Hamelmann E, Schorlemer C, Derichs N
… +17 more, Eber E, Gerstlauer M, Jung A, Kabesch M, Kopp MV, Lau S, Lex C, Möller A, Schaub B, Schwerk N, Spindler T, Taube C, Vogelberg C, Zacharasiewicz A, Zielen S, Schuster A, Gappa M
Asthma is the most common chronic respiratory disease in children and adolescents. While most patients achieve good control with guideline-based treatment, a significant proportion experience persistent symptoms, frequen...Asthma is the most common chronic respiratory disease in children and adolescents. While most patients achieve good control with guideline-based treatment, a significant proportion experience persistent symptoms, frequent exacerbations, and impaired quality of life.This guideline aims to define severe and difficult-to-treat asthma in children and adolescents, support diagnostic precision, and provide practical, evidence-based recommendations for assessment and management, including biological therapies.The S1 guideline was developed under the coordination of the German Society for Pediatric Pulmonology following AWMF procedures. A structured consensus process involving experts from pediatric pulmonology, allergology, and general pediatrics was conducted. Existing national and international guidelines and new evidence were systematically reviewed and adapted.Key elements include a stepwise diagnostic algorithm to distinguish difficult-to-treat from truly severe asthma, guidance on assessing adherence, comorbidities, and inflammation biomarkers, and recommendations for targeted biological treatment. This guideline addresses monitoring tools, transition to adult care, and the role of rehabilitation.Children and adolescents with severe asthma require early referral to specialized centers and a structured, interdisciplinary approach. Personalized treatment strategies-including biologics-should be guided by phenotyping and biomarkers. Registry data are essential to improve care quality and generate real-world evidence.
Pulmonary problems are common in children with Downsyndrome/trisomy 21, alongside other health issues, but are often given too little attention. The aim of this review is to summarize these aspects for pediatric pulmonol...Pulmonary problems are common in children with Downsyndrome/trisomy 21, alongside other health issues, but are often given too little attention. The aim of this review is to summarize these aspects for pediatric pulmonologists. Narrow nasal passages, a small pharynx and larynx, in combination with relative macroglossia, other airway malformations, and generalized muscular hypotonia, lead to glossoptosis, which in very young infants frequently causes obstructive sleep apnea syndrome. If left untreated, this is associated with impaired cognitive development. The children also suffer from chronic rhinitis. Together with recurrent silent aspirations resulting from the typical dysphagia of children with Trisomie 21 and immune dysregulation, lower respiratory tract infections are common and often severe. Viral infections caused by RSV, influenza, and SARS-CoV-2 more frequently lead to hospitalizations and have a much higher mortality rate than in healthy children. Children with Down syndrome are also more likely to develop chronic wheezing. The development of pulmonary hypertension may rarely occur even without an associated heart defect. This article summarizes the diagnostic and therapeutic tasks related to pulmonary problems in children with Down syndrome for the pediatric pulmonologist.
Leukemic infiltration of the lungs is rarely reported in children. Clinical symptoms are often variable and nonspecific, making diagnosis challenging. The actual frequency of pulmonary involvement, the severity of local...Leukemic infiltration of the lungs is rarely reported in children. Clinical symptoms are often variable and nonspecific, making diagnosis challenging. The actual frequency of pulmonary involvement, the severity of local findings, and typical imaging characteristics in pediatric patients remain largely unclear. Most literature studies on the radiological features of leukemic lung infiltration have focused on adults, leaving a significant gap in pediatric data. This lack of information can hinder clinical and radiological assessment in children. Here, we present a case of leukemic pulmonary infiltration in an adolescent with nonspecific symptoms and markedly abnormal computed tomographic findings. We describe the morphological abnormalities, discuss differential diagnoses, and review the limited literature on pulmonary involvement in childhood leukemia. Further studies are needed to better characterize the frequency, types, and imaging features of leukemic pulmonary infiltration in children.
Pediatrics in general and pediatric oncology in particular place the high demands on interprofessional teams. For teamwork, psychological safety is a basic prerequisite. Establishing it in pediatrics and their subspecial...Pediatrics in general and pediatric oncology in particular place the high demands on interprofessional teams. For teamwork, psychological safety is a basic prerequisite. Establishing it in pediatrics and their subspecialties requires extensive knowledge. While much is known about psychological safety in other industries, descriptions of psychological safety in pediatrics are lacking. Therefore, the aim of this scoping review was to (i) describe the current state of the literature, (ii) identify facilitating and hindering factors in individual areas, and (iii) highlight approaches in terms of best practice examples. In the period between March 25, 2024, and April 14, 2024, PubMed was searched in accordance with the PRISMA Guidelines Scoping Review Extension. The initial search retrieved 924 articles. Twenty-seven papers were included for final analysis. The main reasons for exclusion were a lack of thematic relevance, non-availability of a full text and languages other than English and German. Factors influencing psychological safety in interprofessional teams are discussed. In particular, the influences of communication, the working environment, and employees' mental health are explained. In view of the of the increasing shortage of skilled workers, team turnover, and intention to leave, psychological safety in pediatrics should be addressed. Future studies should elucidate which interventions have a persistent positive influence on psychological safety in pediatrics.
Multisystem inflammatory syndrome in children emerged as a result of the COVID-19 pandemic and has been reported to cause many different symptoms. We aimed to evaluate the electroencephalographic findings as well as the...Multisystem inflammatory syndrome in children emerged as a result of the COVID-19 pandemic and has been reported to cause many different symptoms. We aimed to evaluate the electroencephalographic findings as well as the neurological manifestations of children, followed up with multisystem inflammatory syndrome in children in comparison with healthy controls.Children who were diagnosed with multisystem inflammatory syndrome between March 2020 and 2022 were included. The demographic characteristics of the patients, complaints, electroencephalographic findings, and follow-ups were examined.Seventy patients, with a mean age of 108 (±47.7) months and 44 (62.9%) males, were included in the study. Multisystem inflammatory syndrome in children was divided into three categories based on severity:mild (=41; 58.5%), moderate (=24; 34.2%), and severe (=5; 7.1%). At least one neurological symptom was present in 51 (72%) of cases. Table 1 lists the admission grievances. Electroencephalographic recordings were made for all patients in terms of sleep and wakefulness. Electroencephalographic abnormalities were detected in 20 (28.6%) patients (=2 generalized and =18 focal paroxysmal activity). Six weeks later, patients with abnormal electroencephalographic patterns underwent imaging and a control electroencephalography. Generalized epileptiform activity was detected in two patients on electroencephalography, but the patients had normal cranial magnetic resonance imaging and no neurological deficit was found. Of these 20 patients,12 had neurological manifestations, and 8 were asymptomatic. This study provides an in-depth evaluation of neurological findings in multisystem inflammatory syndrome in children and includes one of the largest case series on electroencephalographic findings available in the literature. The results highlight the significance of electroencephalographic abnormalities in multisystem inflammatory syndrome in patients, emphasizing the need for close neurological monitoring.
This study aims to evaluate the diagnostic and follow-up utility of complete blood count-derived biomarkers -neutrophil-to-lymphocyte ratio, mean platelet volume, and red cell distribution width - in pediatric tuberculos...This study aims to evaluate the diagnostic and follow-up utility of complete blood count-derived biomarkers -neutrophil-to-lymphocyte ratio, mean platelet volume, and red cell distribution width - in pediatric tuberculosis. A total of 52 children diagnosed with tuberculosis and 55 healthy controls, followed between 2020 and 2023 at a tertiary pediatric infectious disease clinic, were retrospectively analyzed.Laboratory values were recorded at diagnosis, the second month of treatment, and at least 6 months post-treatment. Receiver operating characteristic analysis was performed to assess diagnostic performance. At diagnosis, the neutrophil-to-lymphocyte ratio and red cell distribution width levels were significantly higher in the tuberculosis group than in control group (<0.001), while mean platelet volume showed no significant difference (=0.096). During treatment, the neutrophil-to-lymphocyte ratio and red cell distribution width values progressively decreased. Receiver operating characteristic analysis demonstrated good diagnostic performance with optimal cut-off values of 1.7 for the neutrophil-to-lymphocyte ratio and 15.4 for the red cell distribution width. The neutrophil-to-lymphocyte ratio and red cell distribution width are accessible, cost-effective biomarkers that may support the diagnosis of tuberculosis and monitor treatment responses in children.While promising as supportive tools, the diagnostic specificity of these markers is subject to study limitations, including an age-unmatched control group. Therefore, they should be considered complementary to existing diagnostic methods, especially when microbiological confirmation is challenging in pediatric cases.
Yogurt is a type of fermented milk. There is limited information on the yogurt's effect on managing cow's milk allergy. The aim of this study was to determine the factors affecting tolerance to yogurt using an oral food...Yogurt is a type of fermented milk. There is limited information on the yogurt's effect on managing cow's milk allergy. The aim of this study was to determine the factors affecting tolerance to yogurt using an oral food challenge test in children with cow's milk allergy and investigate the role of the cow's milk-specific IgE levels, cow's milk skin prick test wheal diameters, and the cow's milk-specific IgE/total IgE ratio in predicting oral food challenge outcomes in the IgE-mediated cow's milk allergy group.This retrospective study analysed the demographic and clinical features, laboratory data, skin prick tests, and the results of the yogurt oral food challenge from the children diagnosed with cow's milk allergy.Of the 132 patients included in the study, 68 (51.5%) of them were categorised asIgE-mediated, while 27 (20.5%) and 37 (28%) of them were categorised as non-IgE-mediated and mixed-type reaction groups, respectively. The findings indicated that 68.2% of the study population and 51.5% of the IgE-mediated group are associated with the cow'smilk allergy tolerated yogurt. In the IgE-mediated cow's milk allergy group, skin prick test wheal diameters, cow's milk-specific IgE, and the cow's milk-specific IgE/total IgE ratio were determined to be significantly different between patients with positive and negative oral food challenge results (<0.05). Cow's milk-specific IgE performance contributed more to predicting any reaction and/or anaphylaxis in the yogurt oral food challenge (area under the curve: 0.831and 0.876). The ratio and the skin prick test wheal diameter performance were lower in the probability of any reaction and/or anaphylaxis in the yogurt oral food challenge.This study suggests that yogurt may be tolerated by a significant proportion of children with various forms of cow's milk allergy.
Rare pediatric pulmonary diseases, such as childhood interstitial lung disease and congenital thoracic malformations, pose diagnostic and therapeutic challenges due to their low prevalence and clinical heterogeneity. In...Rare pediatric pulmonary diseases, such as childhood interstitial lung disease and congenital thoracic malformations, pose diagnostic and therapeutic challenges due to their low prevalence and clinical heterogeneity. In contrast to cystic fibrosis and primary ciliary dyskinesia, which are supported by dedicated care networks, many other rare pediatric pulmonary diseases lack structured management pathways. This study aimed to assess pediatric pulmonologists' clinical exposure, confidence, and educational needs related to rare pediatric pulmonary diseases. A web-based survey was distributed to all 914 members of the German Society for Pediatric Pulmonology. The questionnaire evaluated clinical experience, diagnostic confidence, and preferences for educational contents and formats. Responses were analyzed using descriptive statistics and group comparisons. Among 209 respondents (22.9% response rate), clinical exposure was low (median: 3 patients/y; interquartile range: 1-5), with 22.5% treating none. Only 36.7% of respondents felt confident in suspecting a rare pediatric pulmonary disease, 22.0% in diagnosis, and 13.3% in treatment. Educational interest was high (68.8%), particularly in clinical presentation (70.7%), treatment (69.8%), and imaging (59.0%). Clinicians with<10 years of experience reported greater interest in clinical presentation than those with≥10 years (84.5% vs. 57.3%, =0.0002). Workshops, webinars, and online discussions were the most preferred learning formats. Despite limited exposure and low reported confidence, pediatric pulmonologists express strong interest in further education on rare pediatric pulmonary diseases. Tailored, accessible educational strategies are essential to improve awareness, diagnosis, and care for children with rare pulmonary conditions.