European Journal of Pediatrics最新文献

Achieving optimal vancomycin trough concentrations in vivo is crucial to its therapeutic effectiveness. This study was a retrospective, single-center, observational cohort analysis designed to further investigate factors affecting vancomycin trough levels and adverse reactions in pediatric patients with infections, building upon previous research on the rational pediatric use. Additionally, we explored the relationship between vancomycin trough levels and clinical symptom improvement in children infected with Methicillin-resistant Staphylococcus aureus (MRSA). The findings demonstrated that initial vancomycin dosing regimens, as well as serum albumin, hemoglobin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase levels, did not differ significantly among the three trough concentration groups: target (10-20 mg/L), high (≥ 20 mg/L), and low (< 10 mg/L) (P > 0.05). The estimated glomerular filtration rate (GFR) values at treatment initiation were 108.4 (87.8-163.7), 95.2 (65.8-144.3), and 149.8 (95.3-201.6) for the three groups, respectively (P < 0.05). Multiple linear regression identified GFR as the most predictive variable for vancomycin trough concentration, showing a negative linear correlation with the initial GFR value in children undergoing vancomycin treatment (R² = 0.1565, P = 0.014). For children with MRSA infections, the time to normalization of infection markers and the time to negative microbial cultures were shorter in the target and high trough concentration groups compared to the low trough concentration group (P < 0.05). However, the incidence of acute kidney injury during hospitalization was higher in the high concentration group compared to the target and low concentration groups. Therefore, vancomycin trough concentrations in pediatric patients are inversely related to GFR levels. There were no statistically significant differences in the rates of acute liver injury, thrombocytopenia, neutropenia, or 30-day mortality among the three groups (P > 0.05).Conclusion: For children with MRSA infections, clinical effectiveness is superior at target and high vancomycin trough concentrations; however, elevated trough concentrations are linked to an increased risk of acute kidney injury. Clinically, vancomycin should be administered at lower doses as recommended by guidelines.

The aim of the study was to compare the effectiveness of daycare-simulated interrupted phototherapy versus continuous phototherapy for treating neonatal jaundice. A parallel randomized controlled trial with one-to-one allocation was conducted involving low-risk jaundiced neonates. The neonates in the intervention group received 10 h of phototherapy, while the control group received continuous phototherapy for 24 h. Total serum bilirubin (TSB) was measured before the start of phototherapy and at 24 h of treatment. Seventy-four neonates were recruited, and 37 neonates were randomly allocated to each group. The mean rate of fall of TSB per hour was not statistically significantly different between the intervention and control groups (1.71 versus 1.9 µmol/L/h; p = 0.529). The mean of TSB post-treatment in the intervention group was higher than in the control group and statistically significant (182 versus 158 µmol/L; p = 0.045) but not clinically significant, as none of the neonates required reinstitution or continuation of phototherapy.

Conclusion:  Ten hours of phototherapy which could be given in daycare may be effective and safe.

Trial registration: This trial wasregistered with Australian New Zealand Clinical Trials (trial ID: ANZCTR 12624000860561) prospectively on 12 July 2024.

What is known: • Intermittent phototherapy is known to be as effective as continuous phototherapy.

What is new: • We designed a study in which phototherapy was interrupted after 10 h, simulating daycare phototherapy. • Daycare phototherapy for 10 h may be feasible in treating neonatal hyperbilirubinemia in low-risk neonates.

Invasive candidiasis poses a serious risk to preterm infants, due to its rapidly progressive and severe clinical course, resulting in considerable mortality and long-term morbidity. Therefore, the aim of the current study was to assess the clinical characteristics of invasive candidiasis in very preterm infants to increase awareness among clinicians. A multicenter cohort study database was screened for infants, born in one of ten Neonatal Intensive Care Units (NICUs) in the Netherlands and Belgium between October 2014 and May 2025, with blood- and/or cerebrospinal fluid culture-proven invasive candidiasis (gestational age < 30 weeks) in the first 29 days of life. Clinical data were retrospectively collected. Out of 2.824 infants, 24 were diagnosed with invasive candidiasis (0.8%), most frequently caused by Candida albicans (83%). Affected infants demonstrated distinct clinical features: extreme prematurity (mean 25.7 weeks ± 9 days), low birth weight (mean 827 ± 198 g), vaginal delivery (88%), and sepsis and/or gastrointestinal disease prior to clinical onset (46%). In 58%, initiation of antifungal treatment was delayed. The disease course was generally severe with end-organ disseminated candidiasis (33%), need for invasive ventilation (58%), cardiorespiratory support (42%), and red blood cell and/or platelet transfusion (71% and 33%). Both C-reactive protein and platelet count at diagnosis were associated with fatal outcome (p = 0.040 and p = 0.010, respectively).

Conclusion: In infants with distinct clinical features, clinicians should maintain a high index of suspicion, particularly in NICUs with a higher incidence of Candida colonization and/or infection. Our findings underline the need for a rapid diagnostic test to reduce treatment delays and improve clinical outcomes.

What is known: • Invasive candidiasis poses a risk to preterm infants due to its rapidly progressive disease course, high mortality, and long-term morbidity. • A critical need exists to enhance vigilance among clinicians, enabling timely diagnosis, and initiation of targeted treatment.

What is new: • Affected infants are characterized by shared clinical features and substantial disease burden. • Frequent vaginal delivery in affected infants suggests that colonization and infection may result from vertical transmission, offering opportunities for early prevention.

To evaluate parental perceptions and experiences of neurally adjusted ventilatory assist (NAVA) in neonatal intensive care, focusing on understanding, comfort, and willingness to recommend its use. A survey of parents whose infants received NAVA or Non-invasive ventilation (NIV) NAVA at a tertiary NICU between January 2024 and July 2025. St George's University Hospitals NHS Foundation Trust, London, UK. Fifty parents were invited; 32 returned completed surveys (response rate: 64%). Parent-reported understanding of ventilation modes, perceptions of infant comfort and willingness to recommend NAVA. Most respondents (81%, n = 26) felt staff explained different modes of breathing support clearly; 4 (13%) found explanations unclear, and 2 (6%) received none. Seventeen (53%) parents felt their baby was calmer and more settled during NAVA/NIV NAVA compared with other modes; 11 (34%) noticed no difference, and 4 (13%) perceived less comfort. The NAVA catheter scored a mean of 3.77/5 for comfort. Twenty-three (78%) stated they were "very likely" to recommend NAVA, 5 (16%) were "likely," 1 (6%) was "neutral," and 2 (12%) would not recommend it.Conclusion: Most parents reported positive perceptions of NAVA, with improved comfort compared with conventional modes.

Advancements in care for critically ill children have lowered mortality but increased morbidity in survivors. Post-intensive care syndrome (PICS) in children including their families (PICS-p) underscores the need for interventions to mitigate long-term effects. Early mobilization shows promising results in adults; however, evidence in pediatrics is limited. Enhanced parental involvement may contribute to improved long-term psychological outcomes. This pilot study examines the impact of an early mobilization program on parental stress and psychological health after admission on a pediatric intensive care unit (PICU). This single-center pilot study was conducted between 2021 and 2024 at the PICU of the Radboudumc University Hospital. Data of parents of patients admitted before (n = 45) and after (n = 45) implementation of an early mobilization bundle (December 2022) were compared. Parental psychological health outcomes were assessed using validated post-traumatic stress disorder (PTSD), burden scales, anxiety, and depression questionnaires, completed within 3-6 months after admission. Ninety patients were enrolled. There was no significant difference between pre- and post-intervention groups, but a trend towards lower parental experienced distress score (2.2 (IQR 0-8) vs 4.0 (IQR0-9) p 0.08) and lower depression scores in fathers (8.5 (IQR 8-15) vs 9.5 (8-32), p 0.07) in the post-intervention group was observed.

Conclusion: Although no significant effect of early mobilization on parental psychological health was found, a trend towards a positive effect on the experienced distress scale and the paternal depression score emerged. A future nationwide study, on larger scale, is intended to further evaluate these findings.

What is known: • Early mobilization in adult critical care improves patient recovery and reduces ICU-acquired weakness and improves physical and psychological outcomes. • In the pediatric critical care setting, early mobilization is considered safe and feasible, but research on long-term effects is limited.

What is new: • This study focuses on the long-term effects of early mobilization on parental psychological health. • Findings indicate no significant difference between pre- and post-intervention group, but a positive trend of early mobilization on experienced distress scale and paternal depression score.

Single-balloon enteroscopy (SBE) and double-balloon enteroscopy (DBE) are widely used for diagnosing small-bowel disorders in adults. However, anatomical differences in children present unique challenges for operators. This meta-analysis evaluates the efficacy and safety of both techniques in pediatric patients, comparing results with adult data. A comprehensive literature search was performed to identify studies evaluating SBE and DBE in pediatric small-bowel disorders. Primary outcomes included diagnostic yield, therapeutic yield, and incidence of adverse events. Secondary outcomes included depth of maximal insertion (DMI), complete enteroscopy rate, and other relevant measures. A univariate random-effects meta-analysis was conducted. Twenty-four studies comprising 1463 patients were included. The pooled diagnostic yield was 0.72, therapeutic yield 0.61, oral DMI 211.6 cm, rectal DMI 137.9 cm, and complete enteroscopy rate 0.10. DBE achieved greater DMI and a higher complete enteroscopy rate than SBE, with other outcomes remaining comparable. The overall adverse event rate was 5.50%. Compared to data from adult meta-analyses, pediatric balloon enteroscopy (DBE and SBE) is associated with a lower rate of complete enteroscopy (0.44 in adults), a more limited depth of insertion (262 cm orally in adults), and a higher adverse event rate (2% in adults).

Conclusion:  This meta-analysis suggests that both SBE and DBE may be safe and effective for pediatric small-bowel disorders. However, outcomes in children, including shallower insertion, lower complete enteroscopy rates, and higher adverse events, differ from adults. Given the low certainty of evidence, these findings, particularly differences between techniques, are preliminary and require confirmation in future standardized studies.

Trial registration: The study protocol has been registered in PROSPERO ( https://www.crd.york.ac.uk/prospero ) under the registration number CRD420251131086.

What is known: • Balloon enteroscopy (DBE and SBE) is well-established for small-bowel diseases in adults. • Due to anatomical differences, balloon enteroscopy faces challenges in pediatric applications, and its performance and safety in children remain uncertain.

What is new: • This first meta-analysis to directly compare SBE and DBE in children demonstrates comparable diagnostic and therapeutic yields. • Pediatric procedures are associated with lower complete enteroscopy rates, shallower insertion, and higher adverse event rates compared to adults.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is the most common periodic fever syndrome in children. On-demand corticosteroids stop attacks but may shorten fever-free intervals. This systematic review assessed the effectiveness of daily colchicine prophylaxis in pediatric PFAPA. Furthermore, MEFV status association with colchicine efficacy has been explored. PubMed, Scopus, and Web of Science were systematically searched from inception to 6 November 2025 to identify trials and observational studies presenting participants with a diagnosis of PFAPA, colchicine prophylaxis as interventions, and attack frequency/attack-free interval as outcomes. All eligible records identified up to that date were screened.

Conclusion: Colchicine reduced attack frequency, lengthened attack-free intervals, and lowered steroid use, with benefits often within 1 month. A short randomized comparison showed similar 3-month efficacy to cimetidine. Adverse events were mostly mild gastrointestinal; discontinuations were uncommon. MEFV variants as predictors of response remain uncertain. Current evidence supports colchicine as an efficacy and generally well-tolerated preventive option.

What is known: • PFAPA is the most common periodic fever in children. On-demand corticosteroids stop attacks but may shorten symptom-free intervals; preventive options include cimetidine, selective tonsillectomy, and biologics. • Colchicine modulates innate immunity and it is effective in familial Mediterranean fever; MEFV variants occur in a subset of PFAPA, supporting interest in repurposing.

What is new: • Continuous colchicine reduced attack frequency, prolonged attack-free intervals, and lowered steroid use; adverse events were mostly mild gastrointestinal, with few treatment discontinuations. • Clinical improvement often appeared by about 1 month and stabilized by 3 months; this supports early reassessment to adjust dose or change therapy. MEFV is not clearly associated.

Acute eosinophilic pneumonia (AEP) is a rare, rapidly progressive respiratory disease characterized by diffuse pulmonary eosinophilia. Its etiology, clinical course, and prognosis in children remain incompletely understood. We conducted a retrospective cohort study at Yuying Children's Hospital, enrolling children diagnosed with AEP between January 2014 and December 2024. Demographic, clinical, laboratory, radiological, treatment, and outcome data were analyzed. Among 31 patients with pediatric AEP, the highest proportion occurred in autumn (38.7%). Respiratory infections were identified in 26 (83.9%) patients, most commonly Mycoplasma pneumoniae (n = 12) and human bocavirus (n = 4). Passive smoke exposure was identified in five patients (16.1%). Children with allergic comorbidities (10/31, 32.3%) demonstrated significantly elevated total immunoglobulin E levels (median, 742.0 vs. 317.5 IU/mL, P = 0.012), but otherwise comparable clinical laboratory profiles. Fifteen patients (48.4%) who presented with respiratory failure demonstrated significantly elevated procalcitonin (PCT, 0.39 vs. 0.07 µg/L, P = 0.002) and D-dimer levels (1.10 vs. 0.55 µg/mL, P = 0.015), longer hospital stays (7.0 vs. 5.0 days, P = 0.028), and a higher prevalence of pleural effusion (53.3% vs. 18.8%, P = 0.044) compared with the non-respiratory failure group. Twenty-two patients (71.0%) received systemic corticosteroids. Most achieved full recovery, though asthma (n = 5) was observed during follow-up.

Conclusion:  Pediatric AEP is primarily infection-driven, with a probable autumn seasonality and passive smoke exposure as a potential co-trigger. Elevated PCT and D-dimer levels are associated with the development of respiratory failure. The overall prognosis is generally favorable, but long-term follow-up is essential to monitor sequelae.

What is known: •  AEP is a rare, acute hypoxemic disease characterized by eosinophil-mediated inflammation triggered by infection, inhalational exposures, or medications. •  It responds rapidly to corticosteroid therapy; pediatric-specific guidelines are lacking, and existing evidence is largely limited to case reports.

What is new: •  Pediatric AEP appears to be primarily infection-driven, with autumn clustering and a potential contribution from passive smoke exposure, while generally maintaining a favorable prognosis. •  Elevated PCT and D-dimer levels are associated with the development of respiratory failure in pediatric AEP.

The choice of vascular access (VA) plays a key role in the success of hemodialysis (HD). Despite their widespread use, central venous catheters (CVCs) are associated with higher rates of dysfunction, thrombosis, and catheter-related bloodstream infections (CRBSI). We investigated current practices in pediatric HD across European pediatric nephrology centers, focusing on VA choices, infection control measures, and CRBSI management. An online questionnaire was e-mailed to 119 members of the European Society for Pediatric Nephrology (ESPN) Dialysis Working Group and European Pediatric Dialysis Working Group (EPDWG). Descriptive statistics were used to summarize practices across centers, comparative analyses between centers in countries with Human Development Index (HDI) > 0.90 and < 0.90. Thirty-one centers across Europe participated in the survey. CVCs were the primary VA in 73.1% of the centers. Twenty (66.7%) centers reported malfunction as the most common CVC complication, followed by catheter thrombosis (19.4%) and CRBSI (12.9%). The diagnostic approach for CRBSI varied widely, with 35.4% of centers relying on a single positive catheter culture, while 57.9% did not collect a second culture from the peripheral vein or HD circuit. The most common empirical treatment was glycopeptides combined with third-generation cephalosporins. Nearly all centers used intravenous antibiotics for less than 3 weeks, and over half modified lock solutions with antibiotics following CRBSI diagnosis. Catheter removal practices were inconsistent, even in cases of severe infection. Centers reported a total of 548 HD patients. Exit-site infections and CRBSI were observed in 98 (17.8%) and 155 (28.2%) patients, respectively. CRBSI rates and CRBSI-related catheter replacements were significantly higher in centers from countries with HDI < 0.90 and in centers without a dedicated pediatric HD unit.

Conclusion: The suboptimal adherence to current VA recommendations and wide variability in catheter care practices including the prevention, diagnosis, and management of CRBSI highlight the need for standardized pediatric-specific protocols to enhance catheter longevity and improve patient outcomes.

What is known: • Central venous catheters are widely used in pediatric hemodialysis but carry a high risk of complications, especially catheter-related bloodstream infections (CRBSI).

What is new: • This multinational survey reveals significant variability in vascular access selection, CRBSI prevention, diagnosis, and treatment across European pediatric hemodialysis centers, with clear disparities by national HDI levels. • The findings highlight the need for standardization of vascular access care and CRBSI management and evidence-based pediatric-specific guidelines.