AIM: Neonates discharged home on medications remain at risk of medication errors. The PADDINGToN programme previously developed parent co-designed resources to support safer medication administration following discharge....AIM: Neonates discharged home on medications remain at risk of medication errors. The PADDINGToN programme previously developed parent co-designed resources to support safer medication administration following discharge. The aim of this study, PADDINGToN-2, is to evaluate the feasibility of recruiting and retaining parents in a study assessing these resources in order to support safer medication administration at home. METHODS: Prospective single-centre feasibility study in a level 3 neonatal unit between March and December 2025. Parents of infants discharged on ≥ 2 medications were recruited before discharge, and followed for 12 weeks. Primary outcome was recruitment and retention using predefined progression criteria. Secondary outcomes included assessment of parental anxiety and confidence in medication administration. RESULTS: In all, 35 parents were recruited. Retention was 42.8%, meeting predefined 'Amber' progression criteria indicating feasibility with protocol modification. Anxiety scores decreased from a median of 9 at baseline to 5 at follow-up. CONCLUSIONS: Recruitment was feasible, and retention met predefined criteria, supporting progression to a larger multi-centre implementation study with optimised retention strategies.
AIM: Bronchiolitis is a major cause of hospitalisation in young children, but the effectiveness of inhaled hypertonic saline remains unclear. We compared treating hospitalised infants with nebulised hypertonic saline or...AIM: Bronchiolitis is a major cause of hospitalisation in young children, but the effectiveness of inhaled hypertonic saline remains unclear. We compared treating hospitalised infants with nebulised hypertonic saline or normal saline. METHOD: This multisite, double-blind RCT was conducted from 1 October 2023 to 1 April 2025 in four Polish paediatric units. Children from 5 weeks to 24 months, who had been hospitalised with mild-to-moderate bronchiolitis, were randomly assigned to receive nebulised 3% hypertonic saline or 0.9% normal saline until discharge. They were followed for 7 days. RESULTS: The study comprised 181 children (55% male) with a mean age of 8.3 ± 6.3 months: 90 were randomised to hypertonic saline and 91 to normal saline. The median hospital stay was 2.68 (1.92-4.03) days in the hypertonic saline group and 2.79 (1.8-3.96) days in the normal saline group. The mean difference was -0.11 days (95% confidence interval -0.73 to 0.12, p = 0.3). No differences were observed in clinical severity scores between the groups. Readmissions only occurred in the normal saline group (5.9%). CONCLUSION: Hypertonic saline inhalation did not reduce the length of hospital stay or improve clinical severity scores in hospitalised children with bronchiolitis, but it was associated with a lower risk of rehospitalisation.
AIM: Research on the drug delivery of inhaled corticosteroids and combination medications via valved holding chambers (VHCs) with children's breathing patterns is limited. We aimed to evaluate the in vitro performance of...AIM: Research on the drug delivery of inhaled corticosteroids and combination medications via valved holding chambers (VHCs) with children's breathing patterns is limited. We aimed to evaluate the in vitro performance of commercially available VHCs without facemasks under preschooler breathing conditions, focusing on total delivered dose and fine particle dose (FPD). METHODS: We evaluated the FPD in 1-5 μm range of fluticasone/salmeterol combination inhaler, fluticasone propionate mono-inhaler, and ciclesonide delivered through three VHCs: AeroChamber Plus Flow-Vu, EasyChamber, and OptiChamber Diamond. Drug delivery was measured using a Next Generation Impactor with simulated breathing representative of a 4-year-old child. RESULTS: The total delivered dose compared to the label claim was highest for ciclesonide with all the VHCs. The median FPD in 1-5 μm range was significantly higher with EasyChamber compared to AeroChamber and OptiChamber for salmeterol and fluticasone from combination-inhaler and ciclesonide. Overall, relative throat deposition was lowest for ciclesonide and highest for fluticasone mono-inhaler. OptiChamber yielded lowest relative throat depositions for ciclesonide and fluticasone mono-inhaler, while EasyChamber gave lowest relative throat depositions for salmeterol and fluticasone from combination inhaler. CONCLUSION: There were notable differences between the tested VHC's drug delivery. Ciclesonide exhibited favourable aerodynamic properties than fluticasone.
Bay ET, Breindahl N, Heiring C
… +5 more, Nielsen MM, Terheggen U, Tolsgaard MG, Aunsholt L, International Collaborative for Training in Neonatal Transport
AIM: This study aimed to identify and prioritise medical skills for inclusion in a simulation-based training curriculum for interdisciplinary neonatal interhospital transport teams. METHODS: A modified three-round Delphi...AIM: This study aimed to identify and prioritise medical skills for inclusion in a simulation-based training curriculum for interdisciplinary neonatal interhospital transport teams. METHODS: A modified three-round Delphi process was conducted. We included 144 healthcare professionals (101 physicians and 43 non-physician healthcare professionals including nurses, nurse practitioners, paramedics and respiratory therapists) with neonatal transport experience from 14 European countries. In Round 1, participants suggested medical skills. In Round 2, skills were prioritised using a modified Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula. In Round 3, skills were re-prioritised and eliminated based on consensus (> 75% agreement). RESULTS: Consensus was reached on 21 medical skills for physicians and 34 for non-physician healthcare professionals. The highest-ranked skills for physicians included manual non-invasive ventilation, set-up of mechanical ventilation, chest compressions, endotracheal intubation and umbilical venous catheterisation. For non-physician healthcare professionals, the highest-ranked skills included set-up of the transport incubator, monitoring, administration of intravenous infusions and set-up of infusion drivers. CONCLUSION: This study identified and prioritised medical skills for physicians and non-physician healthcare professionals on neonatal transport teams, which supports the development of simulation-based training aligned with the clinical complexity and interdisciplinary nature of neonatal transport.
AIM: Maternal immunization is essential for preventing severe influenza and pertussis in pregnant women and young infants. Despite clear recommendations, uptake in Greece remains suboptimal, and evidence on effective ant...AIM: Maternal immunization is essential for preventing severe influenza and pertussis in pregnant women and young infants. Despite clear recommendations, uptake in Greece remains suboptimal, and evidence on effective antenatal interventions is limited. This study evaluated the impact of a structured counselling programme on maternal influenza and pertussis vaccination coverage. METHODS: A prospective before-after study was conducted among 595 pregnant women delivering at a regional perinatal centre across two influenza seasons (2022-2023 and 2024-2025). During the pre-intervention period, routine antenatal care lacked standardized counselling. The intervention included provider-initiated structured counselling supported by an educational leaflet and routine prescription of both vaccines. Vaccination status was confirmed postpartum. Multivariable logistic regression identified determinants of uptake. RESULTS: Antenatal counselling increased from 43.1% to 74.2%. Influenza vaccination rose from 38.5% to 61.4%, pertussis from 33.8% to 65.5% and combined uptake more than doubled (27.0% to 58.4%). Structured counselling significantly improved adherence (OR 8.7; 95% CI 5.236-14.493). Fear of vaccine-related risks remained the main reason for refusal, though less frequently reported post-intervention. CONCLUSIONS: Structured antenatal counselling substantially improved maternal influenza and pertussis vaccination coverage. Integrating standardized counselling and routine prescription into antenatal care aligns with international recommendations and may strengthen maternal immunization efforts in Greece.
Banos DR, Patrascu M, Ravine A
… +46 more, Giordano S, Hiitola J, Jessen RS, Hamnvik OP, Reed E, Blomqvist L, Grönroos M, Olakivi O, Bolstad SH, Bromseth J, Christiansen M, Era R, Ganesh A, Jacobsen IL, Kennedy N, Keyes O, Koi P, Leino U, McNamara M, Rosenthal S, Sansfaçon AP, Söderström I, Tuomenvirta K, Vähä-Savo V, Valaskivi L, Vandendriessche C, Venäläinen S, Verlooy R, Warenius MAS, Wolfe I, Allen LR, Bjerkeli ET, Brevik I, Dokken M, Jektvik A, Lelièvre F, Adom S, Frydenlund SW, von Knorring T, Lund J, Prevelle AP, Saarinen M, Tarjamo K, Hartmann A, Lorentzen F, Korbmacher M
AIM: To study how pubertal timing associates with cardiometabolic measures in puberty and young adulthood. METHODS: Cardiovascular risk factors, anthropometry and pubertal development were regularly studied in STRIP stud...AIM: To study how pubertal timing associates with cardiometabolic measures in puberty and young adulthood. METHODS: Cardiovascular risk factors, anthropometry and pubertal development were regularly studied in STRIP study subjects until age 26 years. The study participants were divided into tertiles (early, average, and late) according to the age at the beginning of breast/testicular growth, menarche in females, and end of testicular growth in males. Differences in cardiometabolic variables between tertiles were analysed using one-way ANOVA. RESULTS: Earlier breast development was associated with higher body mass index (BMI), waist circumference (WC), and blood pressure (BP) in adulthood compared to the late group. Earlier age at menarche was associated with higher BMI and WC in adulthood. Earlier beginning of testicular enlargement was associated with higher insulin and insulin resistance at 26 years when compared to the late group. Earlier end of testicular growth tended to have higher insulin values and insulin resistance at 26 years than the average group. CONCLUSIONS: Early pubertal development in females is associated with higher BMI and WC. In males, early pubertal development is associated with increased insulin levels and insulin resistance. More research is needed to study whether these metabolic differences build up a cumulative burden.
AIM: To describe prevalence, background and gross motor function of cerebral palsy (CP) in western Sweden 2015-2018 and compare to birth-years 1999-2014. METHODS: Population-based study covering 108 963 live births in 20...AIM: To describe prevalence, background and gross motor function of cerebral palsy (CP) in western Sweden 2015-2018 and compare to birth-years 1999-2014. METHODS: Population-based study covering 108 963 live births in 2015-2018. Birth characteristics, neuroimaging findings and motor outcome were analysed and prevalence calculated and compared to previous cohorts. RESULTS: CP was diagnosed in 194 children, 180 had pre- or peri/neonatal background. Crude prevalence was 1.78 per 1000 live births compared to 2.18 in 1999-2002. Gestational age-specific prevalence for < 28 gestational weeks was 65.9 per 1000 live births, 41.4 for 28-31 weeks, 5.6 for 32-36 weeks and 1.06 per 1000 for > 36 weeks of gestation. Hemiplegia was found in 51.7%, diplegia in 30.6% and tetraplegia in 5.6%, dyskinetic CP accounted for 10.6% and ataxia for 1.7%. Neuroimaging showed maldevelopments in 7%, white matter lesions in 54% and grey matter lesions in 29%. Motor function had improved since the birth years 1999-2002, both in term and in extremely preterm children. Prenatal aetiology was considered in 34.4% and peri/neonatal in 49.4%. Aetiological period remained unclassified in 16.1%. CONCLUSION: The prevalence of CP is declining. Gross motor function has improved over time. White matter lesions are increasingly common.
AIM: The aim of this study was to compare the outcomes and complications of infants born at 34 gestational weeks (GW) clinically stable between those admitted with their mother and those admitted separately. METHODS: Ret...AIM: The aim of this study was to compare the outcomes and complications of infants born at 34 gestational weeks (GW) clinically stable between those admitted with their mother and those admitted separately. METHODS: Retrospective observational study at a tertiary hospital that included stable infants born at 34 GW between January 2021 and December 2025. Feeding outcomes, complications, and length of stay were compared between infants admitted in rooming-in with the mother (RI) and those admitted to the neonatal unit (NU). RESULTS: 121 infants were included (RI: 57; NU: 64), with similar baseline characteristics. Infants in RI had earlier skin-to-skin contact (RI: 0 h (IQR 0); NU: 1 h (IQR 14.2); p < 0.001) and colostrum exposure (RI: 2 h (IQR 3.2); NU: 5.5 h (IQR 8.2); p < 0.001), with higher rates of exclusive breastfeeding at 15 days post-discharge (RI: 63.2%; NU: 37.5%; p = 0.005). They required less nasogastric tube feeding (RI: 10.5%; NU: 76.6%; p < 0.001) and were discharged earlier (RI: 8 days (IQR 7); NU: 19 days (IQR 14); p < 0.001), without increased complications. CONCLUSION: RI is a model of care for clinically stable infants born at 34 GW that, in our population, improves early contact and feeding outcomes and reduces hospital stay without more complications than admission to the neonatal unit, supporting the importance of zero-separation policies.
AIM: To evaluate the association between reported symptoms upon exposure to airborne allergens and sensitization to the corresponding allergen. METHOD: In a population-based cohort, 1647 children aged 12 years were inter...AIM: To evaluate the association between reported symptoms upon exposure to airborne allergens and sensitization to the corresponding allergen. METHOD: In a population-based cohort, 1647 children aged 12 years were interviewed about symptoms from eyes, nose and lower airways upon exposure to birch, timothy, cat, dog, and horse, and were afterwards skin prick tested for the same allergens. Positive predictive value (PPV) was calculated for reported symptoms in relation to sensitization. RESULTS: The prevalence of sensitization was generally higher in boys than girls, while reporting of symptoms was equal upon exposure. The proportion of sensitization among individuals reporting symptoms ranged from 70% to 95% and was highest for lower airway symptoms upon dog and cat exposure. Lower airway symptoms were the least prevalent but had the highest PPV for sensitization to each allergen (PPV = 75%-95%). The increasing number of symptoms when exposed to a specific allergen increased the likelihood of sensitization, and the PPV for three symptoms upon cat and dog exposure was > 95%. CONCLUSIONS: Self-reported symptoms upon aeroallergen exposure highly predict sensitization to the same allergen. Unless allergen-immunotherapy is indicated, objective measurements of sensitization may not always be necessary in 12-year-old children with a convincing history of airborne allergy.
There are many misconceptions about the immune system in children, its impact on infectious disease susceptibility and its role in the rapidly increasing rates of immune mediated diseases in industrialized societies. In...There are many misconceptions about the immune system in children, its impact on infectious disease susceptibility and its role in the rapidly increasing rates of immune mediated diseases in industrialized societies. In this mini review, I will discuss common believes and the data supporting or countering such believes, with a focus on clinically relevant topics of relevance to trainees and practicing paediatricians. I will emphasize data from studies performed in humans rather than reductionist mouse models. I discuss open questions requiring further investigation and end with a discussion on clinical observations of particular concern which paediatricians should consider when caring for children in their practices. Immune development is increasingly recognized as an important determinant of health, not just early in life, but also long term and all of us caring for children should know more about it.
AIM: Paediatric hospital care has become increasingly complex with many children requiring monitoring and support beyond general ward capabilities. This review evaluated the role of paediatric intermediate care units (PI...AIM: Paediatric hospital care has become increasingly complex with many children requiring monitoring and support beyond general ward capabilities. This review evaluated the role of paediatric intermediate care units (PIMCUs) within tiered paediatric care systems, with a focus on organizational impact and implementation in Italy. METHODS: We conducted a narrative review using PubMed, Embase, Scopus and the Cochrane Library up to 31 December 2025. Studies addressing PIMCUs were included, together with selected adult studies on organizational and economic aspects. The PIMCU model at the Gaslini Institute in Genoa, Italy, was also described. RESULTS: PIMCUs provided intermediate care for children requiring enhanced monitoring and noninvasive support without full intensive care. Paediatric studies suggested improved patient allocation, reduced inappropriate intensive care admissions and safer transitions of care, findings supported by adult literature with potential cost-effectiveness. In Italy, limited intensive care capacity, regional disparities and lack of formal recognition of PIMCUs contributed to fragmented care pathways. The model developed by our Institute showed that an integrated PIMCU within a hub-and-spoke network improved patient flow, preserved intensive care capacity and enhanced system resilience. CONCLUSIONS: PIMCUs are key components of acuity-based paediatric care systems. Their implementation may improve efficiency, equity and patient safety.
AIM: To examine equity and respectful care for women and infants from five perspectives: the global context; economic issues; healthcare systems; legal and policy issues; opportunities to benefit from biomedical research...AIM: To examine equity and respectful care for women and infants from five perspectives: the global context; economic issues; healthcare systems; legal and policy issues; opportunities to benefit from biomedical research. METHODS: Narrative review. RESULTS: Healthcare accounts for half the variance in health in low-income countries and substantially less in high-income settings; however, healthcare investment remains efficient and equitable. Gross Domestic Product (GDP) affects women and infants disproportionately. Women undertake the major proportion of domestic and childcare duties including breastfeeding as unremunerated labour. This is not factored into GDP, so they do not benefit from growth-promoting incentives. Many countries do not provide adequate paid parental leave, nor the option of sharing leave with the non-birthing parent, despite their positive impacts on infant wellbeing and family cohesion with economic benefits. The rights of infants have received little attention. Women and infants have less opportunities to benefit from biomedical preclinical, translational, and population research. Only one medicine has been developed specifically for a neonatal disease (surfactant). CONCLUSION: Inequity and disrespect to mothers and infants is a barrier to human progress. Recognising the problem and developing policies and legislation to ensure equitable and respectful care, as well as monitoring effectiveness, are extremely important.
AIM: Febrile infants ≤ 90 days are at increased risk of serious and invasive bacterial infections (SBIs/IBIs), although viral illnesses account for most febrile episodes. Current management algorithms prioritize bacteria...AIM: Febrile infants ≤ 90 days are at increased risk of serious and invasive bacterial infections (SBIs/IBIs), although viral illnesses account for most febrile episodes. Current management algorithms prioritize bacterial risk stratification, while viral epidemiology is inconsistently integrated into pathways. Aim of this study is to describe age-specific bacterial and viral etiologies, seasonality, temporal trends, and co-infections in febrile infants presenting to a tertiary paediatric emergency department. METHODS: Retrospective observational study including infants ≤ 90 days evaluated between 2018 and 2025. Infants were stratified into three age groups (≤ 28, 29-60, 61-90 days). Bacterial and viral etiologies, co-infections, seasonal distribution, and temporal trends were analysed. RESULTS: Among 1529 infants, SBI represented 15% of cases. IBI was age-dependent, peaking in neonates ≤ 28 days, whereas viral infections predominated across all groups. Approximately 10% of SBIs occurred with documented viral co-infection. Bacterial infections showed no seasonal pattern, while viral infections demonstrated seasonality, with winter respiratory peaks and summer enterovirus/parechovirus circulation. Viral detections declined during 2020-2021 and rebounded in 2022 whereas bacterial rates remained stable. CONCLUSIONS: Viral etiologies display pronounced seasonality, whereas bacterial infections remain non-seasonal. Viral positivity does not exclude SBI and urinalysis should remain routine. An epidemiology-aware approach may support without replacing bacterial risk stratification.