European Journal Of Pediatrics[JOURNAL]
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200 papers
Structural lung assessment in children with primary ciliary dyskinesia: evaluation with the SPEC scoring system.
Akca Dinç G, Ertuna EY, Özkan Tabakçı S … +11 more , Bilgiç I, Kürtül Çakar M, Ünlü A, Yetişgin H, Yıldırım Ç, Ademhan Tural D, Eryılmaz Polat S, Tuğcu GD, Keçeli AM, Sığırcı A, Cinel G
Eur J Pediatr · 2026 May · PMID 42133077 · Publisher ↗
Primary ciliary dyskinesia (PCD) is a rare genetic disorder that may result in progressive lung damage. The Specific PCD Evaluation by CT (SPEC) scoring system has been specifically used in PCD patients since 2024. This...
Primary ciliary dyskinesia (PCD) is a rare genetic disorder that may result in progressive lung damage. The Specific PCD Evaluation by CT (SPEC) scoring system has been specifically used in PCD patients since 2024. This study aimed to evaluate the SPEC score in children with PCD. This retrospective, cross-sectional, single-center study included 47 children with confirmed or highly likely PCD who underwent thin-section thoracic computed tomography (CT). Pediatric radiologists evaluated CT scans using SPEC, Bhalla, and modified Brody scoring systems. We analyzed pulmonary function tests performed within 3 months of CT. We compared its performance with established scoring systems. The median age at CT was 8 years (Q1-Q3: 5.5-13.0). SPEC scores ranged from 0 to 51 (median 29). All three CT scoring systems showed strong intercorrelations; the SPEC-modified Brody correlation was ρ = 0.894 (p < 0.001), and the SPEC-Bhalla correlation was ρ = - 0.838 (p < 0.001). SPEC scores showed strong negative correlations with FEV₁ z-score (ρ = - 0.748, p < 0.001) and FVC z-score (ρ = - 0.722, p < 0.001) and positively correlated with age (ρ = 0.425, p = 0.003). SPEC scoring showed bronchiectasis predominantly in the lower and middle lobes, with the left lower lobe most frequently affected (68.1%). Conlsuions: The SPEC scoring system is valid for assessing structural lung disease in children with PCD. Strong correlations with pulmonary function and established CT scoring systems support its clinical utility. SPEC may help guide treatment decisions and serve as an outcome measure in pediatric PCD trials. What is Known: • Bhalla and modified Brody CT scoring systems were developed for cystic fibrosis and may not fully capture PCD-specific findings. • SPEC, introduced in 2024 as the first PCD-specific CT scoring system, has limited pediatric data. • Structural lung damage in PCD is progressive and may precede spirometric decline. What is New: • This study provides an independent pediatric application cohort for the SPEC scoring system, outside the development study. • SPEC scores correlated strongly with pulmonary function parameters. • SPEC can guide clinical decisions and serve as an outcome measure in the pediatric PCD population.
Drug-induced sarcoidosis-like reaction following IL-4/IL-13 receptor blockade by dupilumab.
Yasui K, Yashiro M
Eur J Pediatr · 2026 May · PMID 42126659 · Publisher ↗
The purpose of the study is to review reported cases of dupilumab-associated drug-induced sarcoidosis-like reaction (DISR) and consider possible immunologic mechanisms. This short review aims to raise awareness of dupilu...
The purpose of the study is to review reported cases of dupilumab-associated drug-induced sarcoidosis-like reaction (DISR) and consider possible immunologic mechanisms. This short review aims to raise awareness of dupilumab-associated DISR and discuss safety considerations in pediatric patients.Conclusion: Dupilumab is a human monoclonal antibody that reduces inflammation driven by T helper 2 (Th2) cells and is used to treat type 2 inflammatory disorders, including atopic dermatitis. The most common adverse reactions during the first year of treatment are local reactions at the injection site, conjunctivitis, and headache. Although DISR is rare, it has been documented in dupilumab-treated patients. We hypothesized that dupilumab shifts the Th1/Th2 equilibrium toward Th1 and granulomatous inflammation, which may present as DISR. We identified and reviewed 10 recently reported DISR cases and observed that reported features of DISR-including uveitis, optic neuritis and meningoencephalitis, bilateral hilar lymphadenopathy, and histopathologically noncaseating granulomas-can mimic systemic sarcoidosis. Discontinuation of dupilumab resulted in favorable outcomes in most reported DISR cases; however, symptoms worsened in some cases and sequelae became a concern. Case reports of DISR have so far been limited to adults or adolescents, but awareness of potential adverse effects of dupilumab remains important in pediatric patients.
Association between weight changes the first postnatal week and bronchopulmonary dysplasia-free survival in infants born at 23-26 weeks of gestation.
Boffard A, Brotelande C, Quintane M … +6 more , Combes C, Ouhab I, Gaudaire A, Durand S, Gavotto A, Cambonie G
Eur J Pediatr · 2026 May · PMID 42126617 · Publisher ↗
UNLABELLED: This study aimed to assess the relationship between weight change during the first postnatal week and hospital outcomes among extremely premature infants. This observational 10-year cohort study enrolled infa...
UNLABELLED: This study aimed to assess the relationship between weight change during the first postnatal week and hospital outcomes among extremely premature infants. This observational 10-year cohort study enrolled infants born at 23-26 weeks' gestational age (GA). Infants were classified in two groups, « weight loss Within the Target» (WT), if maximal weight loss was between 5 and 15% of birthweight, and « weight loss Outside the Target» (OT), if it was < 5% or > 15%. The primary endpoint was survival without moderate-to-severe bronchopulmonary dysplasia (BPD) at 36 weeks' GA, assessed using a propensity score approach. Secondary analyses were carried out among 3 subgroups of weight changes, (< 5%, 5-15%, and > 15% of birthweight). Two hundred and forty-five infants [25.7 (24.8, 26.2) weeks, 780 (680, 880) g] were included: 112 (46%) in the WT group, and 133 (54%) in the OT group. Survival without moderate-to-severe BPD was 60% (67/112) in the WT group, vs 37% (49/133) in the OT group (aOR 1.90 [1.02-3.54]). Moderate-to-severe BPD was 24% in the WT group, vs 46% in the OT group (aOR 0.44 [0.20-0.94]). Secondary analyses found higher survival without moderate-to-severe BPD, and lower rate of moderate to severe BPD in the WT infants compared to infants with maximal weight loss < 5% (p < 0.01 each). CONCLUSION: Maximal weight loss during the first postnatal week between 5 and 15% of birthweight is associated with higher odds of BPD-free survival in extremely premature infants. WHAT IS KNOWN: • A positive fluid balance the first postnatal days is associated with poor outcomes. • Weight variation allows to estimate fluid balance and to adjust daily fluid intake. WHAT IS NEW: • Half of infants born at 23-26 weeks'gestational age lose 5-15% of birthweight. • Weight loss of 5-15% of birthweight is associated with increased BPD-free survival.
The ambulatory arterial stiffness index is not a measure of arterial stiffness in a selected group of children at risk of secondary hypertension.
Bokov P, Surget E, Benzouid C … +3 more , Dudoigon B, Hogan J, Delclaux C
Eur J Pediatr · 2026 May · PMID 42126604 · Publisher ↗
UNLABELLED: The ambulatory arterial stiffness index (AASI) has emerged as an ambulatory blood pressure monitoring (ABPM) measure of stiffness and is supposedly useful in younger subjects. The objective of our study was t...
UNLABELLED: The ambulatory arterial stiffness index (AASI) has emerged as an ambulatory blood pressure monitoring (ABPM) measure of stiffness and is supposedly useful in younger subjects. The objective of our study was to evaluate the relationships between the AASI and indices of arterial stiffness in a pediatric population at risk of hypertension. Cross-sectional study of children/adolescents (8-18 years) whose pulse wave velocity (PWV: carotid-to-femoral cf-PWV and heart-finger hf-PWV), augmentation index (AIx; normalized at 75 bpm: AIx), systemic arterial stiffness (aortic pulse pressure/stroke volume, measured via pulse contour analysis), and ABPM were measured. At-risk populations were potential vascular remodeling (preterm birth, n = 44 and chronic kidney diseases, n = 7) and potential hyperkinetic causes (congenital central hypoventilation syndrome, n = 14 and psychostimulant treatment, n = 10). The mean age of the 75 participants was 12.3 ± 2.5 years (34 girls), and their mean AASI was 0.33 ± 0.17. AASI did not correlate with cf-PWV, hf-PWV, AIx, or systemic arterial stiffness. In contrast, the AASI correlated with both systolic and diastolic BP dipping at night (R = - 0.23; p = 0.048 and R = - 0.33; p = 0.004, respectively). Systemic arterial stiffness correlated with hf-PWV and AIx (R = 0.35; p = 0.004 and R = - 0.34; p = 0.013, respectively). Based on ABPM, 15/75 (20%) participants had hypertension, and they had higher cf-PWV than participants without hypertension (5.64 ± 0.70 vs 4.92 ± 0.78 m/s, p = 0.002) and not different AASI values (0.34 ± 0.14 vs 0.32 ± 0.18, p = 0.756). CONCLUSION: AASI is not a measure of arterial stiffness in children at risk of secondary hypertension. WHAT IS KNOWN: • The ambulatory arterial stiffness index (AASI) has emerged as an ambulatory blood pressure monitoring measure of stiffness and is supposedly useful in younger subjects. Few adult studies validated the concept of AASI as a marker of arterial stiffness, and recent studies suggested the need for AASI measurement in pediatric subjects. WHAT IS NEW: • Our cross-sectional study, which used different methods for the assessment of vascular remodeling, shows that the AASI is not a reliable marker of arterial stiffness in children at risk of secondary hypertension.
Leaving without being seen and against medical advice from the pediatric emergency department: a single-center retrospective cohort study in Türkiye.
Onur D, Çam O, Öztürk Ö … +1 more , Berksoy E
Eur J Pediatr · 2026 May · PMID 42120588 · Publisher ↗
UNLABELLED: Emergency department overcrowding and flow disruptions frequently lead to patients leaving without being seen (LWBS) or leaving against medical advice (LAMA). These phenomena disrupt continuity of care and re...
UNLABELLED: Emergency department overcrowding and flow disruptions frequently lead to patients leaving without being seen (LWBS) or leaving against medical advice (LAMA). These phenomena disrupt continuity of care and represent substantial patient safety concerns associated with delayed diagnosis and increased morbidity. Comprehensive research addressing these pediatric patients in Türkiye is lacking. To identify the characteristics and predictors of LWBS and LAMA in a Pediatric Emergency Department (PED) and to evaluate their re-attendance rates. This retrospective cohort study analyzed visits (Jan 2020-July 2025) at a tertiary PED in Türkiye. The final analysis included all eligible visits, excluding patients older than 18 years and those with missing discharge data. Demographics, triage categories, Door-to-Physician (D2P) time, Door-to-Disposition (D2D) time, disposition status, crowding indicators, and re-attendance rates (early within 3 days; late within 7 days) were extracted from electronic health records. Multivariable logistic regression was performed to identify independent predictors of LWBS and LAMA. Of 612,911 pediatric visits, 1.4% resulted in LWBS and 0.1% in LAMA. In multivariable analysis, LWBS was independently associated with ED crowding in a dose-response pattern, high-acuity triage codes, and the pandemic period. LAMA was independent of crowding but strongly associated with night shift (aOR = 2.38; 95% CI, 1.91-2.95; P < 0.001), red-code triage (aOR = 7.09; 95% CI, 5.37-9.24; P < 0.001), and showed a progressive secular increase over the study period. LWBS patients had longer D2D times compared with all other groups (P < 0.001). No significant association was found between LWBS or LAMA and early and late re-attendance; however, patients initially admitted or transferred exhibited significantly higher re-attendance rates (both P < 0.001). CONCLUSIONS: LWBS and LAMA have distinct predictor profiles: LWBS is primarily a capacity-driven event linked to crowding, whereas LAMA is associated with the clinical decision-making process and overnight communication dynamics. High-acuity patients carry independently elevated elopement risk, indicating that interventions must adopt differentiated strategies beyond throughput optimization. WHAT IS KNOWN: • Overcrowding and prolonged waiting times in pediatric emergency departments are established global causes of treatment incompletion and safety risks. WHAT IS NEW: • Multivariable analysis demonstrates that high-acuity triage categories carry independently elevated elopement risk after adjustment for crowding, temporal, and pandemic-related factors. • LWBS and LAMA have distinct predictor profiles: LWBS is primarily capacity-driven with a dose-response relationship to ED crowding, whereas LAMA is independent of crowding but strongly associated with night shift and clinical decision-making dynamics. Neither LWBS nor LAMA was associated with increased early or late re-attendance rates in this cohort.
Wheeze detection in real-world pediatric care: AI applied to smartphone lung auscultation.
Pais-Cunha I, Pessoa D, Silva MC … +7 more , Ferreira-Cardoso H, Rocha B, Paiva RP, de Carvalho P, Fonseca JA, Azevedo I, Jácome C
Eur J Pediatr · 2026 May · PMID 42118398 · Full text
UNLABELLED: Smartphone-based lung auscultation, combined with artificial intelligence (AI), may offer a promising alternative for pediatric respiratory telemonitoring. The aim of our study was to evaluate the performance...
UNLABELLED: Smartphone-based lung auscultation, combined with artificial intelligence (AI), may offer a promising alternative for pediatric respiratory telemonitoring. The aim of our study was to evaluate the performance of an AI model on wheeze detection from pediatric respiratory sounds recorded via smartphone. An observational cross-sectional study was conducted at the Pediatric Department of a Portuguese tertiary hospital, including children aged 0-17 years (pre-school, school-aged, and adolescent), with or without respiratory disease. Respiratory sounds were recorded at four locations using smartphone microphones and independently classified by at least 2 blinded annotators for quality and presence of wheezes. A hybrid convolutional-recurrent neural network (CNN + LSTM) trained on public electronic stethoscope databases was used to detect wheezes. AI model performance was assessed using positive predictive value, sensitivity, specificity, accuracy, and F1-score. A total of 217 children (59.9% male; median 10 [Q1-Q3 4.5-13] years) were included. From 2020 respiratory sound recordings, 1500 (74.3%) met quality criteria. Manual annotation identified 271 recordings with wheezes, whereas AI detected 217, most frequently in pre-school children (64.5% AI; 53.9% manual). The model achieved an overall accuracy of 87% (95% CI 86-89) and an F1-score of 61% (95% CI 56-66). The best accuracy was found in adolescents (92%, 95% CI 90-94) and the best global F1-score in pre-school children recordings (64%, 95% CI 58-71). CONCLUSION: This study supports the feasibility of AI-assisted analysis of smartphone-recorded pediatric respiratory sounds in real-world settings. Future multicenter studies with larger datasets and model fine-tuning using smartphone recordings are expected to improve AI model performance and generalizability. WHAT IS KNOWN: • Continuous monitoring of pediatric respiratory diseases is essential to improve outcomes and reduce healthcare and family burden. • Smartphone lung auscultation is feasible in children but AI wheeze detection models have only been applied to recordings from electronic stethoscopes. WHAT IS NEW: • First study applying an AI model to detect wheezes in smartphone-recorded lung sounds. • Quality recordings were obtained across all pediatric age groups and the AI model performance showed promising results, comparable to studies using electronic stethoscopes.
Long-term ambient temperature and asthma severity and hospitalization in children: a population-based study.
Makrufardi F, Chuang HC, Lin YC … +7 more , Ho KF, Chung KF, Chadeau-Hyam M, Rusmawatiningtyas D, Arguni E, Murni IK, Lin SC
Eur J Pediatr · 2026 May · PMID 42118377 · Publisher ↗
To estimate the risk projection of temperature on pediatric asthma severity and hospitalization under four Shared Socioeconomic Pathways (SSPs) possible future climate scenarios using the Intergovernmental Panel on Clima...
To estimate the risk projection of temperature on pediatric asthma severity and hospitalization under four Shared Socioeconomic Pathways (SSPs) possible future climate scenarios using the Intergovernmental Panel on Climate Change (IPCC) model. A retrospective study was conducted involving 102,160 pediatric asthma patients from the Taipei Medical University Clinical Research Database (TMUCRD). We utilized global climate model (GCM) outputs to project future temperature for each subject from optimistic (SSP126) to pessimistic (SSP585) projections. A multinomial logistic regression was used to examine the odds ratio of pediatric asthma severity and hospitalization. A 1 °C increase in 1-year, 5-year, and 10-year average temperatures was associated with 1.004-fold (95% CI: 1.003-1.005) and 1.332-fold (95% CI: 1.327-1.338), 1.004-fold (95% CI: 1.002-1.005) and 1.303-fold (95% CI: 1.298-1.308), and 1.005-fold (95% CI: 1.004-1.006) and 1.282-fold (95% CI: 1.278-1.287) increase in the OR for mild persistent and hospitalization of pediatric asthma. We observed a non-linear association between temperature under SSP126, SSP245, SSP370 and SSP585 with moderate persistent pediatric asthma and pediatric asthma hospitalization, with the highest OR increases observed in 2033 at 33.4% and 32.3%, 27.6% and 32.3%, 29.1% and 32.4%, and 27.2% and 32.3%, respectively. Conclusion: Projected future temperature changes as a result of climate change may be associated with a possible increase in pediatric asthma severity and hospitalization in the coming years, with an expected increase of 8.0% and 2.5% per 1 °C increase, respectively. Pediatric asthma patients may be more susceptible to poorer outcomes under climate change in the future. What is Known: • Rising temperatures have been linked to increased asthma severity and hospitalization. • Climate change worsening pediatric asthma outcomes and increasing the healthcare burden. What is New: • Long-term exposure to rising ambient temperatures and PM is significantly associated with increased odds of moderate and severe persistent asthma in children. • Theoretical projections linking multiple climate model scenarios (SSP126-SSP585) with future pediatric asthma burden.
Qualitative analysis of the impact of top surgery on physical activity in transmasculine and non-binary adolescents and young adults: a pilot study.
Sandepudi K, Haddad B, Roblee C … +8 more , Arteaga R, Krausse A, Gaudette J, Eyo C, Hackenberger P, Chen D, Beach L, Jordan SW
Eur J Pediatr · 2026 May · PMID 42118346 · Full text
UNLABELLED: Physical activity (PA) is crucial in adolescents and young adults (AYA) for the promotion of long-term cardiovascular health. In transgender and non-binary (TGNB) AYA who were assigned female at birth (AFAB),...
UNLABELLED: Physical activity (PA) is crucial in adolescents and young adults (AYA) for the promotion of long-term cardiovascular health. In transgender and non-binary (TGNB) AYA who were assigned female at birth (AFAB), chest dysphoria may lead to avoidance of sports and exercise. Thus, it is important to understand the impact of gender-affirming top surgery on PA in TGNB AFAB AYA. In this pilot study, we conducted a qualitative analysis of the associations among chest dysphoria, top surgery, and the relationship with PA. Two focus groups, each consisting of five TGNB AFAB patients who were 13-25 years old at the time of top surgery, were conducted to elicit perspectives on factors impacting PA, including top surgery. Focus group transcripts were analyzed using grounded theory coupled with situational analysis. Identified themes were grouped into barriers, facilitators, and complicating factors of PA. Most barriers, including structural accessibility, passing, binding/clothing restrictions, and physical safety, were prominent prior to top surgery. Several facilitators to PA arose after top surgery, including top surgery improving PA, social acceptance, and PA to augment the post-op chest. Complicating factors included mental health, which impacted PA both before and after surgery, and the post-op healing process, which impacted PA for up to 6 months post-surgery. CONCLUSION: In TGNB AFAB adolescents and young adults, chest dysphoria poses several barriers to PA, many of which are resolved by top surgery. These findings suggest that alleviation of chest dysphoria via gender-affirming care has implications for the long-term cardiovascular health of TGNB patients. WHAT IS KNOWN: • Chest dysphoria can be a barrier to physical activity in transgender and non-binary (TGNB) adolescents and young adults (AYA). • Physical activity in adolescence can shape longer term cardiovascular health. WHAT IS NEW: • Gender-affirming top surgery resolves many barriers to physical activity in TGNB AYA. • Our findings suggest top surgery can have implications for long-term cardiovascular health.
The cardiovascular future of childhood cancer survivors: are we ready?
López-Guillén JL, Pozza A, Milani GP … +2 more , Deiros-Bronte L, -Larraya FG
Eur J Pediatr · 2026 May · PMID 42118344 · Publisher ↗
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Prevalence, characteristics and outcomes of respiratory viral co-infection among hospitalized children.
Reisler I, Levinsky Y, Tausky O … +5 more , Mulla D, Goldberg B, Itzhaki-Wygoda N, Scheuerman O, Goldberg L
Eur J Pediatr · 2026 May · PMID 42118312 · Full text
UNLABELLED: Respiratory tract infections (RTIs) are a leading cause of pediatric hospitalization. Although multiple concurrent viral infections are frequently detected, their impact on clinical outcomes remains unclear....
UNLABELLED: Respiratory tract infections (RTIs) are a leading cause of pediatric hospitalization. Although multiple concurrent viral infections are frequently detected, their impact on clinical outcomes remains unclear. This study evaluated whether viral co-infection in children leads to worse clinical outcomes, higher inflammatory markers, or increased medical management compared to single-virus infections. We retrospectively studied children aged 0-18 years hospitalized with RTIs at a tertiary pediatric center (2017-2024). Inclusion required at least one virus detected by multiplex polymerase chain reaction (PCR). Clinical, laboratory, and hospitalization data were compared between children with single versus multiple viral infections. Multivariable regression models adjusted for age, sex, and season were used to assess associations with clinical outcomes. Of 5,703 hospitalized children, 1,120 (19.6%) had multiple viral infections. Co-infected children were younger (median 0.9 years [IQR 0.5-1.6] vs. 1.2 [IQR 0.4-3.2], p < 0.0001) and more likely to have elevated inflammatory markers, including higher C-reactive protein (CRP) and white blood cell (WBC) counts. Despite these differences, key hospitalization outcomes, including length of stay (median 4 days [IQR 3-6] in both groups), intensive care unit (ICU) admission (8.0% vs. 7.2%), and 30-day rehospitalization rates, did not differ significantly. Co-infected patients were more frequently treated with bronchodilators and steroids. CONCLUSIONS: Viral co-infections were common, particularly among younger children, and were associated with modestly higher inflammatory responses and increased use of anti-inflammatory medications. However, co-infection did not significantly affect hospitalization duration or ICU admission. These findings suggest that multiple viral infections may not substantially worsen disease severity in hospitalized children. WHAT IS KNOWN: • Viral co-infections are common in pediatric respiratory illness, yet their impact on clinical severity and outcomes remains debated and inconsistent in current literature. WHAT IS NEW: • Co-infection is associated with significantly higher inflammatory markers and increased use of steroids and bronchodilators compared to single-virus infections. • Despite laboratory differences and higher medication use, co-infection does not increase length of stay, ICU admission rates, or 30-day rehospitalization.
Serum metabolomic signatures and hepcidin levels in early childhood iron deficiency anemia: a case-control study.
Sohail A, Siddiqui AJ, Moiz B … +2 more , Masqati NU, Musharraf SG
Eur J Pediatr · 2026 May · PMID 42118173 · Publisher ↗
UNLABELLED: Iron deficiency anemia (IDA) remains a significant global health issue among children aged 24-59 months. It can lead to systemic metabolic changes that hinder neurodevelopment and growth. This study examined...
UNLABELLED: Iron deficiency anemia (IDA) remains a significant global health issue among children aged 24-59 months. It can lead to systemic metabolic changes that hinder neurodevelopment and growth. This study examined serum metabolomic profiles and hepcidin levels in young children with IDA to identify the metabolic pathways affected by iron deficiency. This observational case-control study was conducted at the pediatric clinic of University Teaching Hospital in Karachi, Pakistan, from July to September 2024. We initially recruited and screened 100 children aged 24-59 months (50 with IDA and 50 healthy controls). After applying predefined clinical and laboratory exclusion criteria, all 50 eligible IDA cases and 38 controls were included in the final analysis. Hemoglobin and ferritin levels were measured as markers of iron status. Serum hepcidin was quantified using ELISA. Untargeted metabolomic profiling was performed with gas chromatography - mass spectrometry (GC-MS). Statistical analyses were performed using SPSS (v26.0), R (v4.4.3), and MetaboAnalyst (v6.0). Children with IDA had significantly lower body weight, hemoglobin, and ferritin levels than controls (p < 0.001). Serum hepcidin levels were lower in IDA but did not differ significantly between groups (p = 0.10). Metabolomic analysis identified twelve metabolites that were significantly downregulated in IDA (p < 0.05). Pathway analysis revealed that cholesterol is a key metabolite linked to bile acid and steroid biosynthesis. Ferritin demonstrated strong positive correlations with cholesterol and 9, 12, 15-octadecatrienoic acid (r = 0.70). CONCLUSIONS: Children with IDA showed alterations in lipid-related metabolites, with cholesterol emerging as a key associated metabolite. However, pathway-level interpretations based primarily on a single sterol signal should be interpreted cautiously. Hepcidin levels were not significantly different, indicating complex regulatory influences in early childhood. WHAT IS KNOWN: • Iron deficiency anemia (IDA) in early childhood is linked to impaired growth, neurodevelopment, and metabolism. • Earlier studies have suggested associations between iron deficiency and altered lipid metabolism, but pediatric metabolomic data are still limited. WHAT IS NEW: • This study utilizes untargeted GC-MS metabolomics with serum hepcidin measurements in young children with IDA from a high-prevalence setting. • Children with IDA showed altered lipid-related metabolites, with cholesterol being the most consistently altered metabolite related to bile acid and steroid biosynthesis pathways.
Association between body roundness index and cardiopulmonary fitness: a cross-sectional study of children and adolescents aged 7-18 years in Mainland China.
Bi C, Ran X, Zhang F … +4 more , Wang H, Zhang M, Sun P, Wang M
Eur J Pediatr · 2026 May · PMID 42115525 · Publisher ↗
Cardiorespiratory fitness (CRF) is closely associated with multiple health indicators. The Body Round Index (BRI) is a new indicator of obesity, yet few studies have examined its association with CRF. The purpose of this...
Cardiorespiratory fitness (CRF) is closely associated with multiple health indicators. The Body Round Index (BRI) is a new indicator of obesity, yet few studies have examined its association with CRF. The purpose of this study is to investigate whether CRF in adolescents is associated with BRI. From September to December 2023, a cross-sectional assessment of height, weight, waist circumference, and 20 m shuttle run test(20-m SRT) performance was conducted among 42,341 [boys, 21849 (51.6%)] children and adolescents aged 7-18 years across five regions in mainland China using stratified cluster sampling. The association between BRI and cardiorespiratory fitness was analyzed using one-way analysis of variance (ANOVA), LSD comparisons, and curve regression analysis. 20-m SRT among children and adolescents aged 7-18 years in mainland China was (39.84 ± 18.29) laps, with a BRI of (2.11 ± 0.98). As BRI progressively increased, 20-m SRT exhibited a trend of initial increase followed by a decline. The effect of BRI on 20-m SRT was more pronounced in boys than in girls. Overall, 20-m SRT peaked at BRI values of 0.635, 1.435, 2.315, and 2.155 for children and adolescents aged 7-9 years, 10-12 years, 13-15 years, and 16-18 years, respectively, reaching values of 18.747 laps, 26.899 laps, 37.343 laps, and 40.565 laps, respectively.Conclusions: Children and adolescents aged 7-18 in mainland China exhibit an inverted U-shaped relationship between BRI and 20-m SRT, with both boys and girls showing the same trend.
Machine learning-based integration of respiratory oscillometry and spirometry for predicting clinical outcomes in spinal muscular atrophy.
Chang HH, Liang WC, Hsieh TH … +12 more , Liu YC, Wang YC, Cheng YF, Wu YH, Wang CH, Lo SH, Tseng YH, Hsu JH, Dai ZK, Wu JR, Jong YJ, Chen IC
Eur J Pediatr · 2026 May · PMID 42113282 · Publisher ↗
UNLABELLED: Assessing respiratory function in spinal muscular atrophy (SMA) is challenging due to the effort-dependent nature of traditional spirometry. While respiratory oscillometry offers a passive alternative, its cl...
UNLABELLED: Assessing respiratory function in spinal muscular atrophy (SMA) is challenging due to the effort-dependent nature of traditional spirometry. While respiratory oscillometry offers a passive alternative, its clinical utility in predicting clinical status remains underexplored. This study evaluates the efficacy of integrating spirometric and respiratory oscillometric indices through machine learning (ML) to predict ambulatory status and the requirement for bilevel positive airway pressure (BiPAP) in SMA patients. We retrospectively analyzed forty-five patients with a genetically confirmed diagnosis of SMA. To address data imbalance, we utilized the SMOTETomek technique and validated Random Forest models through leave-one-out cross-validation. SHAP (SHapley Additive exPlanations) analysis was used to interpret the contribution of individual physiological markers. In univariate logistic regression, forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory flow at 75% of vital capacity (FEF75) were significant predictors for walking support. FEF25, FEF50, FEF75, and FEF 25-75 were associated with the requirement for BiPAP use. None of the respiratory oscillometric parameters reached statistical significance in regression models. However, ML models achieved high predictive accuracy, with SMOTETomek improving BiPAP requirement recall from 0.00 to 1.00. SHAP analysis revealed that respiratory oscillometry gained significant predictive weight that traditional models overlooked. R20Hz emerged as a key predictor for ambulatory status, while R5-20 Hz was identified as a decisive feature for predicting the BiPAP use. CONCLUSION: The integration of effort-independent respiratory oscillometry with traditional spirometry via ML has the potential to enhance risk stratification in SMA. WHAT IS KNOWN: • SMA requires lung function monitoring, but traditional spirometry is challenging due to the need for forceful expiratory maneuvers. • Respiratory oscillometry provides an effort-independent assessment of respiratory mechanics through tidal breathing. WHAT IS NEW: • Machine learning successfully integrates effort-independent respiratory oscillometry with spirometry to significantly enhance clinical predictions in SMA. • It identifies R20Hz and R5-20 Hz as critical physiological markers for predicting ambulatory status and the requirement for respiratory support, respectively.
Navigating complexity: a retrospective review of pre-diagnostic healthcare trajectories of youth diagnosed with Fetal Alcohol Spectrum Disorder.
Dugas EN, Demont C, Malloum K … +6 more , Smyth C, LeBlanc D, LeBlanc N, Mallet NM, Walsh T, Bouhamdani N
Eur J Pediatr · 2026 May · PMID 42113056 · Publisher ↗
UNLABELLED: Experts highlight the urgent need to increase clinical capacity for the early diagnosis and treatment of Fetal Alcohol Spectrum Disorder (FASD). FASD is a multifaceted and complex diagnosis that requires mult...
UNLABELLED: Experts highlight the urgent need to increase clinical capacity for the early diagnosis and treatment of Fetal Alcohol Spectrum Disorder (FASD). FASD is a multifaceted and complex diagnosis that requires multidisciplinary care, yet few specialized clinics exist. Individuals often navigate the healthcare system for years before receiving a diagnosis. To better understand the pre-diagnostic healthcare trajectories of children and adolescents with FASD, this study aimed to describe the following: (i) the number and types of healthcare professionals consulted; and (ii) the number and types of medical diagnoses received prior to a FASD diagnosis. This retrospective descriptive study analyzed medical records from 155 patients diagnosed with FASD at the NB FASD Center of Excellence, a provincial specialized clinic in New Brunswick (Canada). Among the 155 youth included (63% male), the average age at diagnosis was 11.4 years (SD = 3.9). Patients had consulted a mean of 9.3 (SD = 3.9) HCPs and received a mean of 3.5 (SD = 2.3) medical diagnoses prior to FASD diagnosis. Males consulted significantly more healthcare professionals (HCPs) than females (p = 0.01), though no sex differences were found in age at diagnosis or number of diagnoses. The number of HCPs consulted ranged from 1 to 21. CONCLUSION: The findings highlight the extensive and varied pre-diagnostic healthcare journeys of youth with FASD. Despite growing policy attention, timely access to FASD diagnosis remains limited. These results underscore the need for earlier recognition, improved clinical training, and increased diagnostic capacity to reduce delays and support families more effectively. WHAT IS KNOWN: • Fetal Alcohol Spectrum Disorder (FASD) is underdiagnosed due to limited awareness, stigma, and diagnostic complexity. • Youth with FASD often experience delays in diagnosis and multiple misattributed comorbidities. WHAT IS NEW: • This is the first Canadian study to quantify pre-diagnostic healthcare encounters in youth with FASD while also illustrating the complexity of these trajectories through patient partner insights. • Findings show FASD is often excluded from differential diagnoses, revealing major gaps in clinical training and awareness.
Lactate abnormalities during intravenous linezolid therapy in hospitalized children: a brief report.
Ozsumbul TI, Demir OO, Aykac K … +1 more , Ozsurekci Y
Eur J Pediatr · 2026 May · PMID 42105018 · Publisher ↗
Linezolid is commonly used in children for the treatment of severe gram-positive infections; however, data on metabolic adverse effects remain limited. We evaluated lactate abnormalities in pediatric patients receiving i...
Linezolid is commonly used in children for the treatment of severe gram-positive infections; however, data on metabolic adverse effects remain limited. We evaluated lactate abnormalities in pediatric patients receiving intravenous linezolid. Among 215 children, hyperlactatemia/lactic acidosis occurred in 55.8%. Hyperlactatemia and/or lactic acidosis tended to develop early after treatment initiation and was more frequently observed in younger children and in those with complex underlying conditions, including neurometabolic and hemato-oncologic disorders. These findings suggest that host-related factors may influence susceptibility to lactate disturbances during linezolid therapy and support careful clinical monitoring in selected pediatric populations.
Diagnostic accuracy of artificial intelligence versus 263 pediatric clinicians for childhood exanthems.
Gençeli M, Metin Akcan Ö, Soran GB … +12 more , Çokbiçer A, Saraç U, Üstüntaş T, Yücel M, Doğan M, Yılık Kömür E, Gençeli S, Yılmaz Dağlı H, Sarı M, Kılıç AO, Şahin S, Akkuş A
Eur J Pediatr · 2026 May · PMID 42104164 · Full text
Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the perform...
Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents (P = .001; ε = 0.13).Conclusions: AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight.
Feasibility, reproducibility, clinical value of the VExUS score after pediatric cardiac surgery and main differences from adults' perspective.
Palanca Arias D, Clavero Adell M, Lorente López A … +4 more , Ayerza Casas A, Estabén Boldova V, Gil Hernández I, Alonso Ojembarrena A
Eur J Pediatr · 2026 May · PMID 42104142 · Full text
UNLABELLED: The venous excess ultrasound score (VExUS) is a promising method to assess venous congestion in adults, but evidence in children is scarce. This study aimed to evaluate the feasibility, reproducibility, and c...
UNLABELLED: The venous excess ultrasound score (VExUS) is a promising method to assess venous congestion in adults, but evidence in children is scarce. This study aimed to evaluate the feasibility, reproducibility, and clinical usefulness of VExUS in pediatric patients. We also explored whether portal venous Doppler (PVD) alone could serve as a faster alternative and assessed the role of inferior vena cava (IVC) measurements. In this prospective single-center study, 35 pediatric patients were enrolled between 2022 and 2024. Associations between clinical variables and VExUS grades at admission (VExUS-0), 24 h (VExUS-24 h), and 48 h (VExUS-48 h), as well as PVD at corresponding time points, were analyzed. The relationship between IVC diameter and VExUS was also evaluated. VExUS demonstrated perfect reproducibility (κ coefficient and intraclass correlation coefficient = 1). Patients with VExUS-0 or VExUS-24 h grades 2-3 had longer aortic cross-clamp times (p = 0.03; 0.04) and higher vasoactive-inotropic scores (p = 0.01) than those graded 0-1. A higher incidence of acute kidney injury was observed in VExUS-24 h grades 2-3 (p = 0.04). Similar associations were found with PVD. Most patients with VExUS grades 2-3 had non-dilated IVCs according to pediatric reference values. CONCLUSION: VExUS is a feasible, reproducible, and clinically relevant bedside tool for detecting venous congestion in children. Its association with morbidity markers suggests prognostic potential, with optimal performance 24 h after PICU admission. PVD may provide comparable information in less time, while IVC diameter appears unreliable for this purpose. WHAT IS KNOWN: • VExUS enables bedside assessment of venous congestion and is associated with adverse outcomes in adults, particularly after cardiac surgery. • However, pediatric evidence is limited, and its clinical applicability remains uncertain. WHAT IS NEW: • This study shows that VExUS is feasible, reproducible, and associated with morbidity after pediatric cardiac surgery, with the highest prognostic value at 24h. • Portal Doppler may provide comparable performance, whereas IVC diameter is is not a reliable marker of venous congestion in this population.
Cerebral gliomas in adolescents and young adults: a scoping review of evidence gaps in diagnosis, treatment, and prognosis.
Sole VM, Elia G, Alessandro P … +6 more , Marco P, Gianluca P, Pietro F, Gianluigi Z, Gabriele G, Andrea B
Eur J Pediatr · 2026 May · PMID 42104111 · Publisher ↗
UNLABELLED: Cerebral gliomas represent a heterogeneous group of tumours that pose unique diagnostic and therapeutic challenges. Adolescents and young adults (AYAs, 15-39 years) often fall into a clinical gap, receiving c...
UNLABELLED: Cerebral gliomas represent a heterogeneous group of tumours that pose unique diagnostic and therapeutic challenges. Adolescents and young adults (AYAs, 15-39 years) often fall into a clinical gap, receiving care modelled on paediatric or adult oncology, which may not address their distinct biological and psychosocial needs. A review was conducted to systematically map the existing literature on cerebral gliomas in AYAs and identify evidence gaps in diagnosis, treatment, and prognosis. Our scoping review was conducted following PRISMA-SR guidelines, using PubMed and Scopus to identify studies on gliomas in AYAs. Eligibility criteria consisted of articles focused on gliomas in AYAs, published in English between 2000 and 2024. Studies exclusively focused on AYA populations, as well as studies including AYAs within mixed populations, were considered eligible. Extracted data included study characteristics, population, interventions, and outcomes (survival, quality of life, molecular markers), which were synthesised thematically into epidemiology, molecular/histological profiles, treatments, outcomes, and psychosocial impacts. Our systematic review identified 33 studies on gliomas in AYAs. Most of the included studies (62.5%, n = 20) were published between 2020 and 2024. Geographically, the studies were primarily conducted in the USA (25%, n = 8), followed by Canada (9.4%, n = 3) and Europe (9.4%, n = 3). From an epidemiological perspective, gliomas were the most common cerebral tumours. Molecular analyses revealed overlap between pediatric- and adult-type alterations, emphasising diagnostic ambiguity and the need for comprehensive profiling. Treatment reports underscored surgery as central, with emerging roles for proton therapy, targeted agents, and immunotherapy, although the lack of AYA-specific trials remains a barrier. Prognostic and psychosocial studies highlight survival disparities associated with molecular markers and socioeconomic factors, as well as unmet needs related to fertility preservation, neurocognition outcomes, and palliative care. CONCLUSION: The review identified major gaps, such as heterogeneous adoption of advanced diagnostic approaches, the absence of age-specific treatment protocols, and scarce research on long-term outcomes and quality of life in AYAs with gliomas. Addressing these issues requires AYA-focused clinical trials within a multidisciplinary care framework. WHAT IS KNOWN: • Gliomas in adolescents and young adults (AYAs) present overlapping molecular and clinical features of paediatric and adult-type gliomas, determining diagnostic and therapeutic challenges in everyday care. • Current management of glioma in AYAs is usually extrapolated from paediatric or adult populations, with limited AYA-specific trials, without the presence of evidence-based guidlines. WHAT IS NEW: • Our review has the aim to map the existing literature on cerebral gliomas in AYAs and to identify the major gaps in diagnosis, molecular profiling, treatment, outcome, and psychosocial aspects. • There is an urgent need to develop AYA-specific molecularly informed, multidisciplinary treatment strategies and clinical studies for gliomas focused on management and long-term outcomes.
Thyroid-metabolic interactions in pediatric epilepsy: insights from central sensitivity indices and peripheral hormone markers.
Calcaterra V, Labati L, Scavone IAM … +3 more , Scelsa B, Veggiotti P, Zuccotti G
Eur J Pediatr · 2026 May · PMID 42104025 · Full text
UNLABELLED: Childhood epilepsy is often linked to endocrine and metabolic disturbances, partly from prolonged antiseizure treatment. While thyroid dysfunction is known in this population, routine tests may miss subtle ch...
UNLABELLED: Childhood epilepsy is often linked to endocrine and metabolic disturbances, partly from prolonged antiseizure treatment. While thyroid dysfunction is known in this population, routine tests may miss subtle changes in hormone sensitivity or peripheral metabolism. This study seeks to thoroughly assess central and peripheral thyroid hormone regulation in pediatric epilepsy and explore its connection to metabolic health. In this cross-sectional study, 152 children and adolescents with epilepsy and 116 age- and sex-matched controls underwent assessment of thyroid function (TSH, FT4, FT3), central thyroid hormone sensitivity indices (TFQI, PTFQI, TSHI, TT3RI, TT4RI), peripheral thyroid hormone metabolism (FT3/FT4 ratio), and metabolic parameters (fasting glucose, insulin, and lipid profile). Stratified and multivariable regression analyses were performed to identify independent associations, and correlation analyses were used to explore thyroid-metabolic relationships. Children with epilepsy had higher fasting insulin and a worse lipid profile than controls. Thyroid function markers (TSH, FT4) and central thyroid sensitivity indices were similar between groups, but FT3 and the FT3/FT4 ratio were elevated, suggesting altered peripheral thyroid metabolism despite preserved central regulation. Multivariable analyses identified BMI z-score as a major independent determinant of metabolic alterations and thyroid hormone sensitivity, while antiepileptic drug exposure and disease duration showed variable and modest associations. CONCLUSIONS: Pediatric epilepsy is characterized by preserved central thyroid regulation but altered peripheral thyroid hormone metabolism, as reflected by an increased FT3/FT4 ratio. These findings suggest a multifactorial and potentially adaptive endocrine-metabolic remodeling influenced by adiposity and treatment exposure, warranting further investigation in longitudinal studies. WHAT IS KNOWN: • Pediatric epilepsy and antiseizure medications are associated with subtle thyroid alterations and increased metaboli crisk, commonly assessed using TSH and FT4. WHAT IS NEW: • Children with epilepsy show increased FT3 and FT3/FT4 ratio despite preserved central thyroid regulation, suggesting altered peripheral thyroid metabolism. • BMI z-score emerged as a major independent determinant of thyroid sensitivity indices and metabolic impairment.
Design, implementation, and evaluation of an educational-interactive telenursing web application for mothers of high-risk neonates.
Beykmirza R, Ghofrani M, Mehrabani ER … +3 more , Giv A, Nasiri M, Varzeshnejad M
Eur J Pediatr · 2026 May · PMID 42103994 · Publisher ↗
The transition of high-risk neonates from the neonatal intensive care unit (NICU) to home remains a complex process, often hindered by inadequate and fragmented discharge education. This study aimed to develop, implement...
The transition of high-risk neonates from the neonatal intensive care unit (NICU) to home remains a complex process, often hindered by inadequate and fragmented discharge education. This study aimed to develop, implement, and evaluate an interactive telenursing web application designed to enhance discharge education for mothers of high-risk neonates. A multi-method study with a three-phase approach (design, implementation, and evaluation) was conducted to develop and assess a bilingual telenursing web application. The application was developed using the waterfall model. Implementation and evaluation phase in this study was conducted as a quasi-experimental study, involving 60 mothers of high-risk neonates. These mothers were randomly assigned to either an intervention group (N = 30), which received interactive, multimedia-based discharge education via the web application, or a control group (N = 30) that received standard discharge education. Maternal knowledge and user satisfaction were the primary outcome measures. The findings are structured into two distinct components: (1) web application design and (2) implementation, and its evaluation. This application was designed as a bilingual (Persian/English) platform. Its various components include the following: A- Login Page (this web application has three user roles: Mother, nurse, and Supervisor (Editor)), B- Home Page, C- Educational Icons Page, D- multiple questions to assess mothers' understanding of the educational content. E- Nurses' Page, F-Messages Page. Evaluation of the Intervention on maternal knowledge showed that the mean knowledge score in the intervention group was significantly higher than in the control group (p = 0.008). User Satisfaction and Usability questionnaire results showed that the overall mean satisfaction score was 3.90 ± 0.77 out of 5. The highest-scoring domain was Information Quality (Mean ± SD = 4.13 ± 0.63), followed by Aesthetics (Mean ± SD = 3.96 ± 0.66) and Functionality (Mean ± SD = 3.90 ± 0.84). The lowest-rated domain was Subjective Quality (Mean ± SD = 3.63 ± 0.73). Conclusion: The findings indicate that the bilingual, competency-driven bilingual telenursing web application is an effective tool for improving maternal knowledge and engagement in post-NICU care. The platform's features, including real-time nurse-mother communication and adaptive learning modalities, facilitate better discharge preparedness and may contribute to reduced emergency healthcare utilization. Future research should explore integration with electronic health record systems to enable personalized and continuous care pathways.
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