Acta Paediatrica最新文献_第10页

Bronchiolitis (The Snotty Lung): Prevention Is Likely to Be More Helpful Than a ‘Cure’ 毛细支气管炎（流鼻涕的肺）：预防可能比“治疗”更有帮助。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-26 DOI: 10.1111/apa.70384

Mark L. Everard

<p>In 1963, Reynolds and Cook observed that <i>oxygen is vitally important</i> (in the treatment of acute bronchiolitis) <i>and there is little evidence that any other therapy is consistently or even occasionally useful</i> [<span>1</span>] and this still holds true more than 60 years later. In the study by Loveys et al. published in this issue [<span>2</span>] the authors address the suggestion that the macrolide antibiotic, azithromycin, may reduce the severity of the acute illness and the prevalence of subsequent respiratory symptoms. They concluded <i>‘</i>There is insufficient evidence to support the use of azithromycin as part of hospital care for infants with bronchiolitis<i>’</i>. While none of the included studies individually found evidence to support the use of macrolides, the initial meta-analysis suggested that it may have a small effect on the length of stay. However, in their sensitivity analysis, which involved removing the studies that reported longer durations of stay than the authors felt were typical for Australasia [<span>2</span>], this apparent effect disappeared.</p><p>Azithromycin joins an extensive list of potential therapies which fell by the wayside when subject to more rigorous testing. These include ‘asthma therapies’ such as β-agonists, corticosteroids, theophylline, anti-cholinergics and a leukotriene antagonist; antibiotics and antivirals and approaches to improve airways clearance including inhaled hypertonic saline and physiotherapy. Despite the evidence, adherence to guidelines is frequently poor as illustrated by the two Australasian studies in which non-macrolide antibiotics were used in 60%–70% of patients. The rationale for using a macrolide antibiotic in these studies was based on having anti-inflammatory, immunomodulatory and anti-viral effects [<span>2</span>]. Macrolides appear to have a role in downregulating neutrophilic inflammation and, as noted by Loveys et al., the airways inflammation in bronchiolitis is dominated by neutrophils. The use of azithromycin has become ubiquitous, particularly in adult respiratory medicine, largely because of its perceived anti-inflammatory effects (even though, as in these studies, it is used at doses that have antibacterial activity). The downside of using this convenient ‘magic bullet’ so widely is, of course, the fact that macrolides are extremely effective in driving antimicrobial resistance [<span>3</span>].</p><p>Every paediatrician knows what ‘acute bronchiolitis’ looks like when they see it, but there is no universally agreed definition. There is no definitive test for the condition, and the diagnosis is based on a cluster of signs [<span>4</span>]. The studies included in the review allow subjects to have crackles and/or wheeze as a sign of airways obstruction. Crackles are generally observed in young infants (< 6 months) and represent the snapping opening of alveolar units. Secretions in the airways and mucosal oedema are almost certainly responsible for

1963年，Reynolds和Cook观察到氧气是至关重要的（在急性细支气管炎的治疗中），几乎没有证据表明任何其他治疗方法都是持续有效的，甚至偶尔有效。60多年后，这一观点仍然成立。在Loveys等人发表于本期b[2]的研究中，作者提出大环内酯类抗生素阿奇霉素可能降低急性疾病的严重程度和随后呼吸道症状的患病率。他们得出结论：“没有足够的证据支持将阿奇霉素作为毛细支气管炎婴儿医院护理的一部分。”虽然纳入的研究中没有单独发现支持大环内酯类药物使用的证据，但最初的荟萃分析表明，它可能对住院时间有很小的影响。然而，在他们的敏感性分析中，包括删除报告的停留时间比作者认为的澳大拉西亚bbb的典型停留时间更长的研究，这种明显的影响消失了。阿奇霉素加入了众多潜在疗法的行列，这些疗法在接受更严格的测试时被搁置了。其中包括“哮喘疗法”，如β激动剂、皮质类固醇、茶碱、抗胆碱能药和白三烯拮抗剂；抗生素和抗病毒药物以及改善气道清除率的方法包括吸入高渗盐水和物理治疗。尽管有证据，但澳大利亚的两项研究表明，对指南的遵守往往很差，其中60%-70%的患者使用了非大环内酯类抗生素。在这些研究中使用大环内酯类抗生素的基本原理是基于其具有抗炎、免疫调节和抗病毒作用b[2]。大环内酯类药物似乎具有下调中性粒细胞炎症的作用，正如Loveys等人所指出的，毛细支气管炎的气道炎症以中性粒细胞为主。阿奇霉素的使用已经变得无处不在，特别是在成人呼吸系统医学中，主要是因为它被认为具有抗炎作用（尽管在这些研究中，它的使用剂量具有抗菌活性）。当然，广泛使用这种方便的“灵丹妙药”的缺点是，大环内酯类药物在推动抗菌素耐药性方面非常有效。每个儿科医生在看到“急性细支气管炎”时都知道它是什么样子，但没有一个普遍认可的定义。对于这种情况没有明确的测试，诊断是基于一组体征。本综述中包括的研究允许受试者有噼啪声和/或喘息作为气道阻塞的迹象。裂纹通常在婴儿（6个月）中观察到，代表肺泡单位的破裂。气道中的分泌物和粘膜水肿几乎肯定是远端气道关闭的原因。对于较大的婴儿和学步儿童，气道较大，完全关闭远不常见。然而，分泌物和粘膜水肿仍然会导致血流受限，从而产生喘息（所有的喘息都不是哮喘）。因此，相同的炎症模式可能导致两种不同的临床表现：一种是噼啪声，一种是喘息声。第三种常见的声音是由呼吸道分泌物发出的咔嗒声，尽管吸气和呼气的声音都很刺耳，但它通常被误认为是喘息声。相反，伴随喘息的病毒感染可由两种不同的病理生理过程引起，因为气流受限也可由气道平滑肌收缩引起，这是哮喘的典型特征。哮喘似乎是气道平滑肌体内平衡的获得性丧失，其患病率随着年龄的增长而增加，直至生命的早期。相比之下，由病毒引起的无支气管收缩的中性粒细胞炎症（细支气管炎）引起的明显气流阻塞的发生率在学龄前逐渐下降。因此，在学龄前，有明显病毒感染的喘息儿童队列将包含两种类型的患者，哮喘的比例随着年龄的增长而增加。纳入临床无法区分的哮喘患者和非哮喘患者，可以解释在“学龄前喘息”治疗研究中观察到的相互矛盾的结果。诸如皮质类固醇之类的药物是否有帮助取决于哮喘和毛细支气管炎患者的比例。Loveys等人表示，他们的目的是“综合阿奇霉素对患有或因细支气管炎住院的婴儿（12个月大）的疗效和安全性的证据”，大概是为了确保绝大多数患有细支气管炎。有趣的是，在他们的研究中，只有两项研究只招募12个月以下的婴儿，其他5项研究的招募年龄分别为18个月或24个月。第三种常见的学龄前呼吸道疾病是持续性细菌性支气管炎，尽管这些患者即使在急性发作期间也很少到医院就诊。他们不喘息，但在那些有ruttle，家长通常报告这是喘息。鉴于急性细支气管炎在绝大多数情况下是一种相对短暂的自限性疾病，人们可能会质疑是否有可能找到一种对临床病程有显著影响的治疗方法。正如Lovey等人所指出的，高质量护理的本质包括良好的支持性护理。补充氧气有助于防止可能导致疲惫和最终死亡的剧烈躁动。这种躁动通常在婴儿的饱和度降到80度以上时变得明显。不幸的是，在那些医疗基础设施欠发达的国家，死亡率仍然很高，据估计，全世界的死亡人数达到数十万人。因此，在这些环境中，防止病情恶化的干预措施将是非常宝贵的，即使在发达国家，鉴于每年冬天收治的大量病人，这种干预措施也将是有价值的。这种干预是否可能的答案可能在于我们对这种情况的病理生理学的理解。纳入试验的受试者几乎总是住院，代表了受影响最严重的患者亚组。即使对于这些患者，据广泛报道，住院时间的中位数为两到三天，几乎没有机会对病程产生影响。此外，有证据表明，至少对于RSV来说，病毒滴度和中性粒细胞数量在入院前后再次达到峰值，这使得它很难对随后的病程产生显著影响。如果发现一种药物可以安全地减轻疾病的严重程度，很可能需要在发生下气道阻塞之前给药，这是一个具有挑战性的前景。在纳入系统评价的研究中，有三项研究要求确定RSV为急性疾病的病因。其中一项是基于一种信念，即早期严重的呼吸道合胞病毒感染在引起哮喘方面具有独特的作用。这个想法在近70年前首次提出，一度几乎无处不在，但现在基本上已被抛弃。RSV是毛细支气管炎入院的最常见原因，可能是由于它能够损害有效长期免疫的发展。因此，年龄最小的婴儿的被动获得性免疫相对较差，而年龄最小的婴儿（1-6个月）最有可能经历最严重的下呼吸道感染，这在很大程度上是由于导气管直径相对较小。奇怪的是，许多临床医生现在支持这样的建议，即人类犀牛病毒在引起哮喘的能力方面是独一无二的！其余四项研究包括临床诊断为“细支气管炎”的患者，而不考虑病毒状态。未发现病毒的患者比例在26%至60%之间变化。这些研究者大概接受了这样一种观点：不管病毒是什么，潜在的病理生理都是相似的。证据是所有的呼吸道病毒都会诱导嗜中性粒细胞流入呼吸道上下呼吸道都是如此。因此，急性细支气管炎可以被认为是“流鼻涕的肺”，类似于患有尿路感染的人流鼻涕的鼻子。气道阻塞不像哮喘那样主要是由于平滑肌收缩。研究表明，在患有细支气管炎的婴儿样本中发现一种以上的病毒并不罕见，而且两种或两种以上病毒的存在似乎与更严重的疾病无关。相比之下，一项对幼儿园学龄前儿童的研究发现，感冒时鼻分泌物的数量和脓量在那些有潜在致病菌[8]的儿童中要大得多。在患有急性细支气管炎的婴儿中也发现了类似的结果，这表明获得新病毒的影响受到宿主微生物群[5]的强烈影响。我们对常驻微生物组在影响急性和慢性气道疾病表现中的作用的理解仍处于非常初级的阶段，尤其是因为在下气道中进行研究非常困难。此外，患有疾病和没有疾病的人的气道微生物谱的差异似乎是一个连续体的一部分，在健康和疾病之间没有明确的区分。最近的随机对照试验表明，与单克隆制剂[10]一样，母体接种RSV疫苗可提供显著的住院保护。未来几年，这些干预措施对入院人数的影响将会很有趣，因为其他病毒可能会填补部分空缺，也许更重要的是，如果所有婴儿都得到保护（尽管他们只占人口的很小一部分），面对越来越大的变异压力，突变的可能性会开始出现。即使有了这些预防性干预措施，诊断和管理细支气管炎的挑战也不会消失。本期发表的系统综述有助于强调围绕毛细支气管炎这种常见疾病的许多争议和挑战，以及在幼儿中将流鼻涕的肺与病毒和哮喘区分开来的挑战。马克·埃弗拉德：构思，写作-原稿，写作-审查和

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Views and Perspectives on Children With Complex Health Complaints and Complex Care Needs 对复杂健康投诉和复杂护理需要儿童的看法和观点。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-25 DOI: 10.1111/apa.70383

Peter Almgren, Lars Gelander

<p>Peter Almgren</p><p>Lars Gelander</p><p>Effective management of a child with complex care needs requires a comprehensive perspective that considers the physical, psychological and social factors influencing the child's symptoms and their underlying causes. This holistic approach is especially crucial for children who have frequent referrals or repeated visits to clinics and emergency departments.</p><p>As Lygre et al. [<span>1</span>] describe in the study published in Acta Paediatrica, a broad perspective can easily be lost when a child's symptoms are evaluated individually. They state: “Managing patients with complex health complaints is challenging, because cumulative functional impairment may be overlooked when such complaints are considered individually” [<span>1</span>].</p><p>In the current study, the children suffered from less severe but very common problems but still, a low quality of life, a high school absence and parents being absent from work to a high degree were found. The functional impairment had a considerable impact on their everyday lives. It is well known that this imposes a risk for long-term consequences, for the individuals as well as for society as a whole [<span>2</span>].</p><p>The present study explores common symptoms, such as recurrent abdominal pain and headache, in paediatric patients who have undergone multiple referrals without an established organic diagnosis [<span>1</span>]. These cases highlight a broader challenge within the current medical care system. The management of conditions like paediatric obesity, for example, is often complicated by a high co-occurrence of psychiatric disorders, including autism or attention-deficit disorder [<span>3</span>]. A similar complexity exists in the treatment of paediatric feeding disorders [<span>4</span>]. Moreover, conditions resulting from child abuse, parental stress or emotional or physical neglect can present with symptoms that mimic medical problems like chronic pain [<span>5</span>] or growth disorders [<span>6</span>]. Consequently, managing psychiatric issues in this population often requires a broad, interdisciplinary approach.</p><p>However, what can be stated concerning this population of children, whom we both observe and overlook in our routine clinical practice? How can we effectively approach this group, enhance our understanding, and more critically—how can we best address their needs, prevent suffering, and promote optimal health? In Region Västra Götaland, Sweden, we found that approximately 20% of all children had long-term and/or more extensive contact with the healthcare system, often necessitating coordinated interventions from either one or more of multiple specialists in paediatrics, child psychiatry, child habilitation, and a range of paramedical disciplines [<span>7</span>]. Furthermore, the number of children with special healthcare needs has significantly increased over time [<span>7</span>]. At the time of our article, there were no es

对有复杂护理需求的儿童进行有效管理需要综合考虑影响儿童症状的生理、心理和社会因素及其根本原因。这种整体方法对于经常转诊或反复访问诊所和急诊科的儿童尤其重要。正如Lygre等人在发表在《儿科学报》上的研究中所描述的那样，当对儿童的症状进行单独评估时，很容易失去一个广阔的视角。他们说：“管理有复杂健康抱怨的患者是具有挑战性的，因为当这些抱怨被单独考虑时，累积的功能损伤可能会被忽视。”在目前的研究中，孩子们遭受的问题不太严重，但很常见，但仍然是低质量的生活，高中缺勤和父母缺勤程度很高。功能障碍对他们的日常生活产生了相当大的影响。众所周知，这给个人和整个社会带来了长期后果的风险。本研究探讨了多次转诊但没有明确器质性诊断的儿科患者的常见症状，如复发性腹痛和头痛。这些案例凸显了当前医疗保健系统面临的更大挑战。例如，对儿童肥胖等疾病的管理往往因精神疾病（包括自闭症或注意力缺陷障碍）的高发生率而复杂化。儿科喂养障碍的治疗也存在类似的复杂性。此外，儿童虐待、父母压力或情感或身体忽视造成的状况可能会出现类似慢性疼痛[5]或生长障碍[6]等医学问题的症状。因此，管理这一人群的精神问题往往需要一个广泛的，跨学科的方法。然而，对于这些我们在日常临床实践中既观察又忽视的儿童群体，我们能说些什么呢？我们如何才能有效地接近这个群体，增进我们的理解，更重要的是，我们如何才能最好地满足他们的需求，预防痛苦，促进最佳健康？在瑞典Västra Götaland地区，我们发现大约20%的儿童与医疗保健系统有长期和/或更广泛的接触，往往需要来自儿科、儿童精神病学、儿童康复和一系列医疗辅助学科的一位或多位专家的协调干预[10]。此外，随着时间的推移，有特殊保健需要的儿童人数显著增加。在我们写这篇文章的时候，还没有确定的定义，也没有不同的方法来评估有复杂护理需求或特殊医疗保健需求的儿童的患病率。在这方面，将“复杂健康症状”定义视为同一主题的另一种变体是很有趣的。对整个群体的严重程度进行分级也很困难，因为它的范围很广，从轻度慢性疾病到极端严重。Lygre等人展示了一种通过生活质量评分[1]来显示功能障碍儿童更均匀比例的方法。对于有复杂护理需求的儿童来说，这可能是一个好的集体变量吗？除了我们自己的研究外，我们还对有复杂护理需求的儿童的父母进行了结构化访谈。一位母亲大声喊道：“他们基本上把她的肺送到哮喘专家那里，胃送到胃肠科医生那里，耳朵送到耳鼻喉科。”他们把关节和肌肉送到理疗师那里。他们把流鼻血和耳部感染的孩子送到耳鼻喉科医生那里，但从来没有人想过：嘿，等一下：我们有一个8岁的孩子，有很多不同的症状。也许我们应该考虑这可能是一种疾病？我认为在我们去过的地方没有得到好的帮助。他们试图解决他们所面临的问题。只是我不认为他们中的任何一个人能自己解决问题——他们必须互相交谈。所以，他们永远不会想出解决办法。”许多家长也对基于医疗保健结构的不协调、分割的方法提出了类似的看法。与此同时，我们应该记住，我们不应该把面临健康挑战的儿童视为弱者或可怜的人，更不应该把他们视为具有强大生命力和健康的个体，而不顾疾病或症状。它总是在倾听、观察和照顾需求之间取得平衡，但也要为生活、恢复力和健康的视角提供空间。即使是病得很重的孩子也有快乐的精神，需要正常和玩耍。长期以来，医疗保健系统一直在为仔细研究疾病和问题做好准备，这可能会给更有疗效和更全面的视角蒙上阴影。同样重要的是，要发现所有的症状和最终受损的生活质量，这些最重要和简单的事情，如更深入的倾听、理解和联系，在某些情况下，本身可能会缓解症状和功能障碍。但是，医疗保健系统的解决方案是什么呢？我们能否重新组织儿童医疗服务，以提供更全面的方法？目前的研究来自挪威，那里的医疗保健系统是为了确保初级保健的连续性而组织的。这在减少急诊就诊甚至延长寿命方面显示出了重要的好处。但是，对儿童的二级保健是否也可以进行重组，以确保连续性和多学科团队，而不仅仅是与特定的医疗问题相关，而是为特定的儿童量身定制需求？我们如何在最适当的护理水平上进行早期识别和干预？例如，初级保健能否提供更多早期和务实的支持和干预，以避免升级到二级保健，并保持与家庭医生和团队的连续性？在一份国家调查报告中，对这些问题作了进一步阐述，并作为供瑞典政府决定的建议提出，该报告宣布国家社会事务和卫生委员会有必要分析和确认国家定义、护理需要和针对有广泛和长期保健需要的儿童的建议性行动。还应更积极地满足他们的需求，并在密切的护理环境中加以整合，这包括在初级保健、学生健康和专业护理利益攸关方之间建立强有力的伙伴关系和协作。在同一调查b[10]的第一份报告中提出了一项针对所有儿童（从怀孕到20岁）的特殊国家卫生方案，旨在加强瑞典卫生保健系统的这一发展。整个项目目前正处于建设的最后阶段，将于2026年8月提交。该方案还包含对有复杂健康问题的儿童或其他需要迅速、适当和协调干预的痛苦或疾病的早期信号的“危险信号”功能。在这方面，必须克服二级护理儿科和儿童精神病学内部以及之间的服务划分组织，以保证提供有效的无缝多学科方法。我们不能再对社会和个人的长期后果视而不见了[9,10]。我们需要为有复杂护理需求的儿童提供协调和无缝的近距离护理，将初级保健和专科保健结合起来。Peter Almgren：写作-原稿，写作-审查和编辑，调查，概念化，方法论。Lars Gelander：写作-原稿，写作-审查和编辑，调查，方法论，概念化。作者声明无利益冲突。没有与这篇社论直接相关的相关数据。

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引用次数: 0

Population-Based Cohort Study for Development of National Retinopathy of Prematurity Screening Criteria 制定国家早产儿视网膜病变筛查标准的人群队列研究。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-25 DOI: 10.1111/apa.70381

R. Gerull, C. Sanchez, A. Atkinson, M. Schuler-Barazzoni, M. Adams, F. Barcos Munoz, C. Gerth-Kahlert, S. M. Schulzke, the Swiss Neonatal Network

Aim

Screening criteria for retinopathy of prematurity (ROP) vary among countries. Early detection of ROP and minimising the burden of screening are important.

Methods

We analysed data from very preterm infants born in Switzerland between 2006 and 2022. Logistic regression models were fitted to evaluate 17 potential risk factors for ROP treatment.

Results

168/11354 patients (median (range) gestational age (GA) 29.6 (23.0–31.9) weeks) required ROP treatment. All would have been detected and screening burden would have been reduced by 56% if screening had required meeting ≥ 1 of the following criteria: GA < 27 weeks (89.3%), birth weight < 1000 g (97.0%), intraventricular haemorrhage≥II° (24.0%), congenital tumour (1.2%). We identified six statistically significant risk factors for ROP: GA (adjusted odds ratio (aOR) 0.46, 95% CI 0.40–0.52, p < 0.001), birth weight z-score (aOR 0.58, 95% CI 0.46–0.73, p < 0.001), duration of supplemental oxygen (aOR 1.01 95% CI 1.01–1.02, p < 0.001), duration of mechanical ventilation (OR 1.01, 95% CI 1.00–1.02, p = 0.018), caesarean section (OR 1.84, 95% CI 1.06–3.36, p = 0.038), and congenital tumour (OR 26.3, 95% CI 2.71–189, p = 0.002). The model allowed for excellent prediction of ROP treatment (AUC 0.963, 95% CI 0.944–0.981).

Conclusions

Safely reducing the burden of ROP screening appears achievable in Switzerland.

目的：早产儿视网膜病变（ROP）的筛查标准因国家而异。早期发现ROP和尽量减少筛查负担是很重要的。方法：我们分析了2006年至2022年在瑞士出生的极早产儿的数据。拟合Logistic回归模型评价17个ROP治疗的潜在危险因素。结果：168/11354例患者（中位胎龄（GA） 29.6（23.0-31.9）周）需要ROP治疗。如果筛查要求满足以下≥1个标准，所有患者都将被检测到，筛查负担将减少56%:GA结论：在瑞士，安全减轻ROP筛查负担似乎是可以实现的。

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引用次数: 0

Letter to the Editor—Response to Banos et al. 致编辑的信——对Banos等人的回应

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-24 DOI: 10.1111/apa.70378

Anne Waehre, Hugo Lagercrantz

引用次数: 0

Bacterial Meningitis in Norwegian Children 2010–2023: Low Incidence but Still a Major Threat in Neonates 2010-2023年挪威儿童细菌性脑膜炎：低发病率但仍是新生儿的主要威胁。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-22 DOI: 10.1111/apa.70379

Ingrid Kristine Lovund, Anders Batman Mjelle, Christian Magnus Thaulow, John Espen Gjøen

Aim

Bacterial meningitis (BM) has become less frequent, partly due to national vaccination programmes, and recent data on BM in Nordic children is limited. We reviewed the incidence, aetiology, symptoms, treatment and outcomes of BM in Norwegian children.

Methods

Data were collected from electronic medical records of children under 15 diagnosed with microbiologically confirmed BM at Haukeland University Hospital, Bergen, from 2010 to 2023.

Results

We identified 40 cases of BM, of which 22 (55%) were boys. The median age was 10 days (range 0–5243). The overall annual incidence was 2.8 per 100 000. BM was most frequent in the neonatal period, with an annual incidence of 36 per 100 000 live births. BM after the neonatal period occurred in 1.1 per 100 000 per year. The most common bacteria were group B Streptococcus (50%), Streptococcus pneumoniae (18%) and Escherichia coli (18%). Altered consciousness occurred in 37 patients (93%). The combination of altered consciousness, fever and nuchal rigidity was found in three patients (8%). Long-term disabilities occurred in 15 patients (37%), and two died.

Conclusion

The incidence of BM in Norwegian children was low between 2010 and 2023, with neonates constituting the majority. BM still carries mortality risk and high sequelae rates.

目的：细菌性脑膜炎（BM）已经变得不那么常见，部分原因是由于国家疫苗接种计划，最近关于北欧儿童BM的数据有限。我们回顾了挪威儿童脑脊髓炎的发病率、病因、症状、治疗和结局。方法：收集2010年至2023年在卑尔根豪克兰大学医院被微生物学证实为BM的15岁以下儿童的电子病历数据。结果：我们确定了40例BM，其中22例（55%）为男孩。中位年龄为10天（范围0-5243）。年总发病率为每10万人2.8例。BM最常见于新生儿期，年发病率为每10万活产36例。新生儿期后BM发生率为每年每10万人1.1例。最常见的细菌是B群链球菌（50%）、肺炎链球菌（18%）和大肠杆菌（18%）。37例（93%）患者发生意识改变。3例患者（8%）出现意识改变、发热和颈部僵硬。15例（37%）发生长期残疾，2例死亡。结论：2010 - 2023年挪威儿童BM发病率较低，以新生儿为主。BM仍然存在死亡风险和高后遗症率。

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引用次数: 0

Addressing the Silent Pandemic: The Role of Italian Primary Care Paediatrics in Combating Antimicrobial Resistance 应对无声的流行病：意大利初级保健儿科在抗击抗菌素耐药性方面的作用。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-22 DOI: 10.1111/apa.70380

Giovanni Cerimoniale, Elena Chiappini, Nicolò Monti, Antonio D'Avino, Nicola Roberto Caputo, Osama Al Jamal, Giuseppe Di Mauro, Domenico Careddu, Antonella Antonelli, Silvia Zecca, Paolo Felice, Raffaele Losco

<p>The discovery of penicillin by Alexander Fleming in 1928 marked the beginning of the antibiotic era [<span>1</span>]. Since then, the development of antimicrobial agents has transformed modern medicine, yet each new antibiotic has been accompanied by the inevitable emergence of bacterial resistance [<span>1</span>]. In response to this threat, the Infectious Diseases Society of America (IDSA) formally introduced in 2007 the concept of antimicrobial stewardship programs (ASPs), defined as a coordinated set of interventions aimed at optimising antimicrobial use—choosing the right agent, dose, route and duration—without compromising patient outcomes [<span>1, 2</span>].</p><p>The Italian Ministry of Health launched the first National Action Plan on Antimicrobial Resistance (PNCAR) in 2017, establishing a multisectoral task force that included family paediatricians, thereby recognising the key role of primary care in antimicrobial resistance (AMR) containment.</p><p>In Italy, AMR is estimated to cause over 11 000 deaths each year—accounting for one-third of all AMR-related deaths in Europe, with a significant proportion occurring in younger individuals [<span>2</span>].</p><p>In this context, family paediatricians are pivotal. Their trusted relationships with families position them as central figures in promoting judicious antibiotic use and raising public awareness about infection prevention.</p><p>The most recent <i>AIFA National Report on Antibiotic Use in Italy</i> (2023) underscores critical and persistent issues in paediatric prescribing, placing renewed responsibility on primary care paediatricians [<span>3</span>]. In 2023, 40.9% of children aged 0–13 years received at least one systemic antibiotic—up from 33.7% in 2022. Many of these prescriptions were deemed inappropriate, particularly among children aged 2–5 years, in whom viral infections are the most common cause of fever and respiratory symptoms [<span>3</span>]. There has also been a notable decline in adherence to clinical guidelines, coupled with increased use of broad-spectrum antibiotics. Only 54.4% of prescriptions were from the WHO ‘Access’ group, well below the EU's 65% target [<span>2, 4</span>].</p><p>Significant regional disparities persist; in Northern Italy, 37.7% of children receive antibiotics, compared to 44.1% in the South [<span>4</span>]. Moreover, broad-spectrum antibiotics such as macrolides and third-generation cephalosporins are heavily overused in southern regions, while narrower-spectrum penicillin remains more common in the North [<span>4</span>]. The amoxicillin/amoxicillin-clavulanate ratio—an established quality indicator—is 0.61 in the North but just 0.20 in the South [<span>4</span>]. Even more striking is the broad-to-narrow spectrum antibiotic ratio: 10.9 in the South versus 2.8 in the North, highlighting how Italy continues to lag behind European benchmarks [<span>4</span>]. These findings cast serious doubt on whether the PNCAR 2022–2025 target of a

亚历山大·弗莱明1928年发现青霉素标志着抗生素时代的开始。从那时起，抗菌剂的发展改变了现代医学，但每一种新的抗生素都不可避免地伴随着细菌耐药性的出现。为了应对这一威胁，美国传染病学会（IDSA）于2007年正式引入了抗菌药物管理计划（asp）的概念，将其定义为一套协调的干预措施，旨在优化抗菌药物的使用——选择正确的药物、剂量、途径和持续时间——而不影响患者的预后[1,2]。意大利卫生部于2017年启动了首个抗微生物药物耐药性国家行动计划（PNCAR），建立了一个包括家庭儿科医生在内的多部门工作队，从而认识到初级保健在控制抗微生物药物耐药性方面的关键作用。在意大利，抗微生物药物耐药性估计每年造成1.1万多人死亡，占欧洲所有抗微生物药物耐药性相关死亡人数的三分之一，其中很大一部分发生在年轻人中。在这种情况下，家庭儿科医生至关重要。他们与家庭的信任关系使他们成为促进明智使用抗生素和提高公众对感染预防意识的核心人物。AIFA最新发布的意大利抗生素使用国家报告（2023年）强调了儿科处方中存在的关键和持续存在的问题，重新赋予初级保健儿科医生责任。2023年，40.9%的0-13岁儿童接受了至少一种全身抗生素治疗，高于2022年的33.7%。许多这些处方被认为是不合适的，特别是在2-5岁的儿童中，病毒感染是发烧和呼吸道症状的最常见原因。对临床指南的依从性也有显著下降，加上广谱抗生素的使用增加。只有54.4%的处方来自世卫组织“可及”组，远低于欧盟65%的目标[2,4]。显著的地区差异依然存在；在意大利北部，37.7%的儿童接受抗生素治疗，而在南部，这一比例为44.1%。此外，广谱抗生素如大环内酯类和第三代头孢菌素在南方地区被严重滥用，而窄谱青霉素在北方地区仍较为常见。阿莫西林/阿莫西林-克拉维酸的比率——一个既定的质量指标——在北方是0.61，而在南方只有0.20。更引人注目的是广谱与窄谱抗生素的比例：南方为10.9，北方为2.8，这突显出意大利继续落后于欧洲基准。这些发现使人们严重怀疑PNCAR 2022-2025年将这一比例降低≥20%的目标是否能够实现。2019年至2021年在意大利进行的一项前瞻性观察研究（Picca等人）调查了家庭儿科医生对呼吸道感染儿童的抗生素处方做法。阿莫西林-克拉维酸酯是最常用的处方药物，支气管炎（典型的病毒性疾病）占不适当处方的73%。仅发烧一项就使使用抗生素的可能性增加了三倍，即使在不需要抗生素的情况下也是如此。这些发现与2023年AIFA报告一致，该报告记录了与2022年相比，全面性抗生素使用增加了5.4%，破坏了到2025年减少10%的PNCAR目标。一个新出现的问题是服务药房的作用越来越大，由第73号法令（2024年6月7日）引入。虽然它们提供快速诊断检测（例如，SARS-CoV-2和A组链球菌抗原检测，CRP），但缺乏医生监督往往导致抗生素处方完全基于检测结果，绕过必要的临床判断。这些干预措施旨在使社区处方做法与国家和全球抗微生物药物耐药性控制目标保持一致，并根据2022年7月29日第226号部令的规定，从国家恢复和复原力计划（nrp）中拨出资金，支持为全科医生和家庭儿科医生购买诊断设备。但是，这些资金尚未使用。2025年3月27日，意大利卫生部提交了政府、大区和自治省之间的协议草案，以供批准拨款1.2亿欧元用于实施《国家行动计划2022-2025》（2023年至2025年每年4000万欧元）。这项投资将通过与世卫组织“一个健康”框架相一致的跨部门办法，将人类、兽医和环境卫生结合起来，支持监测、预防和适当使用抗生素。ECDC《2023年年度流行病学报告》对欧洲抗菌素耐药性进行了发人深省的概述，意大利是受影响最严重的国家之一。南欧和东南欧报告由耐多药微生物引起的血液感染发生率最高。在意大利，碳青霉烯耐药肺炎克雷伯菌、MRSA和万古霉素耐药屎肠球菌（VREfm）尤其令人担忧，VREfm患病率超过20%。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯的耐药性也有惊人的报道[2,4]。欧洲每年面临约2.5万例与抗菌素耐药性相关的死亡，医疗保健和生产力成本接近15亿欧元。与此同时，在美国，门诊抗生素处方仍然很普遍，特别是在幼儿中，他们每年收到超过6500万张处方，其中至少29%是不必要的。抗生素耐药性仍然是一个主要的公共卫生问题，意大利儿科初级保健中不适当的抗生素处方在很大程度上造成了这一问题。尽管有国家指导方针和管理努力，但广谱抗生素——特别是阿莫西林-克拉维酸酯和大环内酯——的过度使用仍然存在，同时治疗时间也不必要地长。我们的调查证实了这些重大差距，特别是在管理常见呼吸道感染方面，区域差异进一步突出了有针对性干预措施的必要性。为实现国家和国际抗微生物药物耐药性控制目标，必须使儿科处方与现有证据保持一致，加强地区管理计划，并通过教育、监测和诊断工具支持家庭儿科医生。加强这些干预措施对于使处方行为与现行指南保持一致、缩小区域差异和遏制抗微生物药物耐药性的上升至关重要。对概念化和研究设计有贡献。g.c.、e.c.、n.m.、a.d.、n.r.c.、o.a.j.、g.d.m.、d.c.、a.a.、s.z.、P.F.和R.L.参与了数据收集、患者管理和分析。e.c.和N.M.起草了手稿，所有作者都严格审查并批准了最终版本。作者没有什么可报告的。这项研究是按照《赫尔辛基宣言》中概述的伦理原则进行的。作者没有什么可报告的。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。

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引用次数: 0

Alarming Global Rise in Adolescent Metabolic Dysfunction-Associated Steatotic Liver Disease by 2030 到2030年，全球青少年代谢功能障碍相关脂肪变性肝病的发病率将惊人上升。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-21 DOI: 10.1111/apa.70373

Xiang Li, Hua Yu

Aim

This study forecasts the global burden of ultrasound-diagnosed MASLD in adolescents (15–19 years) from 2020 to 2030, examining socioeconomic influences.

Methods

Using generalised additive models (GAM) and estimated annual percentage change (EAPC), age-standardised incidence (ASIR), mortality (ASDR) and disability-adjusted life years (DALYs) rates were projected. Regional analyses used the Socio-Demographic Index (SDI), with regression models quantifying associations.

Results

Global ASIR is projected to rise significantly (EAPC: +1.46%), outpacing slower increases in DALYs (EAPC: +0.20%) and ASDR (EAPC: +0.18%). High-income North America faces the steepest ASIR surge (EAPC: +2.52%), while Central/Eastern Europe and Central Asia are stable. By 2030, low-SDI regions will have the highest median ASIR, with Turkmenistan predicted to have the world's highest (0.77 per 100 000). Striking disparities exist: higher SDI strongly correlates with elevated ASIR in Europe (R² = 0.339), indicating lifestyle risks in affluent settings. Conversely, higher SDI correlates with reduced DALYs/ASDR elsewhere. Despite some declines in low-SDI areas, high-income North America and vulnerable low-SDI regions (e.g., Turkmenistan) face escalating burdens.

Conclusions

Socioeconomic factors and lifestyle disparities drive divergent global adolescent MASLD trajectories. Without intervention, the burden will surge by 2030—particularly in high-income North America and low-SDI hotspots—demanding region-specific policies to address metabolic health inequities.

目的：本研究预测2020年至2030年全球15-19岁青少年超声诊断的MASLD负担，并考察社会经济影响。方法：采用广义加性模型（GAM）和估计年百分比变化（EAPC），预测年龄标准化发病率（ASIR）、死亡率（ASDR）和残疾调整生命年（DALYs）率。区域分析使用社会人口指数（SDI），并使用回归模型量化关联。结果：全球ASIR预计将显著上升（EAPC: +1.46%），超过DALYs （EAPC: +0.20%）和ASDR （EAPC: +0.18%）的缓慢增长。高收入的北美面临着最急剧的ASIR增长（EAPC: +2.52%），而中欧/东欧和中亚则保持稳定。到2030年，低sdi地区的ASIR中位数将最高，土库曼斯坦预计将达到世界最高水平（0.77 / 10万）。存在显著的差异：在欧洲，较高的SDI与较高的ASIR密切相关（R2 = 0.339），表明富裕环境中的生活方式存在风险。相反，较高的SDI与其他地方降低的DALYs/ASDR相关。尽管低sdi地区有所下降，但北美高收入地区和脆弱的低sdi地区（如土库曼斯坦）面临着日益加重的负担。结论：社会经济因素和生活方式差异导致全球青少年MASLD发展轨迹的差异。如果不进行干预，到2030年，这一负担将激增——尤其是在高收入的北美和低sdi热点地区——这就要求采取针对特定区域的政策来解决代谢健康不平等问题。

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引用次数: 0

EBNEO Commentary: Cord Blood Red Cell Transfusions and Severe Retinopathy of Prematurity in Preterm Neonates EBNEO评论：脐带血红细胞输注和早产儿严重视网膜病变。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-20 DOI: 10.1111/apa.70376

Mahmud Benoune

Teofili L, Papacci P, Pellegrino C, Molisso R, et al. Cord Red Blood Cell Transfusions for Severe Retinopathy in Preterm Neonates in Italy: A Multicenter Randomized Controlled Trial (BORN Trial). eClinicalMedicine 87 (2025): 103426. https://doi.org/10.1016/j.eclinm.2025.103426.

This multicenter randomised trial [1] explores an innovative approach to transfusion in preterm neonates—preserving fetal haemoglobin (HbF) via cord blood–derived RBCs to mitigate oxidative complications such as ROP and BPD. The investigators deserve recognition for demonstrating both the feasibility and safety of cord blood transfusions in ELGANs, addressing a major logistical challenge in neonatal transfusion medicine.

Methodologically, the study was robust—randomised, blinded, and multicenter—with clinically meaningful endpoints. The biological rationale is sound: HbF's high oxygen affinity may reduce retinal hyperoxia and free radical–mediated injury. The results are promising—no severe retinopathy of prematurity (ROP) or bronchopulmonary dysplasia (BPD) among infants who received only cord blood—but interpretation must remain cautious.

Nearly half of the intervention group received mixed transfusions due to unit shortages, severely limiting statistical power in the ITT analysis. The striking benefit in the per-protocol subgroup, though compelling, was based on only 17 infants and is therefore hypothesis-generating rather than definitive. Additionally, logistical and cost barriers—cord collection, processing, and inventory constraints—would currently prevent large-scale adoption [2].

This trial aligns with previous observational data linking lower HbF levels to higher ROP and BPD risk [3, 4]. It adds randomised evidence supporting a potential causal mechanism but falls short of establishing clinical efficacy. Future studies should ensure adequate HbF exposure, standardised transfusion thresholds, and long-term visual and neurodevelopmental follow-up.

The clinical message is that cord-derived transfusions may hold protective potential; however, the evidence remains preliminary. Neonatal units should continue to follow existing restrictive transfusion guidelines while further multicenter trials clarify the role of HbF-preserving strategies.

URL LINK: https://ebneo.org/ebneo-commentary-cord-blood-red-cell-transfusions-and-rop

Mahmud Benoune: writing – review and editing, conceptualization, writing – original draft, formal analysis.

The author declares no conflicts of interest.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

李建军，李建军，李建军，等。脐带红细胞输注治疗意大利早产儿严重视网膜病变：一项多中心随机对照试验（BORN试验）。临床医学87(2025):103426。https://doi.org/10.1016/j.eclinm.2025.103426.This多中心随机试验[1]探索了一种通过脐带血来源的红细胞输血保存胎儿血红蛋白（HbF）的创新方法，以减轻氧化并发症，如ROP和BPD。研究人员证明了在elgan中脐带血输血的可行性和安全性，解决了新生儿输血医学的主要后勤挑战，值得肯定。在方法学上，该研究是稳健的——随机、盲法和多中心——具有临床意义的终点。生物学原理是合理的：HbF的高氧亲和力可能减少视网膜高氧和自由基介导的损伤。结果很有希望——在只接受脐带血的婴儿中没有严重的早产儿视网膜病变（ROP）或支气管肺发育不良（BPD）——但解释必须保持谨慎。由于单位短缺，近一半的干预组接受混合输血，严重限制了ITT分析的统计效力。每个方案亚组的显著益处虽然令人信服，但仅基于17名婴儿，因此是假设产生而不是决定性的。此外，物流和成本障碍——脐带收集、处理和库存限制——目前将阻碍大规模采用。该试验与先前的观察数据一致，即较低的HbF水平与较高的ROP和BPD风险有关[3,4]。它增加了支持潜在因果机制的随机证据，但没有建立临床疗效。未来的研究应确保充分的HbF暴露，标准化的输血阈值，以及长期的视觉和神经发育随访。临床信息是脐带来源的输血可能具有保护潜力；然而，证据仍然是初步的。新生儿单位应继续遵循现有的限制性输血指南，同时进一步的多中心试验阐明hbf保存策略的作用。网址链接：https://ebneo.org/ebneo-commentary-cord-blood-red-cell-transfusions-and-ropMahmud贝农：写作-审查和编辑，概念化，写作-原稿，形式分析。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。

{"title":"EBNEO Commentary: Cord Blood Red Cell Transfusions and Severe Retinopathy of Prematurity in Preterm Neonates","authors":"Mahmud Benoune","doi":"10.1111/apa.70376","DOIUrl":"10.1111/apa.70376","url":null,"abstract":"<p>Teofili L, Papacci P, Pellegrino C, Molisso R, et al. Cord Red Blood Cell Transfusions for Severe Retinopathy in Preterm Neonates in Italy: A Multicenter Randomized Controlled Trial (BORN Trial). <i>eClinicalMedicine</i> 87 (2025): 103426. https://doi.org/10.1016/j.eclinm.2025.103426.</p><p>This multicenter randomised trial [<span>1</span>] explores an innovative approach to transfusion in preterm neonates—preserving fetal haemoglobin (HbF) via cord blood–derived RBCs to mitigate oxidative complications such as ROP and BPD. The investigators deserve recognition for demonstrating both the feasibility and safety of cord blood transfusions in ELGANs, addressing a major logistical challenge in neonatal transfusion medicine.</p><p>Methodologically, the study was robust—randomised, blinded, and multicenter—with clinically meaningful endpoints. The biological rationale is sound: HbF's high oxygen affinity may reduce retinal hyperoxia and free radical–mediated injury. The results are promising—no severe retinopathy of prematurity (ROP) or bronchopulmonary dysplasia (BPD) among infants who received only cord blood—but interpretation must remain cautious.</p><p>Nearly half of the intervention group received mixed transfusions due to unit shortages, severely limiting statistical power in the ITT analysis. The striking benefit in the per-protocol subgroup, though compelling, was based on only 17 infants and is therefore hypothesis-generating rather than definitive. Additionally, logistical and cost barriers—cord collection, processing, and inventory constraints—would currently prevent large-scale adoption [<span>2</span>].</p><p>This trial aligns with previous observational data linking lower HbF levels to higher ROP and BPD risk [<span>3, 4</span>]. It adds randomised evidence supporting a potential causal mechanism but falls short of establishing clinical efficacy. Future studies should ensure adequate HbF exposure, standardised transfusion thresholds, and long-term visual and neurodevelopmental follow-up.</p><p>The clinical message is that cord-derived transfusions may hold protective potential; however, the evidence remains preliminary. Neonatal units should continue to follow existing restrictive transfusion guidelines while further multicenter trials clarify the role of HbF-preserving strategies.</p><p>URL LINK: https://ebneo.org/ebneo-commentary-cord-blood-red-cell-transfusions-and-rop</p><p><b>Mahmud Benoune:</b> writing – review and editing, conceptualization, writing – original draft, formal analysis.</p><p>The author declares no conflicts of interest.</p><p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":"115 3","pages":"748-749"},"PeriodicalIF":2.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.70376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Concerns About Nyquist, Torgersen, David, Diseth, Gulbrandsen and Wæhre's “Treatment Trajectories Among Children and Adolescents” 对Nyquist， Torgersen, David, Diseth， Gulbrandsen和Wæhre的“儿童和青少年的治疗轨迹”的关注。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-19 DOI: 10.1111/apa.70375

David R. Banos, Alma Marstein, Monica Patrascu, Anine Hartmann, Janne Bromseth, Max Korbmacher

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Perspectives on Pertussis Prevention. 百日咳预防的观点。

IF 2.1 4区医学 Q1 PEDIATRICS

Acta Paediatrica

Pub Date : 2025-11-19 DOI: 10.1111/apa.70377

Ulrich Heininger

引用次数: 0