European Journal Of Pediatrics[JOURNAL]
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200 papers
Comparison of complete blood count (CBC) parameters in patients with Sanjad-sakati syndrome and healthy controls in Abuzar Hospital, Ahvaz.
Choromzade S, Aghaei M, Saki N … +2 more , Vahid MA, Abolnezhadian F
Eur J Pediatr · 2026 Jun · PMID 42362859 · Publisher ↗
Sanjad-Sakati syndrome (SSS) is a rare autosomal recessive disorder characterized by hypoparathyroidism, growth retardation, and dysmorphic features. However, the hematological profile of affected patients remains poorly...
Sanjad-Sakati syndrome (SSS) is a rare autosomal recessive disorder characterized by hypoparathyroidism, growth retardation, and dysmorphic features. However, the hematological profile of affected patients remains poorly characterized. This study aimed to investigate complete blood count (CBC) parameters in patients with SSS compared to healthy controls. This cross-sectional observational study included 19 patients with Sanjad-Sakati syndrome and 31 age- and sex-matched healthy controls. Blood samples were collected for CBC analysis measuring 14 hematological parameters. Statistical comparisons were performed using independent t-tests or Mann-Whitney U tests with Benjamini-Hochberg correction for multiple comparisons. Effect sizes (Cohen's d or r) were calculated to quantify differences. Patients with SSS showed significantly lower red blood cell count, hemoglobin (10.16 ± 1.86 vs. 13.87 ± 1.13 g/dL), hematocrit (32.25 ± 5.15 vs. 38.75 ± 2.75%), MCH, and MCHC compared to controls (all p < 0.01). Conversely, white blood cell count (13.37 ± 5.74 vs. 6.08 ± 1.61 × 10/L), RDW-CV (18.69 ± 4.05 vs. 13.15 ± 0.77%), eosinophils, basophils, and monocytes were significantly elevated in patients (p < 0.001). The largest effect sizes were observed for hemoglobin (d = - 2.57), RDW (d = 2.17), and WBC (d = 1.95). MCV, platelet count, neutrophils, and lymphocytes showed no significant differences.Conclusion: Sanjad-Sakati syndrome is associated with significant hematological alterations including microcytic anemia and leukocyte imbalances. Routine CBC monitoring is recommended for clinical management of affected patients.
The organization of pediatric care: the right care, from the right professional, at the right time and place: an editorial update.
Peters VJT, de Winter JP
Eur J Pediatr · 2026 Jun · PMID 42360510 · Publisher ↗
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Extracorporeal membrane oxygenation in Non-Immune Hydrops fetalis - a registry-based data analysis over the last 25 years.
Kuelshammer M, Matzik AS, Hansmann A … +7 more , Moersdorf J, Strizek B, Dresbach T, Schmitt J, Sabir H, Mueller A, Schroeder L
Eur J Pediatr · 2026 Jun · PMID 42360500 · Full text
UNLABELLED: Non-immune hydrops fetalis (NIHF) is a rare condition that can lead to serious cardiopulmonary compromise after birth, often resulting in the need for intensive cardiorespiratory support, and in selected case...
UNLABELLED: Non-immune hydrops fetalis (NIHF) is a rare condition that can lead to serious cardiopulmonary compromise after birth, often resulting in the need for intensive cardiorespiratory support, and in selected cases including extracorporeal membrane oxygenation (ECMO). Outcome is complicated due to a high rate of preterm birth. Morbidity and mortality data regarding NIHF and outcome of ECMO treatment in this population are very sparse. This is the first update and analysis of the Extracorporeal Life Support Organization (ELSO) registry-based data of neonates with NIHF. Neonatal patients with a diagnosis of NIHF and treated with ECMO during the years 2000-2024, reported to the ELSO registry, were retrospectively analyzed. Exclusion criteria were HF due to hemolytic disease, congenital diaphragmatic hernia (CDH), and major cardiac defects. After the application of exclusion criteria, 171 patients remained for final analysis, of these 88 (52%) survived until discharge. Infants with a higher birth weight (p = .011) and those with a gestational age (GA) ≥ 35 weeks (p = .032), as well as female patients (p = .027), had significantly higher in-hospital survival rates. The ECMO support type (veno-arterial vs. veno-venous) did not influence in-hospital mortality rate (p = .524) or complication rate. Female sex and higher BW (> 2.5 kg) remained independently associated with higher in-hospital survival after a binary logistic regression analysis. CONCLUSION: Mortality rates over the last 25 years remained largely unchanged. Our analysis revealed baseline characteristics as independent predictors for higher in-hospital survival in these patients. In comparison with other underlying conditions treated with neonatal ECMO, neonates with NIHF present comparable morbidity and mortality rates after veno-arterial or veno-venous ECMO treatment. WHAT IS KNOWN: • NIHF is a rare neonatal disease leading to preterm birth and a high risk of cardiorespiratory compromise, sometimes resulting in the need for ECMO treatment. • ECMO treatment for preterm infants is feasible, with increasing survival rates. WHAT IS NEW: • After ECMO treatment, neonates with NIHF show acceptable complication rates and in-hospital survival, supporting a case-selective discussion of ECMO therapy. • Both veno-arterial and veno-venous ECMO are potential rescue therapy options in experienced neonatal ECMO centers with comparable outcomes.
Ventilatory efficiency during high-frequency oscillatory ventilation with volume guarantee in preterm infants.
Ali K, Alsenani M, Alshareedah S … +7 more , Alamer F, Alberti P, Homedi A, Alsaif S, Ali I, Dassios T, Greenough A
Eur J Pediatr · 2026 Jun · PMID 42350871 · Full text
UNLABELLED: This study aims to evaluate the relationship between ventilator-derived carbon dioxide clearance and arterial CO elimination during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG), and...
UNLABELLED: This study aims to evaluate the relationship between ventilator-derived carbon dioxide clearance and arterial CO elimination during high-frequency oscillatory ventilation with volume guarantee (HFOV-VG), and to examine determinants and clinical relevance of ventilatory efficiency. In this cohort study, preterm infants less than 30 weeks of gestation receiving HFOV-VG were studied during the first 72 h after birth. Minute-level ventilator data were paired with arterial blood gases. Ventilatory efficiency was defined as weight-normalised DCO divided by arterial PCO. Temporal patterns and determinants were analysed using generalised estimating equations. The clinical outcome was death or moderate-to-severe bronchopulmonary dysplasia (BPD). A total of 185,018 ventilator observations and 595 paired ventilator-blood gas measurements from 60 infants were analysed. Arterial PCO remained stable (50 [43-56] mmHg) despite wide variation in DCO (34.6 [27.1-47.8]). Ventilatory efficiency varied between infants (0.72 [0.55-0.98]) and demonstrated a temporal pattern, decreasing from 0.77 (0.61-0.90) at 0-6 h to 0.65 (0.45-0.80) at 6-12 h and increasing to 0.76 (0.56-1.07) at 24-48 h. Higher efficiency was associated with higher oscillatory frequency (p < 0.001). Death or moderate-to-severe BPD occurred in 85.0%, 70.0%, and 45.0% across low, intermediate-, and high-efficiency tertiles, respectively. Ventilatory efficiency demonstrated moderate discrimination for the composite outcome (AUC 0.69), improving to 0.76 with FiO and mean airway pressure. CONCLUSION: During HFOV-VG, ventilator-derived CO clearance showed limited correspondence with arterial PCO. Ventilatory efficiency had moderate discrimination for adverse respiratory outcomes. WHAT IS KNOWN: • During high-frequency oscillatory ventilation, ventilator-derived indices such as oscillatory tidal volume and DCO2 are commonly used to guide carbon dioxide clearance. • The relationship between ventilator-derived carbon dioxide transport and effective arterial CO2 elimination during HFOV with volume guarantee remains incompletely understood. WHAT IS NEW: • Ventilatory efficiency provides a physiological measure integrating ventilator-derived carbon dioxide transport and arterial CO2 elimination during HFOV with volume guarantee, a relationship that is not routinely evaluated in clinical practice. • Ventilatory efficiency demonstrated modest discrimination for death or moderate-to-severe bronchopulmonary dysplasia, with discrimination improving when combined with markers of respiratory support intensity.
Congenital cytomegalovirus screening by dried blood spot: a systematic review.
Machado RA, Bicalho Garcia IS, de Albuquerque GS … +6 more , de Araújo JLP, Coelho Gonçalves R, Rodrigues de Almeida NM, Dos Santos Borges R, Machado Carellos EV, de Castro Romanelli RM
Eur J Pediatr · 2026 Jun · PMID 42350831 · Full text
UNLABELLED: Congenital human cytomegalovirus (cCMV) infection is a leading cause of sensorineural hearing loss and neurological sequelae in children. Although newborn screening strategies remain controversial, dried bloo...
UNLABELLED: Congenital human cytomegalovirus (cCMV) infection is a leading cause of sensorineural hearing loss and neurological sequelae in children. Although newborn screening strategies remain controversial, dried blood spots (DBS) collected for routine metabolic screening have been proposed as a low-cost method for large-scale detection. This systematic review assessed studies that evaluated the accuracy of DBS testing for screening newborns for cCMV infection. A systematic review was conducted following the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and reported in accordance with PRISMA-DTA. The PIRT strategy included the following: Population (newborns undergoing screening for cCMV), Index test (detection of cCMV using DBS samples), Reference standard (confirmatory testing using saliva or urine PCR collected within 21 days of life), Target condition (cCMV infection). Searches were performed in PubMed/MEDLINE, Scopus, Bireme, Embase, LILACS, SciELO, and CENTRAL. The search identified 365 articles; after removing 210 duplicates, 155 were screened by title and abstract, and 9 studies were included. The included studies tested between 1174 and 551,034 DBS samples each. Confirmatory testing used PCR in urine (seven studies) or saliva (two studies). Three studies used paired samples for screening; sensitivity ranged from 28.3% to 79.3%, specificity from 99.9% to 100%. Positive predictive value (PPV) ranged from 39 to 100%, and negative predictive value (NPV) from 99.6% to 99.9%. CONCLUSION: Neonatal screening for congenital cytomegalovirus using DBS samples is promising, since it would allow early identification for timely interventions to reduce sequelae. WHAT IS KNOWN: • Congenital CMV is a leading cause of sensorineural hearing loss and neurodevelopmental sequelae, with many cases asymptomatic at birth. Diagnosis relies on early viral detection, and while saliva/urine PCR is sensitive, newborn screening lacks consensus and feasibility is unknown in many settings. WHAT IS NEW: • DBS PCR emerges as a scalable, feasible low-cost screening alternative for cCMV screening. A few states in the USA and provinces in Canada have implemented newborn cCMV screening programs using DBS, but the sensitivity appears lower than in research studies. Improving DNA extraction and PCR methods are required as well as assessing feasibility of using other specimens (e.g., urine or saliva) for screening.
Stunting, underweight and thinness in internationally adopted children: prevalence and associated factors in a large cohort study.
Monti N, Kulak M, Lisi C … +6 more , Rakevich Y, Manca M, Venturini E, Bianchi L, Galli L, Chiappini E
Eur J Pediatr · 2026 Jun · PMID 42350820 · Full text
Internationally adopted children (IAC) are at high risk of growth impairment due to early-life deprivation, institutional care, and prenatal exposures. Data on determinants of stunting and other forms of malnutrition in...
Internationally adopted children (IAC) are at high risk of growth impairment due to early-life deprivation, institutional care, and prenatal exposures. Data on determinants of stunting and other forms of malnutrition in this population remain limited. To evaluate the prevalence of stunting, underweight, and thinness, and to identify factors associated with these conditions in a large cohort of internationally adopted children (IAC), we conducted a large cohort study including 1,955 IAC referred to a tertiary pediatric center in Italy between 2015 and 2025. The cohort mainly included children aged 5-9 years (52.2%) and 1-4 years (33.8%), while only a minority were younger than 1 year or older than 14 years. Growth parameters were assessed using WHO standards. Stunting (HAZ < - 2 SD) and thinness (BMIZ < - 2 SD) were assessed in children aged 1 month to 18 years, while underweight (WAZ < - 2 SD) was evaluated in children younger than 10 years. Demographic, clinical, and laboratory variables were analyzed using a population-averaged generalized estimating equations (GEE) model, followed by univariate and multivariable logistic regression analyses for specific growth outcomes. An interaction analysis between low ferritin and abnormal TSH was also performed. A total of 1,955 internationally adopted children (IAC) were included in the analysis. Stunting was observed in 12.2% of children, underweight in 12.7%, and thinness in 5.6%. In the GEE model evaluating overall growth impairment (stunting, underweight and thinness), independent risk factors included anemia, younger age (1-4 years), Asian origin, and fetal alcohol spectrum disorder (FASD), with FASD showing the strongest association (OR 4.77, 95% CI 3.32-6.86; p < 0.001). In outcome specific univariate analyses, independent predictors of stunting included age 1-4 years (OR 3.09), Asian origin (OR 1.48), anemia (OR 2.30), FASD (OR 4.26), and abnormal thyroid-stimulating hormone (TSH) levels (OR 1.83). Anemia was significantly associated with parasitic infections (p = 0.05), supporting a potential contribution of infectious burden to nutritional impairment. Among children with available ferritin and thyroid data, hypoferritinemia was significantly associated with abnormal TSH levels (p = 0.024); however, this association was not confirmed in univariate logistic regression. Conclusions: A high prevalence of stunting persists among IAC at first presentation to our center. Both prenatal factors, particularly FASD, and postnatal conditions contribute to malnutrition. Early comprehensive screening, including nutritional, infectious, and endocrine assessment, is essential to identify at-risk children and guide targeted interventions. What is known- What is new: The IAC are at high risk of growth impairment due to early-life deprivation, institutional care, and prenatal exposures, with stunting frequently reported at arrival. In this large cohort of IAC, stunting affected 12.2% of children and was independently associated with FASD, young age, Asian origin, and anemia, highlighting the combined role of prenatal and postnatal factors and the need for comprehensive early screening.
Pathological fractures in pediatric extremities: a comparative analysis of patient characteristics, trauma mechanisms, and lesion types.
Clar C, Rünk J, Reinbacher P … +3 more , Sackl V, Leithner A, Kraus T
Eur J Pediatr · 2026 Jun · PMID 42350698 · Full text
UNLABELLED: Pathological fractures in children are uncommon manifestations of underlying bone lesions. Differences in biomechanical loading and lesion distribution between the upper and lower extremities may result in di...
UNLABELLED: Pathological fractures in children are uncommon manifestations of underlying bone lesions. Differences in biomechanical loading and lesion distribution between the upper and lower extremities may result in distinct fracture characteristics and clinical presentations. The aim of this study was to characterize pathological fractures in the growing skeleton and to identify location-specific differences between upper- and lower-extremity fractures regarding patient demographics, trauma mechanisms, fracture characteristics, and underlying lesion types. This retrospective single-center study included 235 pediatric patients (0-17 years) with radiologically confirmed pathological fractures treated between 1999 and 2021. Demographic, clinical, and radiographic data were extracted from institutional records. Fractures were classified according to trauma mechanism, accident setting, anatomical location and underlying pathology. Statistical comparisons between upper- and lower-extremity fractures were performed using standard statistical tests, with statistical significance defined as p < 0.05. A total of 235 pathological fractures were analyzed, including 120 fractures of the upper extremity (51.1%) and 115 fractures of the lower extremity (48.9%). Age distribution was comparable between groups (median age 11 years; p = 0.887). Female patients were significantly more likely to sustain a pathological fracture of the lower extremity than of the upper extremity (38.3% vs. 25.0%; OR 1.86, 95% CI 1.06-3.25; p = 0.041). Significant differences were observed regarding accident setting and trauma mechanism (p = 0.011 and p = 0.0015, respectively). Lower-extremity fractures occurred more frequently in the absence of trauma or following low-energy trauma, whereas upper-extremity fractures were predominantly associated with falls on level surfaces. Malignant lesions were more common among lower-extremity fractures than upper-extremity fractures (9.6% vs. 3.3, p = 0.063). CONCLUSION: Pathological fractures of the upper and lower extremities in children demonstrate distinct clinical characteristics. Lower-extremity fractures were more frequently associated with absent or low-energy trauma and showed a trend toward a higher proportion of malignant underlying lesions, whereas upper-extremity fractures predominantly resulted from falls on level surfaces. These location-specific differences suggest that fracture location may provide valuable diagnostic information and should be considered during the evaluation of children presenting with pathological fractures. WHAT IS KNOWN: • Pathological fractures in children may be the first manifestation of underlying skeletal pathology. • Fractures after minimal trauma warrant careful diagnostic evaluation. WHAT IS NEW: • Lower-extremity pathological fractures were more frequently associated with absent or low-energy trauma and a higher burden of systemic or multifocal bone disorders. • Lower-extremity fractures showed a trend toward a higher prevalence of malignant underlying lesions, supporting their value as a diagnostic red flag.
Sleep disturbances and dermatology-related quality of life in children with cutaneous mastocytosis: a patient-centered perspective.
Karakurt LT, Altınkaynak PY, Kacar D … +2 more , Sonkur AC, Arga M
Eur J Pediatr · 2026 Jun · PMID 42350664 · Full text
UNLABELLED: Pediatric cutaneous mastocytosis is a heterogeneous mast cell disorder that typically presents as cutaneous disease with a benign and self-limiting course. Despite its favorable prognosis, children with cutan...
UNLABELLED: Pediatric cutaneous mastocytosis is a heterogeneous mast cell disorder that typically presents as cutaneous disease with a benign and self-limiting course. Despite its favorable prognosis, children with cutaneous mastocytosis may experience symptom-related effects on daily functioning that have not been comprehensively characterized. Data on sleep disturbances and QoL in pediatric cutaneous mastocytosis, unfortunately, remain limited. This study aimed to evaluate the relationship between sleep parameters and dermatology-related QoL and assess whether disease severity modifies the association between sleep disturbances and QoL. Thirty-five children with confirmed cutaneous mastocytosis and 50 healthy controls were enrolled. Disease severity was assessed with SCORing MAstocytosis (SCORMA) Index. Sleep characteristics were evaluated with Children's Sleep Habits Questionnaire (CSHQ), and dermatology-related QoL was assessed with Children's Dermatology Life Quality Index (CDLQI). Children with cutaneous mastocytosis exhibited significantly higher total CSHQ scores compared with controls (median 47.0 vs 39.0, respectively) (p = 0.004), with a markedly higher proportion exceeding the clinical screening threshold for sleep disturbance (85.7% vs 31.4%, respectively) (p < 0.001). Patients demonstrated increased bedtime resistance, sleep anxiety, night wakings, parasomnias, and daytime sleepiness. CDLQI impairment was generally mild, with 94.2% of patients reporting no or small impact. CDLQI scores correlated strongly with SCORMA scores (ρ = 0.57, p < 0.001) but were not significantly associated with overall sleep disturbance. CONCLUSION: Children with cutaneous mastocytosis frequently exhibit sleep disturbances, whereas the impact on dermatology-related QoL was generally mild in most patients. Notably, sleep problems were highly prevalent even when dermatology-related QoL impact was minimal, indicating that dermatology-specific QoL instruments may not fully capture the sleep-related burden of pediatric cutaneous mastocytosis. These findings support the integration of routine sleep and dermatology-related QoL screening into the comprehensive management of pediatric cutaneous mastocytosis. WHAT IS KNOWN: • Cutaneous mastocytosis in children generally has a favorable prognosis, but symptoms such as pruritus and flushing may affect daily functioning. • Data regarding sleep disturbances and dermatology-related quality of life in pediatric cutaneous mastocytosis are limited. WHAT IS NEW: • Children with cutaneous mastocytosis had significantly more sleep disturbances than healthy controls, with most patients exceeding the clinical screening threshold for sleep problems. • Sleep disturbances were common even among patients reporting minimal impairment in dermatology-related quality of life, suggesting that dermatology-specific QoL measures may underestimate disease burden.
The rare disease tree: adolescent voices, family narratives, and health professionals' views in Greece.
Tsitsani P, Soteriades ES
Eur J Pediatr · 2026 Jun · PMID 42347978 · Publisher ↗
UNLABELLED: Adolescents with rare diseases and their families navigate challenges that extend well beyond clinical symptoms, intersecting with educational, social, and structural constraints. In this qualitative study, w...
UNLABELLED: Adolescents with rare diseases and their families navigate challenges that extend well beyond clinical symptoms, intersecting with educational, social, and structural constraints. In this qualitative study, we examined the lived experiences of adolescents with rare conditions, their caregivers, and healthcare professionals, focusing on the interpersonal and systemic factors that shape well-being and form care pathways within the Greek National Healthcare System (NHS). A constructed interpretive framework for this study integrates ecological, dialogical, and relational dimensions of rare disease experiences. Ten focus groups were conducted, each including two adolescents, two parents, one to two pediatricians and one allied health professional (physiotherapist, speech therapist, occupational therapist, nurse). Semi-structured group interviews were audio-recorded, transcribed verbatim and analyzed using the approach of qualitative content analysis. Adherence to the COREQ-32 criteria supported the systematic design, documentation and presentation of research findings. Analysis yielded eight themes: (a) family dynamics and caregiving burden, (b) educational and occupational challenges, (c) social participation and financial strain, (d) healthcare accessibility and effectiveness, (e) conflicting priorities among adolescents, caregivers and providers, (f) future planning and goal setting, (g) emotional strain as a shared burden, and (h) parental advocacy and activism. CONCLUSIONS: Rare disease experience emerges from the interplay of structural conditions, relational processes and policy dynamics. Ecological forces shape daily life, while dialogical interactions influence how illness is understood and managed and power relations determine whose perspectives are prioritized. Despite these constraints, adolescents, families and healthcare personnel demonstrate resilience and agency, mobilizing resources and developing networks to navigate difficulties within the available healthcare settings. WHAT IS KNOWN: • Adolescent care for rare diseases is often fragmented, adult-oriented, and insufficiently responsive to young people's social, educational, and familial realities. • Young people's lived experiences and meaning-making around rare disease care remain insufficiently explored in research and practice. WHAT IS NEW: • An integrated adolescent care framework combines ecological context, dialogical construction of meaning, and critical reflexivity to center adolescents' voices and include the lived experiences of both families and therapists. • Through qualitative study, these concepts are translated into preliminary suggestions, offering an approach for more equitable, youth-friendly care situated in the Greek National Healthcare System.
Urine leukocyte count demonstrates limited diagnostic accuracy for complicated appendicitis in children: a retrospective cohort study.
Cansaran S, Gür K, Pıçaklar K … +2 more , Erdede Ö, Yamanel RGS
Eur J Pediatr · 2026 Jun · PMID 42347864 · Publisher ↗
Acute appendicitis remains a diagnostic challenge in children, and early identification of complicated disease is critical for timely management. While urinalysis is routinely obtained during emergency evaluation, its cl...
Acute appendicitis remains a diagnostic challenge in children, and early identification of complicated disease is critical for timely management. While urinalysis is routinely obtained during emergency evaluation, its clinical value in assessing appendicitis severity remains unclear. This study aimed to evaluate the association between routine urinalysis findings and appendicitis severity, with particular emphasis on urine leukocyte count, and to compare its performance with systemic inflammatory markers. A retrospective cohort study was conducted at a tertiary pediatric referral center including 156 consecutive pediatric patients who underwent appendectomy for suspected acute appendicitis between January 2020 and October 2022. Patients were categorized into uncomplicated appendicitis, complicated appendicitis (frank perforation, gangrenous appendicitis, or periappendiceal abscess), and negative appendectomy based on operative and histopathological findings. Urinalysis parameters and systemic inflammatory markers were recorded at presentation. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminatory performance of urine leukocyte count for complicated appendicitis. Multivariable logistic regression was performed on 113 patients with complete data to identify independent predictors of complicated appendicitis. A total of 156 patients were included (uncomplicated appendicitis, n = 111; complicated appendicitis, n = 31; negative appendectomy, n = 14). Urine leukocyte counts were significantly higher in the complicated appendicitis group compared with other groups (p < 0.01). However, urine leukocyte count demonstrated limited diagnostic accuracy for complicated appendicitis (AUC 0.637), with low sensitivity (45.2%) and modest positive predictive value (46.7%). In contrast, C-reactive protein (CRP) levels increased stepwise with disease severity and showed marked separation between uncomplicated and complicated appendicitis (p < 0.001). In multivariable analysis, only CRP remained independently associated with complicated appendicitis (OR 1.04 per 1 mg/L increase, 95% CI 1.02-1.05; p < 0.001), whereas urine leukocyte count did not retain independent predictive value. Conclusion: Although urine leukocyte count is statistically associated with complicated appendicitis in children, it demonstrates poor discriminatory performance and limited clinical utility as a standalone marker. Systemic inflammatory markers, particularly CRP, provide superior and independent predictive value for appendicitis severity. In operated children with suspected appendicitis, routine urinalysis has limited value in separating complicated from uncomplicated disease and should not substitute for CRP measurement or appropriate imaging in the diagnostic workup.
Correlation between diaphragmatic electrical activity and clinical respiratory distress in infants: a prospective observational study.
Kulkarni A, Choudhary R, Mohmmed B … +3 more , Tolentino D, Richards J, Shetty S
Eur J Pediatr · 2026 Jun · PMID 42340429 · Publisher ↗
UNLABELLED: The electrical activity of the diaphragm (EDi), measured via neurally adjusted ventilatory assist (NAVA), reflects neural respiratory drive and may provide an objective marker of respiratory distress in infan...
UNLABELLED: The electrical activity of the diaphragm (EDi), measured via neurally adjusted ventilatory assist (NAVA), reflects neural respiratory drive and may provide an objective marker of respiratory distress in infants. However, its relationship with clinically assessed respiratory distress remains uncertain, particularly across different levels of maturity. To evaluate the correlation between EDi peak values and respiratory distress severity, as measured by the Silverman-Anderson Score (SAS), in infants with NAVA catheters in situ. A prospective observational study was conducted at a tertiary neonatal unit between January 2024 and December 2025. Infants with a NAVA catheter were included. Infants with congenital diaphragmatic anomalies, neuromuscular disorders, significant congenital heart disease, or receiving palliative care were excluded. Respiratory distress was independently assessed by four experienced clinicians using SAS (≤ 3: minimal/no distress; > 3: moderate/severe distress). Simultaneous EDi peak values (μV) were recorded and averaged across breaths. Correlation between EDi and SAS was assessed using Pearson's correlation coefficient. Subgroup analyses were performed by corrected gestational age (cGA < 32 vs ≥ 32 weeks) and weight at assessment (W < 1500 vs ≥ 1500 g). A total of 200 observations from 44 infants were analysed. Median cGA was 24 + 3 weeks (range 22 + 4-39 + 2) and median weight was 580 g (380-3850). Median SAS was 2 (0-7) and median EDi peak was 6.9 μV (0.5-43.6). EDi peak demonstrated a moderate positive correlation with SAS (r = 0.405, p < 0.001). Among infants with SAS > 3, 60% had EDi peak < 15 μV, whereas only 7% of those with SAS ≤ 3 had EDi peak > 15 μV. In infants with SAS > 3, more mature infants (cGA ≥ 32 weeks and W ≥ 1500 g) had significantly higher EDi peaks than less mature infants (p = 0.001). CONCLUSIONS: EDi peak correlates moderately with clinical respiratory distress in infants but demonstrates limited sensitivity in detecting moderate to severe distress, particularly in less mature and lower weight infants. Maturational differences significantly influence EDi responses, suggesting that EDi should be used as an adjunct to, rather than a replacement for, clinical assessment when guiding respiratory support. WHAT IS KNOWN: • EDi, measured via NAVA, reflects neural respiratory drive in neonates. • Respiratory muscle strength and neural control mature with increasing gestational age. WHAT IS NEW: • EDi peak shows only moderate correlation with SAS; 60% of infants with moderate/severe distress had EDi < 15 μV. • Maturational stage significantly influences EDi response to distress; published 'normal' EDi thresholds should not be used in isolation to guide ventilatory support.
Allergy burden score and lung function impairment in children with asthma: a dose-response cross-sectional study.
Zhao J, Wang Z, Wang Y … +3 more , Dai Q, Qu S, Ru L
Eur J Pediatr · 2026 Jun · PMID 42337151 · Full text
UNLABELLED: Children with asthma commonly present with multiple allergic comorbidities; however, the quantitative dose-response relationship between cumulative allergic burden and lung function has not been established i...
UNLABELLED: Children with asthma commonly present with multiple allergic comorbidities; however, the quantitative dose-response relationship between cumulative allergic burden and lung function has not been established in pediatric populations. This retrospective cross-sectional study included 264 treatment-naive children with asthma aged 4-16 years. An allergy burden score (ABS) was constructed using a cumulative disease count strategy incorporating allergic rhinitis, atopic dermatitis, food allergy, drug allergy, and family history of allergic disease. Multivariable linear regression and restricted cubic spline (RCS) analyses assessed dose-response relationships between ABS and FEV% predicted. Bootstrap-based statistical decomposition examined the contribution of type 2 inflammatory markers, and logistic regression assessed the odds of lung function abnormality. In the fully adjusted model, each 1-point increase in ABS was associated with a 3.03% decrease in FEV% predicted (95% CI: - 3.77 to - 2.29; P < 0.001). RCS analysis indicated significant nonlinearity (P for nonlinearity < 0.001), with accelerated decrease at ABS ≥ 3. Type 2 inflammatory markers accounted for only 2.7% of the statistically decomposed total association. Each 1-point increase in ABS was associated with 43% higher odds of lung function abnormality (adjusted OR = 1.43, 95% CI: 1.07-1.94). CONCLUSION: A dose-response association exists between cumulative allergic comorbidity burden and lung function impairment in treatment-naive children with asthma. Peripheral type 2 inflammatory markers explain only a small proportion of this association, suggesting additional contributing mechanisms. The ABS may warrant further evaluation as a simple clinical indicator for identifying children with greater lung function impairment, pending prospective multicenter validation. TRIAL REGISTRATION: Not applicable. As a retrospective cross-sectional study, this research analyzed existing medical records without prospective assignment of interventions by the research team, and therefore does not meet the WHO criteria for clinical trial registration. WHAT IS KNOWN: • Allergic comorbidities are prevalent in children with asthma and associated with worse clinical outcomes. The quantitative dose-response relationship between cumulative allergic burden and lung function has not been established in pediatric populations. WHAT IS NEW: • Each 1-point increase in the Allergy Burden Score (ABS) was associated with a 3.03% decrease in FEV1% predicted, with a nonlinear threshold effect at ABS ≥ 3. Type 2 inflammatory markers collectively accounted for only 2.7% of the total association, suggesting that mechanisms beyond peripheral type 2 inflammation may be involved.
Children's disability and caregivers' health-related quality of life in Australia: A nationwide longitudinal study.
Ahammed B, Alam K, Hoque Z … +1 more , Keramat SA
Eur J Pediatr · 2026 Jun · PMID 42337140 · Full text
UNLABELLED: Childhood disability is a significant health concern with profound implications for caregivers' well-being. This study examines the association between children's cumulative disability profile, encompassing d...
UNLABELLED: Childhood disability is a significant health concern with profound implications for caregivers' well-being. This study examines the association between children's cumulative disability profile, encompassing disability status, types, and multiplicity, and caregivers' health-related quality of life (HRQoL) in a cross-sectional Australian setting. Utilising data from the Longitudinal Study of Australian Children (LSAC), this study examined the association between children's cumulative disability profile and caregivers' cross-sectional HRQoL. Caregivers' HRQoL was assessed using the Assessment of Quality of Life-8 Dimensions (AQoL-8D) instrument. Multivariable linear regression models were estimated to assess these associations, adjusting for sociodemographic and economic covariates. Overall, 25% of children experienced at least one form of disability. A significant lower mean utility score was observed (mean difference = 0.034; 95% confidence interval [CI], [0.018, 0.050]; p < 0.001) among caregivers of children with disabilities compared with caregivers of children without disabilities. After adjusting for covariates, caregivers of children with disabilities had significant lower utility (β = - 0.0230; 95% CI, [- 0.0376, - 0.0084]; p = 0.002), physical super dimension (β = - 0.0339; 95% CI, [- 0.0497, - 0.0182]; p < 0.001), and psychological super dimension (β = - 0.0181; 95% CI, [- 0.0353, - 0.0009]; p = 0.039) scores than caregivers of children without disabilities. Similarly, children experiencing physical, sensory, psychosocial disabilities, or multiple coexisting disabilities were associated with lower HRQoL among their caregivers compared with caregivers of children without disabilities. CONCLUSION: Childhood disability is associated with a lower HRQoL for the caregivers. These findings highlight the need for targeted support services, particularly for families caring for children with physical, sensory, psychosocial, and multiple disabilities, and provide estimates of reductions in health state utility scores to inform future cost-utility analyses of caregiver-focused interventions. WHAT IS KNOWN: • Caregivers of children with disabilities report lower health-related quality of life (HRQoL) and significantly higher caregiving time demands than caregivers of children without disability. • Despite these recognised challenges, there is a paucity of population-level evidence in the Australian context on how specific child cumulative disability profiles, including status, types, and multiple coexisting conditions, are associated with caregiver cross-sectional HRQoL. WHAT IS NEW: • Using a nationally representative Australian cohort, this study identifies a significant disparity in health state utility scores between caregivers of children with disabilities and caregivers of children without disabilities. • Beyond overall cumulative disability status, specific categories (physical, sensory, and psychosocial), and the presence of multiple coexisting disabilities are significantly associated with lower caregivers' HRQoL across both physical and psychological dimensions. • The findings provide specific estimates of reductions in health state utility scores, which are essential for informing future cost-utility analyses of targeted policy interventions for Australian families.
Cognition and language of 2-year-old very preterm children measured using brief validated parental report instruments: a cross-sectional study.
Markkula A, Pyhälä R, Munck P … +3 more , Buchwald J, Metsäranta M, Stolt S
Eur J Pediatr · 2026 Jun · PMID 42337090 · Full text
UNLABELLED: The purpose of this study is to assess the cognitive and language skills of very preterm (VP) children using brief parental report instruments at age 2 years (corrected age), potential sex differences in chil...
UNLABELLED: The purpose of this study is to assess the cognitive and language skills of very preterm (VP) children using brief parental report instruments at age 2 years (corrected age), potential sex differences in children's skills, and differences between four profile groups of typical/weak cognition/language. Cognitive and language skills of 110 VP children without major neurological impairment from Finnish-speaking families were assessed using brief validated parental report instruments (cognitive scale of PARCA-R, FinCDI-SF, sentence complexity subscale of PARCA-R, CSBS-DP-ITC). Based on norms, the prevalence of weak skills (< 10th percentile) varied across cognitive and language domains between 16 and 34%. Typical development was found in 47% of the participants, while 12% showed weak skills in both domains. Weak cognition with typical language was found in 19% and typical cognition with weak language in 22% of the children. While boys and girls did not differ in raw scores, girls more frequently had weak cognition and typical language in norm-based profile groups. Furthermore, the amount of perinatal risk factors and medical complications differed in profile groups of typical/weak cognition/language. CONCLUSION: Brief parental report instruments are useful in identifying weak cognitive and language development of VP children at age 2 years. The missing sex difference indicates that sex-specific developmental trajectories may not be applicable in VP children's population at this age. Weak skills can occur in cognition or language, highlighting the importance of separate assessment. More research is needed on the influence of background characteristics in profile groups based on cognition and language. WHAT IS KNOWN: • Very preterm children have a high risk for cognitive and linguistic delays. • Brief parental report instruments are efficient and valid in detecting delayed development, but more knowledge is needed on their utility in preterm populations. WHAT IS NEW: • Brief parental report instruments are useful in detecting delayed development among 2-year-old very preterm children. • No sex differences could be detected in cognitive or language development. Approximately 40% of very preterm children had weak skills in only either cognition or language, highlighting the importance of assessing them separately.
Changes in the epidemiology of paediatric brain abscess in China: a nationwide study during the years 2016-2023.
Dou Z, Wang X, Kang X … +7 more , Feng G, Ma L, Tang Y, Guo L, Hu B, Chen T, Liu G
Eur J Pediatr · 2026 Jun · PMID 42337068 · Full text
UNLABELLED: Paediatric brain abscess (BA) is a rare but life-threatening condition, and large-scale epidemiological studies are limited. We aimed to characterize the temporal trend of pediatric BA in China during 2016-20...
UNLABELLED: Paediatric brain abscess (BA) is a rare but life-threatening condition, and large-scale epidemiological studies are limited. We aimed to characterize the temporal trend of pediatric BA in China during 2016-2023. We conducted a nationwide study using the FuTang Update Medical Records (FUTURE) database, which includes face-sheets of discharge medical records from 33 tertiary children's hospitals across China. Case-identification strategies were validated, and the optimal strategy was applied to identify BA cases. Demographic information, predisposing factors, complications, and clinical outcomes of included cases were collected and analyzed. The main analytic cohort was constructed at the index qualifying episode level. A total of 799 children were identified, with 6.4-8.4 patients per 100,000 hospitalized children annually (P = 0.377). After 2020, the proportion of patients aged 1-3 years decreased, whereas the proportions of patients aged 10-12 and 13-17 years increased (all P < 0.05). Among predisposing factors, contiguous-site infections were more common in 2020-2023 than in 2016-2019 (OR, 1.997; 95% CI, 1.287-3.100; P < 0.001), whereas congenital heart disease remained stable. Neurosurgical intervention, complications, length of stay (LOS), and hospitalization costs were higher in 2020-2023 after adjustment for age, sex, and predisposing factors (all P < 0.05). CONCLUSION: Although the proportion of BA among hospitalized children in China remains stable, the distribution of its predisposing factors has changed, and increases in LOS and hospitalization costs were observed. WHAT IS KNOWN: • Bacterial meningitis was reported as the most common predisposing factor for paediatric brain abscess (BA) in a single-centre study in China during 2006-2016. • Large-scale epidemiological data on paediatric BA are limited. WHAT IS NEW: • This nationwide study in China showed changes in the predisposing factors for paediatric BA from 2016 to 2023. • Contiguous-site infections increased over time and were more common in 2020-2023 than in 2016-2019.
Sequential emergence of hematuria and proteinuria in autosomal dominant Alport syndrome: a pathophysiological perspective.
Uemura O
Eur J Pediatr · 2026 Jun · PMID 42334616 · Publisher ↗
UNLABELLED: Autosomal dominant Alport syndrome (ADAS) is characterized by pathogenic variants in COL4A3 or COL4A4 and typically presents with persistent microscopic hematuria, while clinically detectable proteinuria ofte...
UNLABELLED: Autosomal dominant Alport syndrome (ADAS) is characterized by pathogenic variants in COL4A3 or COL4A4 and typically presents with persistent microscopic hematuria, while clinically detectable proteinuria often emerges later in the disease course. The pathophysiological basis for this sequential pattern remains incompletely understood. From a structural and biophysical perspective, erythrocyte impermeability represents a more stringent requirement of the glomerular filtration barrier than protein impermeability. Glomerular basement membrane thinning alone is unlikely to permit red blood cell passage, suggesting that microscopic hematuria may reflect focal full-thickness disruption of the filtration barrier at a limited number of sites. In contrast, clinically detectable proteinuria may require a substantially greater reduction in effective filtration barrier integrity and surface area, potentially involving both glomerular basement membrane and podocyte injury. We therefore propose that the common clinical sequence of isolated hematuria followed by proteinuria can be interpreted as a continuum of increasing glomerular fragility in a genetically vulnerable filtration barrier. Although alternative explanations, including age-dependent expression and variable penetrance, should be considered, this model offers a plausible pathophysiological framework for understanding disease progression. CONCLUSION: Persistent hematuria in children with ADAS may therefore represent an early marker of ongoing glomerular vulnerability rather than a completely benign finding, highlighting the importance of longitudinal monitoring before the development of overt proteinuria. WHAT IS KNOWN: • Hematuria is usually the earliest manifestation of autosomal dominant Alport syndrome. • Proteinuria is associated with a higher risk of kidney disease progression. WHAT IS NEW: • Sequential emergence of hematuria and proteinuria may reflect progressive impairment of the glomerular filtration barrier in autosomal dominant Alport syndrome. • A pathophysiological model based on injury to the three components of the glomerular filtration barrier-the endothelium, glomerular basement membrane, and podocytes-is proposed.
Postoperative arrhythmias and long-term cardiac function in pediatric congenital heart disease after cardiopulmonary bypass: a single-center retrospective cohort study.
Qu Y, Hou A, Zhang X … +2 more , Yang J, Liu C
Eur J Pediatr · 2026 Jun · PMID 42334615 · Publisher ↗
Postoperative arrhythmias are common in pediatric patients undergoing cardiopulmonary bypass (CPB); however, their impact on long-term cardiac function remains unclear. To investigate the association between postoperativ...
Postoperative arrhythmias are common in pediatric patients undergoing cardiopulmonary bypass (CPB); however, their impact on long-term cardiac function remains unclear. To investigate the association between postoperative arrhythmias and long-term cardiac function, and to develop a prediction model for adverse outcomes. This retrospective cohort study included 712 children with congenital heart disease who underwent CPB. Postoperative arrhythmias were assessed using continuous electrocardiographic monitoring. The primary outcome was impaired long-term cardiac function at 6-12 months postoperatively. Multivariable logistic regression and least absolute shrinkage and selection operator (LASSO) regression were used to identify associated factors. The incidence of postoperative arrhythmias was 40.6%. Prolonged corrected QT (QTc) interval and premature ventricular contractions (PVCs) were significantly associated with impaired long-term cardiac function. A dose-response relationship was observed between the number of postoperative arrhythmia types and the risk of adverse outcomes (P for trend < 0.001). Multivariable analysis identified CPB duration (odds ratio [OR] = 1.02), QTc prolongation (OR = 2.70), and PVCs (OR = 1.88) as independently associated factors. The prediction model demonstrated moderate discriminative ability (area under the curve [AUC] = 0.67) and provided a certain degree of clinical net benefit. Risk stratification analysis revealed a clear gradient in the incidence of adverse outcomes across risk groups (6.3% vs 12.3% vs 21.8%). Conclusions: Postoperative arrhythmias, particularly QTc prolongation and PVCs, are closely associated with impaired long-term cardiac function. The developed prediction model enables effective risk stratification and may facilitate individualized postoperative management.
Not just there by chance: a qualitative study on continuity and quality of spiritual care in paediatric palliative care.
Berkhout LO, Hennus MP, Helms ACE … +4 more , de Man MACP, Smeets W, Spelt A, Kars MC
Eur J Pediatr · 2026 Jun · PMID 42334605 · Full text
UNLABELLED: Children with life-limiting conditions and their families face profound existential and spiritual challenges throughout the paediatric palliative care (PPC) trajectory. While spiritual care (SC) is a recognis...
UNLABELLED: Children with life-limiting conditions and their families face profound existential and spiritual challenges throughout the paediatric palliative care (PPC) trajectory. While spiritual care (SC) is a recognised component of PPC, its continuity and quality across care settings remain underexplored. This study examined how SC can be organised and safeguarded across the PPC continuum, from the perspectives of parents, healthcare professionals, and spiritual care providers. An exploratory qualitative study was conducted using multidisciplinary peer consultation groups. Two groups met online in 2022-2023, discussing six PPC cases over seven sessions. Participants included spiritual care professionals, clinicians from hospital and home settings, and parents. Data sources included audio-recorded transcripts, structured case descriptions, and field notes. A modified QUAGOL approach was used for narrative-informed thematic analysis. Coding was supported with team discussions. Continuity of care (relational, informational, and managerial) informed interpretation as a sensitising framework. Two themes were identified: (1) challenges in ensuring continuity of spiritual care, including fragmented referrals, lack of coordination, and cultural disconnects; and (2) defining and delivering quality SC, emphasising relational consistency, cultural and linguistic fit, and interprofessional collaboration. Parents valued providers who "knew their story", while professionals stressed clearer referral pathways and role alignment. Gaps in coordination and information transfer constrained support across transitions. CONCLUSION: Continuity of spiritual care in PPC is not merely a logistical task but a relational and interpretive process. Embedding SC into proactive care planning and interprofessional practice may improve coordination, enhance cultural responsiveness, and support families throughout the illness trajectory. WHAT IS KNOWN: • Spiritual care is an essential dimension of paediatric palliative care but is often fragmented across settings. Traditionally, SC has been hospital-centred. • Families frequently lack consistent support during transitions between hospital, home, and community care. WHAT IS NEW: • This study suggests that continuity in spiritual care relies on sustained relationships, cultural attunement, and clear coordination. • Embedding spiritual care in proactive planning may support consistency and family-centred support throughout the illness trajectory.
Umbilical vein-ductus venosus angle: a novel ultrasound marker for predicting optimal umbilical venous catheter placement.
Gierek K, Mikołajczak A, Stefańska M … +3 more , Kusibab-Mytych M, Różańska K, Bokiniec R
Eur J Pediatr · 2026 Jun · PMID 42334601 · Full text
UNLABELLED: Umbilical venous catheterization is a common procedure performed in intensive care units. Point-of-care ultrasonography enables efficient vascular access and reliable assessment of catheter tip position. This...
UNLABELLED: Umbilical venous catheterization is a common procedure performed in intensive care units. Point-of-care ultrasonography enables efficient vascular access and reliable assessment of catheter tip position. This prospective study aimed to determine whether the angle formed between the terminal segment of the umbilical vein (UV) and the initial segment of the ductus venosus (DV) can predict successful umbilical venous catheter (UVC) placement in the inferior vena cava, and to evaluate the effectiveness of ultrasound-guided navigation. Between 2021 and 2023, 78 neonates in a single-center study underwent umbilical venous catheterization. Ultrasonography, performed by an experienced ultrasonographer, was used to assess UVC tip position, DV caliber, and the UV-DV angle. After identifying catheter tip malposition, infants were classified into two groups: low and correct catheter positions. Ultrasound-guided maneuvers were applied to achieve optimal tip placement. The umbilical vein-ductus venosus (UV-DV) angle differed significantly between low and correctly positioned UVCs, median 136.9° (IQR 128.8-151.5°) vs. 157.4° (IQR 151.4-164.6°), p < 0.001. In multivariable analysis, both the UV-DV angle (p = 0.0032) and ductus venosus caliber (p = 0.0047) were independent predictors of correct catheter positioning. The catheter was correctly positioned on the first attempt in 73% of cases, increasing to 85% after adjustment maneuvers. CONCLUSION: These findings highlight the usefulness of ultrasound navigation for effective UVC placement and the UV-DV angle appears to be a promising ultrasound marker for predicting optimal catheter positioning. The study was approved by the Bioethics Committee of the Medical University of Warsaw No. KB/110/2020 and retrospectively registered at ClinicalTrials.gov (NCT07434102) on 25.02.2026. WHAT IS KNOWN: • Umbilical venous catheterization is associated with complications related to incorrect catheter positioning. • Thoracoabdominal radiography has traditionally been used to assess UVC tip position; however, point-of-care ultrasound provides the most accurate evaluation. WHAT IS NEW: • The umbililcal vein-ductus venosus angle may serve as a novel ultrasound marker of difficult UVC advancement and may support bedside procedural planning. • Point-of-care ultrasound emerged as an essential tool for guiding maneuvers to achieve correct catheter positioning.
Atopic dermatitis/eczema phenotypes and their association with food allergy: a nationwide birth cohort study in Japan.
Kuniyoshi Y
Eur J Pediatr · 2026 Jun · PMID 42332302 · Full text
UNLABELLED: Atopic dermatitis (AD) is a heterogeneous disease often preceding food allergy (FA). However, it remains unclear how different developmental trajectories of AD/eczema influence the risk of FA. This study aime...
UNLABELLED: Atopic dermatitis (AD) is a heterogeneous disease often preceding food allergy (FA). However, it remains unclear how different developmental trajectories of AD/eczema influence the risk of FA. This study aimed to characterize longitudinal AD/eczema phenotypes from infancy to early adolescence and evaluate their specific associations with FA risk. We analyzed data from the Longitudinal Survey of Newborns in the 21st Century in Japan, including 23,767 participants followed from age 0.5 to 12 years. Distinct AD/eczema phenotypes were identified using group-based trajectory modeling derived from healthcare visit histories. Multivariable logistic regression examined the association between AD/eczema phenotypes and cumulative FA healthcare visit history, adjusting for sociodemographic factors and asthma comorbidity. Five AD/eczema phenotypes were identified: "Early-onset transient" (6.4%), "Early-onset persistent" (23.2%), "Toddler-onset persistent" (17.3%), "Late-onset" (2.1%), and "No/minimal symptoms" (51.0%). Compared with the "No/minimal symptoms" group, all AD/eczema phenotypes were associated with increased FA risk. The "Early-onset transient" (adjusted odds ratio [aOR], 2.33; 95% CI, 1.98-2.74) and "Early-onset persistent" (aOR, 2.33; 95% CI, 2.10-2.59) groups showed the strongest associations. The "Late-onset" phenotype was also associated with increased risk (aOR, 1.42; 95% CI, 1.04-1.93), with elevated risk observed in early childhood preceding the peak of overt skin symptoms. CONCLUSION: Distinct developmental trajectories of AD/eczema are differentially associated with FA risk. While early-onset phenotypes confer the highest risk, the elevated risk in "Late-onset" trajectories before peak symptoms suggests shared underlying susceptibility or subclinical pathology. Monitoring FA development is important across all clinical trajectories of AD/eczema. WHAT IS KNOWN: • Atopic dermatitis (AD) is a primary precursor for the atopic march, but how different longitudinal trajectories influence food allergy (FA) risk remains unclear. • Early-onset persistent AD is considered to pose the highest risk for FA. WHAT IS NEW: • Early-onset transient AD/eczema carries a high FA risk comparable to persistent cases, indicating that timing of onset is more critical than disease duration for FA development. • Late-onset AD/eczema trajectories show elevated FA risk in early childhood preceding peak skin symptoms, suggesting shared underlying susceptibility or subclinical pathology.
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