Acta Paediatrica最新文献

Aim: Children with acute lymphoblastic leukaemia (ALL) are at risk of metabolic and cardiovascular complications. We evaluated the development of overweight and obesity for 5 years after diagnosis in children and adolescents treated for ALL.

Methods: The medical records of children diagnosed with ALL at one centre during 2000-2018 were assessed. Weight and height measurements were retrieved from medical records and were used to calculate age- and sex-adjusted International Obesity Task Force-Body Mass Index (ISO-BMI). ISO-BMI was determined at selected time points during treatment and up to 5 years after diagnosis, and the change in mean ISO-BMI was assessed.

Results: We studied 115 patients diagnosed with ALL, 54 (47%) of whom were male. Mean age at diagnosis was 6.6 ± 4.6 (range 0-17.99) years. ISO-BMI increased significantly during treatment (p < 0.0001) and remained elevated at 5 years after diagnosis (p < 0.0001). The number of overweight and obese patients increased from 17% and 4% at diagnosis to 26% and 16% at the five-year follow-up.

Conclusions: Patients treated for ALL are at significant risk of weight gain and obesity, with the prevalence of overweight and obesity doubling from diagnosis to 5 years post-treatment. ISO-BMI remained persistently elevated across all treatment risk groups.

Aim: This study investigated whether family composition and other household factors are associated with adherence to vitamin D supplementation during infancy.

Methods: A cross-sectional survey was conducted between March 21 and April 30, 2023, among caregivers of infants aged 4 weeks to 12 months at the Ca' Granda Hospital, Milan, Italy. The survey investigated demographic data, health status, daily vitamin D₃ administration frequency, and family characteristics. Multiple logistic regression was used to identify factors associated with poor adherence.

Results: A total of 241 caregivers completed the survey. Overall, 85% of infants received vitamin D supplements at least four times per week. Good adherence was more frequent in families with one child (91%) compared with those with two or more children (78%). In multivariable analysis, the presence of siblings was the only factor significantly associated with poor adherence (odds ratio 2.72, 95% confidence interval 1.25-5.92). No associations were found with caregiver education, infant age, chronic disease, intercurrent illness, or time spent outdoors.

Conclusion: In this cohort, adherence to vitamin D prophylaxis was significantly lower in families with more than one child. Awareness of this association could inform counselling strategies and the design of interventions to sustain adherence.

Aim: Prenatal maternal infections may impair infant brain development. This study investigated the effect of maternal infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy on infant neurodevelopment by assessing general movements (GMs).

Methods: Infants were recruited for this multicenter prospective cohort study from LMU University Hospital sites in Munich after birth or during routine visits. GMs were recorded and assessed between 1 July 2022 and 31 January 2023, using the Hadders-Algra method. Odds ratios for abnormal GMs were calculated for infants with parent-reported prenatal SARS-CoV-2 exposure compared to unexposed controls. Specific GM subgroups were analysed at preterm, writhing, and fidgety ages.

Results: The study comprised 114 exposed infants (55.3% male) and 92 controls (54.3% male). There were no significant differences between the groups at birth. Two of the mothers were infected twice and one of them required hospitalisation. GMs were assessed at a mean corrected age (CA) of 4 weeks. The odds ratios showed no significant differences in GM quality between exposed infants and controls in either the total group or the subgroups.

Conclusion: Prenatal exposure to SARS-CoV-2 did not affect early neurodevelopment, which was determined by GM quality. Further studies should include long-term outcomes.

Trial registration: The study was registered at the German Clinical Trial Register (ID: DRKS00029247; https://drks.de/search/de/trial/DRKS00029247).

Aim: To compare adverse outcomes in neonates born by planned vaginal birth to those born by planned caesarean section.

Method: This retrospective cohort study analysed data from southern Sweden between 1995 and 2015, using the perinatal revision South Register. Only women with singleton, term (≥ 37 + 0 weeks) and cephalic presentation were included. Planned vaginal birth included all vaginal non-instrumental, instrumental, and emergency caesarean births. Logistic regression was used to study the relationship between neonates born via planned vaginal birth and planned caesarean section to adverse neonatal outcomes.

Results: Of 97,886 included, 91,834 (8.9%) underwent planned vaginal birth, and 6052 (91.1%) underwent planned caesareans. After adjustment, neonates with planned caesarean birth had lower odds for UApH < 7.05 [OR 0.64; 95% CI, 0.46-0.88, p = 0.006] but higher need for continuous positive airway pressure [OR 2.22; 95% CI, 1.74-2.85, p < 0.001]. No differences were seen for apgar score < 7 at 5 min, seizures, central nervous system disease or hypoxic ischemic encephalopathy.

Conclusion: While planned caesarean birth may reduce the risk of neonatal acidemia, it is associated with a higher odds of respiratory support after birth. Overall, both planned birth modes demonstrated comparable risks for other serious neonatal outcomes, indicating that decisions should balance these specific differences alongside individual clinical circumstances.

Aim: Urinary tract infection (UTI) is the most common and significant complication after voiding cystourethrography (VCUG) but the reported incidence in children varies highly. Therefore, the aim of this study was to evaluate the rate and possible risk factors for UTIs after VCUG.

Method: A multicentre retrospective cohort study of children < 15 years of age undergoing VCUG between 2017 and 2022 was conducted. Lower UTI (cystitis) and febrile UTI (pyelonephritis) within 14 days of VCUG were registered, defined by clinical assessment and a positive urinary culture.

Results: One thousand and one examinations were included (median age 1 year, 52% boys). Previous febrile UTI was present in 58%. Pathology was found in 47% of children, of which 83% had vesicoureteral reflux (VUR). Post VCUG UTI occurred in 34 (3.4%) children within 14 days, of which 60% were within 7 days and 88% were febrile. Only dilating VUR increased the risk for post VCUG UTI (adjusted odds ratio 5.4 [2.6-8.7] p < 0.001).

Conclusion: There was a low rate of post VCUG UTIs. Since children with dilated VUR are at risk for chronic kidney injury, targeted interventions after VCUG could possibly lower additional UTIs in this group.

Aim: This study investigated the epidemiological and clinical characteristics, diagnostic and therapeutic approaches and outcomes of neonatal pertussis cases hospitalised with coughs. We also aimed to identify the risk factors for severe pertussis.

Method: Newborn infants with coughs, who were admitted to Beijing Children's Hospital, China from November 2015 to October 2019, were retrospectively enrolled. Multivariable logistic regression analysis identified risk factors associated with pertussis.

Results: The study comprised 714 infants and 39 had pertussis. The pertussis group exhibited earlier symptom onset, more rapid clinical progression and prolonged coughing than those without pertussis. Their mean white blood cell count was 20.1 ± 10.8 × 10⁹/L, but 20.5% did not exhibit marked leukocytosis. Levels of immunoglobulin G antibodies against pertussis toxins were detected in 270 patients without pertussis and 77.8% showed a concentration of < 5 IU/mL. Risk factors for severe pertussis were delayed macrolide administration after symptoms appeared and leukocytosis. Serological testing for pertussis-specific antibodies was a powerful addition to conventional diagnostic methods.

Conclusion: Neonates with pertussis exhibited early symptoms, more rapid progression and prolonged coughing than infants without pertussis and risk factors for severe pertussis were leukocytosis and delayed macrolide administration. Serological antibody testing enhanced conventional methods.

Aim: To give a comprehensive overview of genetic findings in children with cerebral palsy, including a description of subtype, comorbidities and neuroimaging, providing insight into the clinical utility of genetics.

Method: A systematic review of previous literature using Embase and Medline as databases. All studies were published between 2000 and 2022, each including at least 10 individuals with cerebral palsy.

Results: A total of 19 studies were included, comprising a total of 3707 individuals with cerebral palsy. The overall diagnostic yield was 22.2%, with the highest yield (up to 55%) in cryptogenic cerebral palsy. Variants in a total of 377 unique genes were identified, most frequently CTNNB1, SPAST and ATL1. In addition, 59 different CNVs were identified, of which 32 were in known (micro)duplication/-deletion syndromes such as 22q11.2 microdeletion/-duplication and 14q12 microdeletion. Spastic and dyskinetic cerebral palsy were the most common phenotypes among genetically diagnosed cases. Findings also included variants in genes linked to epilepsy, specific neuroimaging patterns and potentially treatable conditions.

Conclusion: These results highlight the importance of genetic evaluation for diagnostic clarification, targeted treatment, monitoring of comorbidities and genetic counseling. We recommend offering genetic testing to individuals with cryptogenic cerebral palsy to optimize management and prevention.

Aim: Medical gases, including nitric oxide, carbon monoxide, hydrogen sulphide and molecular hydrogen, have emerged as key regulators of redox balance and cellular signalling. This mini-review examines their relevance to paediatric endocrine and neurodevelopmental pathways, domains particularly sensitive to oxidative and inflammatory disturbances.

Methods: We surveyed preclinical and clinical studies published between 2007 and 2025 on gas-mediated regulation of metabolic-redox homeostasis, bone biology, pubertal control and neurodevelopment. Additional attention was given to conditions marked by oxidative stress, such as Klinefelter and Turner syndromes.

Results: Evidence shows that gasotransmitters modulate synaptic plasticity, neurotransmission and neuroinflammation, influencing disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder and outcomes after perinatal hypoxia. They also participate in metabolic regulation, osteogenesis, osteoclast activity and hypothalamic control of puberty. These mechanistic insights highlight the emerging translational potential of gas-mediated pathways in paediatric health.

Conclusion: Although paediatric clinical applications remain limited, advances in omics-based profiling, mechanistic studies and biomaterial-supported gas delivery are rapidly expanding the therapeutic horizon. Integrating gasotransmitter biology into paediatric endocrinology and neurodevelopment may support future diagnostic, preventive and targeted therapeutic strategies.

100% oxygen with the cord intact improves early oxygenation in preterm infants.