception of weight loss, was associated with a greater increase in BMI (respectively, β = 5.833; 95%CI: 2.223; 15.304; R² = 67.2%; p < .001; β = .131; 95%CI: 0.003; 0.292; R² = 85%; p < .001).

Conclusion: Accurate perception of body weight changes may influence positively body composition in adolescents with obesity.

What is known: • Adolescence is a critical developmental period for obesity, during which body image and weight perception play a central role in health behaviors and treatment engagement. • Weight status misperception is common among adolescents with obesity and may act as a barrier to effective weight management; however, data focusing specifically on adolescents under obesity treatment are limited.

What is new: • In adolescents with obesity followed in a specialized clinic, inaccurate and lack of perception of weight change is highly prevalent, even under regular clinical monitoring, being associated with unfavorable changes in body composition. • Accurate perception of weight change emerges as a relevant factor linked to body composition evolution, underscoring the clinical importance of assessing and addressing weight perception during adolescent obesity treatment.

Lung ultrasound (LUS) and targeted neonatal echocardiography (TNE) are employed in some neonatal intensive care units throughout the hospital stay to monitor heart- and lung-related morbidities. However, preterm infants are at risk of increased rates of respiratory and cardiovascular morbidities across their lifespan. This commentary aims to define the utility of long-term TNE and LUS follow-up and to assess the challenges of incorporating these techniques into long-term practice. The cardiovascular phenotype of bronchopulmonary dysplasia (BPD) includes diverse cardiac and extracardiac anomalies. Many of these arise during hospitalization and can be detected on a multiparametric echocardiography examination. Nonetheless, several complications of prematurity related to pulmonary vascular disease arise after discharge, notably acute and chronic pulmonary hypertension and pulmonary vein stenosis. Similarly, LUS facilitates the diagnosis and prediction of several respiratory conditions affecting preterm infants during hospitalization, including respiratory distress syndrome and BPD. Limited data exist on LUS evolution after discharge. Multiple studies demonstrated that TNE significantly improves clinical and therapeutic outcomes in critically ill neonates, while evidence supporting LUS utility, though limited, continues to accumulate. Implementation of both LUS and TNE in preterm follow-up is challenged by limitations in training, resources, and institutional support.

Conclusion: Available evidence supports continuous ultrasound cardiopulmonary monitoring from birth through hospital discharge and into long-term follow-up. Neonatologists should look beyond immediate perinatal complications, as cardiorespiratory morbidities may remain subclinical yet emerge months to years later. Their unique integrated assessment of the cardiopulmonary system, coupled with safe and accessible tools, supports post-discharge TNE-LUS implementation without substantial barriers.

What is known: • LUS and TNE are typically utilized during the admission period, a role that is well-defined and extensively documented in the literature. • After discharge, echocardiography provides comprehensive longitudinal data, whereas LUS has been poorly investigated.

What is new: • The utilization of LUS and integrated TNE-LUS after discharge represents a significant research gap and a field of considerable potential utility in the long-term management of preterm infants. • Given their safety profile and accessibility, no substantial barriers preclude their post-discharge implementation.

Gastrointestinal endoscopy is rarely performed in neonates due to concerns regarding safety and technical feasibility. This study aimed to evaluate its safety, feasibility, and diagnostic yield, and to explore its role as both a diagnostic and therapeutic tool in neonatal gastrointestinal diseases. This retrospective study included 42 neonates, both preterm and term, who underwent gastrointestinal endoscopy at Shanghai Children's Hospital between 2015 and 2025. Indications for endoscopy, endoscopic findings, therapeutic approaches and follow-up outcomes were analyzed. All neonates underwent successful gastroscopy, including 4 who also received colonoscopy. The cohort included both term and preterm infants. The most common indication was gastrointestinal bleeding, particularly hematemesis. In preterm neonates, the primary indications were feeding intolerance and the need for enteral nutritional support. Abnormal endoscopic findings were identified in over 85.7% of infants, including mucosal erosion, ulcer, hemorrhagic lesion, congenital or acquired mechanical obstruction and inflammation. Endoscopic interventions included topical hemostatic therapy, nasojejunal tube placement, and balloon dilation. No procedure-related complications such as perforation, respiratory deterioration were observed.

Conclusions: With ongoing advances in gastrointestinal endoscopy and increasing clinical experience, its use in neonates has expanded. In some cases, endoscopy serves as an adjunct to diagnostic evaluation and therapeutic management.

What is known: • Gastrointestinal endoscopy is rarely performed in neonates due to technical limitations and concerns regarding safety. • Most existing studies involve small case series, offering limited data on diagnostic yield and therapeutic potential.

What is new: • A 10-year clinical cohort demonstrates that endoscopy is safe and feasible in both term and preterm neonates using ultrathin instruments. • Endoscopy provides substantial diagnostic value for diverse neonatal gastrointestinal conditions and enables targeted therapeutic interventions, including topical hemostatic therapy, Nasojejunal tube placement, and balloon dilation.

Lumbar puncture (LP) is a common but challenging procedure in neonates, with reported high rates of failure and traumatic taps. Real-time ultrasound (US) guidance may improve accuracy and safety, but evidence in the neonatal population remains limited. We retrospectively reviewed five neonates who underwent two-operator real-time US-guided LP in a tertiary neonatal intensive care unit between 2023 and 2024. Both static pre-procedural assessment and dynamic real-time guidance were applied. Demographic data, operator experience, procedural details, and outcomes were collected. The median gestational age at birth was 38 weeks (range 32-41). At the time of LP, postmenstrual age ranged from 33 to 44 weeks and weight from 1820 to 3960 g. Three procedures were performed by inexperienced operators, one by an intermediate, and one by an experienced operator. All LPs were successfully completed on the first attempt, irrespective of operator experience or patient position (lateral or seated). No traumatic LPs occurred, and no complications were observed. Cerebrospinal fluid (CSF) analysis yielded diagnostic results in all cases, including one case of parechovirus meningitis.Conclusion: Our case series demonstrates that real-time US guidance allows safe and effective LP in neonates, achieving 100% success without trauma even when performed by inexperienced operators. These findings support the feasibility of incorporating US-guided LP into routine neonatal practice. Larger prospective studies are warranted to confirm its benefits and define standardized protocols. What is Known: • Lumbar puncture (LP) in neonates has a high failure and traumatic tap rate compared to older children • Real-time ultrasound guidance can increase LP success and reduce complications in pediatric patients What is New: • Ultrasound guidance proved effective regardless of operator experience, suggesting a role in training and skill acquisition • These findings support the feasibility of systematically implementing ultrasound-guided LP in neonatal clinical practice.

Pediatric battery ingestion can result in serious complications and mortality. We aimed to determine the incidence and complication rate of pediatric battery ingestion in the Netherlands. Cases of pediatric battery ingestion, including patient characteristics, battery characteristics, complications and interventions (2018-2021) were prospectively reported by pediatricians using the Dutch Pediatric Surveillance System and combined with population-related data of Statistics Netherlands. Follow-up data were assessed by standardized questionnaires. In total, 153 episodes of ≥ 1 battery ingestion were reported (49.7% female, median age 2.8 years). An average of 38 episodes per year, reflecting an incidence of 1.18 episodes per 100,000 children per year was found. Most ingested batteries (87.6%) were button batteries. Complications occurred in 26 (17.0%) of battery ingestions. Severe complications were mortality following esophageal-aortal fistula causing hemorrhagic shock (n = 1; 0.7%), carotid artery bleeding (n = 1; 0.7%), tracheal-esophageal fistula (n = 1; 0.7%) and (pneumo)mediastinitis (n = 2; 1.3%). In most cases, batteries were ingested as loose items (n = 47; 30.7%), or as components of lights (n = 25; 16.3%) and toys (n = 22; 14.4%). Complications were significantly associated with younger age (p 0.004), symptoms at first presentation (p < 0.001), larger batteries (p 0.021), and location in the upper (p < 0.001) and middle third part (p 0.037) of the esophagus.

Conclusion: The population-related incidence of pediatric battery ingestion is 1.18 episodes per 100,000 children per year in the Netherlands with 17% complications. Battery swallowing in young children is a life-threatening emergency-urgent action and increased awareness among politicians, industry and healthcare professionals are essential to prevent serious harm.

What is known: • Battery ingestion can lead to severe complications and mortality. • Young children are prone to accidental button battery ingestion due to oral exploration. • Esophageal impaction and related complications are more common in children compared to adults due to small anatomy.

What is new: • The incidence rate of pediatric battery ingestion is rarely described worldwide. In the Netherlands, the incidence is 1.18 per 100,000 children per year. • Unfortunately, complications are relatively often after ingestion (17%).

This prospective observational study investigated the hemodynamic changes in cardiac function and cerebral blood flow velocity (CBFV) in neonates with hypoxic-ischemic encephalopathy (HIE) requiring therapeutic hypothermia (TH). Data were collected at five timepoints, viz., pre-TH (T0), 0-24 h of TH (T1), 24-48 h of TH (T2), 48-72 h of TH (T3), and within 24 h postrewarming (T4). Healthy neonates served as the control group (n = 20). A total of 43 neonates with HIE requiring TH were enrolled. Left ventricular output was significantly lower than that in the control group at T1 and T2 and increased from T1 to T4 (92.8 ± 29.5 ml/kg/min vs. 103 ± 29.7 ml/kg/min vs. 109.5 ± 28 ml/kg/min vs. 144.5 ± 34.4 ml/kg/min (T4 vs. T1, T2, or T3: p < 0.05). Systolic mitral annular velocity and systolic tricuspid annular velocity were lower than those in the control group across T1-T4 (p < 0.05). Middle cerebral artery peak systolic flow velocities increased across T1-T3 (T1 vs. T2, p < 0.05; T1 vs. T3, p < 0.05; T1 vs. T4, p < 0.05).

Conclusion: Irrespective of HIE severity, left cardiac output reduced but consistently increased over time in neonates with HIE who required TH. The trend of CBFV gradually increased throughout the TH and rewarming phase.

What is known: • TH is the standard neuroprotective treatment for moderate-to-severe neonatal HIE, yet survivors continue to face significant neurological sequelae. • Hypoxic-ischemic injury often leads to myocardial dysfunction, and TH itself induces hemodynamic alterations; however, the dynamic evolution of cardiac function and cerebral hemodynamics in neonates with HIE during TH has not been fully elucidated.

What is new: • This study demonstrates that, regardless of HIE severity, left cardiac output decreases initially during TH but consistently recovers over time, and biventricular longitudinal systolic function does not deteriorate during the hypothermia phase. • We further observed a gradual increase in CBFV throughout both TH and rewarming. Additionally, even when using Google Chrome, it was not possible to create line breaks during the editing process while adding this section. I sincerely apologize for any formatting issues this may have caused.

Differentiating serious bacterial infections (SBIs) from viral illnesses in infants remains challenging. Although serum procalcitonin (PCT) is a well-established biomarker, its measurement requires invasive blood sampling. This study investigated the correlation between salivary and serum PCT and evaluated the diagnostic accuracy of salivary PCT for identifying SBIs in infants under 1 year of age. This prospective observational study included 160 infants under one 1 year of age presenting to a pediatric emergency department with suspected SBI. Paired serum and saliva samples were collected. Salivary PCT and serum PCT levels were measured. Serum C-reactive protein (CRP), a routinely used inflammatory marker in pediatric emergency practice, was included as a comparator biomarker. Patients were classified into SBI and viral infection groups based on final diagnoses. The diagnostic accuracy of the biomarkers was assessed and compared using receiver operating characteristic (ROC) curve analysis.Of the 160 infants (median age 8 months; 63% male), 11.3% (n = 18) were diagnosed with SBI and 88.7% (n = 142) with viral infections. Median salivary PCT levels were markedly higher in the SBI group than in the viral infection group (69.3 pg/mL vs. <0.01 pg/mL; p < 0.001). The area under the curve (AUC) for diagnosing SBI was 0.92 for salivary PCT, 0.96 for serum PCT, and 0.88 for serum CRP. At a cutoff value of 31.3 pg/mL, salivary PCT demonstrated a sensitivity of 89% and a specificity of 92.3%, with a negative predictive value (NPV) of 98.7%. A weak but statistically significant correlation was found between serum and salivary PCT levels (r = 0.250; p = 0.001). Conclusion: Salivary PCT shows strong correlation with serum PCT and demonstrates high diagnostic accuracy as a non-invasive biomarker for identifying SBIs in infants. Its performance approaches that of serum PCT and exceeds that of serum CRP, highlighting its potential clinical value in reducing the need for invasive blood sampling. What is Known: • Serum procalcitonin (PCT) is a well-established marker for detecting serious bacterial infections (SBI) in infants, surpassing CRP, though it requires invasive sampling. What is New: • Salivary PCT demonstrates comparable diagnostic performance to serum PCT and exceeds CRP, highlighting its potential as a non-invasive alternative for SBI assessment in infants.

To evaluate the diagnostic performance of and the potential reduction in blood sampling by (a) visual assessment (VA) for jaundice and (b) transcutaneous bilirubinometry (TcB) at 12-24 h after stopping phototherapy in detecting rebound hyperbilirubinemia requiring re-initiation of phototherapy in neonates born at ≥ 35 weeks' gestation. This prospective observational study was conducted at a tertiary neonatal unit in India. Eligible neonates underwent VA using Modified Kramer's method by a neonatal fellow with > 3 years of pediatrics training, TcB using Dräger JM-105™, and total serum bilirubin (TSB) by point-of-care spectrophotometry (One Beam; Ginevri, Italy) at either 12 h (neonates with hemolytic jaundice) or 24 h (neonates with non-hemolytic jaundice) after phototherapy cessation. Outcomes included sensitivity, specificity, likelihood ratios, and reduction in TSB sampling. Among 160 enrolled neonates (gestation: 36 ± 3 weeks; birthweight: 2743 ± 483 g; 35 [21.9%] with hemolytic jaundice), rebound hyperbilirubinemia occurred in 8 (5%). Sensitivity was 100% for both VA and TcB, with VA demonstrating higher specificity (88.2% vs. 71.7%). Positive predictive values were low (VA: 30.8%; TcB: 15.7%), while negative predictive values were 100% for both. Positive likelihood ratios for VA and TcB were 8.4 and 3.5, respectively. VA and TcB could have reduced TSB sampling in 134 (83.8%; 95%CI 77.0-88.7) and 109 (68.1%; 95%CI 60.4-70.9) neonates, respectively.

Conclusions: Given their excellent sensitivity and negative predictive values, VA and TcB can enable ruling out rebound hyperbilirubinemia after stopping phototherapy. Using them as primary screening tools can significantly reduce the need for blood sampling to detect rebound hyperbilirubinemia.

What is known: • Rebound hyperbilirubinemia requiring re-initiation of phototherapy occurs in a subset of neonates with pathological hyperbilirubinemia. • While visual assessment (VA) and transcutaneous bilirubinometry (TcB) are non-invasive methods for monitoring jaundice, their role in identifying rebound hyperbilirubinemia remains unclear.

What is new: • This study shows excellent sensitivity and negative predictive values of VA and TcB for detecting rebound hyperbilirubinemia. • The results suggest the potential of these two non-invasive methods to decrease blood sampling for serum bilirubin levels, making them valuable tools particularly in resource-constrained settings.