European Journal of Pediatrics最新文献

Vascular access is a cornerstone of neonatal intensive care, yet current practice remains heterogeneous due to the lack of harmonized international guidelines. In this article, we present a position paper developed by a group of European experts - the Neonatal European Vascular Access Teams (NEVAT) - designed as a guide in planning, inserting, and maintaining vascular access in neonates. The position paper was developed using a not anonymous consensus method. Seven working groups prepared preliminary drafts on seven specific topics: peripheral venous devices, umbilical catheters, epicutaneo-cava catheters, ultrasound-guided central catheters, intraosseous access, peripheral arterial catheters, and infusion line management. The drafts were analyzed, modified, and validated through multiple rounds of open discussion, until full agreement was reached. The resulting position paper advocates a proactive, individualized, and standardized approach. Key elements include evidence-based selection of the device, structured preprocedural evaluation, maximal aseptic precautions, systematic use of ultrasound, securement with cyanoacrylate and semipermeable dressings, and structured post-insertion surveillance. Infusion line management emphasizes the use of closed systems, passive disinfection caps, and checklists. The NEVAT developed this position paper with the purpose of combining best evidence with expert agreement, so as to reduce variability in clinical practice, enhance safety, and improve neonatal outcomes, while encouraging multidisciplinary collaboration and family-centered care. What is Known: • Neonates are highly vulnerable to vascular access complications, but current practice is heterogeneous, with limited evidence-based guidance and significant variability across NICUs. What is New: • The NEVAT group provides the first European position paper on neonatal vascular access, aiming to improve homogeneity in device selection, insertion, and maintenance, promoting a safer and more consistent care.

Clinical studies have shown that Elexacaftor-Tezacaftor-Ivacaftor (ETI) improves lung disease and body weight in individuals with cystic fibrosis (CF); however, gastrointestinal system effects remain unclear. The purpose of this study was to evaluate exocrine pancreatic function using fecal elastase-1 (FE-1) levels in CF patients receiving ETI therapy and to assess changes in fat-soluble vitamin levels specifically within the pancreatic-insufficient (PI) subgroup. We retrospectively evaluated FE-1 levels before and during ETI treatment in the entire study group. Additionally, sweat chloride levels and growth parameters were assessed before and after follow-up ETI therapy in the entire study group. Also, vitamin A, D, E, PT, and INR levels were evaluated in PI patients before and after follow-up ETI treatment. The study included 20 pediatric CF patients with baseline FE-1 values. PI was present in 18 patients. The median age at the start of ETI therapy was 9.5 years (IQR 7.7-13.5; range 3-21 years). The median time between the baseline FE-1 test and the last FE-1 test was 12.0 months (IQR 12.0-19.5). The median FE-1 value before ETI therapy was 20.6 mcg/g (IQR 20.6-31.9), and after follow-up, 20.6 mcg/g (IQR 20.6-32.5) in 18 PI patients. Both PS patients maintained FE-1 levels ≥ 200 mcg/g before and after follow-up on ETI therapy. A significant increase in vitamin A levels was observed in PI patients, with a mean rise of 122.8 µg/L (p = 0.016). No significant change was observed in vitamin E levels (mean change 0.63 ± 4.14 µg/L; p = 0.304). Conclusion: In our study, no significant improvement in FE-1 levels was observed in pediatric CF patients receiving ETI therapy, whereas a substantial increase in vitamin A levels was found in patients with PI. These findings suggest that the effect of ETI therapy on pancreatic function may be limited and that its impact on exocrine pancreatic function should be further investigated. What is Known: • Exocrine pancreatic insufficiency is common in cystic fibrosis and is typically assessed using fecal elastase-1 (FE-1). • CFTR modulator therapies, especially ETI, improve respiratory and nutritional outcomes by targeting CFTR function, but their impact on pancreatic exocrine function in pediatric patients remains unclear. C What is New: • In this real-life pediatric cohort, no significant increase in FE-1 levels was observed during ETI treatment. • Despite improvements in CFTR function and nutritional status, these changes were not accompanied by recovery of pancreatic exocrine function.

Ultra-short celiac disease (USCD) represents a histopathological variant with selective involvement of the duodenal bulb. The mechanisms underlying the sparing of the second duodenal portion remain unclear. The histopathological progression of USCD under continued gluten exposure is not yet defined and represents a significant gap in current understanding. This retrospective study assessed histological changes in the duodenal bulb and second portion of the duodenum in pediatric patients who maintained gluten consumption until a definitive USCD diagnosis. Inclusion criteria required persistent dietary gluten intake, initial diagnosis confirmed by Marsh-Oberhuber classification, and elevated tissue transglutaminase (tTG) antibody levels. Fifteen out of 35 patients with USCD underwent repeat endoscopies. Villous atrophy was consistently confined to the first portion of the duodenum, with preservation of the second portion despite gluten exposure. Extensive celiac disease (ECD), characterized by involvement of the second portion of the duodenum, was associated with a significantly increased prevalence of short stature (p < 0.001) and iron deficiency anemia (p = 0.010), as well as substantially higher titers of tTG antibodies (p < 0.001). Both the USCD and ECD groups had similar rates of additional autoimmune diseases.  Conclusion: In children, USCD presents with a distinct and localized duodenal response to gluten. Although USCD presents with a milder clinical and serological profile, the comparable autoimmune burden underscores the necessity for accurate diagnosis and timely treatment. What is Known: • Patients with USCD typically demonstrate milder clinical symptoms and lower serological markers compared to those with more extensive small-intestinal involvement. • The histopathological response to ongoing gluten exposure in USCD has not been characterized to date. What is New: • USCD remains histologically confined to the duodenal bulb, with no progression to the second portion of the duodenum observed over time, even with continued gluten intake. • Isolated duodenal bulb involvement may be sufficient to initiate systemic autoimmunity in celiac disease, despite mild clinical and serological features.

Congenital heart disease (CHD) is the most common major birth defect, affecting nearly 1% of live-born infants. There is a high prevalence of CHD among premature neonates, with prematurity and low birth weight compounding the risks associated with CHD and leading to increased morbidity and mortality. Despite advances in diagnosis, surgery, and intensive care, outcomes for preterm infants with CHD remain guarded, particularly in the earliest gestational age groups. These infants face heightened risks of neonatal decompensation, cardiac arrest, and early mortality, but also long-term complications including neurodevelopmental impairment. The interplay between maternal-fetal factors, perinatal environment, and the complex physiology of both prematurity and CHD underscores the need for multidisciplinary care. Prenatal diagnosis, careful delivery planning, specialized postnatal management, and tailored surgical timing are critical to optimizing outcomes. Neonatal and cardiac intensivists, cardiologists, surgeons, anesthesiologists, and allied professionals must collaborate closely to address diverse challenges including hemodynamic instability, respiratory support, nutrition, neuroprotection, and social disparities. This review synthesizes current evidence on the epidemiology, pathophysiology, and management of neonates with CHD with a focus on prematurity. We highlight evolving models of interdisciplinary care and outline priorities for research. A physiology-based, team-oriented approach is essential to improve both survival and long-term quality of life for this vulnerable population. What is Known: • CHD is the most common birth defect and a leading cause of neonatal morbidity and mortality. • Prematurity and low birthweight worsen outcomes, with complications and surgical risk inversely related to gestational age. What is New: • Pregnancies with CHD carry up to a threefold higher risk of preterm delivery. • Outcomes reflect maternal-fetal and neonatal factors, highlighting the need for tailored timing, evaluation, and surgical strategies, with a key role for multidisciplinary care.

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.