European Journal of Pediatrics最新文献

Purpose: This cross-sectional monocentric study aims to utilize the Early Childhood Attention Battery to investigate early attention patterns in young preterm children and ascertain the extent to which their attentional abilities diverge from those of term peers.

Methods: Inclusion criteria encompassed gestational age < 34 weeks, with assessments conducted between 3 and 5 years 11 months. Exclusion criteria included major brain lesions, significant motor or behavioral disorders, and intellectual functioning with IQ < 70. Preterm raw scores converted to scaled scores and percentiles. Frequency analysis compared preterm scores to norms. Non-parametric tests assessed significance between scaled scores and subgroups (age, gestational age, sex, birth weight).

Results: One hundred nineteen preterm patients were enrolled in the study between November 2016 and June 2023. Comparisons with published norms showed lower mean scores across all subtests and domains for preterm children. A notable proportion of assessments (13-40%) fell below the 5th percentile, with the dual task item in sustained attention being the highest (40%). Sex did not predict differences, except for auditory sustained and visual search subtests. Gestational age did not correlate with abnormal scores, consistent with previous studies. The prevalence of assessments below the 5th percentile highlights preterm children's vulnerability to attention issues. The test's sensitivity to attention deficits in preterm populations suggests its potential in identifying at-risk children early for tailored interventions.

Conclusions: The battery effectively detects attentional deficits in preterm children. Early detection and targeted insights support tailored educational interventions. By focusing on specific attention skills, the battery guides clinicians in choosing individualized or group activities based on areas most affected.

What is known: • Attention is often impaired in preterm children but it is not systematically investigated before school age. The ECAB is a tool specifically designed for preschool children.

What is new: • Using the ECAB we evidenced a different level of attention between pre-term and term-born children at preschool age.

Alcohol-related emergency department attendance in adolescents should be considered as a valuable opportunity to address and mitigate future alcohol consumption. Therefore, a paediatric department of a major district hospital in the Netherlands developed an outpatient preventive program targeting adolescents admitted for acute alcohol intoxication. The primary aim of this study is to evaluate how adolescent drinking patterns participating in the preventive program developed over time. This retrospective observational study involved 310 patients from the Reinier de Graaf Hospital, Delft, the Netherlands (years 2014-2022). The outpatient preventive program consists of three main components: an initial intervention, subsequent an extended counselling session and psychological interventions. The alcohol consumption was compared at three time points: before the admission for acute alcohol intoxication(T = 0), 4-6 weeks after hospital admission (T = 1) and 6-12 months after the hospital admission (T = 2). Moreover, sociodemographic variables, adolescent risk-taking behaviour and family and pedagogical factors were included in secondary analysis. Adolescents who experienced an alcohol intoxication exhibited more adolescent risk-taking behaviour (higher rates of lifetime smoking, substance use and sexual intercourse) compared to the Dutch average. Initially, these adolescents had significantly higher rates of alcohol consumption and drunkenness. Alcohol use decreased significantly in the month following intoxication, even below the Dutch average. Though 6-12 months later, their alcohol consumption increased but remained statistically lower and involved less binge drinking than the Dutch average.

Conclusions: The findings of this study demonstrate that a preventive program following acute alcohol intoxication contributes to the reduction of adolescent alcohol use and associated risk-taking behaviours.

What is known: • Earlier studies showed that adolescents with problematic alcohol use reported reduced alcohol consumption and fewer alcohol-related problems after participating in a motivational interviewing intervention compared to standard care. • During the follow-up assessment of adolescents with acute alcohol intoxication it is possible to signalize mental disorders and to determine whether the patient requires referral to specialized mental healthcare.

What is new: • These findings suggest that the preventive program had a short-term impact in reducing alcohol consumption among adolescents with acute alcohol intoxication, as well as a long-term impact in reducing binge-drinking behaviours. • The program's success in mitigating binge-drinking behaviours aligns with its goals of promoting safer drinking habits among adolescents.

Cystinosis metabolic bone disease (CMBD) is an emerging concept in infantile nephropathic cystinosis, patients presenting with bone pains, fractures, and deformations during teenage or early adulthood. The underlying mechanisms remain unclear. Our aim was to explore the pro-inflammatory profile of osteoclastic lineage in cystinotic patients. We obtained blood samples from 14 cystinotic patients and 10 pediatric healthy controls. Peripheral blood mononuclear cells (PBMCs) were isolated and used to explore by RT-qPCR the transcript expression of 8 inflammatory markers (Il-6, Il-8, Il-1β, CXCL1, CCL2/MCP-1, CXCR3, Il-1 Receptor, Il-6 Receptor). In addition, when possible, PBMCs were differentiated into osteoclasts for further experiments. The expression of Il-6, IL-8, CXCR3, and CCL2/MCP-1 was significantly increased in PBMCs from cystinotic patients. We also explored the expression of Il-1 Receptor and Il-6 Receptor, two major pro-osteoclastic signal inducers, in osteoclasts differentiated from PBMCs from controls (N = 3) and patients (N = 4). The expression of IL-1 Receptor (but not IL-6 receptor) was increased in osteoclasts obtained from cystinotic patients.

Conclusion: There is an inflammatory profile in PBMCs and osteoclastic lineage in cells obtained from cystinotic patients. CXCR3 and MCP-1 stimulate migration and activation of macrophages, that may explain the previously reported local increased osteoclastogenesis. The osteoclastic overexpression of IL-1 Receptor is a relevant observation in the field since blocking Il-1β signaling has recently been proposed as a novel therapeutic approach to improve muscular wasting in this orphan disease.

What is known: • Cystinosis metabolic bone disease (CMBD), an emerging concept with unclear underlying mechanisms, induces bone pains, fractures and deformations in patients with cystinosis. • Blocking Il-1β signaling may be a novel therapeutic approach to improve muscular wasting in cystinosis.

What is new: • There is an inflammatory profile in PBMCs and osteoclastic lineage in cells obtained from cystinotic patients, with an over-expression of IL-1 Receptor in osteoclasts. • We provide another experimental rationale to propose targeted anti-inflammatory therapies in cystinotic patients with severe bone disease.

This study explores the efficacy of early systematic postnatal corticosteroids (PCS) in reducing bronchopulmonary dysplasia (BPD) and mortality among preterm infants, focusing on identifying the populations most likely to benefit. Although PCS has been extensively studied for its anti-inflammatory effects in preventing BPD, the ideal target population remains unclear. This meta-analysis included 26 randomized controlled trials (RCTs) focusing exclusively on systemic intravenous PCS. Studies were stratified by baseline BPD or mortality rates in control groups (< 50%, 50-65%, and > 65%). Results indicated that PCS effectiveness in reducing BPD or mortality was significantly associated with baseline risk, with rate differences (RD) for BPD or mortality of - 0.03 (95% CI - 0.08, 0.01) in lower-risk groups (< 50%), - 0.07 (95% CI - 0.12, - 0.01) in moderate-risk groups (50-65%), and - 0.18 (95% CI - 0.32, - 0.04) in high-risk groups (> 65%). Linear logistic analysis demonstrated a significant trend, with higher baseline event rates in control groups associated with a more substantial RD (RD ~ rates in controls, R² = 0.228, p = 0.014). Both dexamethasone and hydrocortisone showed similar trends.

Conclusion: These findings underscore that the baseline event rates in the control group are potentially correlated with the efficacy of PCS in preventing BPD or mortality, offering more precise guidance beyond the general "high-risk" category and supporting baseline risk stratification for more targeted PCS therapy in clinical practice.

What is known: • Early postnatal corticosteroids (PCS) have been widely studied for their anti-inflammatory effects in preventing bronchopulmonary dysplasia (BPD) in preterm infants. • Determining the optimal target population for PCS remains challenging due to varying baseline risks and associated neurodevelopmental concerns.

What is new: • Stratifying infants by baseline BPD or mortality rates reveals that PCS shows greater efficacy in high-risk groups, particularly those with baseline event rates above 50%. • Considering baseline risk stratification represents a key direction for future clinical decision-making.

Four indicators of severe neonatal morbidity (SNM) (intraventricular hemorrhage stages 3-4, retinopathy of prematurity (ROP) stage 3, severe bronchopulmonary dysplasia (BPD), and/or necrotizing enterocolitis) are well-known to be associated with poor infancy outcome after very preterm birth. Practice changes according to recent guidelines were implemented after medical team restructuration. We hypothesized that these changes may have improved overall survival and SNM-free survival in extremely preterm infants (EPI). We conducted a monocentric, retrospective, uncontrolled before-after study at our neonatal intensive care unit including all inborn alive neonates with gestational age less than 28 weeks during two periods (period 1 2016-2017, period 2 2019-2020). We compared the global and SNM-free survival rates before and after changes were implemented. Clinical, ventilatory, and nutritional data were also collected for comparison. We included 163 EPI (76 for period 1, 87 for period 2). Twenty-five patients deceased before home discharge in each group. The median duration of invasive ventilation was shorter during period 2 (4 vs 17 days, p < 0.01). Patients of period 2 had an earlier exclusive enteral nutrition (20 vs 34 days, p < 0.01). The composite endpoint of "death or SNM" was lower during period 2 (40.2% vs 55.3%, p = 0.06). Neonates of period 2 were more frequently free of any SNM indicators (83.9% vs 66.7%, p = 0.03). ROP and nosocomial infections were less frequent during period 2 (3.2% vs 21.7%, p < 0.005 and 37.1% vs 62.7%, p = 0.006; respectively). We also observed lower rates of moderate and severe BPD during period 2.

Conclusion: The evolution of our clinical practices appears to have positive effects on global and SNM-free survival and seems to have reduced the incidence of nosocomial infections.

What is known: • Using global survival and severe neonatal morbidity-free survival rates allows to compare inter- and intra-team critical care practices in neonatal intensive care units. • Major changes in clinical procedures, in accordance to recent guidelines, were implemented after the restructuration of the medical team in 2018, with the expected objective of improving morbidity and mortality of extremely premature infants (EPI) in our unit.

What is new: • After the changes, EPI exhibit a lower composite endpoint of "death or severe neonatal morbidity (SNM)" and were more frequently free of any SNM indicators concomitantly with a shorter median duration of invasive ventilation and parenteral nutrition. • The evolution of local clinical practices may positively impact mortality and morbidity within a few years.

We aim to estimate the incidence rates (IRs) of SARS-CoV-2 infections stratified by disease severity and comorbidities in pediatric population and to describe the COVID-19 vaccination coverage in children with and without comorbidities. A population-based cohort study was conducted in 6 electronic healthcare records databases from Italy, Spain, and Norway. The study lasted from 1 January 2020 to the latest databases' available data in each site, i.e., in Italian ARS Tuscany and PEDIANET: December 2021, in Spanish BIFAP: February 2022; SIDIAP: June 2022, and VID: December 2021. Finally, in Norwegian Health Registries: December 2021. Children and adolescents were included and stratified into three age categories (< 5, 5- < 12, and 12- < 18 years old). IRs (95% confidence intervals) per 100 person-years (PY) for non-severe (positive SARS-CoV-2 test or diagnosis without hospitalization) and severe COVID-19 (hospitalization, intensive care unit admission, and death after COVID-19) are reported. The cumulative COVID-19 vaccination rollout was stratified by population with and without comorbidities. The study population comprised 5,654,040 individuals < 18 years of age (51% females) across the six European databases (median age: 6 years), with 1.4 to 8.5% of them having at least one at-risk comorbidity for severe COVID-19. Incidence rates of severe COVID-19 were low (0-1 per 100 PY) but 3 to 4 times higher among children and adolescents with comorbidities during Omicron BA.1-2 wave in December 2021-January 2022. Percentages of vaccination rollout in the general population were between 13% in PEDIANET-IT and 64% in BIFAP-ICU-ES. In ARS-IT and SIDIAP-IT, vaccination rate in children with comorbidities was slightly lower than that in the general population.

Conclusion: Severe COVID-19 was rare across databases, but up to 3 to 4 times higher in children with comorbidities during the predominance of Omicron BA.1-2 variant in winter 2021-2022. COVID-19 vaccination coverage was slightly lower in children with comorbidities in ARS (Tuscany) and SIDIAP (Catalonia) data sources. Our findings will inform future public policies aimed to protect the pediatric population, both within these countries and globally.

What is known: • Pediatric population is susceptible to SARS-CoV-2 infection. • COVID-19 severity rates in children vary across study settings and context.

What is new: • This study confirms the low severity rates of COVID-19 in the pediatric population based on a large cohort of children and adolescents residing in Spain, Italy, and Norway. • Incidence of severe COVID-19 in children and adolescents with comorbidities was up to 3 to 4 times higher than in the general pediatric population during the SARS-CoV-2 high transmission wave of Omicron BA.1-2 variant in winter 2021-2022 in Italy and Spain.

Many adolescents must overcome a broad range of barriers to access health information and care and are consequently reluctant to pursue assistance for their health concerns. In this review, we examine from whom and how adolescents seek help (for example, by consulting with friends and family members and by searching for health information using online platforms) and how adolescents treat symptoms without consulting with a clinician by engaging in self-medication. Next, we suggest ways to help adolescents receive accurate health information and access to healthcare through school-based health education programs and health centers. We also discuss how to improve the experience of care for adolescents by collaboratively engaging young patients with their physicians and caregivers using shared decision-making. Finally, we propose developing and posting accurate and engaging multilingual materials on popular online platforms to improve adolescent access to accurate health information and knowledge of how to engage with the healthcare system.

Conclusion: The purpose of this review is to examine how adolescents seek, and propose ways to help adolescents access, health information and care despite the many barriers they face.

What is known: • Adolescents encounter a broad range of barriers to access health information and care and turn to family members and friends, and search online, for health information. In addition, adolescents benefit from school-based health education programs and health centers that reduce barriers to healthcare access.

What is new: • Adolescents engage in self-medication, including with cannabis use, to treat self-diagnosed illness or symptoms in a potentially harmful manner. • While many adolescents distrust health information shared on social media, recent evidence suggests adolescents are receptive to, and will change some beliefs, in response to health information posted on social media platforms.

The Finnish Current Care Guideline recommends rapid antigen tests as the primary diagnostic tool for both adults and children with Centor score ≥ 3. We aimed to analyze the association of Centor score and rapid antigen test positivity of group A streptococcal pharyngitis (GAS) in Finnish children. We performed a retrospective single-center study from July 2019 to June 2022. We included all children aged 0-15 years based on ICD-10 diagnostic codes for acute pharyngitis. We manually extracted the data from the electronic healthcare records. We extracted the information on Centor score signs and symptoms, rapid antigen tests, throat cultures, and C-reactive protein (CRP) levels. Comparisons were made between different groups by calculating a difference of two proportions with 95% confidence intervals. A total of 464 children were included and rapid antigen tests were taken from 433 (93.3%). We did not detect any significant association between rapid antigen test positivity and Centor scores. Sensitivity of Centor score ≥ 3 for rapid antigen test positivity was 22.3 (95% confidence interval 17.3-27.9) and specificity 79.0% (72.4-84.8). Positive throat culture was found in 17.1% of the patients with negative rapid antigen test. Centor scores correlated positively with CRP levels, but elevated CRP did not predict positive antigen test results.

Conclusion:  The Centor score alone does not seem to be of any utility in guiding the diagnosis of suspected streptococcal pharyngitis. Microbiological testing remains necessary for accurate diagnosis and CRP should not be used to differentiate viral and bacterial pharyngitis cases.

What is known: • The Centor score is a clinical prediction model for differentiating Group A streptococcal (GAS) pharyngitis from viral pharyngitis. • Finnish Current Care Guideline recommends rapid antigen testing in patients with Centor score ≥ 3 for diagnosing GAS infections and antibiotics prescribed based on confirmed test results.

What is new: • The Centor score alone does not seem to have any use in guiding the diagnosis of suspected streptococcal pharyngitis in children. • Microbiological testing remains necessary for accurate diagnosis in patients with sore throat.