European Journal of Pediatrics最新文献

In pediatric outpatient care, overuse and misuse of antibiotics is linked to a high risk of adverse events and increased antibiotic resistance. In 2019, building upon the work of the Antibiotic Therapy in Bielefeld (AnTiB) project (founded in 2016), a collaboration among the AnTiB, the German Society for Pediatric Infectious Diseases (DGPI), and the Professional Association of Outpatient Pediatricians and Adolescent Physicians (BVKJ) was established to develop consensus recommendations for antibiotic therapy in pediatric outpatient settings in Germany. This working group became the Antibiotic Stewardship in Outpatient Pediatrics (ABSaP). ABSaP institutes recommendations for antibiotic use in outpatient pediatric settings in Germany and updates them regularly. The ABSaP guidelines recommend restrictive, targeted, evidence-based prescription practices for antibiotics used to treat common infections among pediatric outpatients. This expert-driven, pragmatic, best-practice guidance is designed to be a living document. ABSaP's most recent update was published in March 2024. The recommendations aim to guide and standardize rational antibiotics use by emphasizing the importance of avoiding unnecessary prescriptions, while also promoting the application of narrow-spectrum antibiotics, short-duration therapy, and watchful waiting, when treating mild, self-limiting infections in children without significant risk factors.

Conclusions: ABSaP's guidelines may provide a model for others, as well as offer a basis for discussing practical, effective antibiotic stewardship (ABS) measures in pediatric primary care. An international, expert consensus on ABS for pediatric outpatients could help promote a culture of responsible antibiotic use, improve prescribing safety, and contribute to broader ABS efforts.

What is known: • Overuse and misuse of antibiotics are associated with adverse events and increased antibiotic resistance, prompting the need for effective antibiotic stewardship initiatives. • The Antibiotic Stewardship in Outpatient Pediatrics (ABSaP) working group was established to develop and regularly update evidence-based best practice recommendations for the targeted and restrictive use of antibiotics in pediatric outpatient settings in Germany.

What is new: • The most recent update of the ABSaP guidelines was published in March 2024, emphasizing the importance of narrow-spectrum antibiotics, short-duration therapy, and watchful waiting for mild infections, aiming to standardize rational antibiotic use in children. • The ABSaP guidelines have become widely accepted in Germany and are now being translated into English to foster international dialogue and collaboration on antibiotic stewardship in pediatric primary care, potentially serving as a model for similar initiatives in other countries.

Biochemical analyses of cerebrospinal fluid (CSF) are routinely performed at diagnosis in many pediatric oncology and hematology centers when acute leukemia is diagnosed. However, the clinical relevance of these analyses remains unclear. We conducted a retrospective analysis of biochemical CSF data from children diagnosed with acute leukemia at two French hospitals between 2016 and 2023 assessing the results in relation to the presence or absence of leukemic neuromeningeal involvement and the correlation between cytological and biochemical analyses. On 151 patients, 13 had a central nervous involvement (CNS), only one with neurological symptoms. All our patients had a biochemical analysis of CSF at diagnosis. We did not find any strong correlation (p < 0.05) between cytological studies and biochemical analysis in CSF.

Conclusion: Without therapeutic impact, we conclude that routine measurement of biochemical analysis in the CSF is not indicated in children with acute leukemia.

What is known: • Biochemical analysis of the cerebrospinal fluid (CSF) is routinely performed in children with acute leukemia in some centers while its clinical value remains uncertain. • Cytology is the gold standard technique for the detection of central nervous system (CNS) involvement in leukemia.

What is new: • No significant correlation was found between CSF biochemical and cytological analyses and CSF biochemical analysis had no added clinical value in this study. • Our results suggest that routine CSF biochemical analysis may be omitted in this clinical context.

Purpose: High-accuracy diagnostic screening tests for Mycobacterium tuberculosis (MTB) infection are required, primarily to detect patients with latent infections (LTBIs) in order to avoid their progression to active tuberculosis disease. The performance of the novel IGRA LIOFeron®TB/LTBI was evaluated in children. The originality of this test is the new MTB antigen contained (L-alanine dehydrogenase), identified as a tool to differentiate active TB from LTBI infection.

Methods: From March 2022 to November 2023, a population of 90 children was enrolled and grouped into healthy, active TB or LTBI individuals, based on diagnostic guidelines. The blood of all these participants was tested with LIOFeron®TB/LTBI assay in comparison to diagnosis, as gold standard, and to the current used IGRA QuantiFERON®-TB Gold Plus.

Results: The two assays demonstrated an excellent concordance of their results with patients' diagnosis of MTB infection. The performance of LIOFeron®TB/LTBI assay in terms of accuracy of MTB infection diagnosis was high at ROC analysis (AUC = 0.997), and the test showed 100% sensitivity in LTBI detection. The QuantiFERON®-TB Gold Plus sensitivity for LTBI detection was 85.7%.

Conclusions: Based on the obtained results, the LIOFeron®TB/LTBI assay appears to be a promising test for TB and LTBI screening among paediatric patients.

What is known: • The detection of LTBI in children, exposed to MTB infections, followed by appropriate treatment, has a pivotal role in reducing tuberculosis burden. • IGRA tests are easy-to-use methods for helping large TB screening in paediatrics.

What is new: • The LIOFeron®TB/LTBI performance evaluation showed 100% of sensitivity in the detection of LTBI patients. • The LIOFeron®TB/LTBI assay might be useful for the detection of LTBI and active tuberculosis paediatric patients.

The purpose of this study was to translate and validate a questionnaire to be used by children with chronic diseases during procedures. Specific research questions were as follows: Is the translated versions reliable? Is there a correlation between VCM and another questionnaire measuring discomfort to enhance the validity of VCM? The three versions of Visual CARE measure (VCM) were translated following the principles of good practice for translation and cultural adaptation of patient-reported outcome measures, according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Cognitive debriefing interviews with children, parents, and healthcare professionals were carried out. The correlation between empathy and discomfort was evaluated using DISCO-RC. The final versions of VCM were administered to children and their parents after a needle procedure or a nasal tube insertion. The Cronbach's alpha was 0.89 for the 5Q version, 0.93 for the 10Q version, and 0.96 for the 10Q-Parent version, which implies high internal consistency. The intra-class correlation was 0.623 for VCM 5Q, with a mean difference of 1.35 and an ICC of 0.767 for VCM 10Q, with a mean difference of 1.17. This is considered a good agreement between children's and their parents' assessments. A significant difference in the children's reports could be seen when experiencing high discomfort as opposed to low discomfort.

Conclusion: VCM is a useful Patient-Reported Experience Measure (PREM) that can help enhance the quality of care for children in a paediatric setting by capturing their perception of the empathy shown.

What is known: • Parents' by-proxy reports are not always aligned with children's self-reports. In healthcare situations, children can be hurt when they are ignored. • Research shows that empathic encounters relieve distress, improve the relationship between the patient (who could be a child) and carer, and create an open, trusting relationship.

What is new: • This study shows that all three versions of the Visual CARE Measure are valid for assessing children's experience of empathy shown by nurses during a procedure.. • This is one of the first studies that confirms the correlation between children's experience of nurses' levels of empathy and the child's discomfort. • This study shows that the Visual CARE Measure can support the evaluation of children's rights with regards to communication in a clinical context.

Periorifical dermatitis (POD) is a papular, chronic inflammatory skin disease commonly seen in women in their 2nd to 4th decade of life. The major differential diagnosis is persistent acne. In children, POD is less common than in adults. In infants and preschoolers POD is rare. We performed a narrative review for POD in children ≤6 years of age. Diagnosis is clinical. The disease presents with monomorphic erythematous papules that usually leave a 1-2 mm Grenz zone around the red lips unaffected. Perinasal skin, nostrils and eyelids can be involved, while extrafacial manifestations are rare. The granulomatous subtype of POD is more common in small children that in adults. The most important differential diagnoses in children include atopic and seborrheic dermatosis, pediatric rosacea, juvenile acne, and cutaneous sarcoidosis. While topical macrolides, azelaic acid, and calcineurin inhibitors are often used in mild cases of adult POD, oral tetracyclines are the treatment of choice in more advanced cases. In infants and preschoolers, tetracycline should be avoided since they can affect the calcification (hardening) of the bones and teeth and lead to permanent discoloration of teeth. There are no randomized controlled trials for POD in this age group available. Topical metronidazole or erythromycin and oral erythromycin are most used. New drugs like JAK inhibitors are on the horizon.

To evaluate the accuracy of the lung ultrasound score (LUS) in predicting ventilatory weaning failure during neonatal hospitalization in the NICU and to identify factors associated with weaning failure, including corrected gestational age (CGA). This prospective, longitudinal, pragmatic and observational cohort study included neonates on mechanical ventilation for at least 48 h. The primary outcome was the accuracy of lung ultrasound in predicting 3-day weaning failure, with the ROC curve used to determine the best LUS cutoff (sensitivity and specificity). Among 55 neonates, the pre-extubation LUS did not show statistical significance in predicting weaning failure (AUC 0.61; 95% CI: 0.46-0.76, p = 0,169). In the subgroup analysis, a score ≥ 4 suggests the need for ventilatory support after extubation (area under the curve [AUC] = 0.91, 95% CI: 0.80-1.0, p < 0.001) in neonates with GA ≥ 28 weeks. In extremely preterm infants, the pre-extubation LUS was not statistically significant in predicting weaning failure (AUC = 0.38, 95% CI: 0-0.77, p = 0.535). In contrast, CGA ≥ 28.7 weeks at extubation was predictor of successful weaning within 3 days (AUC = 0.95, 95% CI: 0.85-1.0, p < 0.001).

Conclusion: LUS show promise in predicting weaning failure, though its accuracy may be limited in extremely preterm infants, highlighting the need for further well-powered studies. CGA at extubation also emerges as a key consideration in this population, warranting confirmation through robust future research.

What is known: • Identifying the optimal timing for extubation is crucial, as both prolonged mechanical ventilation and failed extubation are linked to increased morbidity. • Lung ultrasound plays a well-established role in diagnosing various neonatal lung pathologies, allowing clinicians to make rapid, bedside decisions for the treatment of newborns.

What is new: • LUS appears to be accurate in predicting weaning failure, though its accuracy may be lower in extremely preterm infants. • In extremely preterm infants, CGA may play an important role in extubation decision-making. • These findings are hypothesis-generating and warrant further investigation in future studies.

Among acute mastoiditis (AM) complications, cerebral venous sinus thrombosis (CVST) is particularly severe, leading to increased intracranial pressure and potential neurological sequelae. Predicting the development of such complications is challenging. The aims of the present study were to evaluate the incidence, clinical characteristics, and risk factors for the development of CVST in AM. A retrospective study was conducted on children hospitalized with AM at the Meyer Children's Hospital between 2016 and 2024. Patients were divided into two groups: those with CVST (group A) and those without (group B), comparing demographic, clinical, and laboratory data. CVST was diagnosed using computed tomography (CT) and cerebral magnetic resonance angiography (MRA). To identify predictors of CVST complications, univariate and bivariate binary regression models were used. Out of 100 patients with AM, 15 (15%) developed CVST. Patients with CVST more frequently presented with fever, neurological symptoms (headache, vomiting), elevated CRP, and white blood cell counts compared to those who did not (p < 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). Streptococcus pyogenes and Streptococcus pneumoniae were more commonly encountered in patients with thrombotic complications (p = 0.024 and p = 0.05). Multivariate regression identified white blood cell (WBC) count and elevated C-reactive protein (CRP) as independent predictors of CVST in AM patients (OR: 1.14, 95% CI: 1.03-1.26, and OR: 1.10, 95% CI 1.00-1.21, p = 0.010 and p = 0.049, respectively). Conclusions: CVST is a frequent and serious complication of AM. Neurological symptoms and systemic inflammation (WBC count and CRP) are predictive indicators of CVST. Further studies are needed to develop risk algorithms for early diagnosis and to reduce sequelae. What is known: • Cerebral venous sinus thrombosis (CVST) are severe complications of acute mastoiditis, potentially leading to neurologic sequelae What is new: • An elevated inflammatory burden, namely a high C-reactive protein level and white blood cell count predict thrombotic complications in children with acute mastoiditis.

Advancements in perinatal care have improved survival rates of extremely preterm infants born at 22 to 23 weeks of gestation, thus introducing new ethical challenges associated with their treatment. Therefore, we reviewed the epidemiological prognosis, treatment evolution, and ethical considerations associated with the care of preterm infants at the limit of viability. We comprehensively searched PubMed to find relevant English-language articles published between January 2014 and July 2024. Survival rates of infants born at 22 to 23 weeks of gestation have improved but remain low. Proactive treatment can result in survival rates exceeding 50% for infants born at 22 weeks; however, these infants are at high risk for complications and neurodevelopmental impairment. Advancements in obstetric and neonatal care have contributed to improved outcomes. Ethical challenges include balancing survival with the disability risk, managing patients with uncertain prognoses, and considering parental wishes.Conclusion: The care of preterm infants at the limit of viability presents complex ethical dilemmas. Shared decision-making between healthcare providers and families as well as engaging in societal discourse are crucial to addressing these challenges.

Trisomy 18 is a severe aneuploidy associated with multiple malformations and a poor prognosis. The diagnosis is typically made prenatally, leading to a high rate of pregnancy terminations. The aim of this study is to demonstrate that even though the prognosis is heterogeneous, prolonged survival is possible and these children are an enrichment for their families after all. A retrospective, descriptive and monocentric study was conducted on fetuses diagnosed with trisomy 18, evaluated between March 2017 and June 2023 at our Institution. The objective was to investigate the natural history of trisomy 18 and the psychological impact on parents who choose to carry the pregnancy on, through a retrospective data collection and the use of a questionnaire. Sixteen couples with a diagnosis of trisomy 18 were cared for within the Perinatal Hospice Pathway during the study period. Cardiac defects were identified in 93.7% of cases, structural abnormalities in 71.4%, respiratory defects in 14.3% of the fetuses, while genitourinary defects affected nearly half of the study population. The survival rate was typically less than one day, however two babies survived for more than four years. All couples reported being satisfied with their decision to continue the pregnancy and would do so again if given the opportunity.Conclusions: despite the severity of the diagnosis, couples may choose to continue the pregnancy and give birth. Our study shows that trisomy 18 is not merely a lethal condition and the Perinatal Hospice plays a crucial role in supporting these families.