European Journal Of Pediatrics[JOURNAL]
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200 papers
Pediatric continuous reference intervals of coronary artery diameter by echocardiography in healthy Chinese children population.
Zheng L, Peng YG, Yang J … +5 more , Li JY, Zhang X, Sun Y, Liu GW, Ma N
Eur J Pediatr · 2026 May · PMID 42103989 · Publisher ↗
UNLABELLED: The aim of this study was to establish body surface area (BSA)-dependent Z-score continuous reference intervals of coronary artery diameter measured by Echocardiography in healthy Chinese children population....
UNLABELLED: The aim of this study was to establish body surface area (BSA)-dependent Z-score continuous reference intervals of coronary artery diameter measured by Echocardiography in healthy Chinese children population. Echocardiography measured 1221 healthy Chinese children's coronary artery diameters, including the LMCA, LAD, LCX, RCA-pro, RCA-mid, and RCA-dis. We employed the LMS (Lambda-Mu-Sigma) method for the model and the Haycock equation for the BSA estimation. The coronary artery diameter Z-score continuous reference intervals were established using the LMS method and passed the internal and external validation. CONCLUSIONS: The study outcome provides BSA-dependent Z-score continuous reference intervals for the coronary artery diameters in healthy Chinese children. There is a web Z-score calculator with convenient application for clinicians and ultrasound doctors, facilitating subsequent external validations in a larger population. WHAT IS KNOWN: • Echocardiography is the primary non‑invasive modality for assessing coronary artery (CA) diameter in children, and body surface area (BSA)‑dependent Z‑scores provide a more objective evaluation than absolute values. • The LMS (Lambda‑Mu‑Sigma) method is an internationally accepted approach for establishing continuous reference intervals, as used in the WHO child growth standards. WHAT IS NEW: • This study establishes BSA‑dependent Z‑score continuous reference intervals for six coronary artery segments (LMCA, LAD, LCX, RCA‑pro, RCA‑mid, RCA‑dis) specifically in healthy Chinese children aged 0 days to 18 years. • It provides a validated, LMS‑based model along with an online Z‑score calculator and a fully reproducible computational procedure, addressing the lack of updated, ethnicity‑specific continuous reference intervals for the Chinese pediatric population.
Rate and timing to clinical remission in celiac children on a gluten-free diet.
Sbravati F, Arsani C, Gori D … +7 more , De Palo B, Frigo I, Del Bono C, Brintazzoli S, Barbieri G, Labriola F, Alvisi P
Eur J Pediatr · 2026 May · PMID 42103965 · Publisher ↗
UNLABELLED: This observational retrospective study describes the rate and time of symptom resolution in celiac disease (CD) in a cohort of pediatric patients following a gluten-free diet (GFD). We evaluated the rate and...
UNLABELLED: This observational retrospective study describes the rate and time of symptom resolution in celiac disease (CD) in a cohort of pediatric patients following a gluten-free diet (GFD). We evaluated the rate and time to symptom resolution after starting a GFD, as well as associated predictive factors (age, gender, comorbidities, familial history, IgA anti-transglutaminase antibodies (TGA-IgA) at diagnosis, dietary adherence), in children diagnosed with CD between 2014 and 2022 at the Gastroenterology Unit of Maggiore Hospital, Bologna. The minimum follow-up period was 6 months. Of 421 symptomatic patients at diagnosis, 77.4% presented gastrointestinal symptoms (GIs) (40.6% recurrent abdominal pain, 19.5% diarrhea, 21.6% constipation, 17.3% bloating), 47.5% extra-intestinal symptoms (EISs) (16.4% neurological symptoms, 9.0% anemia), and 33.5% growth retardation (31.6% failure to thrive, 17.8% short stature). 96.7% had a high GFD adherence through follow-up. The overall symptom resolution rate was 84.8% (GIs 89.0%, EISs 92.6%, growth retardation 87.4%). Constipation had a significantly lower resolution rate compared to other GIs (p = 0.02) or diarrhea (p = 0.03). In total, 81.7% of patients achieved symptom resolution within 12 months. Short stature and anemia resolved more slowly compared to other symptoms. TGA-IgA normalization and GFD adherence were significant predictors of symptom resolution. CONCLUSION: Most symptoms resolved within the first year of diagnosis. The lower resolution rate for constipation compared to other GIs suggests a functional etiology, while the delayed recovery of anemia and short stature likely reflects their complex etiology. Serological normalization and GFD adherence are confirmed as predictors of clinical remission. WHAT IS KNOWN: • Time to clinical remission in celiac children after starting a gluten-free diet may vary between different symptoms. • Clinical remission is associated with serological normalization and adherence to diet. WHAT IS NEW: • Constipation has a significantly poorer rate of resolution among other gastrointestinal symptoms, due to its functional etiology, while anemia and short stature resolve slightly slower. • Most patients reach clinical remission within the first year on a gluten-free diet; serological normalization and diet adherence are confirmed to be predictors of clinical remission.
Efficacy and safety of telitacicept in IgA vasculitis nephritis: a single-center retrospective study.
Liu T, Sun X, Xiao C … +8 more , Li J, Gao X, Su H, Li P, Jiang M, Fan L, Guo T, Guo Q
Eur J Pediatr · 2026 May · PMID 42101684 · Publisher ↗
UNLABELLED: The objective was to evaluate the clinical efficacy and safety of telitacicept in the treatment of pediatric IgA vasculitis nephritis (IgAVN). A retrospective analysis was conducted on clinical data from pati...
UNLABELLED: The objective was to evaluate the clinical efficacy and safety of telitacicept in the treatment of pediatric IgA vasculitis nephritis (IgAVN). A retrospective analysis was conducted on clinical data from patients aged 3-18 years with IgAVN treated with telitacicept at the Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, between August 2023 and August 2024. Laboratory parameters were assessed at baseline and at 1, 3, 6, and 12 months posttreatment to determine therapeutic efficacy and safety. A total of 16 patients were enrolled (7 males [43.75%]; mean age 14.3 years). The median disease duration from diagnosis to telitacicept initiation was 4.25 (2.06-33.00) months, and the mean treatment duration was 8.63 ± 1.89 months. Early clinical improvement was observed as early as 1 month compared with baseline, characterized by substantial reductions in 24-h urinary protein (24 h-UP) and urinary red blood cell counts compared to baseline. At 12 months, mean 24 h-UP decreased further to 0.16 ± 0.15 g (P < 0.001), with 68.75% (11/16) of patients achieving complete remission. Serum IgG, IgM, and IgA levels were significantly reduced (P < 0.05), while serum albumin significantly increased (P < 0.001). No serious adverse events occurred; three patients experienced mild upper respiratory tract infections that resolved with symptomatic treatment. CONCLUSION: Telitacicept effectively reduces proteinuria, improves renal function, and enhances clinical remission rates in pediatric IgAVN, demonstrating a favorable safety profile. WHAT IS KNOWN: • Telitacicept, a dual BAFF/APRIL inhibitor, has shown potential effi cacy in IgA nephropathy (IgAN) and IgA vasculitisnephritis (IgAVN), particularly in reducing proteinuria and maintaining stable renal function. • Evidence regarding the use of telitacicept in pediatric IgAVN remains limited and is mainly derived from small case series and retrospective studies. WHAT IS NEW: • This study provides real-world data on the use of telitacicept in pediatric IgAVN, showing improvement in proteinuria with stable renal function during follow-up. • Most patients were able to discontinue glucocorticoids and/or immunosuppressive agents within 3-6 months after telitacicept initiation, suggesting a potential steroid- and immunosuppressant-sparing effect.
Correction to: Real-world use of Serial Clinical Observation in culture-proven early-onset sepsis: timing of recognition, treatment and retrospective comparison with the Neonatal Sepsis Calculator.
Miselli F, Lugli L, Dragone G … +16 more , Bedetti L, Spinedi S, Capretti M, Marrozzini L, Di Luca L, Fanaro S, Gambini L, Biasucci G, Piccinini G, Scarponi D, Papa I, Nanni F, Baroni L, Pagano R, Capone V, Berardi A
Eur J Pediatr · 2026 May · PMID 42101675 · Full text
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Pulse oximetry in infants with Robin sequence.
Khirani S, Kerfourn A, Griffon L … +11 more , Adnot P, Poirault C, Vegas N, Dosso M, Vedrenne-Cloquet M, Giuseppi A, Soupre V, Luscan R, Coutier L, Abadie V, Fauroux B
Eur J Pediatr · 2026 May · PMID 42101665 · Publisher ↗
UNLABELLED: Infants with Robin sequence (RS) are at high risk for obstructive sleep apnea (OSA), but screening with poly(somno)graphy (P(S)G) is challenging. The aim of the study was to assess the relationships between d...
UNLABELLED: Infants with Robin sequence (RS) are at high risk for obstructive sleep apnea (OSA), but screening with poly(somno)graphy (P(S)G) is challenging. The aim of the study was to assess the relationships between different pulse oximetry (SpO) parameters and the mixed obstructive apnea-hypopnea index (MOAHI) in these infants. We also compared the findings to infants having other comorbidities (OSA-III). Different SpO parameters were correlated with MOAHI in infants with RS and with OSA-III having similar OSA severity. The SpO parameters were also compared between the 2 groups. Half of the infants with RS had nap studies. Mean MOAHI did not differ significantly between the 2 groups, and the proportion of infants with MOAHI > 10 events/h or ≥ 3% oxygen desaturation index (ODI 3%) > 10 events/h was also similar. Overall, the different SpO parameters correlated better with MOAHI in infants with OSA-III than in those with RS. The best correlation was observed between ODI 3% and MOAHI in RS patients (r = 0.536, p < 0.001), and between the total hypoxic burden and MOAHI in OSA-III patients (r = 0.720, p < 0.0001). Mean ODI 3% was significantly lower in infants with RS (15.8 ± 22.3 (range 0.0-137.0) vs. 21.5 ± 18.3 (range 0.4-93.6) events/h for OSA-III, p = 0.024). Moreover, infants with OSA-III presented deeper desaturations and greater hypoxemic burdens. CONCLUSION: SpO parameters correlated better with MOAHI in infants with OSA-III compared to RS. These findings question the presence of a different OSA phenotype in infants with RS. Future studies should further investigate the potential role of the different SpO parameters to screen for OSA in infants. WHAT IS KNOWN: • Infants with Robin sequence (RS) are at high risk of obstructive sleep apnea (OSA). Polysomnography (PSG) is the gold standard for OSA diagnosis, but may be challenging due to its limited access, and the fact that it is time consuming and requires an experienced team. Pulse oximetry (SpO2) represents a simpler alternative and is used in some centers to screen for OSA. However, no pathological thresholds have been validated. Moreover, the oxygen desaturation index (ODI), which is commonly used, was found to correlate only moderately with the mixed and obstructive apnea-hypopnea index (MOAHI). WHAT IS NEW: • We correlated different SpO2 parameters, such as the hypoxemic burden and the Δ12s index, to the MOAHI in infants with RS and compared the findings to infants with OSA associated to other comorbidities. It seems that infants with RS have a less severe OSA-related hypoxemic profile than infants with OSA-III. These findings question if different obstructive patterns exist according to the disorders.
Ultrasonographic optic nerve sheath diameter for predicting elevated intracranial pressure and clinical severity in children: a prospective observational study.
Naseem M, Anand V, Das R … +1 more , Rathia S
Eur J Pediatr · 2026 May · PMID 42101663 · Publisher ↗
UNLABELLED: Elevated intracranial pressure (ICP) can complicate various neurological conditions in children and may result in fatal brainstem herniation. Early detection and management can prevent this fatal complication...
UNLABELLED: Elevated intracranial pressure (ICP) can complicate various neurological conditions in children and may result in fatal brainstem herniation. Early detection and management can prevent this fatal complication. This prospective observational study conducted over 18 months aimed to evaluate point-of-care ultrasound (POCUS) as a noninvasive, efficient method to detect elevated ICP in children aged less than 14 years. The primary objective of this study is to determine optic nerve sheath diameter (ONSD) values in children, measured by POCUS, and correlate them with the clinical severity of ICP. Secondary objectives include establishing age-specific ONSD values for diagnosing and predicting ICP severity, determining normal ONSD values from age-matched control groups, and estimating ONSD changes in response to hyperosmolar therapy. This study found a significant increase in ONSD in children with raised ICP compared to controls (5.63 mm vs. 4.35 mm), with consistent measurements across different locations. However, ONSD did not correlate with the clinical severity of ICP. While age moderately influenced ONSD in healthy children, it had no significant impact in those with raised ICP. The age-specific cut-off values for POCUS-measured ONSD (e.g., 4.91 mm for 1.5-10 years and 5.27 mm for 10-14 years) exhibited high sensitivity and specificity for detecting raised ICP. Furthermore, both hypertonic saline and mannitol effectively reduced ONSD, with no significant difference in their efficacy, suggesting both are viable options for managing raised ICP. CONCLUSION: This study establishes POCUS-measured ONSD as a reliable tool for detecting raised ICP in children. While more research is needed for age-specific norms and severity prediction, ONSD shows promise as a valuable adjunct in pediatric ICP management. WHAT IS KNOWN: • Optic nerve sheath diameter (ONSD) is a validated noninvasive marker for detecting intracranial hypertension in children. WHAT IS NEW: • ONSD does not correlate with the clinical severity of intracranial pressure, limiting its use as a quantitative stratification tool.
A multidisciplinary paediatric endocrine genetic clinic: experience from a single tertiary centre.
Chen E, McGowan R, Shaikh MG
Eur J Pediatr · 2026 May · PMID 42101527 · Publisher ↗
UNLABELLED: Multidisciplinary care is vital to the smooth running of patient-centred care, especially in the context of rare conditions. This service evaluation aimed to determine the potential benefits of a combined pae...
UNLABELLED: Multidisciplinary care is vital to the smooth running of patient-centred care, especially in the context of rare conditions. This service evaluation aimed to determine the potential benefits of a combined paediatric endocrine genetic clinic at a tertiary hospital, including increased diagnostic rates. Retrospective review of case notes of patients who attended the combined clinic at the Royal Hospital for Children, Glasgow, between 2022 and 2024 was done. Data collected included the type of genetic testing which had been performed, diagnostic yield and clinical outcomes. The data were evaluated qualitatively. A total of 21 patients (median age 5.3 years, range 6 months to 21 years) were included. Then, 43% were given a new genetic diagnosis, the greatest diagnostic yield occurring from whole-exome sequencing and MS-MLPA, with 67% of patients referred for further specialist input or investigations after attendance at the clinic. CONCLUSION: This study brings to light the benefits of a multidisciplinary endocrine-genetics clinic in the management of an under-researched patient cohort. It offers a streamlined diagnostic pathway with high diagnostic yield and improved patient experience. This clinic also highlighted the need for specialist input after genetic diagnoses were made to improve long-term health outcomes. However, limitations are its retrospective nature and absence of patient-reported outcomes; there is a need for future prospective research. WHAT IS KNOWN: • The results of genetic testing can be challenging to interpret without specialist input. • MDT clinics improve care coordination and diagnostic decision-making in complex multisystem conditions. WHAT IS NEW: • This study is the first UK-based study evaluating a combined paediatric endocrine-genetics clinic. • The clinic streamlined care by reducing the need for multiple appointments, directed genetic testing and tailoring management plans.
Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study.
Habermann S, Hartzenberg R, Loucaides EM … +5 more , Lawson G, Carr D, Maconochie I, Nijman RG, London REACH Network Collaborative
Eur J Pediatr · 2026 May · PMID 42101518 · Full text
Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants...
Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90 days of age presenting with fever or caregiver reported fever between 1st April 2021-31st March 2022 were included. Outcome measures were variations in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4-96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1-70.7%), 63.4% had urinalysis (43.4-85.4%) and 62.2% were investigated for SARS-CoV2 (26.5-91.7%). Antibiotics were started in 57.7% (35.4-90.2%) and 63.5% (46.7-99.2%) were admitted. Infants aged < 28 days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8-35.4%), partial adherence in 24.4% (18.0-35.3%), non-adherence in 31.2% (10.6-47.4%), and over-adherence in 23.5% (8.0-44.7%). CPG adherence was higher in infants aged < 28 days.Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.
Outpatient drug therapy for children with heart disease in Switzerland: a survey.
Bärlocher J, Caduff Good A, Di Bernardo S … +8 more , Lava SAG, Stambach D, Tissot C, Knirsch W, Wacker J, Cavigelli-Brunner A, Bosch A, Balmer C
Eur J Pediatr · 2026 May · PMID 42098520 · Publisher ↗
UNLABELLED: Cardiovascular drug therapy in adults is steadily progressing. However, the extent to which children with heart disease in Switzerland benefit from this progress remains unknown. This survey aimed to investig...
UNLABELLED: Cardiovascular drug therapy in adults is steadily progressing. However, the extent to which children with heart disease in Switzerland benefit from this progress remains unknown. This survey aimed to investigate the current outpatient prescribing practices among paediatric cardiologists in Switzerland. We conducted a cross-sectional survey among Swiss paediatric cardiologists. The physicians were asked to state how often they administer drugs on a pre-defined list for the following indications: heart failure, arrhythmia and thromboembolism. Forty-three (56%) out of 77 eligible physicians completed the survey. For paediatric heart failure, the three most frequently prescribed drugs were hydrochlorothiazide ('often prescribed' by n = 25, 58%), lisinopril (n = 24, 56%), and spironolactone (n = 32, 74%). The most frequently prescribed drugs for arrhythmia and thromboembolism were propranolol (n = 26, 60%) and acetylsalicylic acid (n = 31, 72%), respectively. Newer drugs such as sacubitril/valsartan ('never prescribed' by n = 20, 47%), sodium-glucose cotransporter type 2 inhibitors (n = 40, 93%), and direct oral anticoagulants (n = 20, 47%) were rarely used. CONCLUSION: The drugs used to treat heart failure, arrhythmia, and thromboembolism in Switzerland largely reflect current international recommendations. Nevertheless, novel drugs are rarely used. In addition to the lack of large randomized controlled drug trials in children, important obstacles are lack of authorization, lack of reimbursement, and lack of suitable formulations. These issues should be addressed by both the industry and healthcare providers to continuously improve drug therapy for children with heart disease. WHAT IS KNOWN: • Evidence for drug use in Paediatric cardiology mostly relies on extrapolation from adult studies and pathophysiological considerations. • Drug choices are also influenced by drug approval, insurance reimbursement, and availability of age-appropriate formulations. WHAT IS NEW: • Swiss paediatric cardiologists predominantly rely on established drugs to treat cardiovascular diseases in children, with the use of newer drugs remaining limited. • On top of expert consensus, adult evidence, and drug availability, drug prescription appears to be strongly influenced by the availability of child-friendly formulations.
Characterisation and non-pharmacological treatment of Complex Regional Pain Syndrome in under-18-year-olds: a scoping review.
Budhraja M, Purvis R, Tang K … +1 more , Lewis J
Eur J Pediatr · 2026 May · PMID 42098338 · Full text
UNLABELLED: The aim of this review was to explore the published literature describing the presentation, characteristics, and non-pharmacological treatments of Complex Regional Pain Syndrome (CRPS) in under 18-year-olds....
UNLABELLED: The aim of this review was to explore the published literature describing the presentation, characteristics, and non-pharmacological treatments of Complex Regional Pain Syndrome (CRPS) in under 18-year-olds. This scoping review was conducted in line with the Preferred Reporting Guidelines for Scoping Reviews (PRISMA-ScR). Five online databases (AMED, CINAHL + , EMBASE, EBSCO, and MEDLINE) were systematically searched with identified key terms for relevant records and screened against the eligibility criteria. Extracted data from the included studies informed a narrative synthesis. The PAGER framework was used to succinctly present gaps in the field and recommend future directions for research. Online searches yielded 140 articles. Following screening, 30 articles were included for review. Findings suggest primary symptoms included extreme pain, allodynia, and nail changes. The Budapest criteria, radiography, bone scans and laboratory examinations were commonly used diagnostic methods. Various non-pharmacological interventions were used, such as physiotherapy (home exercise), hydrotherapy, desensitisation, and cognitive behavioural therapy. CONCLUSION: The most common symptom in children is severe pain that is disproportionate to the inciting event. Critical gaps in the evidence base such as the absence of age appropriate, validated diagnostic criteria, lack of research understanding the lived experience and impact of the condition or exploring treatment efficacy, were identified as knowledge gaps within the field. WHAT IS KNOWN: • Complex Regional Pain Syndrome is a difficult to diagnose and hard to treat pain condition. Among children, it is not well documented or understood, there are no agreed diagnostic criteria or treatment guidelines. WHAT IS NEW: • This scoping review summarises and presents the published research regarding presentation, diagnosis and non-pharmacological treatment of paediatric CRPS. • Issues relating to the use of treatments lacking demonstrable efficacy and the need for quick and reliable diagnoses are discussed. • Using the PAGER Framework, this review exposes critical gaps in both research (the lack of research around condition experience and treatment efficacy) and practice (the lack of validated diagnostic criteria and treatment pathways) outlining clear and urgent recommendations.
Factors affecting the quality of life in children with joint hypermobility syndrome.
Çevirici T, Çevirici AD, Yılmaz N … +2 more , Kalaycı F, Acar BÇ
Eur J Pediatr · 2026 May · PMID 42098330 · Publisher ↗
UNLABELLED: Juvenile hypermobility syndrome can cause various symptoms in children, including widespread musculoskeletal pain, digestive issues, tingling sensations, urinary problems, sleep disturbances, fatigue, and anx...
UNLABELLED: Juvenile hypermobility syndrome can cause various symptoms in children, including widespread musculoskeletal pain, digestive issues, tingling sensations, urinary problems, sleep disturbances, fatigue, and anxiety. This study aimed to investigate how juvenile hypermobility syndrome and its associated symptoms affect the quality of life of children. The study involved 152 patients between the ages of 6 and 18 who experienced joint pain. The diagnosis of joint hypermobility syndrome was based on the Beighton criteria, and the quality of life was assessed using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Our study included 152 patients, of whom 96 (63.2%) were female. The average age of the patients was 11.2 ± 3.6 years. The knee was the most commonly affected area, with 92 patients (60.5%). The average Beighton score was 6.9 ± 1.3. Accompanying findings were observed in 146 patients; the most common finding was myalgia, which was observed in 32 patients (21.1%). The median PedsQL score reported by the children was 74 (17.7-95.8), with physical health at 78.1 (9.4-100), emotional functionality at 70 (0-100), social functionality at 79.2 (8.3-83.3), and school functionality at 70 (10-100). Similarly, the median PedsQL score reported by the parents for their child was 77.1 (8.3-95.8), with physical health at 75 (3.1-100), emotional functionality at 75 (0-100), social functionality at 83.3 (83.3-83.3), and school functionality at 80 (20-100). CONCLUSION: Many children diagnosed with juvenile hypermobility syndrome experience additional symptoms that affect not only their physical functionality, but also their school and social lives, which can impact their emotional well-being. This can cause concern for parents, and both the child and the family require appropriate support, especially in terms of emotional and social functionality. It is important to ensure that both the child and their family receive necessary support to deal with juvenile hypermobility syndrome. WHAT IS KNOWN: • Many children diagnosed with juvenile hypermobility syndrome experience additional symptoms that affect not only their physical functionality, but also their school and social lives, which can impact their emotional well-being. WHAT IS NEW: • This can cause concern for parents, and both the child and the family require appropriate support, especially in terms of emotional and social functionality. It is important to ensure that both the child and their family receive necessary support to deal with juvenile hypermobility syndrome.
Macroscopic hematuria in children with autosomal dominant polycystic kidney disease - report from four European tertiary centers.
Seeman T, Bláhová K, Fencl F … +5 more , John-Kroegel U, Weigel F, Šuláková T, Podracká L, Feber J
Eur J Pediatr · 2026 May · PMID 42098312 · Full text
UNLABELLED: In adults with autosomal dominant polycystic kidney disease (ADPKD), episodes of macroscopic hematuria are relatively common and are predictors of hypertension. We hypothesized that a history of macroscopic h...
UNLABELLED: In adults with autosomal dominant polycystic kidney disease (ADPKD), episodes of macroscopic hematuria are relatively common and are predictors of hypertension. We hypothesized that a history of macroscopic hematuria will be associated with hypertension also in children with ADPKD. We retrospectively analyzed 289 children (median age 10.2 years) with ADPKD who were followed in four European tertiary nephrology centers. The presence of ≥ 1 episode of macroscopic hematuria (MaHu) defines a group of MaHu+ patients; the absence defines a group of MaHu- patients. Hypertension was defined as the use of antihypertensive drugs upon the last investigation. Macroscopic hematuria occurred in 7.2% of children (n = 21). It was the second most frequent presenting symptom of ADPKD (11 out of 51 children). The etiology of macroscopic hematuria included ruptured cyst, urinary tract infection or urolithiasis. The prevalence of hypertension at the last follow-up in MaHu+ children was significantly higher than in MaHu- children (14.3% vs. 3.1%, p = 0.017). The proportion of patients with elevated blood pressure ≥ 75th percentile was significantly higher in patients with hematuria as compared with patients with no hematuria (95% vs. 64%, p = 0.002). Children from the MaHu+ group had a significantly higher number of cysts when compared to the MaHu- group (20 vs. 10 cysts, p = 0.038). There were no significant differences between MaHu+ vs. MaHu- groups in other variables. CONCLUSION: In children with ADPKD, a history of macroscopic hematuria is associated with an increased risk of developing hypertension and/or elevated blood pressure. WHAT IS KNOWN: • Adults with autosomal dominant polycystic kidney disease have often episodes of macroscopic hematuria that predict development of hypertension. WHAT IS NEW: • In children with autosomal dominant polycystic kidney disease, macroscopic hematuria is rare but is also associated with an increased risk of developing hypertension.
Piperacillin-tazobactam versus cefepime monotherapy in pediatric patients with febrile neutropenia: a systematic review and meta-analysis.
Fernandes BLG, Joseph A, Andriazzi VH
Eur J Pediatr · 2026 May · PMID 42096109 · Publisher ↗
UNLABELLED: The purpose of this study is to evaluate whether piperacillin-tazobactam therapy, compared with cefepime monotherapy, results in significant difference in treatment success, mortality, and duration outcomes i...
UNLABELLED: The purpose of this study is to evaluate whether piperacillin-tazobactam therapy, compared with cefepime monotherapy, results in significant difference in treatment success, mortality, and duration outcomes in pediatric patients with febrile neutropenia (FN). A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched up to February 3. No starting limits for dates were used. We only included studies of pediatric patients with FN comparing piperacillin-tazobactam to cefepime monotherapy. Risk of bias was assessed using Cochrane RoB 2 tool. Meta-analysis was performed using random-effects model to calculate risk ratios (RR) and mean differences (MD). Five RCTs involving 470 episodes were included. The pooled analysis for treatment success showed no statistically significant difference between groups (RR = 1.02; 95% CI [0.89; 1.18]; P = 0.76) with low heterogeneity (I = 0.0%). No significant differences for mortality (RR = 2.09; 95% CI [0.62; 7.03]; P = 0.23; I = 0.0%). Duration of treatment was 0.9 day shorter for cefepime group (MD = 0.9 day; 95% CI [0.2; 1.6]; P < 0.1; I = 0%). CONCLUSION: No statistically significant difference was found in treatment success or mortality between the groups. Patients receiving cefepime had a treatment duration 0.9 days shorter than those receiving piperacillin-tazobactam, although this finding should be interpreted with caution. The available evidence remains limited. Further RCTs are needed to elucidate potential differences in treatment success, mortality, and duration between the drugs. REGISTRATION: PROSPERO (CRD420261296621). WHAT IS KNOWN: • Cefepime and piperacillin-tazobactam are widely utilized as empirical monotherapy for febrile neutropenia, but evidence regarding their comparative clinical efficacy and safety in children remains inconclusive. WHAT IS NEW: • This meta-analysis quantifies differences in treatment success, mortality and duration of treatment outcomes in pediatric patients with febrile neutropenia.
Prognosis of neonates receiving invasive mechanical ventilation in low-resource settings: a systematic review and prognostic meta-analysis.
Krishnegowda VK, Ramaswamy VV, Bandiya P … +4 more , Bandyopadhyay T, Abiramalatha T, Pullattayil AK, Trevisanuto D
Eur J Pediatr · 2026 May · PMID 42096067 · Full text
Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current...
Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current evidence base being restricted to single-centre observational studies, thus limiting comparative analyses and effective healthcare planning. This study aims to estimate the pooled proportion of mortality and morbidity among neonates exposed to IMV in low-resource settings. Medline, Embase, and CENTRAL were searched until 22 August 2025. Randomised and non-randomised studies were included. Two reviewers, blinded to each other, extracted data independently. Proportion-based meta-analyses using random-effects model were performed. Risk of bias was assessed using ROBINS-E, and evidence-certainty was evaluated using the GRADE approach. One hundred of 117 studies were included, with most conducted in South Asia. In-hospital mortality was reported in 68 studies (7193 neonates), with a pooled estimate of 45% (39%-50%), evidence-certainty being very low. Among the secondary outcomes, the pooled rates were as follows: bronchopulmonary dysplasia, 10% (5%-18%); intraventricular haemorrhage (any grade), 10% (5%-19%); necrotising enterocolitis (any stage), 14% (6%-31%); retinopathy of prematurity (any stage), 33% (22%-46%); ventilator-associated pneumonia, 21% (14%-29%); sepsis, 32% (25%-40%) and pulmonary haemorrhage, 9% (6%-14%). Evidence-certainty for all the secondary outcomes was also very low. Subgroup analysis comparing two distinct time epochs revealed a significant difference in mortality, 43% (36%-50%) (I = 93.5%) in the post-2010 epoch compared to 55% (48%-63%) (I = 82.9%) in the pre-2010 epoch (p = 0.004). Heterogeneous outcome definitions and predominance of unadjusted analyses across studies limit the existing evidence.Conclusions: In LRS, the mortality and morbidity rates among neonates receiving IMV remain substantially high with a modest improvement in survival in the past decade. Improving outcomes mandates moving beyond access to the provision of IMV to investing in comprehensive training and scaling up critical auxiliary resources. Future research must adopt standardised outcome definitions and adjusted analyses to precisely quantify the impact of IMV in LRS.
Post-asphyxia acute kidney injury in neonates: a systematic review.
Aderounmu T, Adeyemi B, Bolarinwa A
Eur J Pediatr · 2026 May · PMID 42096066 · Full text
UNLABELLED: Perinatal asphyxia is a major cause of neonatal morbidity and mortality globally. It affects multi-systems and has significant renal consequences. Acute kidney injury (AKI) is a frequent complication of perin...
UNLABELLED: Perinatal asphyxia is a major cause of neonatal morbidity and mortality globally. It affects multi-systems and has significant renal consequences. Acute kidney injury (AKI) is a frequent complication of perinatal asphyxia; however, its burden, diagnosis, and outcomes remain variably characterized. This study employed a scoping review approach to map and synthesize the existing evidence on post-asphyxia AKI in neonates. A total of 30 studies published between 1995 and 2025 were included, encompassing different geographic regions, study designs, and diagnostic criteria. The review demonstrates a clear growth in scholarly attention to post-asphyxia AKI, particularly in the last 25 years, coinciding with the introduction of neonatal-modified KDIGO definitions and advances in neonatal nephrology. Reported incidence of AKI varied widely, ranging from 20% to over 60%, reflecting non-homogeneity in study populations, differing case definitions of acute kidney injury in neonates, the severities of hypoxic-ischemic encephalopathy, and varied methodological approaches. Findings consistently indicate that AKI is strongly associated with severe forms of perinatal asphyxia, the presence of multi-organ dysfunction, prolonged neonatal intensive care stay, and mortality. CONCLUSION: Despite emerging interest in novel biomarkers and standard definitions, important gaps persist in early detection, long-term renal outcome data, and evidence from low- and middle-income countries. Addressing these gaps through standardized monitoring, biomarker validation, and longitudinal follow-up will improve renal survival in neonates affected by perinatal asphyxia. WHAT IS KNOWN: • The newborn kidneys are susceptible to the hemodynamic changes that follow ischemia/asphyxia due to a poor functioning capacity and oftentimes an inadequate structural potential. • Neonatal AKI is closely linked to severe forms of asphyxia, increased length of hospital stay and increased mortality. its reported incidence is widely varied. WHAT IS NEW: • The emergence of novel biomarkers in the identification and diagnosis of neonatal AKI, and the uptake and application of standard definitions (modified neonatal KDIGO) in the identification of neonatal AKI. • The availabiltiy of specialized kidney support therapy (continuous kidney replacement therapy; the carpadiem) in the management of neonatal AKI.
Association of epicardial adipose tissue thickness and left ventricular functions in children with primary dyslipidemia.
Hassan MA, Mamdouh M, Ahmed FA … +1 more , Allam KM
Eur J Pediatr · 2026 May · PMID 42095940 · Full text
UNLABELLED: Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules. To evaluate the significance and relations...
UNLABELLED: Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules. To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and left ventricular function. This prospective case-control study was conducted at Assiut University Children's Hospital between September 2023 and August 2025. Twenty-one children with familial dyslipidemia and twenty-one age-, sex-, and BMI-matched healthy controls underwent clinical evaluation, lipid profile assessment, and transthoracic echocardiography, including measurement of epicardial fat thickness and left ventricular systolic and diastolic function according to American Society of Echocardiography guidelines. Dyslipidemic patients showed significantly higher total cholesterol (332.9 ± 222.3 mg/dL), triglycerides (391.4 ± 251.6 mg/dL), and LDL (154.3 ± 130.4 mg/dL) than controls (p < 0.001). Mixed hyperlipidemia was the most common type (47.6%). Echocardiography revealed increased epicardial fat thickness (2.88 ± 0.94 mm vs. 2.29 ± 0.57 mm; p = 0.018), larger left atrial (21.45 ± 3.86 mm; p = 0.031) and aortic diameters (17.54 ± 3.12 mm; p = 0.013). Triglyceride level was the only independent predictor of epicardial fat thickness (β = 0.437, p = 0.028). CONCLUSION: Echocardiography revealed increased epicardial fat thickness and early cardiac remodeling. Serum triglycerides were the only independent predictor of EFT, suggesting its key role in subclinical cardiovascular risk among dyslipidemic children. WHAT IS KNOWN: • Epicardial adipose tissue is associated with cardiovascular risk factors in adults. • Children with primary dyslipidemia may develop early cardiac dysfunction. WHAT IS NEW: • This study demonstrates a signifi cant association between epicardial adipose tissue thickness and left ventricular function in children. • It highlights the potential role of epicardial fat as an early marker of cardiac involvement in pediatric dyslipidemia.
Clinical characteristics and outcomes of children with measles requiring pediatric intensive care: a multicenter study in Istanbul.
Akçay N, Tosun D, Bingöl İ … +13 more , Menentoğlu ME, Şevketoğlu E, Varol F, Kurtiş GA, Kanğın M, Bayraktar S, Kılınç MA, Aygüler E, Yükselmiş U, Barlas ÜK, Özel A, Bursal B, Yüce S
Eur J Pediatr · 2026 May · PMID 42091738 · Full text
UNLABELLED: Measles remains a major public health concern despite the availability of effective vaccines. Recent global resurgences, including in Türkiye, have been partly attributed to disruptions in routine immunizatio...
UNLABELLED: Measles remains a major public health concern despite the availability of effective vaccines. Recent global resurgences, including in Türkiye, have been partly attributed to disruptions in routine immunization and declining vaccination coverage during the COVID-19 pandemic. Data on children with measles requiring pediatric intensive care are limited. We aimed to describe the clinical characteristics and outcomes of children with measles admitted to pediatric intensive care units (PICUs) in a large metropolitan area. This multicenter retrospective study included children < 18 years with laboratory-confirmed measles admitted to ten PICUs in Istanbul, Türkiye, between January and December 2023. Demographic data, vaccination status, clinical features, laboratory findings, treatments, and outcomes were collected. Patients were stratified by vaccination status. Among 5,685 PICU admissions, 53 children (median age 1.3 years) had laboratory-confirmed measles. Ten (18.9%) were vaccinated and 43 (81.1%) were unvaccinated. The median rash duration was longer in vaccinated children (3 vs. 2 days; p = 0.027). Rash onset most frequently involved the face in vaccinated children (70%), whereas trunk onset predominated in unvaccinated children (51.2%) (p < 0.001). Unvaccinated children were admitted closer to rash onset, indicating a more rapidly evolving clinical course. Rhinorrhea was more common in unvaccinated children (69.8% vs. 20%; p = 0.009). Median oxygen saturation at PICU admission was lower in unvaccinated patients (91% vs. 95%; p = 0.015). Although ARDS, inotropic support, and invasive ventilation were more frequent in unvaccinated children, these differences were not statistically significant. In multivariable analysis, abnormal chest radiographic findings showed a trend toward association with respiratory support, although this did not reach statistical significance. Overall mortality was 2.3% (1/53), occurring in an unvaccinated infant. CONCLUSION: Measles continues to cause critical illness in young children requiring PICU care. Unvaccinated children tended to present with lower oxygen saturation at admission, suggesting more pronounced respiratory involvement. Maintaining high vaccination coverage remains essential to reduce severe measles-related morbidity. WHAT IS KNOWN: • Measles outbreaks persist in areas with suboptimal vaccination coverage, with unvaccinated children at higher risk of severe complications. • Data on critically ill children with measles, particularly those requiring intensive care, remain limited. WHAT IS NEW: • This multicenter study provides contemporary PICU-based data from a recent measles outbreak in a large European metropolitan area, where most critically ill children were unvaccinated and very young. • Unvaccinated children showed trends toward lower oxygen saturation and more pronounced respiratory involvement, though findings should be interpreted cautiously due to the small sample size.
Outcome and epilepsy following neonatal stroke in the Italian Registry of Infantile Thrombosis.
Sartori S, Nosadini M, Brigiari G … +39 more , Francavilla A, Foiadelli T, Veraldi D, Suppiej A, Bagna R, Casellato S, Cao V, Baggio L, Conti M, Farinasso D, Accorsi P, Cordelli DM, Magarotto M, Massoud M, Pegoraro V, Pelizza MF, Saracco P, Arena V, Ballardini E, Falcone A, Gaffuri M, Gentile D, Iodice A, Rosati A, Bugin S, Chiodin E, Fogliani V, Freschi P, Radicioni M, Cavaliere E, Toldo I, Ancona C, Capato L, Pin JN, Guidotti I, Lombardini M, Luciani M, Simioni P, R. I. T. I. Working group
Eur J Pediatr · 2026 May · PMID 42091721 · Full text
UNLABELLED: The perinatal period is a high-risk time for stroke, with possible lifelong effects. We aimed at identifying factors associated with long-term neurological outcomes and post-stroke epilepsy in patients with n...
UNLABELLED: The perinatal period is a high-risk time for stroke, with possible lifelong effects. We aimed at identifying factors associated with long-term neurological outcomes and post-stroke epilepsy in patients with neonatal arterial ischemic stroke (NAIS). We analyzed patients with NAIS from the Italian Registry of Infantile Thrombosis (RITI). Associations between clinical variables and outcomes (neurological deficits and epilepsy at last follow-up) were evaluated using univariate logistic regression. Among the 181 patients included (56.2% male), seizures were the most common initial symptom (79.4%). Stroke was left-sided in 62.0%, and bilateral in 15.0%; multiple lesions were reported in 32.5%. The middle cerebral artery territory was most frequently involved. One patient had a new infarction during hospitalization, and one died. At follow-up (median 21 months), no further recurrences or deaths occurred; neurological deficits were reported in 38.8%, and post-stroke epilepsy in 12.0% (among these latter, prior acute seizures occurred in 86.7%). At univariate regression, factors significantly associated with long-term neurological deficits were higher maternal age (p = 0.031); urgent cesarean (p < 0.001); lower gestational age (p = 0.033); neurological deficits at discharge (p < 0.001); seizures at last follow-up (p = 0.008). Factors significantly associated with post-stroke epilepsy were need for acute-phase assisted ventilation (p = 0.001); radiological brainstem involvement (p = 0.037); and longer admission duration (p = 0.050). CONCLUSION: Mortality and recurrence after NAIS are rare, but neurological deficits occur in about 40%, and epilepsy in 12%. Perinatal and clinical factors may predict adverse outcomes and epilepsy. WHAT IS KNOWN: • The perinatal period is a high-risk window for neonatal arterial ischemic stroke (NAIS), with seizures as the most common presenting symptom. Mortality and recurrent strokes after NAIS are rare, but long-term neurological deficits and post-stroke epilepsy are recognized complications. WHAT IS NEW: • In this registry-based cohort, specific perinatal and clinical factors-such as higher maternal age, urgent cesarean delivery, lower gestational age, neurological deficits at discharge, and seizures at follow-up-were significantly associated with long-term neurological impairments. • Risk factors for post-stroke epilepsy were identified, including need for acute-phase assisted ventilation, radiological brainstem involvement, and longer hospital stays, providing new insights for early prognostication and follow-up strategies.
Maternal concern and refusal toward neonatal heel-prick screening: a cross-sectional survey from Türkiye.
Turgut H, Boz G, Güven T … +1 more , Özdemir R
Eur J Pediatr · 2026 May · PMID 42091716 · Full text
UNLABELLED: Neonatal heel-prick screening is a key component of preventive healthcare, and its effectiveness is strongly influenced by parents' knowledge, perceptions, and willingness to engage in screening. The aim of t...
UNLABELLED: Neonatal heel-prick screening is a key component of preventive healthcare, and its effectiveness is strongly influenced by parents' knowledge, perceptions, and willingness to engage in screening. The aim of this study was to evaluate the relationships between mothers' sociodemographic characteristics and their attitudes and behaviors toward the screening process and the level of concern they experience regarding newborn screening. This cross-sectional study included 350 mothers. Data on sociodemographic characteristics and knowledge, attitudes, and behaviors regarding neonatal heel-prick screening were collected using a researcher-developed structured questionnaire. Maternal concern, defined as a self-reported binary outcome (present/absent), was the primary outcome variable. Associations were analyzed using the chi-square test or Fisher's exact test, as appropriate, and variables with p < 0.10 in univariable analyses were entered into a multivariable Firth's penalized logistic regression model. The results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs), and a two-sided p value < 0.05 was considered to indicate statistical significance. Among 350 mothers, 17.7% reported concern related to the heel-prick test, and 9.7% refused the procedure. Concern was more common among those who refused the test (73.5% vs. 11.7%, p < 0.001) and those with vaccine concern (42.5% vs. 5.9%, p < 0.001). According to the results of the multivariable analysis, vaccine concern was the strongest independent predictor (aOR = 8.98; 95% CI: 4.56-18.69; p < 0.001), whereas rural residence (aOR = 3.18; p = 0.032) and perceiving the procedure as painful (aOR = 4.70; p < 0.001) were also significant risk factors. CONCLUSION: This study revealed that maternal concern about heel-prick screening was associated with insufficient knowledge, negative perceptions of the procedure, concerns about the vaccine, rural residence, and cultural factors. These findings suggest that clear communication, effective education, and culturally sensitive counselling may help reduce maternal concern and improve participation in newborn screening programs. WHAT IS KNOWN: • Parental knowledge, perceptions, and communication with healthcare professionals are important determinants of participation in newborn screening programs. WHAT IS NEW: • Maternal concern toward neonatal heel-prick screening was independently associated with vaccine concern, perceived procedural pain, and rural residence, highlighting the need for targeted and culturally sensitive counselling.
Ultrasonographic evaluation of suprahyoid muscle thickness during the transition to full oral feeding in preterm infants.
Uygun SS, Gokyer B, Ozturk M … +3 more , Kilicli E, Duysak OS, Konak M
Eur J Pediatr · 2026 May · PMID 42091711 · Full text
UNLABELLED: The transition to full oral feeding (FOF) is a critical milestone for discharge in preterm infants and reflects the maturation of multiple physiological systems, particularly swallowing-related neuromuscular...
UNLABELLED: The transition to full oral feeding (FOF) is a critical milestone for discharge in preterm infants and reflects the maturation of multiple physiological systems, particularly swallowing-related neuromuscular coordination. Suprahyoid muscles play a key role in swallowing by enabling elevation of the hyoid-laryngeal complex and protecting the airway. However, the relationship between the structural development of these muscles and the achievement of oral feeding in preterm infants remains insufficiently explored. This prospective single-center observational study included 28 preterm infants born at ≤ 32 weeks of gestation. Suprahyoid muscle thickness (right and left digastric, right and left mylohyoid, and geniohyoid muscles) was measured by ultrasonography at two time points: within the first 72 h of postnatal life and at the time of full oral feeding. Somatic growth parameters, including body weight, body length, and head circumference, were recorded simultaneously. Changes in muscle thickness over time, correlations with somatic growth parameters, and the predictive value of early muscle thickness for time to achieve FOF were analyzed. All suprahyoid muscle thicknesses increased significantly between the early postnatal period and the time of FOF (all p < 0.001). At the time of FOF, digastric muscle thickness ranged approximately between 2.7 and 3.2 mm, mylohyoid muscle thickness between 1.6 and 2.0 mm, and geniohyoid muscle thickness between 3.0 and 3.6 mm, with values appearing to cluster within a relatively narrow range during successful transition to oral feeding. A positive correlation was observed between body weight and certain muscle thickness measurements, particularly left mylohyoid (r = 0.453, p = 0.015) and right digastric muscles (r = 0.386, p = 0.043). However, suprahyoid muscle thickness measured within the first 72 h did not independently predict the time required to achieve FOF in multivariable regression analysis. CONCLUSION: Suprahyoid muscle thickness increases significantly during the transition from early postnatal life to full oral feeding in preterm infants and appears to cluster within a relatively narrow range at the time of feeding maturation. Ultrasonographic evaluation of suprahyoid muscles may provide a non-invasive approach to describe structural changes associated with feeding maturation in preterm infants. WHAT IS KNOWN: • The transition to full oral feeding in preterm infants reflects the maturation of multiple physiological systems, including suck-swallow-breathing coordination, and is a key determinant of discharge readiness. • Ultrasonography has been used as a non-invasive method to assess structural and functional aspects of muscles involved in feeding and swallowing. WHAT IS NEW: • Suprahyoid muscle thickness in preterm infants increases significantly from early postnatal life to full oral feeding and appears to cluster within a relatively narrow range at the time of feeding maturation. • Early postnatal suprahyoid muscle thickness does not independently predict the time to achieve full oral feeding, suggesting that feeding maturation is a multifactorial process beyond a single structural parameter.
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