European Journal Of Pediatrics[JOURNAL]
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Long-term recurrence and acute seizure clustering in children with convulsions with mild gastroenteritis: a systematic review and meta-analysis.
Zou L, Li F, Li H … +1 more , Su Z
Eur J Pediatr · 2026 Jul · PMID 42400644 · Publisher ↗
UNLABELLED: To evaluate acute and long-term recurrence in children with convulsions with mild gastroenteritis (CwG) and to identify candidate factors associated with long-term relapse. This PRISMA 2020-compliant systemat...
UNLABELLED: To evaluate acute and long-term recurrence in children with convulsions with mild gastroenteritis (CwG) and to identify candidate factors associated with long-term relapse. This PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO CRD420261348817) searched five databases from inception to March 25, 2026. Observational studies of children with CwG reporting recurrence-related outcomes were included. Random-effects models were used for all pooled analyses. Twenty-one studies (3,302 participants) were included. The primary pooled long-term relapse rate was 9.8% (95% CI 5.2%-17.7%; I2 = 88.5%); a sensitivity analysis excluding two studies with broader recurrence definitions yielded 6.1% (95% CI 4.9%-7.5%; I2 = 0.0%). Age below 18 months (OR 3.99, 95% CI 1.78-8.91; I2 = 0.0%) and family history of convulsions (OR 4.74, 95% CI 2.23-10.06; I2 = 0.0%) were each associated with long-term recurrence in exploratory pooled analyses of crude odds ratios from two studies. Acute multiple seizures occurred in 57.2% of children (95% CI 47.0%-66.9%; I2 = 86.5%); children with multiple seizures were younger (mean difference - 3.41 months, 95% CI - 6.06 to - 0.75) and had lower serum sodium (- 1.30 mmol/L, 95% CI - 2.42 to - 0.17) than those with a single seizure. CONCLUSION: Long-term relapse occurred in approximately 6%-10% of children with CwG, depending on the recurrence definition (9.8% primary estimate; 6.1% sensitivity estimate). Age below 18 months and family history were each associated with relapse in exploratory two-study analyses; given crude, unadjusted estimates and very low certainty, these should be regarded as hypothesis-generating candidate factors rather than validated predictors. WHAT IS KNOWN: • CwG generally has a favourable neurological prognosis, but recurrence remains a concern for clinicians and families. • Acute seizure clustering and later relapse are distinct outcomes, yet previous studies often analysed them together. WHAT IS NEW: • Long-term relapse was uncommon but not negligible, whereas acute clustering was common during the index illness. • Younger age, family history, and lower serum sodium were hypothesis-generating candidate factors requiring prospective validation.
Cost-benefit analysis of nirsevimab for respiratory syncytial virus prevention in infants: a population-based study.
Alonso-García M, Martos-Barrachina F, Jiménez-Bueno S … +1 more , Arce-Arnáez A
Eur J Pediatr · 2026 Jul · PMID 42399582 · Publisher ↗
Respiratory syncytial virus (RSV) represents a major healthcare, economic, and social burden, particularly among infants. The present study aims to evaluate, from a public health perspective, the economic impact of imple...
Respiratory syncytial virus (RSV) represents a major healthcare, economic, and social burden, particularly among infants. The present study aims to evaluate, from a public health perspective, the economic impact of implementing a universal immunization strategy with nirsevimab in the Community of Madrid (CM).A cost-benefit analysis was conducted from both healthcare and societal perspectives using real-world observational data. The study included all newborns between April 1 and December 31, 2023. The follow-up period corresponded to the RSV epidemic season (October 2023-March 2024). Data sources included administrative, clinical, vaccination, and epidemiological surveillance records. Direct costs included primary care, emergency services, and hospitalizations-with and without intensive care-while indirect costs captured parental productivity losses. A probabilistic model with Monte Carlo simulations (100,000 iterations) was used to assess uncertainty, and the internal rate of return (IRR) was calculated for different dose price scenarios. The study included 37,689 newborns. The incidence density of healthcare events was consistently lower among immunized children. The IRR was 62% at a price of €209 per dose, remaining positive up to €330 per dose. At the base price (€209 per dose), the intervention was cost-beneficial in 100% of simulations. Universal immunization with nirsevimab in the CM proved to be cost-beneficial and robust across various price scenarios, supporting its inclusion in child public health programs. Conclusion: Universal immunization with nirsevimab in the CM proved to be cost-beneficial and robust across various price scenarios, supporting its inclusion in child public health programs. What is known: • Respiratory syncytial virus (RSV) causes a major clinical and economic burden in infants due to high hospitalization and emergency care rates during seasonal epidemics. • Clinical trials and modeling studies suggest that nirsevimab effectively prevents RSV disease and may be economically favorable, but real-world cost-benefit evidence remains limited. What is new: • This study presents a real-world, population-based cost-benefit analysis of a universal nirsevimab immunization campaign using administrative and clinical data from a regional birth cohort. • Universal immunization was cost-beneficial from both healthcare and societal perspectives across a wide range of price scenarios, demonstrating robust economic returns under real-life conditions.
Consensus statement on the use of standardized early mobilization in pediatric patients admitted to pediatric intensive care units in Italy.
Di Nardo M, Poletto E, Bonanomi E … +26 more , Carbonetti R, Conio A, Zardi E, Massa S, Pagano G, Ferrario S, Finazzi P, Giannini A, Amigoni A, Sagredini R, Paluzzano G, Reia N, Pallotto R, Recchiuti V, Lampugnani E, Marinosci GZ, L'Erario M, Moliterni P, Ricci R, Piazza M, Bianzina S, Gorghelli G, Schirru S, Moncada M, Mondardini MC, Italian Society of Neonatal, Pediatric Anesthesia, Intensive Care (SARNePI)
Eur J Pediatr · 2026 Jul · PMID 42399446 · Publisher ↗
UNLABELLED: Prolonged immobility contributes to pediatric intensive care unit (PICU)-acquired weakness and postintensive care syndrome (PICS). Early mobilization (EM) shows feasibility and potential benefits in adults, a...
UNLABELLED: Prolonged immobility contributes to pediatric intensive care unit (PICU)-acquired weakness and postintensive care syndrome (PICS). Early mobilization (EM) shows feasibility and potential benefits in adults, and pediatric experiences suggest safety, though data are limited and practice varies. There is a wide variability in Italy regarding EM practices. Thus, we aimed to develop consensus statements to standardize EM across Italian PICUs today while respecting local variability. This project was conducted by a 20-member multidisciplinary panel of Italian PICU experts, including nurses and physiotherapists. The project was endorsed by the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). A comprehensive search (2010-2015 July 2025) in PubMed, CINAHL, and PEDro was conducted. Eligible studies included prospective and retrospective studies, systematic reviews, meta-analyses, and guidelines. Nine EM research areas were defined; Statements were drafted using a Quaker-based consensus methodology and voted using the RAND/UCLA appropriateness method. From 8380 records, 113 studies met eligibility. Twenty-two statements and four tables were drafted; 20 statements and three tables achieved strong agreement in the first round. The remaining two statements and one table were revised and were classified with weak agreement. Attendance was 93% at online meetings. CONCLUSION: This EM consensus provides standardized, implementable statements to guide EM adoption across Italian PICUs while accommodating local practice differences; future work should focus on validation, implementation, and dissemination. WHAT IS KNOWN: • Prolonged immobility in the PICU is one of the modifiable factors associated with PICU-acquired weakness, delirium, and post-intensive care syndrome. • In Italy only 15% of patients admitted to PICU receives Early Mobilization practices with great variability across PICUs. WHAT IS NEW: • 22 pragmatic statements and four tables have been developed to promote standardized EM interventions across Italian PICUs, while accounting for variability of practices and equipment. • The provision of graded Early Mobilization, responsive to the child's condition and severity of illness, may promote functional recovery both during and beyond the PICU stay.
Ultrasound-guided midline catheters in the neonatal intensive care unit: a single-center pilot study.
Zanetto L, Zamunaro A, Nardo D … +5 more , Divisic A, Della Torre F, Salvadori S, Baraldi E, Bonadies L
Eur J Pediatr · 2026 Jul · PMID 42390693 · Full text
UNLABELLED: To assess the feasibility and performance of ultrasound-guided midline catheters in term and preterm neonates requiring prolonged intravenous therapy without an indication for central access, and to generate...
UNLABELLED: To assess the feasibility and performance of ultrasound-guided midline catheters in term and preterm neonates requiring prolonged intravenous therapy without an indication for central access, and to generate hypotheses on factors influencing catheter outcomes. Single-center prospective observational cohort: 70 consecutive neonates received 2-Fr polyurethane midline catheters in a level IV NICU (March 2024-November 2025). Data were analyzed descriptively; complication-free survival was estimated by Kaplan-Meier, and exploratory subgroup comparisons used Fisher's exact test. Mean weight at insertion was 2582 g (range 700-4920), including very low-birth-weight infants. Median dwell time was 9 days (range 0-176), corresponding to 1144 catheter-days. The primary composite outcome (complication-free dwell ≥ 7 days or elective removal before day 7) was met in 94.3% of devices. Kaplan-Meier complication-free survival was 98.6% at 3 days and 81.2% at 14 days. Device-related complications occurred in 21.4%, predominantly minor and resolving after removal. Bloodstream infection and thrombosis rates were 2.62 and 0.87 per 1000 catheter-days; no thrombophlebitis occurred. Complication rates did not differ by vein diameter < 2 mm or weight < 1500 g, although the study was underpowered for these comparisons. CONCLUSION: In this pilot study, ultrasound-guided midline catheters were feasible in neonates, including very low-birth-weight infants and those with small-caliber veins, with predominantly minor complications. These hypothesis-generating findings require confirmation in adequately powered; comparative studies before midlines can be recommended as an alternative to central access or repeated peripheral cannulation. WHAT IS KNOWN: • Midline catheters may offer an intermediate option between peripheral and central venous access, but neonatal experience, particularly in preterm infants, is limited. • Data on the feasibility and performance of midline catheters in the NICU are scarce. WHAT IS NEW: • In this single-center pilot cohort of 70 neonates, ultrasound-guided midline catheters achieved a high rate of complication-free dwell time, with predominantly minor, self-limiting complications. • Complication rates did not appear to increase in infants < 1500 g or with veins < 2 mm; these hypothesis-generating observations require confirmation in adequately powered studies.
Gastrointestinal pathogens in paediatric patients with diarrhoea during the COVID-19 pandemic in Spain: a multicentre molecular-based prospective study.
Dashti A, Hernández-Castro C, Yuan JM … +14 more , Balasegaram S, Köster PC, Bailo B, Remacha MA, Martínez-Ruiz R, Nogueira B, de Arellano ER, López A, Llorente MT, Castro-Companioni L, García-Ibáñez N, Fernández-García MD, Carmena D, Sánchez S
Eur J Pediatr · 2026 Jul · PMID 42390675 · Full text
Gastroenteritis is a major cause of morbidity in young children worldwide. A prospective multicentre study was conducted from September 2020 to September 2021 in three tertiary hospitals in Spain to assess the burden of...
Gastroenteritis is a major cause of morbidity in young children worldwide. A prospective multicentre study was conducted from September 2020 to September 2021 in three tertiary hospitals in Spain to assess the burden of the gastrointestinal pathogens causing paediatric gastroenteritis in different Spanish regions, to understand the impact of COVID-19 pandemic in their incidence, and to assess potential risk factors for infection. Stool samples from children aged 0-59 months with acute or chronic diarrhoea were analysed by PCR to detect and characterise gastrointestinal bacteria, parasites, and viruses. Whole-genome sequencing was carried out on enteroaggregative Escherichia coli isolates. Epidemiological and clinical data were analysed using univariable and multivariable logistic regression models. A total of 1114 children were included (median age, 16 months; 57.3% male). The most prevalent bacteria were enteropathogenic E. coli (16.0%) and Campylobacter spp. (15.0%). Giardia duodenalis (9.8%) and Cryptosporidium parvum (1.8%) were the most common parasites, while norovirus (5.5%) predominated among viruses. Molecular analyses revealed substantial genetic diversity across all pathogens. Campylobacter infection increased with age and was associated with fever and bloody diarrhoea, while norovirus infection decreased with age and was associated with vomiting.Conclusion COVID-19 countermeasures substantially altered the transmission of faecal-orally transmitted gastrointestinal pathogens in children, particularly reducing person-to-person spread of human-adapted pathogens such as C. hominis and endemic enteroaggregative E. coli subtypes. Zoonotic pathogens were largely unaffected, highlighting the selective impact of non-pharmaceutical interventions on anthroponotic transmission. What is Known: • Paediatric gastroenteritis is caused by faecal-orally transmitted viral, bacterial, and parasitic agents. • COVID-19 countermeasures contributed to the significant reduction of person-to-person transmitted gastrointestinal pathogens. What is New: • COVID-19 countermeasures drastically interrupted the person-to-person transmission of human-adapted Cryptosporidium hominis and endemic enteroaggregative Escherichia coli subtypes in Spanish children. • Cryptosporidium parvum and other zoonotically transmitted gastrointestinal pathogens were largely unaffected.
Low serum immunoglobulin levels in pediatric atopic dermatitis: association with disease severity and exploratory scores.
Duran BC, Bahadir E, Özer M … +2 more , Aytekin C, Özmen S
Eur J Pediatr · 2026 Jul · PMID 42390586 · Publisher ↗
UNLABELLED: Atopic dermatitis (AD) is a common chronic inflammatory skin disease in childhood. Although low serum immunoglobulin (Ig) levels have been reported in children with AD, their clinical significance and associa...
UNLABELLED: Atopic dermatitis (AD) is a common chronic inflammatory skin disease in childhood. Although low serum immunoglobulin (Ig) levels have been reported in children with AD, their clinical significance and association with disease severity remain insufficiently defined. We aimed to evaluate the association between serum Ig levels and AD severity and to characterize the clinical and immunologic course of affected children. In this retrospective-prospective cohort study, 241 children younger than 5 years with AD were evaluated between 2021 and 2023. Patients were classified into an AD group (n = 139) and an AD-low Ig group (n = 102) according to age-adjusted baseline serum Ig levels. Disease severity was assessed using SCORAD and 2 exploratory scoring tools: the Involvement Area Score (IAS) and the Skin Findings Score (SFS). Low serum Ig levels, most commonly isolated IgG deficiency (65.7%), were identified in 42% of the cohort. Lower IgA, IgG, and IgM levels were significantly associated with greater disease severity (p < 0.05), and SCORAD showed a strong negative correlation with IgG levels (ρ = - 0.535, p < 0.001). During follow-up, 52.7% of patients in the AD-low Ig group had persistent Ig abnormalities, which were associated with more severe AD. IAS and SFS correlated strongly with SCORAD and were significantly higher in the AD-low Ig group (p < 0.05). CONCLUSION: Low baseline serum Ig levels may predict a more severe clinical course and that persistent severe AD may be accompanied by ongoing Ig abnormalities. IAS and SFS provide practical and objective tools for assessing disease extent and morphology in routine practice. WHAT IS KNOWN: • Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in childhood. • Low serum immunoglobulin levels may occur in some children with AD, but their associations with disease severity and longitudinal clinical course remain unclear. WHAT IS NEW: • Novel exploratory scoring tools show strong correlation with SCORAD and may serve as practical, objective measures for severity assessment in routine clinical monitoring. • The association of low serum Ig levels with greater disease severity and persistence in pediatric AD supports a risk-based immunologic assessment, particularly in children with severe, early-onset disease, recurrent infections, or extensive skin involvement.
Safely developing respiratory care during emergency neonatal transport through systematic collection and analysis of detailed ventilator data.
Lantos L, Szell A, Szanto G … +2 more , Somogyvari Z, Belteki G
Eur J Pediatr · 2026 Jul · PMID 42390585 · Publisher ↗
UNLABELLED: In a retrospective observational study of prospectively collected data, we investigated whether systematic computerised data collection and analysis enable the safe introduction of advanced ventilation modes-...
UNLABELLED: In a retrospective observational study of prospectively collected data, we investigated whether systematic computerised data collection and analysis enable the safe introduction of advanced ventilation modes-volume guarantee (VG) and high-frequency oscillatory ventilation (HFOV)-into routine clinical care during emergency neonatal transport. Data were downloaded from ventilators during interhospital transport over an 8.5-year period. Ventilator parameters, waveforms and loops were reconstructed and discussed during case review meetings. The quality of respiratory care was assessed against a set of quality indicators for each year. Trends in ventilation practice were also analysed. A total of 1031 infants were included. The use of ventilation modes supporting all breaths increased from 38% in 2017-2020 to 56% in 2021-2025 (p < 0.001). VG use increased during the first 2 years (p < 0.001) and subsequently remained stable at 82-87%. HFOV use increased from 2.6% in 2020 to 20.6% by 2025. pCO after transport met the criteria in 87% of cases, with no significant change over the years. In infants ventilated without VG, the mean expired tidal volume was 4-6 mL/kg in only 31% (52/166) of cases. A significantly (p < 0.001) higher proportion of infants ventilated with VG were in this range (493/758, 65%). Ventilator alarms were active for 5.8% of the time. CONCLUSION: Advanced ventilation modes can be safely introduced into clinical use when accompanied by systematic data collection and analysis. Regular case reviews lead to practice development even without an explicit ventilation protocol. WHAT IS KNOWN: • Modern ventilators offering adaptive and advanced modes such as volume guarantee and high-frequency oscillatory ventilation are increasingly used during neonatal transport. • Their use during neonatal transfer has lagged behind their use in neonatal intensive care units. WHAT IS NEW: • Advanced ventilation modes can be safely introduced into routine clinical care during neonatal transport with systematic collection and analysis of detailed ventilator data. • Regular structured case reviews using these data result in practice development even without an explicit ventilation protocol.
Validity and reliability of the Turkish version of the Physical Activity Parenting Questionnaire for Children.
Sivlim H, Çöme O, Laukkanen A
Eur J Pediatr · 2026 Jul · PMID 42386993 · Publisher ↗
UNLABELLED: Parental practices play a critical role in shaping children's physical activity behaviors, particularly during early school age when parental influence remains strong. The Physical Activity Parenting Question...
UNLABELLED: Parental practices play a critical role in shaping children's physical activity behaviors, particularly during early school age when parental influence remains strong. The Physical Activity Parenting Questionnaire for Children (PAP-C) is a child-reported, multidimensional instrument designed for children aged 7-10 years; however, no validated Turkish version is currently available. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Turkish version of the PAP-C. This methodological, cross-sectional study included 279 children aged 7-10 years attending a pediatric outpatient clinic in Türkiye. The PAP-C was translated and culturally adapted following internationally accepted guidelines. Content validity was assessed. Construct validity was examined using confirmatory factor analysis (CFA). Reliability was evaluated using Cronbach's α and McDonald's ω. The study included 279 children (mean age: 8.6 years). The Turkish PAP-C demonstrated strong content validity (S-CVI). Sociodemographic variables showed no significant differences in scale scores, except for higher Involvement scores in children whose fathers had primary school education (p = 0.033). Confirmatory factor analysis confirmed an acceptable to good model fit (CFI: 0.923, TLI: 0.913, RMSEA: 0.055). Standardized factor loadings ranged from 0.599 to 0.866. All subscales exceeded empirical thresholds for convergent validity. The total scale showed good reliability (Omega: 0.951). HTMT values confirmed distinct discriminant validity among the three latent factors. CONCLUSION: The Turkish version of the PAP-C is a valid and reliable instrument for assessing children's perceptions of physical activity related parenting practices. It provides a culturally appropriate tool for both research and clinical assessment. WHAT IS KNOWN: • Parental practices are key determinants of children's physical activity behaviors, and children's perceptions of parenting are closely linked to motivation and engagement. • The Physical Activity Parenting Questionnaire for Children is a child-reported, multidimensional instrument grounded in Self-Determination Theory, capturing three parenting domains (Structure for Activity, Autonomy Support, and Involvement) and has been validated only in limited cultural contexts. WHAT IS NEW: • This study provides the first Turkish translation, cultural adaptation, and psychometric evaluation of the Physical Activity Parenting Questionnaire for Children in children aged 7-10 years. • Content validity was established with high item-level content validity index and scale-level content validity index based on the average method scores, demonstrating strong expert agreement on item relevance and cultural appropriateness.
Correction to: A novel oxygenation distension index (ODI): a driving pressure-based metric compared with the oxygenation index in pediatric PARDS.
Soydan E, Ceylan G, Demirel O … +10 more , Yay ED, Atakul G, Topal S, Colak M, Hepduman P, Sarac O, Sari F, Karaarslan U, Revelly JP, Agin H
Eur J Pediatr · 2026 Jul · PMID 42384228 · Publisher ↗
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Bubbles in the barely born-contrast-enhanced ultrasound in neonates: a single-center experience.
Rahn A, Müller T, Renz D … +2 more , Drube J, Franke D
Eur J Pediatr · 2026 Jun · PMID 42380351 · Full text
UNLABELLED: To assess clinical value, safety, and applicability of contrast-enhanced ultrasound (CEUS) in neonates, focusing on bedside use in intensive care. This retrospective single-center study included 23 neonates u...
UNLABELLED: To assess clinical value, safety, and applicability of contrast-enhanced ultrasound (CEUS) in neonates, focusing on bedside use in intensive care. This retrospective single-center study included 23 neonates undergoing intravenous CEUS between 2010 and 2024, including seven preterm infants. The liver (n = 18) was the most frequently examined organ, followed by kidneys (n = 2), brain (n = 2), and adrenals (n = 1). Findings were compared with MRI (n = 10), CT (n = 3), or biopsy (n = 8), when available. In nine cases, CEUS findings were consistent with clinical course and treatment response only, without an independent reference standard. Among the 14 cases with available reference diagnostics, CEUS established the diagnosis first in ten (71.4%); histological confirmation was available in eight cases, with concordance in five (62.5%). 13 examinations (56.5%) were performed for bedside problem-solving in the neonatal intensive care unit, and no adverse events were observed. CONCLUSION: CEUS provided clinically relevant diagnostic information in neonates, including preterm and critically ill infants and was well tolerated. CEUS was particularly valuable in hepatic vascular tumors, where it could provide a definite diagnosis, enabled hemodynamic assessment, supported treatment decisions, and aided identification of potentially life-threatening complications. Bedside use enabled timely diagnosis without sedation, intubation, or patient transport, thereby supporting minimal handling. In selected cases, CEUS may reduce the need for cross-sectional imaging. Despite off-label use, our findings suggest a beneficial role for CEUS in neonatal imaging, predominantly for hepatic indications. WHAT IS KNOWN: • Contrast-enhanced ultrasound (CEUS) is a radiation-free, bedside-compatible imaging technique with an established safety profile in pediatric patients. • Neonatal CEUS experience is limited to small case series, predominantly reporting cerebral applications. WHAT IS NEW: • CEUS was feasible and well tolerated in neonates including preterm infants, with no adverse events in 23 examinations. • CEUS yielded clinically relevant diagnostic information across a range of indications, primarily hepatic, encompassing both focal lesions and perfusion assessment, supporting clinical decision-making in neonatal care.
The frequency and characteristics of ultra-short celiac disease in children: A single-center experience.
Sahin Y, Uzger A, Goktepe AR
Eur J Pediatr · 2026 Jun · PMID 42377610 · Publisher ↗
PURPOSE: Due to the patchy nature of mucosal involvement in Celiac disease (CD), histopathological changes may be confined to the duodenal bulb in some patients, leading to diagnostic challenges. This study aimed to inve...
PURPOSE: Due to the patchy nature of mucosal involvement in Celiac disease (CD), histopathological changes may be confined to the duodenal bulb in some patients, leading to diagnostic challenges. This study aimed to investigate the frequency, as well as the clinical and serological characteristics, of ultra-short celiac disease (USCD) in children. METHODS: Between February 2024 and March 2026, pediatric patients diagnosed with CD based on separate biopsy specimens obtained from the duodenal bulb and distal duodenum, each placed in separate containers, were enrolled in this study. The patients were classified into two groups: the USCD group and the classic CD group. RESULTS: Of the 78 patients included, 47 (60.25%) were female, and the overall mean age at diagnosis was 9.58 ± 4.21 years. The median tissue transglutaminase IgA (tTG-IgA) level was 125.50 (IQR: 21.30-200.00) IU/L. Sixteen patients (20.51%) had histopathologically confirmed USCD. The median tTG-IgA level was significantly lower in the USCD group compared to the classic CD group (22.50 vs. 162.00 IU/L; p < 0.05). Additionally, 87.50% of the patients in the USCD group lacked the classic gastrointestinal symptoms typically associated with malabsorption, presenting instead with isolated growth retardation. CONCLUSION: The rate of isolated duodenal bulb involvement in children was remarkably high (20.51%). Ultra-short celiac disease is more prevalent in pediatric patients presenting with fewer classic gastrointestinal findings and tTG-IgA levels below 10 × ULN. Therefore, it is critically important to obtain at least one biopsy specimen from the duodenal bulb and place it in a separate container. Missing bulb biopsies may result in a significant proportion of patients with isolated duodenal bulb involvement going undiagnosed. What is known • The frequency of ultra-short celiac disease (USCD) varies between 2.4% and 22.0% for more accurate differentiation • Intestinal biopsy remains mandatory to diagnose CD in patients with tTG-IgA levels below 10 times the upper limit of normal (10 × ULN) • Duodenal bulb biopsies are not routinely performed even in specialized centers during endoscopy What is new • The frequency of USCD in children with CD was found to be relatively high (20.51%) • Among patients with USCD, 75.00% exhibited tTG-IgA levels below 10 × ULN • Systematic duodenal bulb biopsy substantially enhances USCD detection in patients with low tTG-IgA levels; without it, approximately one in five patients may remain undiagnosed.
Alagille syndrome case series: five new variants and two large deletions.
Varol Fİ, Güngör Ş, Ekici C … +4 more , Tekedereli İ, Selimoğlu MA, Erdoğan S, Gök E
Eur J Pediatr · 2026 Jun · PMID 42377562 · Publisher ↗
UNLABELLED: Alagille syndrome (ALGS) is an autosomal dominant disorder characterized by intrahepatic bile duct insufficiency, cardiac, skeletal, ocular, and characteristic facial features, most commonly caused by pathoge...
UNLABELLED: Alagille syndrome (ALGS) is an autosomal dominant disorder characterized by intrahepatic bile duct insufficiency, cardiac, skeletal, ocular, and characteristic facial features, most commonly caused by pathogenic variants in the JAG1gene and, less frequently, in the NOTCH2 gene. This study aimed to expand the existing literature by reporting novel JAG variants identified in our cohort. This retrospective cross-sectional study included 17 patients diagnosed withALGS between 2010-2025 at the Pediatric Gastroenterology, Hepatology, and Nutrition Clinic of İnönü University Faculty of Medicine. Genetic analysis was performed in 12 patients using JAG1 gene sequencing (n = 6), a targeted cholestasis gene panel (n = 4), or whole-exome sequencing (n = 2). Symptom onset ages ranged from 1 to 150 days. Cholestasis was the most common initial presentation, observed in 13 patients (76.5%). Peripheral pulmonary stenosis was the most frequent cardiac anomaly, identified in 12 patients (70.6%). A molecular diagnosis was established in 12 patients, while five were diagnosed clinically due to the unavailability of genetic testing at presentation. All genetically tested patients harbored pathogenic variants in the JAG1 gene. Ten variants were point mutations and two were large deletions. Five point mutations were classified as novel, as they had not been previously reported in the literature or genomic databases. Additionally, two large deletions involving previously undescribed genomic regions were identified and reported for the first time. CONCLUSIONS: Alagille syndrome should be considered in patients with unexplained cholestasis, especially in populations with high rates of consanguineous marriage, and the diagnosis should be confirmed with genetic testing whenever possible. This study introduces 5 novel variants and two major deletions containing previously unidentified genomic regions to the literature for the first time. WHAT IS KNOWN: • Alagille syndrome (ALGS) is a multisystem disorder most commonly caused by pathogenic JAG1 variants. • Syndromic cholestasis requires early multidisciplinary evaluation and genetic confirmation. WHAT IS NEW: • Five point mutations were classified as novel, as they had not been previously reported in the literature or genomic databases. • Two large deletions involving previously undescribed genomic regions were identified and reported for the first time.
Plasma and urinary sTREM-1 as biomarkers of sepsis-associated acute kidney injury in critically Ill children.
Magdy SM, El-Gawaad TA, Hussein FA … +1 more , El-Farsy MS
Eur J Pediatr · 2026 Jun · PMID 42377559 · Full text
UNLABELLED: Early identification of sepsis-associated acute kidney injury (SA-AKI) is important to enable timely supportive management and reduce further renal injury. However, conventional diagnostic criteria for acute...
UNLABELLED: Early identification of sepsis-associated acute kidney injury (SA-AKI) is important to enable timely supportive management and reduce further renal injury. However, conventional diagnostic criteria for acute kidney injury (AKI), based on serum creatinine and urine output, may delay early detection. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has emerged as a potential biomarker in septic conditions. To evaluate the diagnostic value of plasma and urinary soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in children with sepsis-associated acute kidney injury. This prospective observational cohort study included 50 children with sepsis admitted to the Pediatric Intensive Care Unit, Children's Hospital, Ain Shams University, Cairo, Egypt, between October 2023 and March 2024. Plasma and urinary sTREM-1 levels were measured at the time of sepsis diagnosis according to pediatric Sequential Organ Failure Assessment (pSOFA) criteria. Patients were prospectively followed for the development of SA-AKI, and in those who developed AKI according to pediatric Risk, Injury, Failure, Loss, End-stage kidney disease (pRIFLE) criteria, sTREM-1 levels were reassessed at the time of AKI diagnosis. The median age of the study population was 8.5 months (range 3-24), with a slight female predominance (54%). Plasma sTREM-1 levels were significantly higher in children who developed SA-AKI than in septic children without AKI [222.7 (165.2-325.9) vs 130.3 (85.1-206.2) pg/mL, p = 0.006]. Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.729, with a cutoff value of 159.6 pg/mL, yielding 80% sensitivity and 60% specificity. Urinary sTREM-1 levels were also significantly higher in children who developed SA-AKI [116.3 (53.9-197.3) vs 68.5 (46.7-112.2) pg/mL, p = 0.045]. ROC analysis showed an AUC of 0.666, with a cutoff value of 62.2 pg/mL, yielding 72% sensitivity and 48% specificity. CONCLUSION: Both plasma and urinary sTREM-1 levels were significantly elevated in children who developed sepsis-associated acute kidney injury. Measurement at sepsis diagnosis may aid early risk stratification, while repeat assessment at AKI diagnosis may provide additional prognostic information. WHAT IS KNOWN: • Early recognition of sepsis-associated acute kidney injury in children is challenging, and conventional diagnostic markers may be delayed. sTREM-1 is an inflammatory biomarker with potential value in sepsis-related organ injury. WHAT THIS STUDY ADDS: • Baseline plasma and urinary sTREM-1 levels were higher in septic children who later developed sepsis-associated acute kidney injury, and both rose further after AKI occurrence. Urinary sTREM-1 also showed strong prognostic value for mortality in children with sepsis-associated acute kidney injury.
Update on intestinal ultrasound in pediatric inflammatory bowel disease.
Dunay GA, Däbritz J
Eur J Pediatr · 2026 Jun · PMID 42371204 · Full text
PURPOSE: Intestinal ultrasound (IUS) is an accessible imaging tool in pediatric inflammatory bowel disease (IBD), its validation and standardization are a topic of intensive ongoing research. Here we provide an update o...
PURPOSE: Intestinal ultrasound (IUS) is an accessible imaging tool in pediatric inflammatory bowel disease (IBD), its validation and standardization are a topic of intensive ongoing research. Here we provide an update on recent evidence including interim results from new studies. METHODS: Literature search was performed using PubMed and OpenEvidence on IUS in pediatric IBD and the following subtopics: (1) validation of IUS in pediatric IBD; (2) bowel wall thickness (BWT); (3) Doppler-based evaluation; (4) mesenteric fat; (5) fibrostenosis and intestinal strictures; (6) comparison of different scoring systems; and (7) IUS in pediatric IBD monitoring. Furthermore, conference abstracts and poster presentations from major conferences were screened to identify ongoing studies with relevant preliminary findings. RESULTS: IUS specificity and sensitivity for inflammation was found to be above 80-90% for the bowel segments accessible to ultrasound (colon, terminal ileum), but more limited for small bowel. Consensus is emerging for a threshold value of < 2.5 mm for BWT in deep remission of pediatric IBD, which is lower than in adults. In multiple studies, BWT alone correlated as well as more complex IUS-based scores with endoscopy and laboratory markers of inflammation. The Chicago Mesenteric Fat Index (CMFI) was developed for quantification of mesenteric fat and may improve standardization and reproducibility in research and clinical applications. Conclusion: Significant recent progress in standardization and validation of IUS in pediatric IBD will most likely lead to its widespread application in outpatient and bedside monitoring including possible adoption of IUS based endpoints in clinical studies. WHAT IS KNOWN: • Intestinal ultrasound is gaining importance in the diagnostics and management of pediatric inflammatory bowel disease. WHAT IS NEW: • Simplified ultrasound assessment measuring bowel wall thickness alone may be as informative as more complex scores. A consensus new cut-off value < 2.5 mm for bowel wall thickness in children is emerging. • A standardized quantification system called the Chicago Mesenteric Fat Index in pediatric inflammatory bowel disease has been proposed.
Atypical manifestations of dengue in pediatric patients hospitalized during the 2023-2024 epidemic in Argentina: a multicenter registry.
López O, Tirao E, Juarez X … +20 more , Piedra E, Ensinck G, Gaiano A, Higa V, Borra M, Garnero A, Montiel Ríos D, López L, Arce L, Deschutter V, Alvarez MS, García Oro C, Cervella L, Riofrio V, Miño L, Lobertti S, Ansio C, Mercado C, Calvari M, Brizuela M
Eur J Pediatr · 2026 Jun · PMID 42371151 · Publisher ↗
UNLABELLED: We aimed to characterize encephalitis, myositis, and myocarditis, in hospitalized children during the 2023 - 2024 dengue epidemic in Argentina. This case series included patients younger than 16 years with la...
UNLABELLED: We aimed to characterize encephalitis, myositis, and myocarditis, in hospitalized children during the 2023 - 2024 dengue epidemic in Argentina. This case series included patients younger than 16 years with laboratory-confirmed dengue hospitalized for atypical manifestations across ten centers from Argentina between July 2023 and July 2024. Data was collected via a REDCap form version 12.4.1 (Vanderbilt University). Statistical analysis was performed by RStudio. We enrolled 47 patients; median age was 7 years [IQR 2 - 11], 64% were male, and 62% had no underlying conditions. Encephalitis was the most frequent clinical manifestation (60%), followed by myositis (38%) and myocarditis (4%). One patient had concurrent myositis and myocarditis. DENV-2 and DENV-1 were the identified serotypes. The 32% of patients required PICU admission, primarily those with encephalitis (n = 13) and myocarditis (n = 2). Thirteen patients required inotropic support and mechanical ventilation. Empirical antibiotics were administered in 32% of cases; no bacterial co-infections were identified. Median hospital stay was 5 days [IQR 3 - 8]. In 4 patients residual sequelae at discharge (persistent muscle weakness, myocardial fibrosis, and seizures) were detected. No deaths occurred. Encephalitis, myositis, and myocarditis are uncommon but clinically significant dengue complications in children. CONCLUSION: Encephalitis and myositis were the most frequent atypical manifestations of dengue in this multicenter registry. Encephalitis and myocarditis were associated with a higher rate of PICU admission. WHAT IS KNOWN: • Atypical dengue manifestations in children such as encephalitis, myocarditis, and myositis, affect males predominantly, and may be associated with greater severity. • These clinical pictures are frequent in endemic countries, with a high burden of cases annually. WHAT IS NEW: • Argentina has become an endemic country with a cyclic epidemic pattern. • This was the largest epidemic in the country with a high burden of cases of dengue. • The cases had mild evolution in this new endemic scenario, with adequate clinical support.
Cortical structure alterations in toddlers with different severities of congenital heart disease: a cross-sectional study.
Lu F, Liu Y, Lu S … +11 more , Ma S, Zhu M, Yang F, Yu W, Li H, Fu M, An J, Wen X, Xue P, Mo X, Yang M
Eur J Pediatr · 2026 Jun · PMID 42366252 · Publisher ↗
UNLABELLED: The aim of this study was to characterise the cortical structure in toddlers with congenital heart disease (CHD) of varying severities and to investigate its associations with preoperative laboratory values a...
UNLABELLED: The aim of this study was to characterise the cortical structure in toddlers with congenital heart disease (CHD) of varying severities and to investigate its associations with preoperative laboratory values and neurodevelopmental outcomes. A cohort of 109 toddlers with CHD and 56 healthy controls (HCs) underwent magnetic resonance imaging between August 2021 and December 2023. All toddlers with CHD were assessed using the Gesell Developmental Schedules and stratified into mild, moderate, and severe groups. Generalised linear models were used to compare cortical structural (grey matter volume (GMV) and thickness) differences across CHD severity groups and HCs and to examine their relationships with preoperative laboratory values and neurodevelopmental outcomes. Compared with HCs, toddlers with mild and moderate-to-severe CHD exhibited reduced total brain volume and total GMV. Significant reductions in cortical GMV and thickness were observed in specific brain regions (p < 0.001, family-wise error corrected). Altered cortical structures demonstrated overlapping spatial distributions between the mild and moderate-to-severe CHD groups. In the mild and moderate-to-severe CHD groups, regional alterations were correlated with scores across multiple neurodevelopmental domains (adaptive, gross motor, and fine motor skills), and haemoglobin levels were associated with cortical thickness in the right superior frontal area (β = 0.422; p = 0.021; 95% CI, 0.002-0.007). CONCLUSION: Toddlers with CHD exhibit GMV and cortical thickness variations across all CHD severity levels in this study. Notably, toddlers with mild CHD may demonstrate alterations comparable to those in the moderate-to-severe group at this developmental stage. These cortical alterations may merit early consideration during neurodevelopmental trajectories, irrespective of CHD severity. WHAT IS KNOWN: • While neurodevelopmental risks and behavioural abnormalities in children with complex CHD are well-established, less is known about the neuroanatomical alterations and neurodevelopmental outcomes of those with mild CHD. WHAT IS NEW: • Toddlers with CHD exhibit similar cortical structural alterations across all severity groups in this study. • Cortical structure was associated with haemoglobin levels and neurodevelopmental outcomes, suggesting it may lie on a pathway linking preoperative laboratory values to neurodevelopment. This positions it as a potential neuroimaging correlate of NDD and a candidate target for interventions aimed at improving outcomes.
Lactate/albumin ratio as an independent predictor of mortality in pediatric trauma patients admitted to a pediatric intensive care unit.
Bingöl I, Altınsoy KE
Eur J Pediatr · 2026 Jun · PMID 42366245 · Full text
UNLABELLED: Early identification of pediatric trauma patients at high risk of mortality remains challenging despite advances in critical care management. Systemic inflammatory response and subsequent organ dysfunction pl...
UNLABELLED: Early identification of pediatric trauma patients at high risk of mortality remains challenging despite advances in critical care management. Systemic inflammatory response and subsequent organ dysfunction play a central role in trauma-related mortality. Recently, the lactate/albumin ratio (LAR) and inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) have emerged as potential prognostic indicators; however, their independent predictive value in pediatric trauma remains incompletely defined. In this retrospective cohort study, 272 pediatric trauma patients admitted to a tertiary pediatric intensive care unit (PICU) were screened. After excluding 28 patients who died within the first 24 h and 34 patients with incomplete laboratory data, 210 patients were included in the final analysis. Demographic, clinical, and laboratory parameters were collected at admission. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to evaluate independent predictors of mortality. Among 210 patients, 27 (12.9%) died during PICU stay. Non-survivors had significantly higher PRISM III scores and prolonged mechanical ventilation duration. LAR demonstrated the highest discriminatory performance for mortality (AUC 0.918, 95% CI: 0.839-0.978), followed by NLR (AUC 0.900) and PRISM III score (AUC 0.884). In multivariable analysis, LAR emerged as a prominent independent predictor of mortality (OR 12.22, 95% CI: 3.08-48.49, p < 0.001), while NLR and PRISM III score remained independently associated with adverse outcomes. CONCLUSION: The lactate/albumin ratio was independently associated with in-hospital mortality and improved risk discrimination when added to PRISM III in this selected cohort of pediatric trauma patients. As a simple and readily available biomarker, LAR may complement established severity scoring systems and support early risk stratification, although external validation is required before clinical application. WHAT IS KNOWN: • Serum lactate and inflammatory indices such as the neutrophil-to-lymphocyte ratio are associated with poor outcomes in pediatric trauma, but their independent prognostic value is incompletely defined. • Established severity scores like PRISM III predict mortality but may not fully capture the combined effects of tissue hypoperfusion and inflammation. WHAT IS NEW: • The lactate/albumin ratio independently predicted in-hospital mortality and showed the highest discrimination (AUC 0.918) among tested markers in PICU-admitted pediatric trauma patients. • Adding the lactate/albumin ratio to PRISM III improved risk discrimination, supporting its role as a simple adjunct forearly stratification pending external validation.
Neurodevelopmental care across pediatric critical care settings: toward brain-focused critical care.
Morag S, Bernstein T, Jones MB … +2 more , Wernovsky G, Pollak U
Eur J Pediatr · 2026 Jun · PMID 42365178 · Full text
UNLABELLED: Advances in neonatal and pediatric critical care have expanded the focus from short‑term survival to include greater attention to long‑term neurodevelopmental health and family well‑being. This narrative revi...
UNLABELLED: Advances in neonatal and pediatric critical care have expanded the focus from short‑term survival to include greater attention to long‑term neurodevelopmental health and family well‑being. This narrative review synthesizes the evolution of neurodevelopmental and neuroprotective care across neonatal (NICU), pediatric (PICU), and cardiovascular (CVICU/PCICU) intensive care settings. Developmental care emerged in the NICU through individualized, cue‑based approaches such as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), emphasizing stress reduction, protection of sleep, optimized sensory environments, and parent-infant coregulation. As survivorship after critical illness improved, parallel concerns about post‑intensive care morbidities, including cognitive, behavioral, and functional impairments, catalyzed adoption of family‑centered and brain‑focused practices in the PICU, supported by contemporary guidelines integrating pain and sedation optimization, delirium prevention, environmental stewardship, and early mobility. More recently, dedicated cardiac neurodevelopmental programs have adapted NICU principles to the high‑acuity CVICU/PCICU population, pairing hemodynamic vigilance with developmental goals through structured interdisciplinary models (e.g., developmental rounds, holding protocols, early therapy, feeding support, and caregiver mental health resources). Across settings, common implementation domains include family partnership, cue‑based care, protected sleep and circadian support, sensory modulation, humane pain and sedation strategies, early rehabilitation, and coordinated follow‑up after discharge. CONCLUSION: While the strength of evidence varies by unit type and outcome, available data support feasibility and potential benefits for delirium reduction, functional recovery, feeding, parent experience, and early developmental trajectories. Continued multicenter research and implementation science are needed to define optimal bundles, equity‑informed delivery, and durable long‑term outcomes. WHAT IS KNOWN: • Neurodevelopmental care is well established in NICUs, emphasizing cue-based care, pain reduction, environmental protection, and family partnership. • Survivors of pediatric and cardiac critical illness remain at risk for cognitive, behavioral, emotional, and functional impairments. WHAT IS NEW: • This review extends neurodevelopmental care beyond the NICU to PICU and CVICU settings. • It proposes a unified multidisciplinary framework for brain-focused critical care across pediatric ICU environments.
Assessment of hepatic fibrosis in Egyptian children and adolescents with beta thalassemia major: a single center study.
Elhady MA, Kaddah M, Marzouk A … +2 more , Mogahed EA, Yassin NA
Eur J Pediatr · 2026 Jun · PMID 42362985 · Full text
UNLABELLED: Liver fibrosis is a major complication in patients with transfusion-dependent beta-thalassemia, primarily driven by iron overload and suboptimal chelation therapy. This study aimed to assess the prevalence an...
UNLABELLED: Liver fibrosis is a major complication in patients with transfusion-dependent beta-thalassemia, primarily driven by iron overload and suboptimal chelation therapy. This study aimed to assess the prevalence and severity of hepatic fibrosis in children with beta-thalassemia major using non-invasive modalities and to identify associated clinical and laboratory risk factors. This cross-sectional analytical study included 82 transfusion-dependent thalassemia patients. All participants underwent clinical evaluation, hematological and biochemical investigations, and liver fibrosis assessment using transient elastography (TE) (by FibroScan) and calculation of aspartate aminotransferase (AST)/platelet ratio index (APRI) and Fibrosis 4 score (FIB-4). Based on TE, 18 patients (22%) exhibited significant hepatic fibrosis (F2-F4). Both APRI and FIB-4 scores were significantly elevated in patients with significant fibrosis. Significant fibrosis was associated with older age (p = 0.019), longer disease duration (p = 0.015), heterogeneous liver echotexture on ultrasound (p < 0.001), poor adherence to chelation therapy (p < 0.001), and elevated transaminases and serum ferritin levels (p < 0.05). CONCLUSION: Significant hepatic fibrosis was observed in approximately one-fifth of the studied cohort of Egyptian children with beta-thalassemia major. It is strongly associated with older age, longer disease duration, iron overload, and inadequate chelation. TE, APRI, and FIB-4 are effective for early detection of hepatic fibrosis in these patients. WHAT IS KNOWN: • Hepatic fibrosis is a well-recognized complication of transfusion-dependent beta-thalassemia major, primarily resulting from chronic iron overload. • Liver biopsy remains the gold standard for fibrosis assessment; however, it is invasive. Non-invasive tools such as transient elastography, APRI, and FIB-4 have been increasingly used in adults, but limited data are available in pediatric populations, particularly in low- and middle-income countries. WHAT IS NEW: • This study shows that significant hepatic fibrosis affects approximately one in five Egyptian children with beta-thalassemia major. • It supports the clinical utility of FibroScan, APRI, and FIB-4 for fibrosis assessment in pediatric patients and highlights poor chelation adherence, iron overload, and longer disease duration as key modifiable risk factors.
Feasibility of image-based 3D avatar anthropometry assessment of pediatric obesity: a pilot study.
Del Mar Uclés-Torrente M, Ruiz-Gamarra GE, Alcalde-Llergo JM … +4 more , Vaquero-Álvarez M, Blancas-Sánchez IM, Aparicio-Martínez P, Vaquero-Abellán M
Eur J Pediatr · 2026 Jun · PMID 42362956 · Publisher ↗
UNLABELLED: The purpose of this study is to evaluate the feasibility and validity of 3D avatar-based anthropometry for assessing anthropometric indicators of overweight and obesity in children based on artificial intelli...
UNLABELLED: The purpose of this study is to evaluate the feasibility and validity of 3D avatar-based anthropometry for assessing anthropometric indicators of overweight and obesity in children based on artificial intelligence-derived 3D body reconstruction. This cross-sectional study included 171 children aged 8-10 years from five primary schools in southern Spain. Due to technical constraints of the reconstruction software, 75 children meeting predefined image quality and body weight requirements (≥ 30 kg) were eligible for 3D avatar analysis. Manual anthropometric measurements were obtained following International Society for the Advancement of Kinanthropometry (ISAK) standards and compared with avatar-derived circumferences. Agreement was assessed by using Wilcoxon tests, Spearman correlations, Bland-Altman analyses, and false discovery rate-adjusted comparisons. Avatar-derived circumferences were consistently greater than manual measurements, although waist-to-hip and waist-to-stature ratios demonstrated no significant differences. Avatar and manual circumferences were moderately to strongly correlated (Spearman's ρ = 0.62-0.72; adjusted p < 0.05). However, the mean absolute errors ranged from 6.21 to 7.11 cm, and Bland-Altman analysis revealed systematic overestimation with wide limits of agreement, particularly for waist and hip circumferences. Despite these discrepancies, both methods similarly discriminated between weight status categories. CONCLUSION: Image-based 3D avatar anthropometry is a feasible, noninvasive approach for population-level screening and research in pediatric settings. Although the system reliably captures relative differences and body proportions, its current accuracy is insufficient for individual-level clinical assessment. Further algorithmic refinement and validation in lighter and more diverse pediatric populations are needed before clinical implementation. WHAT IS KNOWN: • Childhood obesity remains a major public health challenge requiring accurate monitoring. • Anthropometric assessment still relies mainly on manual measurements, while AI-based 3D body modeling offers a promising non-invasive alternative. WHAT IS NEW: • Image-based 3D avatar anthropometry is feasible in school settings but is constrained by technical requirements. • Avatar measurements are correlated with manual anthropometry and preserve weight status discrimination but demonstrate systematic overestimation and limited agreement.
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