European Journal of Pediatrics最新文献

We hypothesized that certainty of the available evidence is relatively low in neonatology. Thus, we designed a meta-epidemiological review to examine what is the certainty of evidence in the latest Cochrane neonatal reviews and investigate if the number of trials and enrolled patients is associated with the certainty of evidence. We searched Cochrane neonatal reviews published between January 2022 and May 2024. We included all reviews on interventions concerning neonates that had at least one meta-analysis performed with GRADE-rated evidence certainty. From those reviews, we extracted the presented certainty of evidence and analyzed its association with the number of trials and participants by ANOVA. We screened 55 Cochrane reviews and included 49 of them. In these 49 reviews, there were 443 reported outcomes with graded certainty of evidence. The certainty was reported to be high in 8 (1.8%), moderate in 89 (20.2%), low in 195 (44.0%), and very low in 151 (34%) of the outcomes. Reviews reporting outcomes with higher certainty of evidence had significantly more trials and patients (approximately 3 and 1.5 times more, respectively) than those with only low certainty of evidence.

Conclusion: In the past 2 years, Cochrane neonatal reviews have generally had low or very low certainty of evidence for most outcomes. Only 2% of the reviewed outcomes had high certainty. The number of included patients and trials significantly affected the certainty. These findings highlight the continuous need for better quality and larger trials.

What is known: • Neonatology is among the largest specialities and the evidence certainties of interventions have been varying. • Neonatal patients and studies need to consider the uniqueness of the patients and the acute situations in the study designs.

What is new: • The included 49 reviews consisted of 443 outcomes and of these only 1.8% were classified as high certainty of evidence. • Higher evidence certainties were associated with higher number of included trials and participants.

To understand whether parental smoking influences adeno/tonsillectomy rates in their offspring. A population-based case-control study using data from Clalit Health Services. Israeli children aged 0-18 years who underwent adeno/tonsillectomy between 2003 and 2022 were 1:3 matched with same-age, sex, and ethnicity controls. Parental smoking habits were linked to their children's files. Conditional logistic regression models estimated odds ratios (ORs) for adeno/tonsillectomy associated with parental smoking, adjusting for socioeconomic status. We identified 11,184 children who underwent surgery and 33,552 controls (mean age ± SD 4.10 ± 2.50 years). The likelihood of undergoing adeno/tonsillectomy was significantly higher for children with either one smoking parent (OR 1.14; 95%CI 1.09-1.19) or both (OR 1.53; 95%CI 1.39-1.68) compared to children of non-smokers. The association was more evident for tonsillectomy alone, with an OR of 3.20 (95%CI 2.06-4.97) when both parents were smokers. These associations remained consistent even after adjusting for socioeconomic status. Parental smoking rates were higher in the surgical group across all categories. Maternal smoking prevalence was 10% versus 7.5%, and paternal smoking prevalence was 36% versus 32%, in the surgical group vs. the control group, accordingly. The proportion of children with only one smoking parent was 34% compared to 31%, and for cases with both parents smoking, the rate was 6.3% versus 4.3%.

Conclusion: Parental smoking is associated with higher rates of pediatric adenoidectomy, tonsillectomy, and adenotonsillectomy, especially if both parents smoke. Counseling parents on the negative effects of smoking on their children is crucial in reducing the incidence of these surgeries.

What is known: • Parental smoking can cause multiple pediatirc diseases.

What is new: • Parental smoking is associated with higher rate of adenotonsillar surgery.

The Surprise Question "Would you be surprised if the patient died in the next 12 months?" lacks pediatric research, particularly in neonatal patients. Our study aims to analyze the Surprise Question's predictive ability in neonates and explore pediatricians' views on palliative care patient identification. A prospective cross-sectional study was conducted from February 2021 to June 2023, including all newborns admitted to the Neonatal Intensive Care Unit of a pediatric tertiary hospital and its pediatricians. Patients with less than a year since admission were excluded from final analyses. Recorded variables included patient demographics and condition, pediatricians' profile and opinions regarding the Surprise Question, and palliative care patient identification. The Surprise Question was formulated to one or more pediatricians per neonate at admission, 7 days of life, and 28 days of life, with patient status recorded after 12 months to elaborate a confusion matrix of prognostic test results. A total of 51 pediatricians participated. Most felt they had limited criteria for identifying palliative care patients (55%), believed the Surprise Question could be useful (77%), and predicted death (75%). The Surprise Question was answered at least in one out of the three moments for 262 neonates (61% male and at least 36% preterm), with sufficient sample at each moment to study its predictive ability. High negative predictive values were consistent, with higher positive predictive value at 7 days (26%).

Conclusions: The Surprise Question is a promising tool for predicting neonatal outcome and could guide professionals in initiating palliative care discussions. The 7-day mark appears more suitable for this application.

What is known: • Previous research has established the Surprise Question as a valuable tool for predicting death in adults. However, limited research exists on its use in pediatric patients and its role remains unexplored in the neonatal period.

What is new: • The study evaluates the Surprise Question as a tool for predicting death within the first year of life when applied in the neonatal period. It offers insights into its predictive ability and most suitable time for its application. This study sheds light on its applicability in neonatal care, offering a valuable tool for early identification and referral to palliative care.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition in children, characterized by inattention, hyperactivity, and impulsivity. Recent studies have investigated the potential role of physical exercise as a complementary intervention to traditional ADHD treatments. This study aimed to compare the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on ADHD symptoms and behavioral inhibition in children diagnosed with ADHD. In a randomized controlled trial, 60 male participants aged 7-10 years were allocated into three groups: control, MICT, and HIIT. The intervention lasted 12 weeks, with the MICT group performing 20 min of running at 70-75% of their individual VO2 max and the HIIT group performing alternating intervals of running at 100% and 50% of their VO2 max for 1 min each. The control group received no exercise intervention. Cognitive and symptomatic assessments were conducted using the Children's Symptom Questionnaire (CIS-4) and go/no-go tasks before and 48 h post-intervention. Both MICT and HIIT demonstrated significant improvements in behavioral components, including attention deficit, hyperactivity, and impulsivity (all P < 0.0001). HIIT showed superior effects on attention deficit compared to MICT (P = 0.008). Both HIIT (P < 0.0001) and MICT (P = 0.028) improved correct responses (CR) in the Go task compared to the control group. HIIT also outperformed the control group in erroneous responses (ER) (P = 0.022) and correct reaction time (P = 0.027) in the Go task. In the No-Go task, HIIT showed superiority over the control group in both CR (P = 0.013) and ER components.

Conclusion: This study highlights the comparative efficacy of MICT and HIIT as nonpharmacological interventions for children with ADHD. HIIT, in particular, demonstrated superior benefits for attention deficits, suggesting its potential as a targeted adjunctive treatment. These findings may inform the development of exercise programs to enhance the quality of life and daily functioning of children with ADHD.

What is known: • Physical exercise has been explored as a complementary intervention for ADHD, with evidence suggesting its potential to improve symptoms such as inattention, hyperactivity, and impulsivity. • Moderate-intensity continuous training (MICT) has shown positive effects on cognitive and behavioral outcomes in children with ADHD.

What is new: • High-intensity interval training (HIIT) demonstrated superior benefits over MICT in improving attention deficits in children with ADHD. • Both HIIT and MICT significantly improved behavioral inhibition, with HIIT showing additional advantages in reducing erroneous responses and enhancing reaction times in cognitive tasks.

Given the importance of carbohydrates during pregnancy and the limited evidence on the impact of its excessive intake on offspring neurodevelopment, this study aimed to assess the associations between maternal glycemic index (GI) and glycemic load (GL) during early and late pregnancy and behavior problems in 4-year-old children, considering potential sex-related differences in susceptibility to maternal diet. This observational study included 188 mother-child pairs from the ECLIPSES study. GI and GL were estimated from a validated food frequency questionnaire. Offspring behavior was assessed using the Child Behavior Checklist 1.5-5. Multivariable linear and logistic regression analyses were employed to assess the association between GI, GL, and child behavior. Children of mothers in the highest tertile of GL during the first trimester of pregnancy showed elevated scores of both internalizing (β = 5.77; 95% CI, 2.28-9.26) and externalizing (β = 3.95; 95% CI, 0.70-7.19) problems, including anxiety and depression problems, withdrawn, attention problems, aggressive behavior, and attention-deficit/hyperactivity problems, as well as total (β = 5.24; 95% CI, 1.71-8.77) and autism spectrum problems (β = 3.30; 95% CI, 1.11-5.50). Similarly, higher odd ratios were observed for internalizing (OR = 2.37; 95% CI, 1.09-5.18), externalizing (OR = 3.46; 95% CI, 1.49-8.00), and total problems (OR = 3.83; 95% CI, 1.68-8.71). These associations were more pronounced in girls. No associations were observed during the third trimester. Regarding GI, no associations were found for the evaluated outcomes in any of the trimesters.

Conclusion: These findings indicated that elevated maternal GL during the early pregnancy, but not later stages, was associated with adverse behavioral outcomes in offspring.

Trial registration: EUCTR-2012-005480-28, NCT03196882.

What is known: • Carbohydrate intake is important during pregnancy as glucose is the main energy source for an optimal fetal brain development. • Elevated prenatal glycemic index and glycemic load have been associated with adverse offspring outcomes but their impact on behavioral development remains insufficiently explored.

What is new: • A high maternal glycemic load during pregnancy may increase the risk of behavioral impairments in preschool-aged offspring. • Female offspring may be more vulnerable to behavioral disturbances to elevated maternal glycemic load during gestation.

Chemotherapy can alter body composition, including loss of skeletal muscle mass and density changes, which are linked to negative outcomes. This study investigates body composition changes in children and adolescents with lymphoma, focusing on the impact of chemotherapy protocols and diagnoses. A retrospective observational study included 49 lymphoma patients (ages 6-18) who underwent chemotherapy from 2017 to 2021, excluding palliative care cases. Data on disease, treatment, weight, and height were collected, and anthropometric indices, Body Mass Index by Age (BMI/A) and height by age (H/A) were calculated. Body composition was analyzed using Computed tomography (CT) at the third lumbar vertebra region (L3) with Slice-O-Matic 5.0 software, measuring skeletal muscle area (SMA), skeletal muscle density (SMD) measured in Hounsfield units (HU), total psoas muscle area (PMA), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT). Paired t-tests compared variables before and after treatment, and the delta of body composition parameters was stratified by chemotherapy protocols and diagnoses (Kruskal-Wallis Test), considering p < 0.05 as significant. Forty-nine patients were included (mean age 13.24 years, 49% male). After chemotherapy, there was an increase in SAT, VAT, IMAT, and SMA (p < 0.001), while SMD decreased from 41 HU to 35.27 HU (p < 0.001). The EURONET protocol and Hodgkin lymphoma were associated with increases in SAT (∆ = 78.28 cm²/73.92 cm²) and VAT (∆ = 27.44 cm²/26.36 cm²).

Conclusions: Significant adipose tissue gains were observed in the EURONET protocol and Hodgkin lymphoma, highlighting the impact of chemotherapy on body composition.

What is known: • Computed tomography is used to assess body composition, including muscle, adipose tissue and muscle density in adults. • Chemotherapy treatment negatively affects body composition, reducing muscle mass in adults with cancer.

What is new: • Computed tomography can also be used to assess body composition in children and adolescents with cancer. • In pediatrics, chemotherapy can also impact body composition, with changes varying according to the administered protocol.

Although the administration of antenatal corticosteroids (ACS) is generally recognized as cost-effective and beneficial, recent studies have indicated potential long-term adverse effects on neurodevelopment, particularly for term-born infants. However, limited research has explored the association between the timing of ACS exposure, gestational age (GA) at birth, and their potential implications for mental and behavioral outcomes in offspring compared to non-exposed infants. This study aimed to examine the association between the timing of antenatal corticosteroid (ACS) exposure for threatened preterm labor and childhood mental disorders among early-term and full-term births. All eligible term infants born between 2010 to 2014 were included in this nationwide study and followed until the end of 2021. The primary outcome was any childhood mentaldisorders, with secondary outcomes being attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental delay (DD). Compared to unexposed infants, ACS exposure before 34 weeks of GA increased the risk of developing mental behavior disorders. Exposure to ACS before 34 weeks was significantly associated with an increased risk of ADHD and DD; however, this association was observed only in early-term births but not in those born at full-term.

Conclusion: Our finding suggests a need for further investigation into the influence of GA at birth on these disorders and supports that the risk of childhood mental disorders in term infants varied among different ACS exposure timing.

What is known: • While administration of antenatal corticosteroids (ACS) for preterm birth threats is widely acknowledged as both cost-effective and beneficial, recent studies have raised concerns about potential long-term adverse effects on neurodevelopment, particularly in term-born infants. • Previous studies have found that early-term birth is associated with lower intelligence, ADHD, and poorer school performance compared to full-term birth.

What is new: • There is an interaction between the timing of ACS treatment and gestational age at birth with respect to the likelihood of neurodevelopmental outcomes in term-born infants. • Exposure to ACS before 34 weeks is associated with an increased risk of any childhood mental disorders, specifically ADHD and DD, among early-term births, whereas this association was not observed in infants who reached full-term gestation.

Central venous access devices (CVADs) are vital instruments in pediatric healthcare, enabling the administration of critical treatments such as chemotherapy and parenteral nutrition. However, despite their advantages, CVADs carry a significant risk of complications, including infections, mechanical failures, and thrombotic events. From the current literature, it is unknown whether previous CVAD placements lead to an increased risk for complications in subsequent CVAD placements. We retrospectively analyzed data regarding tunneled, surgically implanted CVADs in children over a period of 2 years at a single tertiary pediatric center regarding their complications. Between 2021 and 2022, 328 CVAD implantations were performed in 313 children. The average age at implantation was 6.6 ± 5.5 years, while most of the patients were younger than 5 years old. During the study period, a total of 102 complications occurred in 96 patients. Most frequent complications were infections (18.29% of all implantations), followed by dislocation of the catheter tip (6.4 0%) and mechanical dysfunctions (4.27%). No patient died from a complication. The choice of catheter type (Port versus Broviac) showed a significant influence on the occurrence of complications (hazard ratio of 3.964 (95% CI 1.993-7.886; p < 0.001). The risk of infection and dislodgement was also higher when comparing Broviac with Ports implantations (infection: HR = 3.236; 95% CI 1.239-8.454; p = 0.017; dislodgement: HR = 5.781; 95% CI 1.229-27.193; p = 0.026). Cox regression showed a statistically significant higher risk of complications (especially infections) when the catheter was inserted via venous cutdown instead of percutaneous puncture technique (complications: HR = 6.709; 95% CI 1.776-25.337; p = 0.005; infections: HR = 7.28; 95% CI 1.096-48.379; p = 0.04). Cox regression did not show a statistically significant influence on complications for neither of the following factors: age, gender, weight, and oncological/non-oncological diagnosis. The complication rate for patients with previous CVAD was nearly the same as for patients who received a CVAD for the first time (previous CVAD: 29.17%; no previous CVAD: 30.74%).

Conclusion: Our study challenges conventional assumptions regarding the impact of previous CVAD placements on complication rates. Nevertheless, ongoing vigilance and adherence to standardized protocols remain crucial in mitigating risks and improving outcomes in pediatric CVAD management.

What is known: • Risk factors predisposing for CVAD-related complications remain insufficiently understood. • It is unknown whether previous CVAD placements lead to an increased risk for complications in subsequent CVAD placements.

What is new: • The complication rate for patients with previous CVAD appears to be the same as for patients who receive a CVAD for the first time.