Acta Paediatrica最新文献

Aim: The Extremely Preterm Infant Target Optimise and Prevent (EPITOP) study aimed to develop an ethical and practical approach to biobanking salvaged residual blood samples from extremely preterm infants (< 28 weeks gestational age, GA) for biomarker research while minimising clinical risks and addressing ethical concerns.

Methods: Initiated in collaboration with Sahlgrenska University Hospital and Biobank Väst, Region Västra Götaland, Sweden, residual blood samples were collected from infants admitted to the neonatal intensive care unit (NICU) from March 2020 to March 2024. Samples were ethically salvaged and biobanked following parental consent and in compliance with Sweden's Biobank Act.

Results: Among 215 eligible infants (mean (GA) 25.4 weeks), 122 consents enabled the collection of 4238 residual samples, of which 92.5% were from blood gas analyses. Sample collection was highest during the first weeks of life, with a median of 35 samples per infant. A higher number of morbidities and lower GA were both associated with an increase in sample numbers. Plasma and whole blood aliquots were prepared and stored for future biomarker studies.

Conclusion: The EPITOP study demonstrates the feasibility of ethically biobanking salvaged residual blood samples from extremely preterm infants. This approach minimises clinical risks while supporting biomarker discovery, providing a scalable model for neonatal research.

Aim: To determine the risk of Grades IV and V kidney injury due to common children's sports.

Methods: A systematic review of studies reporting traumatic kidney injuries (TKIs) associated with basketball, cycling, equestrian, motorsports, netball, rugby, Australian football or soccer. Studies with patients exclusively 18 years or older, non-TKIs or non-sport-related mechanisms were excluded.

Results: Twenty-five studies with 24 424 patients were included. The estimated risk of kidney loss from sports injuries is 0.37 per million child-years. However, the incidence of Grades IV and V injuries could not be calculated in at-risk populations due to limited prospective data. The prevalence of TKIs from sport-specific trauma was low, ranging from 0.6% to 2.2%. Few studies graded the severity of kidney injury, but in the small number reported, Grades IV and V injuries occurred in 33% of soccer TKIs, 26% of bicycling, 23% of Australian football, 20% of basketball and 17% of equestrian injuries. The high number of ungraded kidney injuries (5514/5607) impacts the reliability of findings.

Conclusion: Recommendations to exclude children with congenital single kidneys from specific sports lack a firm evidence-base. Given bio-psycho-social consequences, such recommendations must be carefully considered, particularly for equestrian and motorised vehicles, which carry a higher risk of trauma.

Aim: We aimed to compare characteristics and clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody positive or negative children attending a specialist outpatient clinic for suspected paediatric long COVID.

Methods: A cross-sectional study was conducted of 113 children and adolescents enrolled between 1 December 2020 to 14 September 2021 in a multidisciplinary programme. Clinical and epidemiological data were collected with standardised interviews and laboratory tests including SARS-CoV-2 spike antibody measurement.

Results: A serological link to SARS-CoV-2 infection was found in 52%. Most patients (94.7%) reported several symptoms. Fatigue, post-exertional malaise, dizziness, nausea, headache, and concentration difficulties were the most common. Seronegative children had a higher number of individual symptoms. School absence and drop-out from leisure activities was substantial in both groups with higher numbers for the seronegative group. Self-reported health was low in both groups.

Conclusion: Children attending a specialist paediatric long COVID clinic experienced multiple symptoms and poor self-reported health. The symptomatology was similar regardless of serological status, implying multifactorial causes. A multidisciplinary assessment of this cohort was essential considering the broad spectrum of symptoms displayed and their substantial impact on everyday functioning.

Aim: This study examines trends in paracetamol overdoses among Danish adolescents during and following the COVID-19 pandemic.

Methods: A retrospective observational study was conducted using data from the national databases, covering all paediatric departments in Denmark from January 2016 to December 2023. Patients between 10 and 19 years of age diagnosed with paracetamol overdose were stratified by sex, age and number of hospital admissions. As the dataset covers the entire population, observed values reflect true parameters. A one-sample t-test compared post-COVID-19 values to the pre-COVID-19 mean.

Results: A total of 4.448 patients accounted for 5.794 hospital admissions due to paracetamol overdoses, with a majority being girls. During the second year of the pandemic (2021), a rise in overdose cases (26.5%) and hospital admissions (30.3%) was observed, especially among girls. The average number of admissions per patient increased, indicating repeated self-harm attempts. Cases of severe overdoses leading to acute liver failure increased at Rigshospitalet. These trends reversed post-pandemic.

Conclusion: The findings suggest an association between pandemic-related isolation and an increase in adolescent paracetamol overdoses. While rates began to normalise after restrictions were lifted, further research is needed to assess the long-term mental health impact of such restrictions.

Aim: The study aim was to develop an age-appropriate definition of sport and exercise in children and adolescents for use in concussion research and management.

Methods: A modified Delphi methodology, with three rounds and consensus defined a priori as ≥ 80% agreement.

Results: Thirty-one participants (13 male, 18 female) from 13 countries, including clinical psychologists, epidemiologists, implementation scientists, neurologists, neuropsychologists, neurosurgeons, paediatric emergency physicians, paediatricians, physiotherapists, rehabilitation physicians, speech-language pathologists, and sports medicine physicians came to a consensus that sport-related paediatric concussion extends beyond the sporting arena, and includes the school yard, playground, park, street, recreational site, and home; excludes non-accidental violence, assault, and passenger vehicle road trauma; may include falls; and age-group terminology includes Toddlers and Young Children (1-4 years), Children (5-12 years), and Adolescents (13 to < 18 years). Sport and exercise categories and individual examples are provided.

Conclusions: This consensus definition of sport and exercise in paediatrics for concussion research and management will enable researchers and guideline development groups to expand paediatric concussion research and management guidelines to encompass the broad range of activities commonly associated with sport- and exercise-related concussion in children and adolescents and thus limit exclusion of relevant studies from systematic reviews and guideline development.

Consciousness develops gradually in the womb and after birth, rather than being an all or none phenomenon. A newborn infant is aroused and wakes up at birth, due to the enormous sensory stimulation and stress that it undergoes during the transition from an aquatic environment to air. Its first breaths activate the locus coeruleus, as indicated by the large pupils of the newborn. The infant seems to be aware of its body and can recognise its mother's facial expressions, voice and smell. A default mode network matures soon after birth which appears to keep the brain in a conscious state. Thus the newborn infant is probably conscious, albeit at a low level. The foetus also shows some signs of being conscious after about 24 weeks of gestation, although it is mainly asleep in the womb and less aware of its environment. Before that stage, the nerves from the primary somatosensory, visual and auditory areas are not yet connected with the site of consciousness in the cerebral cortex.

Aim: The study aimed to compare the demographic, clinical and vaccination status of measles cases in 2023 in our region receiving migration from Syria and to evaluate the effect of migration on disease dynamics.

Methods: This retrospective study analysed the demographic profiles, clinical features and vaccination status of a total of 98 (67 children born and raised in Turkey [group 1] and 31 children of Syrian origin [group 2]) clinically compatible measles patients presenting to all healthcare institutions in Batman, Turkey, in 2023.

Results: Significant differences were observed between groups in vaccination coverage (90.3% unvaccinated amongst Group 2 vs. 55.2% amongst Group 1, p < 0.001), IgM positivity (87.1% vs. 26.9%, p < 0.001) and hospitalisation rates (38.7% vs.16.4%, p = 0.015). Group 2 exhibited higher prevalence of fever (93.5% vs. 70.1%, p = 0.010) and cough (58.1% vs. 26.9%, p = 0.003) than Group 1.

Conclusion: The study highlights the impact of migration and socio-economic factors on measles dynamics. Lower vaccination rates amongst Syrian migrants contribute to increased measles incidence and severity. Strengthening vaccination programmes and public health initiatives are crucial for controlling measles outbreaks and improving health outcomes, particularly in vulnerable populations.

Aim: Different hypoglycaemia screening guidelines for infants born small for gestational age (SGA) are applied throughout the world. This narrative review analysed the published guidelines and evaluated the characteristic features of hypoglycaemia in SGA infants to assess the relevance of the issue.

Methods: PubMed and the Cochrane Database of Systematic Reviews were reviewed for papers regarding hypoglycaemia and hypoglycaemia screening guidelines in term and near-term SGA infants. We also searched government-related websites and national healthcare institution websites for guidelines.

Results: Numerous differences among guidelines were found. The American Academy of Pediatrics and the Pediatric Endocrine Society do not specify which SGA infants need screening. Other guidelines suggest screening infants with birth weight < 10th percentile, while still others < 2nd percentile. Depending on the growth curves, the SGA population may change. The hypoglycaemia cut-off value was another relevant variance. The duration of glucose level checks varies from the first 4-24 h of life. The reported incidence of hypoglycaemia was 12%-52%. The timing of hypoglycaemia onset was 2-6 h of life. Specific risk factors for hypoglycaemia in SGA infants were found.

Conclusion: Numerous differences were found in the hypoglycaemia guidelines for SGA infants, and further studies are needed to address strong and uniform guidance.