European Journal of Pediatrics最新文献

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.

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.

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.

Chronic respiratory morbidity following premature birth is associated with significant and long-standing complications affecting airway function, the lung parenchyma and cardiac morphology. The aim of this narrative review was to provide an update on the current evidence for the cardiorespiratory follow-up of extremely preterm infants, particularly those with bronchopulmonary dysplasia. There is currently wide variation in the frequency, components and duration in the follow-up of these infants and an absence of robust evidence to support specific recommendations. Follow-up is most commonly offered up to 2 years of age, and studies beyond this age primarily report spirometric indices to quantify lung function impairment and abnormal respiratory trajectories. Recent evidence has highlighted distinct phenotypes and the complex multisystem nature of respiratory disease following preterm birth, which includes patterns of persistent pulmonary vascular disease, abnormal parenchymal function and impaired cardiorespiratory fitness.

Conclusion:  We suggest that follow-up of these infants should extend in time to early adulthood and focus on capturing and describing not only lung function test abnormalities but also include pulmonary vascular disease, parenchymal disease and cardiorespiratory exercise testing with a view to identify individuals who would benefit most from targeted interventions based on the dominant pathophysiological process at an individual level.

What is known: • Preterm birth is associated with significant respiratory morbidity lasting into childhood, adolescence, and adulthood. • There is a lack of sufficient high-level evidence to inform how these infants should be followed up in childhood and beyond.

What is new: • Other than lung function abnormalities, preterm-born children and adults have parenchymal lung damage, pulmonary vascular disease and exercise limitation. • Follow-up of individuals with significant neonatal respiratory disease should expand beyond early childhood and include more extensive cardiorespiratory assessments.

Background: Central line-associated bloodstream infections (CLABSIs) have been widely studied, but the burden of non-CLABSI hospital-onset bacteremia and candidemia (HOB/HOC) in children outside intensive care units (ICUs) remains poorly understood.

Methods: We retrospectively analyzed pediatric patients (1 month-18 years) admitted to a tertiary referral hospital in Turkey between January 2021 and January 2025. Eligible cases included the first positive blood culture for a non-commensal organism on or after hospital day 4, without central venous catheters, peripherally inserted central catheters, or ICU stay. Demographic, clinical, microbiological, and outcome data were collected.

Results: Of 14,985 blood cultures, 29 episodes of HOB/HOC met inclusion criteria. The median patient age was 38 months (IQR 11.5-78), with 65.5% under 5 years. The most frequent pathogens were Escherichia coli (17.2%), Staphylococcus aureus (17.2%), Coagulase-negative staphylococci (17.2%), Candida species (13.8%), and Klebsiella pneumoniae (13.8%). Clinical sources included skin/soft tissue infections, peripheral intravenous catheter thrombophlebitis, urinary, and respiratory infections. Patients with HOB/HOC stayed in the hospital a median of 11 extra days for infection treatment.

Conclusion: Non-CLABSI HOB/HOC significantly contribute to morbidity in pediatric wards, prolonging hospitalization and involving resistant pathogens. Infection prevention should extend beyond central lines to peripheral devices, supported by enhanced surveillance systems and definitions.

What is known: • Hospital onset bacteremia/candidemia are important healthcare-associated infections, with pediatric non-CLABSI cases largely understudied. • Existing literature offers limited epidemiologic and clinical data on non-ICU pediatric HOB/HOC.

What is new: • This study characterizes non-CLABSI pediatric HOB/HOC in general wards, predominantly affecting younger children. • The study demonstrates notable pathogen diversity with marked antimicrobial resistance and shows that these infections substantially extend hospitalization duration.

The purpose of this study is to evaluate the feasibility, safety, and effectiveness of an individualized online exercise therapy (IOET) designed to improve physical capacity and quality of life in children and adolescents with long-COVID. In a prospective, randomized, single-center exploratory trial, 14 patients aged 9-17 years with long-COVID (median symptom duration: 21 months) received either 6 or 12 weeks of IOET. Sessions were held twice weekly via telemedicine and individually adapted to physical ability and symptoms. Primary outcomes were functional performance (6-minute walk test [6MWT], sit-to-stand test [STST], and handgrip strength test [HST]). Secondary outcomes included school attendance, quality of life (PedsQL), safety, and self-reported recovery. All participants showed clinically improvements. In the 12-week IOET group, 6MWT increased from 396.0 to 616.3 m (+ 220.3 m, 95% CI 98.2-342.4), STST from 25.4 to 32.6 repetitions (+ 7.2, 1.9-12.5), and HST from 16.6 to 27.1 kg (+ 10.5 kg, 4.8-16.1). The 6-week group improved comparably (6MWT: 429.0 m to 601.6 m, (+ 172.6 m, 64.7-280.6); STST: 21.6 to 31.7 (+ 10.1, 3.1-17.1); HST: 17.3 to 22.1 kg (+ 4.8 kg (0.7-8.9)). School attendance rose from 58 to 97%, and PedsQL reflected improved quality of life and reduced fatigue. No adverse events or post-exertional symptom exacerbations occurred. Improvements persisted at the 3-month follow-up.

Conclusions:  IOET is feasible, safe, and associated with improved physical function, reintegration in everyday life, and its quality in pediatric long-COVID. These findings highlight IOET as a promising rehabilitation strategy and justify larger multicenter trials to confirm effectiveness and define optimal duration.

What is known: • Children and adolescents with long-COVID often experience persistent fatigue, impaired physical capacity, and reduced quality of life, with limited evidence-based treatment options available. • Exercise therapy has shown beneficial effects in other chronic pediatric conditions such as cancer- or fatigue-related syndromes, improving strength, well-being, and social participation.

What is new: • This exploratory randomized controlled trial demonstrates that individualized online exercise therapy is feasible, safe, and associated with clinically relevant improvements in physical function, quality of life, and school attendance in pediatric long-COVID, without negative side effects. • The findings highlight the potential of telemedicine-based rehabilitation strategies as accessible and effective treatment approaches for children and adolescents with post-infectious conditions such as long-COVID.

To investigate the value of serum chitinase-3-like protein 1 (CHI3L1) in predicting intravenous immunoglobulin (IVIG) nonresponse in children with Kawasaki disease (KD) and to develop a prediction model incorporating CHI3L1.This study enrolled 152 KD children (23 IVIG nonresponders, 129 IVIG-responders). Serum CHI3L1 levels were measured before IVIG infusion using an enzyme-linked immunosorbent assay (ELISA). Independent predictors were identified by univariate and multivariate logistic regression analyses, and a nomogram was constructed. The model performance was evaluated by the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA), clinical impact curve (CIC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).Serum CHI3L1 levels were significantly higher in the IVIG-nonresponsive group. Multivariate analysis identified CHI3L1 and C-reactive protein (CRP) as independent risk factors for IVIG nonresponse. The nomogram incorporating these two factors achieved an AUC of 0.83, with a sensitivity of 0.91 and a specificity of 0.67. Compared to CHI3L1 or CRP alone, the nomogram provided significant NRI and IDI. Both the calibration curve and DCA demonstrated favorable accuracy and clinical utility of the model.

Conclusion:  Serum CHI3L1 is an independent predictor of IVIG nonresponse in KD. The nomogram combining CHI3L1 and CRP shows favorable predictive performance and may serve as a practical tool for early identification of IVIG-nonresponsive patients.

What is known: • Kawasaki disease (KD) is the leading cause of acquired pediatric heart disease, and IVIG nonresponse increases the risk of coronary artery lesions. • Several biomarkers and scoring systems have been proposed to predict IVIG resistance, but their generalizability and performance remain limited.

What is new: • Serum CHI3L1, a chitinase family protein, is identified for the first time as an independent predictor of IVIG nonresponse in KD. • A novel nomogram integrating CHI3L1 and CRP demonstrates excellent predictive performance, with high sensitivity and improved net reclassification.