European Journal of Pediatrics最新文献

To assess the short-term safety of doxapram for treating apnea of prematurity. This is a retrospective and bicenter study. Eligible children were born before 28 weeks of gestation from January 1, 2020 to December 31, 2021. The association between doxapram treatment and gastrointestinal events was assessed with logistic regression models with adjustment for the main confounding factors: center, sex, intra-uterine growth restriction and gestational age. The main outcome measures are gastrointestinal events (necrotizing enterocolitis or feeding intolerance), the adverse effects of doxapram most frequently reported in the literature. The population consisted of 268 children; 113 (42.2%) received doxapram. As compared with children who did not receive doxapram, those who did had lower gestational age at birth (25.4 vs 26.3 weeks), lower birth weight and more evidence of greater clinical respiratory severity. Doxapram treatment was not associated with increased risk of gastrointestinal events (30.1% and 29.7% in the treated and untreated groups; odds ratio 1.3, 95% CI 0.7-2.4, p = 0.43). More children in the treated than untreated group had high blood pressure (25.7% vs 6.5%).

Conclusion: In children born before 28 weeks of gestation, doxapram treatment for apnea of prematurity was not associated with the occurrence of gastrointestinal events.

What is known: • Doxapram is a well-known second-line treatment for apnea of prematurity. It is a central nervous stimulant that can be used in refractory apnea of prematurity despite continuous positive airway pressure and optimal caffeine therapy. However, its use varies among countries and centers, probably because of suspected adverse effects. Studies suggest that this drug may have potential side effects such as digestive events (necrotizing enterocolitis).

What is new: • We present reassuring data on the digestive safety of doxapram. Use of this drug was not associated with increased rates of digestive events in preterm infants born before 28 weeks of gestation.

Cardiac injury is the critical issue in children with MIS-C, particularly coronary artery dilation. This study aimed to describe the prevalence, risk factors associated with coronary artery abnormalities, and their progression after 3 months of follow-up in MIS-C children in Vietnam. A prospective multicenter case series study was conducted on MIS-C patients diagnosed per WHO criteria from September 2021 to February 2023 at the two largest pediatric hospitals in southern Vietnam. Data on demographics, clinical features, laboratory findings, and treatments during the acute phase of MIS-C were collected. Patients were followed for 3 months post-discharge and categorized into normal and abnormal coronary artery groups for comparative analysis. Among 195 patients (mean age 6.3 years; male to female ratio 1.5:1), 33.3% exhibited coronary artery abnormalities at admission. Treatment included a combination of intravenous immunoglobulin (IVIG) and corticosteroids (53.3%), corticosteroids alone (42.6%), and IVIG alone (4.1%). After 3 months, only 3.6% of patients had persistent coronary artery abnormalities. Independent risk factors for coronary artery dilation included male sex (OR 4.59; 95% CI 1.62-12.94; p = 0.004), Kawasaki-like phenotype (OR 6.42; 95% CI 2.25-18.33; p = 0.001), and mesenteric lymphadenitis (OR 8.79; 95% CI 1.74-44.31; p = 0.008).

Conclusion: Coronary artery dilation in MIS-C patients shows a favorable recovery trajectory after a 3-month follow-up. Male sex, Kawasaki-like MIS-C, and mesenteric lymphadenitis are independent risk factors for coronary artery dilation in MIS-C patients.

What is known: • Multisystem inflammatory syndrome in children (MIS-C) is a severe inflammatory syndrome following SARS-CoV-2 infection, often leading to cardiac complications, particularly coronary artery dilation.

What is new: • Coronary artery dilation in MIS-C patients mostly resolves within three months of follow-up. Factors associated with coronary artery dilation in MIS-C patients include: male sex, Kawasaki-like phenotype and mesenteric lymphadenitis.

Preterm neonates have immature body organs and even have stronger sensitivity towards environmental stress as compared with normal neonates. The NICU is a stress-causing environment because of noise produced from various sources like medical devices, monitor alarms, staff conversation, and the sound of cries from different neonates. The American Academy of Paediatrics recommends sound level should be less than 45 dB in NICU. A non-randomized, controlled, before-after, quality improvement, observational prospective cohort study was conducted on 100 preterm neonates. The samples were divided into two groups of 50 each: control and experimental. Physiological parameters were recorded, and the ABSS tool was used to assess behavioral responses. The control group received routine care, while the experimental group was provided with earmuffs. The study revealed significant improvements in physiological parameters and behavioral responses in preterm neonates using earmuffs. Experimental group neonates showed better thermal stability, reduced stress, improved respiratory and cardiovascular stability, and enhanced oxygenation (p < 0.001). Behavioral improvements included increased sleep duration and reduced restlessness, with statistically significant differences observed in all parameters compared to the control group.

Conclusion: We conclude that the application of Earmuff is a fruitful method for preterm neonates to improve and stabilize the physiological parameters and behavioral response.

What is known: • Excessive noise in NICUs causes stress and physiological instability in preterm neonates. • Noise reduction strategies, including ear protectors, help stabilize vital signs and improve neonatal outcomes.

What is new: • This study confirms the effectiveness of earmuffs in improving physiological and behavioral responses in preterm neonates. • It demonstrates the feasibility of earmuff use in routine neonatal care within the study region.

Assessment of beta-cell function in type 1 diabetes (T1D) has important implications in both clinical and research settings. Studies demonstrating the extent to which puberty influences C-peptide levels are scarce. The aim of this study was to evaluate the influence of pubertal stage, along with age and body mass index (BMI), on multiple C-peptide measures at T1D diagnosis. This study included 275 consecutive children aged between 1 and 18 years with newly diagnosed T1D. Fasting, prandial, and area under the curve (AUC) C-peptide, estimated using fasting and prandial C-peptide levels, were analyzed. Generalized linear regression models were utilized. Median age at diagnosis was 7.9 (1.1-17.3) years, and mean BMI standard deviation score (SDS) was - 0.4 ± 1.4. Of the patients, 66% were prepubertal. Median fasting and prandial C-peptide levels at diagnosis were 0.26 (0.05-1.8) ng/mL and 0.43 (0.05-3) ng/mL, respectively. Fasting C-peptide was almost perfectly correlated with prandial C-peptide (r_s = 0.80, P < 0.001). Fasting, prandial, and AUC C-peptide were positively related with BMI SDS, age, and pubertal stage at diagnosis (P < 0.001 for all). All the associations persisted when the variables were included as independent variables in regression models.

Conclusions: Pubertal stage significantly and independently impacts C-peptide levels at T1D diagnosis along with body mass index and age. The adjustments demonstrating the extent to which puberty influences C-peptide levels in new-onset T1D are presented. Our observations underline the existence of distinct endotypes of T1D characterized by differing immunopathological courses.

What is known: • Throughout the evaluation of beta-cell function at T1D diagnosis, it is essential to consider the factors influencing C-peptide levels.

What is new: • While age and BMI at diagnosis are associated with beta-cell function, our findings set the stage for a greater understanding of the disease process with additional findings regarding puberty, supporting the existence of endotypes of T1D.

The diagnostic accuracy of magnetic resonance (MRI) signs of intracranial hypertension (ICH) in children remains unclear. This study aims to assess how brain MRI signs of ICH correlate with cerebrospinal fluid opening pressure (CSFOP). A retrospective case-control study was conducted with 77 children aged 1 to 18 years, who underwent brain MRI and lumbar puncture with CSFOP measurement. A blinded radiologist evaluated key ICH signs, including distension of the perioptic subarachnoid space, optic nerve (ON) tortuosity, posterior scleral flattening, intraocular protrusion, and enhancement of the prelaminar ON, among others. Odds ratios, likelihood ratios, predictive values, sensitivity, specificity, and the area under the ROC curve (AUROC), were calculated in relation to CSFOP, adjusted for age and sex. The ICH group included 38 patients (49.3%) and the control group 39 (50.7%). The presence of four or more MRI signs of ICH provided the best diagnostic performance (specificity 92%, sensitivity 40%, AUROC 0.759) for identifying elevated CSFOP, particularly with intraocular protrusion of the prelaminar ON (p = 0.006, median CSFOP 49.6 cm H₂O, p < .001) and papilledema (p = 0.042).

Conclusion: The presence of four or more MRI signs is associated with elevated CSFOP in children with non-structural ICH.

What is known: • The diagnostic accuracy of magnetic resonance imaging (MRI) signs of intracranial hypertension (ICH) in children remains unclear. • In children, there is no consensus about the most appropriate diagnostic criteria or robust evidence regarding the diagnostic performance of imaging signs for ICH.

What is new: • The presence of four or more MRI signs is associated with elevated cerebrospinal fluid opening pressure (CSFOP) in children with non-structural ICH. • Intraocular protrusion of the prelaminar ON, and papilledema are particularly relevant signs for identifying elevated CSFOP.

The purpose of this study was to compare two initial surgical strategies for spontaneous intestinal perforation (SIP) in a bi-centric cohort of extremely preterm and/or extremely low birthweight infants. Observational, retrospective study including infants born before 28 weeks of gestation and/or with birthweight < 1000 g, born between 2010 and 2020, operated for SIP in two type 3 centers. Infants were attributed to groups according to the surgical technique of the first intervention: primary anastomosis or suturing (PAS) or enterostomy (ES). The primary endpoint was the duration of parenteral nutrition (PN) analyzed using multivariate Cox model. Secondary endpoints included total number of surgeries under general anesthesia, morbidity and mortality at discharge, and outcomes at 2 years. Among 65 included patients, those in the PAS group (n = 46) had a higher median [IQR] CRIB II score than those from the ES group (n = 19) (11.5 [10-13] vs 8 [4-10], p = 0.01) and were more frequently operated in Robert Debré (78% vs 21%, p < 0.001) but had comparable other clinical characteristics at birth and at the time of surgery. As compared to the ES group, infants from the PAS group had a significantly higher probability of NP weaning after adjustment (adjusted hazard ratio 3.05, 95% CI [1.43-6.49]) and a significantly lower median [IQR] number of general anesthesia (1 [1-1] vs 2 [2-2], p < 0.001). At discharge and at age 2, there was no significant difference in outcomes between groups. Conclusion: Initial one-stage surgery for SIP in extremely preterm infants was associated with shorter NP duration and fewer general anesthesia in this study.

This study assessed the dietary intake of European children by country, gender, and obesity degree across six European countries participating in the Feel4Diabetes study. It also compared food group intakes with European food-based dietary guidelines. The Feel4Diabetes study included 9,847 children (50.4% girls) from six European countries. Families provided baseline data on energy balance-related behaviors and socioeconomic factors via questionnaires. Children's dietary intake and breakfast consumption were assessed using semi-quantitative food frequency questionnaires, and anthropometric measurements were taken. Intake from 11 food groups was analyzed by country, gender, and obesity degree. Chi-square analyses compared food intake with dietary guidelines. "Nutrient-dense " foods (e.g., fruits, vegetables, whole grains) and "energy-dense, low-nutrient" foods (e.g., high in added sugars, saturated fats) were categorized based on the European food-based guideline. Over 85% of children consumed breakfast 5-7 days a week, with no significant differences by Body Mass Index (BMI) or country. Mean intakes of nutrient-dense food groups fell below recommendations, while the intake of energy-dense, low-nutrient foods exceeded limits, particularly in children with overweight/obesity (p = 0.048). No significant gender differences were observed in most food groups.

Conclusions:  Dietary intake varied by country and obesity degree among European children. Across the six countries, children's diets did not align with food-based dietary guidelines. These findings underscore the need for interventions promoting healthier eating habits among European children.

Trial registration: The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872),  http://clinicaltrials.gov What is Known: • Childhood obesity is a growing concern across Europe, with some variations in food consumption observed between European countries • Previous studies have highlighted the role of diet in childhood obesity, but few have examined cross-country comparisons while accounting for gender and BMI status.

What is new: • This study provides a comprehensive cross-country analysis of children's dietary intake, considering gender, BMI status, and adherence to European dietary guidelines. • New insights into gender differences in sweets consumption and the positive association between BMI and food intake (such as soft drinks and sweets) are presented, which can inform targeted dietary interventions.

The measurement (M) of blood pressure (BP) in children may be challenging, and the ideal approach, free of critical issues (such as the interference due to the white coat effect or to the high variability), has yet to be identified. Herein, we compare BP as measured with multiple office BP monitoring (mOBPM) with the standard approach as suggested by guidelines. A cohort of healthy children underwent two mOBPMs 1 year apart. Mean systolic and diastolic values obtained by mOBPM were compared with the 1st, 2nd, 3rd, and 4th measurements (repeated measures ANOVA). mOBPMs with a coefficient of variation (CV) > 15% were excluded. The number of children with BP > 90th centile was determined based on (a) each of the initial three readings, (b) the mean of the 2nd and 3rd Ms, (c) the 4th M, (d) the mOBPM at baseline, and (e) 1 year apart. Out of 164 enrolled children, 13 (7.9%) were excluded because of a CV > 15%. The analysis on the remaining 151 children showed that the first three Ms provided a significantly higher BP than the mOBPM. The 4th M was the first one to be aligned with the results of the mOBPM. Based on the 1st, 2nd, 3rd, and 4th Ms, a BP > 90th centile was observed in 29, 20, 21, and 16 children, respectively. The mean of the 2nd and 3rd Ms identified 12 children with high BP, while the mOBPM revealed elevated BP in only 6 children and this finding was confirmed only in 3 of them 1 year later.

Conclusion: The first three readings systematically overestimate BP, while the 4th one better aligns with the mOBPM. If the 4th reading is abnormal, the complete mOBPM will likely offer a more reliable BP assessment.

What is known: • Blood pressure measurement may be challanging and initial readings systematically overestimate real values.

What is new: • The 4th blood pressure reading better aligns with the mean of 10 measurements. In daily clinical practice, if the 4th reading is abnormal, the complete mOBPM (www.mobpm.com) will likely offer a more reliable BP assessment.