BMC Pediatrics最新文献

Background: Phenobarbital (PB) has long been considered the standard first-line therapy for neonatal seizures, despite suboptimal efficacy and concerns about neurotoxicity and adverse cardiopulmonary effects. Levetiracetam (LEV), a newer antiseizure medication with a more favorable safety profile, has emerged as a potential alternative. This systematic review and meta-analysis aimed to compare the efficacy and safety of LEV versus PB when used as first-line treatment for neonatal seizures.

Methods: A systematic search of PubMed, Scopus, and Web of Science from inception to September 2025 identified eligible randomized controlled trials (RCTs) and observational studies comparing first-line LEV with PB in neonates. Data were pooled using random-effects models to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity, publication bias, and potential effect modifiers were explored through subgroup, and meta-regression analyses.

Results: Twenty-six studies (13 RCTs and 13 observational cohorts) including 9,854 neonates (LEV = 1,601; PB = 8,253) were analyzed. The overall rate of seizure control did not differ significantly between LEV and PB (RR = 0.92, 95% CI 0.82-1.03; p = 0.16). Subgroup analyses by study design yielded consistent findings. LEV was associated with significantly fewer adverse events (RR = 3.59, 95% CI 1.85-6.95; I² = 86%), particularly lower risks of hypotension (RR = 3.90, 95% CI 1.94-7.87) and respiratory depression (RR = 2.06, 95% CI 1.23-3.47) compared with PB. Mortality rates were similar between groups (RR = 1.27, 95% CI 0.84-1.91). Meta-regression revealed that higher gestational age and birth weight were associated with better seizure control, whereas older age at seizure onset predicted poorer response.

Conclusion: LEV and PB demonstrate comparable efficacy for first-line treatment of neonatal seizures; however, LEV provides a more favorable safety and tolerability profile, particularly with respect to cardiopulmonary stability. These findings support the consideration of LEV as an alternative first-line agent, especially in neonates at risk for hemodynamic or respiratory compromise. Further large, high-quality RCTs with standardized EEG confirmation and long-term neurodevelopmental follow-up are warranted.

Background: Central venous access devices (CVADs) are essential in pediatric oncology but frequently associated with infections, thromboses, and dysfunction. Although structured surveillance may reduce complications, implementation is limited by fragmented documentation across clinical systems.

Methods: We conducted a mixed-methods study combining a two-stage interdisciplinary electronic Delphi process with retrospective cohort analysis. Pediatric oncology patients diagnosed between 2020 and 2021 who received a CVAD at our university hospital were included. Data were manually extracted from three hospital information systems. Only the first CVAD per patient was analyzed (n = 112).

Results: Of 219 diagnosed patients, 112 met inclusion criteria, accounting for 126 CVADs. The eDelphi panel identified 30 core surveillance parameters, 23 retrievable from routine records. Complications occurred in 23.2%, most commonly infections leading to premature removal.

Conclusions: Standardized electronic CVAD documentation could enhance surveillance, improve patient safety, and reduce manual data collection efforts.

Purpose: Kawasaki disease (KD) is a vasculitis of the large and medium vessels. Its description and epidemiology in the Afro-descendant (AD) population and in Latin America and the Caribbean (LAC) are limited. The current study aims to describe the epidemiology and clinical and biological characteristics of children with KD in Martinique.

Methods: Our study was descriptive, retrospective, multicenter epidemiological study including all children aged 0-18 years hospitalized for KD in the pediatric and intensive care units of Martinique from January 2013 to December 2019. KD was diagnosed according to the European SHARE guidelines.

Results: Between 2013 and 2019, 63 children were hospitalized with KD in Martinique. The estimated incidence was 34 per 100.000 children under 5 years old (CI95% 27.9-52.5). The male to female ratio was 1.2. Among all patients, 12/63 (19%) had coronary involvement, and 5/63 (8%) had medium or giant coronary aneurysms. No child died of KD during the study. Eighteen children (29%) required a second line of treatment after polyvalent immunoglobulins. The Kobayashi score in our cohort had a sensitivity of 41% (CI95% 28.9% - 53.2%) and a specificity of 78% (CI95% 67.7% - 88.2%) .

Conclusions: Our study is the first epidemiological and descriptive study of KD in a Caribbean island and the first to show the incidence of KD in children in a Caribbean AD population. The incidence was higher than in Caucasian populations, with peaks after arboviral epidemics, but the risk of cardiac complications was similar. The accuracy of the Kobayashi and Kawanet Echo scores were different in our population. Further studies are needed to confirm these trends in AD and LAC populations.

Background: Asthma is a prevalent chronic respiratory, significantly impacting their quality of life. Omalizumab, an anti-IgE monoclonal antibody, was approved for children aged 6 to 11 years in 2016, but its safety and efficacy in this age group have not been thoroughly studied.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published before October 20, 2024, that evaluated the safety and efficacy of omalizumab in pediatric patients aged 6 to 11 years. The review adhered to the PRISMA guidelines and was registered with PROSPERO (CRD42024531092).

Results: Our systematic review and meta-analysis included 4 RCTs with a total of 1078 pediatric patients. Adverse events did not significantly increase with omalizumab compared to placebo. Omalizumab reduced asthma exacerbations (risk ratio (RR) 95% confidence interval (CI) = 0.60 [0.52,0.69], P < 0.01), particularly during the steroid reduction phase (RR 95%CI = 0.52 [0.43,0.64], P < 0.01). Omalizumab also decreased the need to inhaled corticosteroid (ICS) doses and increased the number of patients completely stopping ICS compared to placebo (RR 95%CI = 1.44 [1.10,1.88], P < 0.01). Improvements in pulmonary function indices were observed in the omalizumab group, and analysis of fractional exhaled nitric oxide (FeNO) levels indicated reduced airway inflammation.

Conclusion: These results advocate for the use of omalizumab as an effective therapeutic option for children with allergic asthma aged 6-11 years, highlighting its potential to optimize asthma management and enhance clinical outcomes in this vulnerable age group. Further research is warranted to confirm these findings and explore long-term outcomes.