AIM: To evaluate 25-year national trends in paediatric intensive care utilisation, patient outcomes, rehospitalisations and regional resource distribution in Israel. METHODS: Retrospective, population-based cohort study...AIM: To evaluate 25-year national trends in paediatric intensive care utilisation, patient outcomes, rehospitalisations and regional resource distribution in Israel. METHODS: Retrospective, population-based cohort study of all paediatric (0-17 years) ICU hospitalisations in Israel between 1999 and 2023. We linked the National Hospital Discharge Register with paediatric ICU bed capacity data and Central Bureau of Statistics population estimates. Outcomes included age-adjusted ICU admission rates, in-hospital and 1-year post-discharge mortality, rehospitalisation at 7, 30 and 365 days, and paediatric ICU beds per 100 000 children. RESULTS: The proportion of hospitalisations involving ICU care increased from 3.53% to 6.1%. In-hospital ICU mortality declined from 4.3% to 2.3%, and 1-year post-discharge mortality decreased from 3.2% to 2.6%. One-year rehospitalisation occurred in 46% of ICU survivors versus 29% of non-ICU patients. Between 2018 and 2023, national paediatric ICU bed capacity rose by 23%, yet regional bed-to-population ratios varied up to 2.6-fold. CONCLUSIONS: Over 25 years, paediatric ICU utilisation and capacity nearly doubled, accompanied by reductions in mortality. However, persistently high rehospitalisation rates and regional disparities underscore the need for structured post-ICU follow-up, standardised admission criteria, equitable resource allocation and further research to clarify drivers of ICU utilisation and long-term outcomes.
AIM: Current guidelines based on expert opinions recommend a minimum of 4-6 weeks of antibiotic treatment for paediatric Salmonella osteoarticular infections. In this study, we aim to validate guidelines and investigate...AIM: Current guidelines based on expert opinions recommend a minimum of 4-6 weeks of antibiotic treatment for paediatric Salmonella osteoarticular infections. In this study, we aim to validate guidelines and investigate the duration of antibiotic treatment. METHODS: PubMed, Medline, Embase, Scopus, and Google Scholar were searched for cases according to the PRISMA guidelines. We included all paediatric cases from January 1990 to December 2025 with confirmed Salmonella osteoarticular infection. RESULTS: Outcome was reported in 173 (81%) of 214 children; 117 (68%) previously healthy children fully recovered after a median antibiotic treatment duration of 6.0 weeks, and 32 (18%) children with comorbidities including sickle cell disease fully recovered after a median duration of 8.0 weeks. For all children, approximately half of the treatment duration was administered intravenously. Multivariable logistic regression analysis demonstrated no independent association between antibiotic treatment duration and outcome. CONCLUSION: The majority of children fully recovered after an antibiotic treatment duration within the current guidelines of minimum four weeks in case of joint infection only and six weeks in case of bone infection. The variation in antibiotic treatment durations was substantial. Individualized treatment durations within the recommended timeframe seem reasonable based on the clinical and paraclinical response.
AIM: To investigate whether early lactate dehydrogenase (LDH) and amplitude-integrated electroencephalography (aEEG) improve the prediction of outcome in outborn infants transported for therapeutic hypothermia. METHOD: S...AIM: To investigate whether early lactate dehydrogenase (LDH) and amplitude-integrated electroencephalography (aEEG) improve the prediction of outcome in outborn infants transported for therapeutic hypothermia. METHOD: Secondary analysis of a randomised controlled trial (2016-2019) including 113 asphyxiated newborn infants randomised to transport with a phase-change material mattress or standard care. The analysis included 81 infants with available aEEG, of whom 50 had LDH measured on admission. Outcome at 18 months was categorised as good, defined as normal development or mild delay, or poor, defined as moderate or severe impairment or death. RESULT: Mean (SD) rectal temperature on admission was lower in the PCM group (34.6 [1.1]°C vs. 35.2 [1.1]°C, p = 0.027), but the proportion within target temperature did not differ (39.5% vs. 25.6%, p = 0.235). Clinical characteristics, LDH, aEEG and outcomes were similar between groups. Poor outcome was predicted by LDH > 1000 U/L (89% sensitivity and 61% specificity), severely depressed aEEG within 12 h (87% sensitivity and 47% specificity) and the combination of both (91% sensitivity, 62% specificity and accuracy 81%). CONCLUSION: Combined LDH and aEEG provide a strong early prediction of outcome in encephalopathic infants.
AIM: The review explored the effectiveness of different screening strategies for detecting severe and critical congenital heart defects (CHDs) before neonates were discharged from hospital after birth. These were prenata...AIM: The review explored the effectiveness of different screening strategies for detecting severe and critical congenital heart defects (CHDs) before neonates were discharged from hospital after birth. These were prenatal fetal ultrasounds, postnatal pulse oximetry (POX), and clinical examinations. METHODS: This paper references studies that were published from 2005 to 2025, with a particular emphasis on those from Nordic countries. RESULTS: Prenatal detection rates of 42%-46% in live born infants were registered in nationwide studies. Pregnancy termination rates for severe or critical CHDs increased to 25%-43% and these influenced the prevalences and postnatal detection patterns of such defects. When CHDs that were detected prenatally were excluded, POX screening on the first day of life detected 11%-47% of severe and critical CHDs, depending on the inclusion criteria. When those detected by POX screening were excluded, routine clinical examinations identified 39%-58% of the cases in apparently healthy infants. The remainder were detected because of symptoms or some comorbidity. In infants born in 2014-20, 85%-89% of the severe and critical CHDs were found before discharge. CONCLUSION: Although most severe and critical CHDs were detected before discharge, there are still challenges with regard to developing better screening methods to reduce cases that have been missed.
AIM: To clarify if children with chronic intestinal failure during the neonatal period had a different height at 5 years of age compared to standardised Swedish growth charts. METHODS: This retrospective cohort study of...AIM: To clarify if children with chronic intestinal failure during the neonatal period had a different height at 5 years of age compared to standardised Swedish growth charts. METHODS: This retrospective cohort study of children with chronic intestinal failure during the neonatal period in Gothenburg between 2004 and 2018. Inclusion criterion was parenteral nutrition > 60 days with onset within 3 months from term gestational age. For each child born before week 28 + 0, a control child was identified. RESULTS: Of the 57 children included, 83% were shorter than the population average, and 12% had a height below -2 standard deviations (SD) at 5 years of age, according to the standard growth chart. The height Z-score (standard deviation score) was significantly lower than that of the reference population; median -1.1 SD (range -4.0-2.1). Children with chronic intestinal failure, born before week 28 + 0, were not significantly shorter than their matched controls. CONCLUSIONS: The majority (88%) of children with chronic intestinal failure had a height growth within the normal reference range, even though they had a shorter mean height. These findings suggest that current treatment strategies support overall satisfactory growth outcomes, although further refinement may be required to promote optimal growth.
AIM: This Prospective, Community-Based Cohort Study Investigated Cardiovascular Health and Its Association With Low-Grade Inflammation in Adolescents. METHODS: Data were collected by specially trained medical staff from...AIM: This Prospective, Community-Based Cohort Study Investigated Cardiovascular Health and Its Association With Low-Grade Inflammation in Adolescents. METHODS: Data were collected by specially trained medical staff from 1379 Austrian adolescents aged 14-19 years from 3 February 2021 to 28 February 2023. These included a self-report, assisted questionnaire and structured interview. Cardiovascular health was assessed using the American Heart Association's Life's Essential 8 score and chronic low-grade inflammation was measured by high-sensitivity C-reactive protein levels. Associations were analysed using multivariable linear regression. RESULTS: The average Life's Essential 8 score suggested 75.0% adherence to ideal cardiovascular health recommendations and 68.2% of the cohort had moderate total cardiovascular health scores. High-sensitivity C-reactive protein levels indicated that 66.5% of the adolescents had a low risk of cardiovascular disease. These levels were associated with the total Life's Essential 8 scores (p < 0.001), as well as age (p < 0.001), female sex (p < 0.001), dietary habits (p = 0.029), active smoking (p < 0.001), higher body mass index z-scores (p < 0.001), and oral hormonal contraceptive use (p < 0.001). CONCLUSION: Overall, cardiovascular health was moderate and showed an inverse relationship with high-sensitivity C-reactive protein levels. Improved dietary habits, appropriate physical activity and not using tobacco may help to reduce systemic inflammation and cardiovascular risks.
AIM: Neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) are known biomarkers of brain injury in adults, but their significance in very preterm (VPT) infants remains unclear. Given the strong link...AIM: Neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) are known biomarkers of brain injury in adults, but their significance in very preterm (VPT) infants remains unclear. Given the strong link between inflammation, oxidative stress, and brain injury in this population, we investigated associations between NFL, GFAP, and inflammatory and oxidative stress markers in VPT infants. METHODS: As part of the prospective Finnish PreBaby study on metabolism in VPT infants, serum NFL and GFAP levels were measured at three timepoints from birth to term-equivalent age (TEA) to assess their associations with IL-6 protein levels depicting inflammation, oxidative stress marker urinary 8-isoprostane, and postmenstrual age (PMA). RESULTS: Serum NFL levels showed a strong positive correlation with IL-6 levels (Spearman correlation coefficient 0.784, p < 0.001). Higher NFL concentrations were associated with lower PMA and decreased towards TEA. A weaker correlation was observed between NFL and the oxidative stress marker 8-isoprostane. Serum GFAP levels were not associated with inflammation. CONCLUSIONS: Serum levels of neurofilament light chain are linked to inflammation in very preterm infants. The potential of NFL as an early biomarker of brain injury, potentially guiding preventive interventions and therapy in very preterm infants, should be investigated further.
AIM: There is a need for updated reference intervals for iron status biomarkers during infancy. This study aimed to investigate reference interval trends and diurnal variation of iron, transferrin, and transferrin satura...AIM: There is a need for updated reference intervals for iron status biomarkers during infancy. This study aimed to investigate reference interval trends and diurnal variation of iron, transferrin, and transferrin saturation in infants subjected to delayed cord clamping at birth (DCC). METHODS: Data analysis from population-based Swedish studies, including 362 term-born infants subjected to DCC ≥ 60 s. The 2.5th and 97.5th percentiles were calculated from serum samples: In cord blood, at 48-118 h, four months and 12 months. We used Spearman's rho to test for associations and Student's t-test to compare groups. RESULTS: Iron concentrations in cord blood were initially high, 14-41 μmol/L, and had decreased by 48-118 h to 6-16 μmol/L, remaining mainly constant thereafter. Conversely, early transferrin concentrations were low. Transferrin slowly increased; concentrations at 4 months were positively associated with the average weight gained per day, rho = 0.46, p < 0.001. A small diurnal difference in iron was observed at 48-118 h: Samples collected between 10:30-11:59 were, on average, 1.4 μmol/L (95% CI -2.8 to -0.0) lower compared with samples collected between 15:30-19:59. CONCLUSION: Developmental trends in iron, transferrin, and transferrin saturation in the first year of life need to be considered in the interpretation of test results from infants.
AIM: This systematic review explored associations between brain structural volumes and behavioural outcomes in children born preterm up to 32 weeks of gestation. METHODS: PubMed, PsycINFO, Scopus and Web of Science were...AIM: This systematic review explored associations between brain structural volumes and behavioural outcomes in children born preterm up to 32 weeks of gestation. METHODS: PubMed, PsycINFO, Scopus and Web of Science were searched for papers published in English from 1 January 2013 to 7 November 2023. Studies were included if they examined brain volumetric measures using magnetic resonance imaging and behavioural outcomes from 24 months to 12 years. RESULTS: The search identified 388 records and eight were included. These covered 564 children born at 27-36 weeks, 55.7% of whom were male, with assessments conducted between 2.9 and 10.2 years of age. Three studies were conducted in USA, two in Sweden and one each in Norway, Australia and Switzerland. The findings indicated a higher prevalence of neurodevelopmental and emotional outcomes among children born preterm, particularly autism spectrum disorder, attention deficit hyperactivity disorder and anxiety symptoms. These outcomes were associated with reduced or altered volumes in limbic and subcortical brain regions, such as the amygdala and thalamus. CONCLUSION: Volumetric brain differences were associated with behavioural outcomes and may have reflected early neurobiological vulnerability to later behavioural and emotional difficulties. These findings support early identification of children at risk and targeted intervention strategies.
Jurkowicz M, Somech R, Dominissini D
… +15 more, Keller N, Dresner E, Paret M, Sherman G, Katzenellenbogen G, Gelman E, Asraf K, Doolman R, Lev A, Simon AJ, Vernitsky H, Barg A, Golan H, Toren A, Stein M
AIMS: Paediatric cancer survivors often experience treatment-induced immunosuppression, requiring post-treatment revaccination. However, immune recovery timelines vary, and current revaccination guidelines, largely based...AIMS: Paediatric cancer survivors often experience treatment-induced immunosuppression, requiring post-treatment revaccination. However, immune recovery timelines vary, and current revaccination guidelines, largely based on data of varied quality derived from studies on acute-lymphoblastic-leukaemia (ALL), may not be applicable across all paediatric malignancies. This study evaluated a personalised revaccination approach based on immune recovery. METHODS: Immune recovery was evaluated using antibody titers to common childhood vaccines, immunoglobulin levels, B- and T-cell subpopulations, and T-cell receptor excision circles (TREC) and kappa-deleting recombination excision circles (KREC) markers. The recommended revaccination window was defined as 3-6 months post-treatment. Patients completing immune and serology testing within this window were categorised as the per-protocol-group (PPG), while others were categorised as the protocol-deviated-group (PDG). RESULTS: Among 19 PPG patients, 57.9% required major and 36.8% minor modifications to recommended revaccination guidelines, with major modifications more common among hematologic malignancies than solid tumours (83.3% vs. 46.2%, p < 0.0001). In the intention-to-treat (ITT) cohort (n = 52), 40.4% required major and 57.7% minor modifications; hematologic survivors again had higher rates of major modifications (52.9% vs. 34.3%, p = 0.008). CONCLUSIONS: Immune recovery following paediatric cancer therapy is highly variable, particularly among hematologic malignancies. Personalised revaccination strategies incorporating comprehensive immunological workups may optimise protection against vaccine-preventable diseases.
AIM: The human tongue is a major player for breathing, swallowing, sucking, chewing and speech. Breastfeeding is the initial training for its subsequent tasks. Thus, we aimed to explore the tongue's anatomy and biomechan...AIM: The human tongue is a major player for breathing, swallowing, sucking, chewing and speech. Breastfeeding is the initial training for its subsequent tasks. Thus, we aimed to explore the tongue's anatomy and biomechanics with conclusions on breastfeeding, essential for healthy development. METHODS: Literature on human and animal tongue anatomy and physiology was searched using relevant keywords in the Internet, literature lists from lectures and papers, anatomy and lactation textbooks. As data on tongue anatomy/physiology during breastfeeding is limited, transfer from other research areas was necessary. Own visual material was analysed. We identified and represented contracting and relaxing muscles for three selected tongue movements relevant for breastfeeding and compared them with literature findings. RESULTS: The tongue as a muscular hydrostat creates different shapes. Simultaneously different muscle fibres need to contract, while others relax. The complex movements require excellent neuronal control. Clear conclusions for protection and support of breastfeeding and physiological tongue resting position are drawn from tongue anatomy and function. CONCLUSION: Known breastfeeding recommendations, like frequent breastfeeding in relaxed circumstances, prone position, avoiding artificial nipples and supporting nasal breathing during sleep ('suction-to-palate') are confirmed by tongue anatomy and function as well as by the learning process in neuronal feedback-loops.
Kaiser G, Kayser M, Babel M
… +3 more, Wohlleben J, Weibel S, Spiegler J
Acta Paediatr
· 2026 Jul · PMID 42028996
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AIM: This mapping review presents a systematic approach identifying aggregated evidence and assessing methodological quality. METHODS: MEDLINE (via Ovid), Epistemonikos and the Cochrane database were searched for systema...AIM: This mapping review presents a systematic approach identifying aggregated evidence and assessing methodological quality. METHODS: MEDLINE (via Ovid), Epistemonikos and the Cochrane database were searched for systematic reviews, with or without meta-analyses, published from 2010 to May 6, 2025, addressing any interventions, prognosis, risks, incidence, prevalence, or diagnosis in preterm or very low birth weight children. To ensure quality, we included only those that searched at least two databases, assessed risk of bias, and defined a clear research question according to the PICO framework. Systematic reviews of interventions were assessed for methodological quality using AMSTAR 2. Those on risks, prognosis, prevalence, diagnostics, and qualitative research were assessed with ROBIS following a preliminary quality screening. RESULTS: Of 8000 references, 643 full texts were assessed, 239 systematic reviews met inclusion criteria: 42 interventional, 183 prognosis, risks, incidence and prevalence, 11 diagnostic, and 3 qualitative. Among interventional systematic reviews, seven showed high- or moderate-quality. Out of 197 systematic reviews, preliminary quality screening excluded 192 systematic reviews; ROBIS identified two high-quality prognosis and risk reviews out of five. CONCLUSION: Quality of data on post discharge follow-up in preterm-born children is poor. Preliminary screening improves efficiency by limiting assessment time spent on low-quality reviews.
AIM: To explore changes in body composition in adolescents with obesity treated with glucagon-like peptide-1 receptor agonist (GLP-1 RA) and their association with metabolic syndrome (MetS) components. METHODS: This real...AIM: To explore changes in body composition in adolescents with obesity treated with glucagon-like peptide-1 receptor agonist (GLP-1 RA) and their association with metabolic syndrome (MetS) components. METHODS: This real-world retrospective study included adolescents (12-18 years) with obesity who received multidisciplinary lifestyle-based obesity care between 2020 and 2024. GLP-1 RA therapy (liraglutide or semaglutide) was prescribed and dosed on an individualised basis. BMI and muscle-to-fat ratio (MFR) z-scores (by bioimpedance), and MetS components (glucose intolerance, hypertension, and dyslipidemia) were evaluated and compared with patients not receiving GLP-1 RA at corresponding time points. Multivariable regression analyses adjusted for sex, age, physical activity, and length of follow-up evaluated contributors for improvement in body composition. RESULTS: Of 67 eligible adolescents, 41 (61.2%) received GLP-1 RA therapy. The GLP-1 RA-treated group experienced greater improvements in BMI z-scores (-0.34 [-0.57, -0.07] vs. -0.07 [-0.17, 0.05], p < 0.001), and MFR z-scores (0.41 [0.12, 0.56] vs. 0.13 [0.01, 0.25], p = 0.007) compared to those without GLP-1 RA therapy. GLP-1 RA treatment duration was identified as the sole contributor to BMI and MFR z-score improvements (R = 0.515, p < 0.001 and R = 0.231, p = 0.012, respectively). A 0.25-unit decrease in BMI z-score and a 0.25-unit increase in MFR z-score were associated with 2.8-fold and 1.8-fold higher odds of MetS component improvement, respectively. CONCLUSION: Adolescents with obesity under GLP-1 RA therapy combined with lifestyle intervention demonstrated improvements in body composition and MetS components.
Acta Paediatr
· 2026 Jul · PMID 42010928
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AIM: Nicotine exposure during pregnancy interferes with critical periods of foetal brain development, disrupting the timing and functioning of neurodevelopment. This systematic review and meta-analysis aims to evaluate t...AIM: Nicotine exposure during pregnancy interferes with critical periods of foetal brain development, disrupting the timing and functioning of neurodevelopment. This systematic review and meta-analysis aims to evaluate the effect of prenatal nicotine exposure on postnatal cognitive outcomes. METHODS: Web of Science, PubMed, PsycINFOand OpenGrey databases were searched, with no date restrictions. Human (k = 1) and animal research (k = 8) was included. Studies were required to include at least one postnatal cognitive measure during the pre-weaning period. RESULTS: Exposure to nicotine during pregnancy negatively impacted postnatal outcomes of spatial memory (Cohen's d = -1.117; 95% CI [-2.112, -0.123]), centre exploration in animal studies (d = -1.054; 95% CI [-1.659, -0.449]), and reflex development in human and animal studies (d = -1.126; 95% CI [-1.737, -0.514]). Prenatal nicotine exposure did not have a significant effect on ambulation (d = -0.044; 95% CI [0.485, 0.397]) and rearing (d = -0.45; 95% CI [-1.042, 0.142]) in animals. CONCLUSION: Findings suggest that certain domains may be especially vulnerable to prenatal nicotine exposure, with reflex development showing the strongest effect. The scarcity of human studies underscores an urgent need for further research to ensure informed recommendations on nicotine intake during pregnancy.
AIM: Foreign body ingestion (FBI) in children is a worldwide health concern, yet little research has examined the influence of ethnicity and socioeconomic background. This study compared the epidemiology of FBI among Jew...AIM: Foreign body ingestion (FBI) in children is a worldwide health concern, yet little research has examined the influence of ethnicity and socioeconomic background. This study compared the epidemiology of FBI among Jewish and Bedouin children in southern Israel, two populations with distinct social and economic profiles. METHODS: A retrospective review was conducted of children presenting with FBI to the emergency department at Saban Children's Hospital between 2022 and 2023. RESULTS: A total of 479 children were identified, 53.9% males, with a median age of 6.1 years; 66% were Bedouin. The overall prevalence of FBI was 0.15 per 100 children, with higher rates among Bedouins than Jews (0.19 vs. 0.10 per 100, p < 0.005). Uniquely, Bedouin females presented more often than males. Blunt objects accounted for most ingestions (48.5%), followed by sharp objects (26.7%). Bedouin children ingested sharp objects more frequently than Jews (33.5% vs. 13.5%), while magnet ingestion was more common among Jews (16.6% vs. 3.5%). Hospitalisation was also higher in Bedouins (52.2% vs. 35.6%). CONCLUSION: Bedouin children experienced higher rates of FBI and hospitalisation, likely reflecting socioeconomic disadvantage. Cultural practices, such as hijab pin use, may explain the predominance among Bedouin girls. Targeted education could reduce this burden.