The management of congenital lung malformations (CLM) remains controversial. The aim of this study was to analyze the timing, approach, and outcomes of surgical treatment in children with CLM.A cohort study was conducted...The management of congenital lung malformations (CLM) remains controversial. The aim of this study was to analyze the timing, approach, and outcomes of surgical treatment in children with CLM.A cohort study was conducted comparing children with CLM who underwent thoracoscopic resection with open resection via thoracotomy. All children were treated according to an institutionalized multidisciplinary coordinated treatment algorithm.Between 2002 and 2019, 68 children with CLM were treated. Thoracoscopic resection of CLM (n=44) resulted in a statistically significant longer operative time (mean 169 vs. 97 minutes, p=0.04) but shorter hospital stay (mean 7.2 vs. 16.7/12 days, p=0.01) compared to thoracotomy (n=15) or after conversion to thoracotomy (n=9). There were no major complications in either group. At a mean follow-up of 32.2 months (range 0.5-163), patients after thoracoscopic resection had statistically significantly fewer rip fusions than patients after open resection (n=0 vs. 2/2, p≤0.004) and less chest wall asymmetry than after conversion (n=0 vs. 2, p=0.004).Thoracotomy proved to be a fast and safe surgical approach in respiratory unstable CLM patients. In respiratory stable CLM patients, thoracoscopic resection was feasible in early infancy with good surgical and musculoskeletal outcomes.Thoracoscopic resection of CLM offers advantages over resection by thoracotomy in terms of surgical recovery and musculoskeletal function. Therefore, it should be offered to respiratory-stable patients in specialized centers.
There has been much debate about the appropriateness of over-the-counter (OTC) cough and common cold medications (CCM). The aim of this nationwide study was to analyse the incidence of CCM intoxications in the Czech paed...There has been much debate about the appropriateness of over-the-counter (OTC) cough and common cold medications (CCM). The aim of this nationwide study was to analyse the incidence of CCM intoxications in the Czech paediatric population from 2014 to 2023.We performed a retrospective study on the incidence of CCM intoxications in the Czech paediatric population (ages 0-18 years) from 2014 to 2023.There were 7,056 cases of CCM intoxication in children, of which 6,406 resulted from unintentional intoxication. No lethal doses were reported, but there were 1,769 documented toxic doses. Unintentional CCM intoxications represented 15.60% of all unintentional medication intoxication cases across all ages and medication types. Of the 6,406 unintentional intoxication cases, 5,465 (85.31%) were in children aged 0 to 6 years, including 1,564 (24.41%) in children aged 0 to 2 years. Children aged 0 to 6 years had a significantly higher risk of CCM intoxication compared to those aged 7 to 18 years (RR 9.5, p<0.00001). The annual incidence of unintentional CCM intoxication was 69.26 per 100,000 children aged 0 to 6 years and 7.29 per 100,000 children aged 7 to 18 years.Based on our data, we believe there is low awareness among parents and Czech paediatricians regarding the potential risks of CCM and the lack of proven efficacy of these medications.Our data may contribute to political discussions regarding the general prohibition of CCM use in children younger than six years.
Childhood obesity is a global health problem with increasing prevalence, leading to long-term cardiovascular complications. Research conducted on adults has established a correlation between serum uric acid to creatinine...Childhood obesity is a global health problem with increasing prevalence, leading to long-term cardiovascular complications. Research conducted on adults has established a correlation between serum uric acid to creatinine ratio (SUA/Cr) and metabolic syndrome (MetS) components. The study investigates the relationship between SUA/Cr and hypertension (HT) and MetS components in children with obesity.A total of 103 children with obesity who underwent ambulatory blood pressure measurement (ABPM) were included the study and patients were divided into two groups "HT" (n=60) and "Normal" (n=43). Demographic, anthropometric, and laboratory characteristics were retrospectively analyzed.The study included 103 children (42 female, 61 male) with a mean age of 13.7±2.9 years. HT prevalence was significantly higher in patients with severe obesity and dyslipidemia (p=0.045, p=0.01). Males exhibited significantly higher SUA/Cr than females (p<0.001). However, SUA/Cr showed no significant differences between patients with and without HT, MetS, dyslipidemia, or hyperglycemia (p=0.69, p=0.64, p=0.90, p=0.37). Furthermore, linear regression analysis did not establish a significant effect of SUA/Cr on ABPM parameters (p>0.05).In our cohort, no significant association was found between SUA/Cr and HT, as well as MetS components in children with obesity. These findings highlight the need for further investigation into the complex mechanisms regulating uric acid metabolism, obesity, and cardiovascular risk in children.
Artificial intelligence (AI) is already being used in most medical disciplines, including paediatric pneumology. This review describes current developments in AI-supported technologies and discusses their potential for t...Artificial intelligence (AI) is already being used in most medical disciplines, including paediatric pneumology. This review describes current developments in AI-supported technologies and discusses their potential for the diagnosis and treatment of lung diseases in children and adolescents. The spectrum ranges from models for analysing respiratory sounds and the automated evaluation of medical imaging to systems for supporting clinical decisions. In particular, challenges in the adaptation of AI for paediatric populations are also described. Finally, open questions, such as the implementation of AI-based software in everyday clinical practice, will be discussed.
Evaluation of the cow's milk (CM) and hen's egg (HE) ladder to improve medical care of children with CM and/or HE allergy. Through an anonymous retrospective online questionnaire, we investigated parent perspectives rega...Evaluation of the cow's milk (CM) and hen's egg (HE) ladder to improve medical care of children with CM and/or HE allergy. Through an anonymous retrospective online questionnaire, we investigated parent perspectives regarding the therapy option of a CM and HE ladder in children with CM and/or HE allergy. Of the 54 families contacted, 29 took part in the study. 19/29 children had already completed the ladders when the survey took place. 19/29 children showed an allergic reaction during the treatment of whom 17 presented skin rashes. 16/29 parents were anxious to rise to the next step in the protocol. 15/29 had difficulties with the implementation of the therapy due to the child refusing the offered food and organizational issues. Medical support as well as the ladder as a therapy option were scored satisfactory. The participating parents were satisfied with the therapy option and medical care. We identified two main areas for improvement: First, the suggested food for every step should be more diverse, according to the families' culture background and nutritional needs/demands. Second, to reduce anxiety regarding the therapy, parents must be informed that although allergic reactions are common, they remain mild. Furthermore, we will suggest step changes under medical supervision, especially in families with a slow progression of the food ladder. With these improvements, the duration of therapy could be shortened, thus reducing the risk of an allergic reaction, the need for medical care by an allergist and therefore reducing healthcare costs.
Premastication is a traditional feeding method whereby solids are pre-chewed by the mother or sometimes by other relatives and then given to the infant along with the oral microbiota. The aim of this study was to assess...Premastication is a traditional feeding method whereby solids are pre-chewed by the mother or sometimes by other relatives and then given to the infant along with the oral microbiota. The aim of this study was to assess if premastication is known or performed among the German population as well as to evaluate the expectations regarding this feeding method, particularly in the context of allergy prevention. Two surveys about premastication were conducted. For the survey of the "general population (GP)" 10,000 participants (18 to 65 years old) were randomly selected from the official population register of Berlin. The survey of the "selected population (SP)" was conducted by the patient organization German Allergy and Asthma Association (DAAB). 526 people from the GP and 220 participants from the SP completed the questionnaire. 15.3% (n=114) of all respondents had previously heard of premastication, 1.5% (n=7/455) of the people with children reported that they have performed premastication for their child. 42.8% (n=225) of the GP as well as 36.4% (n=80) of the SP could imagine performing premastication for their future child or grandchild. 59.3% (n=312) of the GP stated that they at least partially think premastication may help to prevent the development of allergies.Premastication appears to be barely known and practiced among the German population. However, a considerable proportion of participants would consider giving pre-chewed food to their infant. A high rate of respondents, especially among the GP, believed that premastication may have a positive impact on the prevention of allergies.
Obesity is one of the most common chronic diseases seen in children and adolescents. This study aims to examine the impact of obesity on body composition, assessed by sonographic and anthropometric measurements, and heal...Obesity is one of the most common chronic diseases seen in children and adolescents. This study aims to examine the impact of obesity on body composition, assessed by sonographic and anthropometric measurements, and health-related quality of life (HRQoL) in adolescents.Anthropometric measurements, sonographic measurements of subcutaneous fat, quadriceps muscle, Achilles tendon thickness, and HRQoL were performed in children between 12-18 years of age. Comparisons between adolescents with obesity and normal body mass index (BMI) were examined.A total of 300 adolescents with similar physical activity levels, 28.7% with obesity, were enrolled. The thickness of mid-forearm/mid-thigh subcutaneous fat tissue and quadriceps muscle was significantly higher in participants with obesity (p≤0.001). Moderate-to-strong correlation with BMI and waist circumference was observed (r>0.40, p<0.01). Participants with longer duration of obesity had thicker quadriceps muscle irrespective of the severity of obesity or presence of metabolic syndrome. Achilles tendon thickness did not differ between the groups. HRQoL was significantly lower in adolescents with obesity and indicated a negative moderate correlation between physical functioning and subcutaneous fat thickness (r<- 0.50, p<0.01).An important relationship between sonographic and anthropometric measurements, and physical functioning was demonstrated in adolescents. Ultrasound seems to have a role in the evaluation of body composition in obesity beyond what is captured by overall BMI. Significantly increased quadriceps muscle thickness in adolescents with obesity, coupled with its relation to the duration of obesity, implies potential temporal association between excess body weight and adaptation of quadriceps muscle.
ABSTRACT:BACKGROUND: Medication handling errors (ME) in long-term antiseizure medication (ASM) compromise patient safety. Training programs to prevent those errors by parents are scarce. ABSTRACT:PATIENTS: The interven...ABSTRACT:BACKGROUND: Medication handling errors (ME) in long-term antiseizure medication (ASM) compromise patient safety. Training programs to prevent those errors by parents are scarce. ABSTRACT:PATIENTS: The intervention concept is designed for parents of children and adolescents aged 0-18 years with at least one long-term ASM. ABSTRACT:METHOD: In a controlled prospective study, we assessed ME of ASM during home visits 3-6 weeks after a patient's in- or outpatient hospital visit (outpatient neuropediatric clinic and Social-Pediatric Center (SPZ)). We investigated the effectiveness of a patient specific, risk-adapted training (intervention group, IG) compared to routine care (control group, CG). For 54 ME in ASM handling, an expert panel classified the clinical risk ranging from Score-0 (no risk) to Score-6 (maximum risk) with the lowest risk actually classified as Score-3. ABSTRACT:RESULTS: We analyzed data from 83 parents in the CG and 85 in the IG who administered 140 ASM per group. The intervention reduced ME per patient from 5 (median; Q25/Q75 3/9) to 4 (2/8; p=0.018). A total number of 589 ME occurred in the CG, 432 in the IG. ME in ASM handling rated Score-6 occurred once in the CG and not in the IG. A relative-risk-reduction (RRR) of ME (with p<0.001) was observed, with a RRR of 55.0% for Score-5, 27.6% for Score-4, and 23.1% for Score-3. RRR was 56.6% for ASM preparation (p<0.001) and 22.4% for oral administration (p=0.045). ABSTRACT:CONCLUSION: Compared to controls, ME with high clinical risk significantly decreased in the IG after the training. Drug safety in chronically ill children with ASM was thereby improved.
BACKGROUND: To explore the attitudes of neonatal healthcare professionals towards disclosing personal opinions when counseling parents about value-laden decisions using scripted video animations, with a view to comparing...BACKGROUND: To explore the attitudes of neonatal healthcare professionals towards disclosing personal opinions when counseling parents about value-laden decisions using scripted video animations, with a view to comparing these later with the attitudes of parents of preterm infants. METHODS: An exploratory study was conducted during the 5th Annual Meeting of the Joint European Neonatal Societies in Rome. Data were collected via a web-based survey during a live session. Two scripted video animations were presented and discussed, one with and one without disclosure of the physician's personal opinion. RESULTS: Sixty-nine healthcare professionals from 19 countries were enrolled. Forty-seven (68.1%) respondents stated that disclosing personal opinions would "unduly influence" the parents' decision-making process. Thirty-seven (53.6%) participants would not have given their personal opinion in the case presented, and 45 (65.2%) participants stated that disclosure of the physician's personal opinion would result in parents being less prepared for decision-making. Discussions were dominated by underlying values and culture rather than the process of sharing opinions. DISCUSSION AND CONCLUSIONS: The study provides new insights into the opinions of healthcare professionals on the disclosure of personal opinions when making difficult treatment decisions, but further research may require a more nuanced approach in different scenarios. Further research with a larger sample and different scenarios is needed to explore in more depth healthcare professionals' and parents' attitudes of autonomous decision-making.
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with numerous etiologies, mostly characterized by magnetic resonance imaging (MRI) abnormalities in the posterior cerebral white and...BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome with numerous etiologies, mostly characterized by magnetic resonance imaging (MRI) abnormalities in the posterior cerebral white and gray matter and acute neurological symptoms. AIM: To examine the predisposing factors, clinical results, and radiological features of PRES in children diagnosed with malignancy. MATERIALS AND METHODS: The study included 20 patients (7 F/13 M) aged 4-16 years at the time of diagnosis who were diagnosed with malignancy and developed PRES during chemotherapy. RESULTS: All the patients were diagnosed as having PRES both clinically and radiographically during chemotherapy. The time from the initiation of the chemotherapy to the onset of PRES ranged from 7-675 days. Hypertension was detected in nine patients, seizure was the most common presenting symptom - had involvement in the occipital and parietal lobes on MRI (n=14)/followed by headache (n=8)/altered consciousness (n=5)/visual impairment (n=4). Hydrocephalus and tentorial herniation were observed in one patient. Most of the lesions on MRI resolved within 10-33 days and the EEG findings within 9 months. Clinical symptoms of PRES also disappeared completely the 5-year Press frequency was found to be 2.48%. CONCLUSION: PRES may complicate the oncological treatment in children. Hypertension is a leading risk factor for PRES, while it should be kept in mind that the blood pressure may be normal in chemotherapy-induced PRES cases. PRES should be included in the differential diagnosis of all patients receiving chemotherapy and presenting with acute neurological symptoms.
BACKGROUND: Early detection of psychological problems is crucial to prevent chronic progression. The Psych-U study evaluated the added value of structured assessment of psychological issues during U-screenings compared t...BACKGROUND: Early detection of psychological problems is crucial to prevent chronic progression. The Psych-U study evaluated the added value of structured assessment of psychological issues during U-screenings compared to routine screenings without such assessment. METHODS: In a cluster-randomized controlled design, a two-arm intervention group (IG; Strengths and Difficulties Questionnaire, SDQ, and Mannheimer Elternfragebogen, MEF) was compared to a control group (CG). In the IG, parents completed a tablet-based structured assessment of potential psychological issues before the U-screening, which was then discussed with pediatricians during the screening. Outcomes included acceptance (participation rate; parent phone interviews), feasibility (focus groups with practice teams), and effectiveness (referral rates) of the structured assessment versus routine care. RESULTS: A total of N=3,138 families participated (participation rate: 85.3%). In parent phone interviews (n=348), the SDQ and MEF showed high acceptance. Focus group interviews with practice teams indicated high feasibility, but noted that implementing structured assessment into routine care would require systemic changes at the health system level (e.g., reimbursement for extra effort), practice level (e.g., digital data collection), and patient level (e.g., addressing language barriers). The IG had a higher referral rate than the CG. CONCLUSION: Structured assessment of psychological issues appears beneficial but requires structural adjustments. Additionally, sufficient local referral options should be available.
Cystic fibrosis (CF) is a genetic disease that results from mutations in the CFTR gene. It primarily affects the lungs and digestive system. Recent advancements in the treatment of CF have been driven by highly effective...Cystic fibrosis (CF) is a genetic disease that results from mutations in the CFTR gene. It primarily affects the lungs and digestive system. Recent advancements in the treatment of CF have been driven by highly effective therapies that modulate the function of the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which target the underlying molecular defects in CFTR function. These modulators have been demonstrated to significantly improve lung function, weight gain, and quality of life for 90% of individuals with CF, particularly those with the F508del mutation. HEMT has also demonstrated potential benefits for pancreatic and liver function, and its early use in young children may delay or prevent disease progression. However, challenges remain in optimizing biomarkers and outcome measures for younger children, addressing side effects, and developing novel therapies for mutations not responsive to current treatments. This review focuses on the efficacy, safety, and future perspectives of HEMT in children under 12 years of age, emphasizing the importance of early intervention to improve long-term outcomes in CF patients.Mukoviszidose (CF) ist die häufigste genetisch bedingte Stoffwechselerkrankung durch Mutationen im CFTR-Gen. Sie betrifft insbesondere die Lunge und das Verdauungssystem. Die jüngsten Fortschritte in der Behandlung der CF sind das Resultat von hochwirksamen Therapien (HEMT), welche die Funktion des CFTR-Proteins (Cystic Fibrosis Transmembrane Conductance Regulator) modulieren und damit eine kausale Therapie ermöglichen. Diese führt nachweislich zu einer Verbesserung der Lungenfunktion und Gewichtszunahme, sowie einer Steigerung der Lebensqualität bei 90% der Menschen mit Mukoviszidose, insbesondere bei denen, die mindestens eine F508del-Mutation aufweisen. Zusätzlich besteht ein potenzieller Nutzen für die Funktion der Bauchspeicheldrüse und der Leber. Eine frühzeitige Anwendung von HEMT bei Kleinkindern kann das Fortschreiten der Krankheit voraussichtlich weiter verzögern oder gar verhindern. Herausforderungen bestehen in der Etablierung valider Biomarker - insbesondere für jüngere Kinder, unerwünschten Arzneimittelwirkungen und der Entwicklung neuartiger Therapien für Mutationen, die auf die HEMT nicht ansprechen. Die vorliegende Übersichtsarbeit beschreibt die Effektivität und Sicherheit bei Kindern unter 12 Jahren, sowie das zukünftige therapeutische Potential der HEMT. Ein besonderes Augenmerk wird dabei auf die Notwendigkeit eines frühzeitigen Therapiebeginns zur Verbesserung des langfristigen Verlaufs gelegt.
BACKGROUND: This study aimed to evaluate the prognostic value of various inflammatory markers and indices derived from complete blood counts in predicting mortality among pediatric trauma patients admitted to the Pediatr...BACKGROUND: This study aimed to evaluate the prognostic value of various inflammatory markers and indices derived from complete blood counts in predicting mortality among pediatric trauma patients admitted to the Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS: We designed a single-center retrospective study that included 165 pediatric trauma patients in the PICU between January 2020 and June 2024. RESULTS: Of 165 patients, 108 (69.2%) were male and the mean age of all patients was 75.16±57.14 months. The mortality rate was found to be 5.45% (9 patients). The Lactate-to-Albumin Ratio (LAR) and Procalcitonin (PCT) demonstrated strong prognostic performance with area under the curve (AUCs) of 0.807 and 0.745, respectively. Notably, LAR and PCT correlated well with mortality and the duration of invasive mechanical ventilation and PICU stay. The Systemic Immune-Inflammation Index (SIRI), Neutrophil-to-Lymphocyte Ratio (NLR), CRP-to-Albumin Ratio (CAR), and Pan-Immune-Inflammation Value (PIV) were less effective individually but showed potential when combined with other indices. CONCLUSION: LAR, PCT, SIRI, NLR, CAR, and PIV were associated with mortality in pediatric trauma patients, with LAR and PCT demonstrating superior predictive value. Therefore, LAR and PCT may serve as reliable standalone markers for identifying critically ill pediatric trauma patients at risk of mortality.
ABSTRACT:OBJECTIVES: Quality of life (QoL) is directly associated with physical-psychological well-being, family and environmental factors in patients with Mucopolysaccharidosis (MPS). The present study aims to investig...ABSTRACT:OBJECTIVES: Quality of life (QoL) is directly associated with physical-psychological well-being, family and environmental factors in patients with Mucopolysaccharidosis (MPS). The present study aims to investigate the factors affecting QoL in both MPS patients and their caregivers. ABSTRACT:METHODS: The sociodemographic characteristics, clinical findings, and special needs of 37 patients with MPS were questioned, among which 28 pediatric patients were evaluated for QoL using the KINDL-parents scale. The World Health Organization Quality of Life Assessment (WHO-QoL-BREF) was used to assess the QoL of 37 caregivers of patients. ABSTRACT:RESULTS: The patients with MPS type III had the lowest median score in the self-esteem domain among the other types. The patients undergoing enzyme replacement therapy scored high in the friends domain, while the physical-psychological/emotional domain scores of the patients with sleep disturbance and their parents were lower than those without. Patients with appetite/eating problems scored low in the self-esteem domain and their caregivers scored low in the social relationship domain. The psychological/emotional domain scores of the patients who needed special education and their parents were lower than those who did not. Total scores and KINDL disease domain scores were decreased in those receiving psychiatric medical treatment. ABSTRACT:CONCLUSIONS: In this study, the aim was to simultaneously assess the quality of life of MPS patients and their parents. Sleep disturbances, appetite problems, special education, and psychiatric treatment negatively impacted QoL.