European Journal of Pediatrics最新文献

{"title":"Talkin' about a revolution: integrating parents of children with Down syndrome as experts-by-experience in pediatric outpatient care.","authors":"V J T Peters, A M de Hoog, H B M van Gameren-Oosterom, J P de Winter, T Eulderink, L A Bok","doi":"10.1007/s00431-025-06532-8","DOIUrl":"https://doi.org/10.1007/s00431-025-06532-8","url":null,"abstract":"<p><p>This study explores the role of parents of children with Down syndrome as experts-by-experience in pediatric outpatient care, a setting where their integration remains understudied, despite growing evidence of their value in other healthcare settings. We conducted a qualitative, exploratory interview study and took the outpatient care provision for children with Down syndrome as our setting. We conducted 18 interviews with healthcare professionals, parents of children with Down syndrome, and experts-by-experience. We utilized thematic analysis to analyze our data. We find that experts-by-experience act as a bridge between healthcare professionals and parents and improve the quality of care and life for children with Down syndrome and their families by offering support that extends beyond medical care into the social-emotional and practical aspects of daily living. Conclusion: Experts-by-experience offer unique contributions to pediatric outpatient care. Their lived experience makes them valuable contributors to improve the quality of care and life. We call for every outpatient multidisciplinary team to integrate experts-by-experience as standard practice. What is Known: • Experts-by-experience are increasingly recognized as valuable contributors in healthcare settings, offering unique perspectives that can enhance care provision.  What is New: • The involvement of parents as experts-by-experience in pediatric outpatient care improves the quality of care and quality of life for children and their parents.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"689"},"PeriodicalIF":2.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking IgE-mediated CMPA to functional gastrointestinal disorders.","authors":"Nur Kevser Özyurt, Merve Kişioğlu, Burcu Güven, Nalan Yıldız, Fazıl Orhan","doi":"10.1007/s00431-025-06533-7","DOIUrl":"https://doi.org/10.1007/s00431-025-06533-7","url":null,"abstract":"<p><p>Numerous factors have been implicated in the development of functional gastrointestinal disorders (FGID). In this study, we aimed to investigate whether a diagnosis of cow's milk protein allergy (CMPA) in infancy is a risk factor for the development of FGID in the long term and whether there is a difference between patients with IgE-mediated and non-IgE-mediated CMPA with regard to the development of FGID. The study included 250 patients aged 4-18 years who had been diagnosed with CMPA in infancy. The control group consisted of 250 children of a similar age without CMPA. A questionnaire including Rome IV criteria was prepared and administered to the parents of 500 children. FGID were observed in 70 (28%) patients with CMPA and in 76 (30.4%) patients without CMPA (p = 0.623). Functional abdominal pain-not otherwise specified (FAP-NOS), irritable bowel syndrome (IBS), and non-retentive fecal incontinence (NRFI) were significantly more common in patients without CMPA (p = 0.009, p = 0.016, p = 0.034, respectively). FGID were observed in 36 (33.6%) patients with IgE-mediated CMPA as opposed to 34 (23.8%) patients with non-IgE-mediated CMPA (p = 0.115). Functional dyspepsia (FD), FAP-NOS, and IBS were significantly more common in patients with IgE-mediated CMPA (p ≤ 0.001, p = 0.001, p = 0.002, respectively).</p><p><strong>Conclusion: </strong>Although the frequency of FGID development did not increase in the long term in our CMPA patients, FD, FAP-NOS, and IBS were significantly more common in these patients, particularly in those with IgE-mediated CMPA. This suggests that subclinical CMPA may persist in patients with IgE-mediated CMPA.</p><p><strong>What is known: </strong>• Literature indicates that CMPA is a predisposing or accompanying factor for FGID in children.</p><p><strong>What is new: </strong>• Our study include the large number of patients and its case-control design. Additionally, there is no existing study in the literature comparing patients with IgE-mediated and non-IgE-mediated CMPA.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"688"},"PeriodicalIF":2.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury in infants with necrotising enterocolitis: A case-control study.","authors":"Dermot Wildes, Brian Patrick Cleary, Ciara Terry, Atif Awan, Daniel O'Reilly, Michael A Boyle","doi":"10.1007/s00431-025-06530-w","DOIUrl":"https://doi.org/10.1007/s00431-025-06530-w","url":null,"abstract":"<p><p>Necrotising enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Acute kidney injury (AKI) is increasingly recognised as a common complication in this population, yet its relationship with NEC remains under-characterised. We sought to evaluate the incidence of AKI in infants with NEC and examine its association with NEC severity (using Bell staging) in a tertiary neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong> A retrospective 1:2 case-control study was conducted in a single tertiary NICU between October 2018 and October 2023. Forty-nine preterm infants diagnosed with NEC were matched to 100 controls based on birth weight, gestational age, and gender. AKI was defined using modified neonatal KDIGO criteria, incorporating both serum creatinine and urine output.</p><p><strong>Results: </strong> AKI was identified in 25 of 149 infants (16.8%), with an incidence among those with NEC of 30.6% compared to controls (10%). NEC exposure was associated with increased odds of AKI in our cohort when controlling for patent ductus arteriosus (PDA), birth weight, gentamicin and ibuprofen receipt, with an adjusted odds ratio (OR) of 3.6 (95% CI 1.3-10.2, p = 0.0129). Among NEC cases, AKI onset occurred a median of two days after diagnosis. No association was found between Bell stage and AKI incidence, albeit with a small sample size. Mortality in the NEC-AKI group was 60%, compared to 20.6% in NEC infants without AKI.</p><p><strong>Conclusions: </strong> NEC is associated with increased risk of AKI in preterm infants, when controlling for birth weight, gestational age PDA, ibuprofen and gentamicin exposure. Bell stage was not associated with AKI incidence, in our cohort. These findings support the consideration of early kidney function surveillance in NEC to inform risk stratification and improve outcomes.</p><p><strong>What is known: </strong>  • NEC is a leading cause of morbidity in preterm infants, often triggering systemic inflammation and multiorgan dysfunction. AKI is common in neonates and associated with poor outcomes, but its relationship with NEC is not well defined.  What is New: •  In our cohort, NEC is associated with increased risk of AKI in preterm infants, when controlling for birth weight, gestational age, PDA, ibuprofen, and gentamicin exposure. NEC-associated AKI is linked to higher mortality. Consideration for routine surveillance for AKI in infants with NEC warrants further study.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"687"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying neonatal transport deficiencies: an integrated framework for weighting core KPIs and ranking challenges in resource-limited settings.","authors":"Mahsa Qeytasi, Mohammad Mehdi Sepehri, Abbas Habibelahi","doi":"10.1007/s00431-025-06523-9","DOIUrl":"https://doi.org/10.1007/s00431-025-06523-9","url":null,"abstract":"<p><p>Health systems often struggle to deploy an adequate number of trained healthcare professionals at the right time and place. These constraints underscore the critical role of efficient referral and transport processes, particularly for critically ill neonates. This study aimed to develop a strategic, data-driven framework to guide system-wide improvement within neonatal transfer systems. A mixed-methods approach was adopted. Qualitatively, a literature review and semi-structured interviews with experts experienced in neonatal transfer were conducted to identify contextual challenges and relevant key performance indicators (KPIs). Quantitatively, a structured survey was then administered to elicit weights for the KPIs and to prioritize the challenges. The analysis was supported by three Multi-Criteria Decision-Making (MCDM) Techniques: the Decision-Making Trial and Evaluation Laboratory (DEMATEL), the Analytic Network Process (ANP), and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Key performance indicators (KPIs) were weighted as follows: Total Transport Time (0.20), Stabilization Care (0.18), In-Transport or 24-h Mortality (0.16), Patient Arrest During Transport (0.12), Medical Gas Supplies (0.10), Medical Equipment Failure (0.09), Accidental Extubation (0.08), and Hypoglycemia (0.06). Based on these weights, the five most critical challenges were: inadequate equipment, low skill level of the transfer team, lack of a centralized transport unit, unclear exchange of information, and transport models constrained by administrative structures.</p><p><strong>Conclusion: </strong>The proposed framework enhances transparency and defensibility in neonatal transport decision-making. By directing resources toward high-impact domains, it supports improved patient outcomes and reduced system risks.</p><p><strong>What is known: </strong>• Previous studies on neonatal transport identify challenges and propose KPIs but often lack prioritization of interventions. • Research relies mainly on qualitative methods with limited quantitative analysis and is highly specific to the country or context of the study.</p><p><strong>What is new: </strong>• By integrating qualitative and quantitative methods, this study identifies challenges and core KPIs of the neonatal transport system, assesses their relative weight, and ranks challenges to guide evidence-based resource allocation. • It provides policymakers with a framework for prioritizing system improvements in any context, including resource-limited settings.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"686"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal transport ground ambulance: the Italian perspective toward a European consensus.","authors":"Carlo Bellini","doi":"10.1007/s00431-025-06536-4","DOIUrl":"https://doi.org/10.1007/s00431-025-06536-4","url":null,"abstract":"<p><p>The European Union (EU) has established EN 1789:2020 + A1:2023 standards for ground ambulances, categorizing them into types A1, A2, B, and C. Type C ambulances are designated for adult intensive care. However, there are no comparable specifications for neonatal ambulances, despite existing standards for neonatal transport incubators (EN 13976-1 and EN 13976-2). This regulatory gap causes confusion and inconsistency because neonatal emergency transport services (NETS) must rely on adult ambulances that are only partially adapted for newborns. These vehicles often lack essential neonatal capabilities, such as reliable access to nitric oxide administration or active cooling systems. Consequently, there is a persistent discrepancy between the advanced technologies available in neonatal intensive care units (NICUs) and the limited resources available during transport, which can compromise care quality. Certification processes further complicate the issue since approval systems are oriented toward adult specifications, creating barriers for neonatal-specific designs. Drawing on the Italian experience, which illustrates the challenges of adapting adult ambulances and the urgent need for solutions focused on neonates, this article emphasizes the importance of achieving a harmonized European consensus. Creating clear, standardized requirements for neonatal ambulances is a critical step in ensuring safe, effective, and equitable neonatal transport across Europe.</p><p><strong>Conclusion: </strong> Drawing on the Italian experience, which illustrates the challenges of adapting adult ambulances and the urgent need for solutions focused on neonates,this article emphasizes the importance of achieving a harmonized European consensus. Creating clear, standardized requirementsfor neonatal ambulances is a critical step in ensuring safe, effective, and equitable neonatal transport across Europe.</p><p><strong>What is known: </strong>• The European Community establishes specific standards for the construction of land ambulances.</p><p><strong>What is new: </strong>• This article analyzes the European situation regarding land ambulances for neonatal transport.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"682"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of intravenous iron supplementation compared to oral iron supplementation during pregnancy on neonatal outcomes-a systematic review of randomized controlled trials.","authors":"Ilari Kuitunen, Kaisa Vepsäläinen, Laura Seppälä, Elli Toivonen, Atte Nikkilä","doi":"10.1007/s00431-025-06522-w","DOIUrl":"https://doi.org/10.1007/s00431-025-06522-w","url":null,"abstract":"<p><p>Anemia and iron deficiency during pregnancy have been associated with preterm birth and neonatal complications. However, the evidence on whether intravenous or oral supplementation should be used has been conflicting. The aim was to assess the effectiveness of intravenous iron compared to oral iron supplementation on objective neonatal outcomes. We conducted a systematic review and meta-analysis of randomized controlled trials. Two databases were searched in November 2024 and the search was updated in February 2025. The main outcomes were the rate of preterm birth, stillbirths, and neonatal mortality. Random-effect meta-analysis was used to calculate risk ratios (RR) with 95% confidence intervals (CI). Evidence certainty was assessed according to GRADE. A total of 375 studies were screened and finally 15 were included. Seven studies with 8431 pregnancies analyzed the risk of preterm birth, and the risk appeared to be similar in both groups (RR 0.96, CI 0.86 to 1.07; moderate certainty evidence). Five studies with 8639 pregnancies analyzed the risk of stillbirth and found no difference (RR 0.85, CI 0.64 to 1.13; low certainty evidence). The neonatal mortality rate was 2.0% in the intravenous iron group, and 2.3% in the oral iron group (RR 0.90, CI 0.66 to 1.22; low certainty evidence). Cord hemoglobin levels were comparable between the study groups (mean difference 0.05 g/l, CI -0.33 to 0.24; low certainty evidence), and ferritin levels were slightly higher in the intravenous group (mean difference 19 µg/l, CI 0.5 to 38; low certainty evidence).</p><p><strong>Conclusions: </strong>Neonatal clinical outcomes did not differ between intravenous and oral iron supplementation treatment in pregnancy. A higher ferritin level in umbilical cord blood was found in the intravenous iron supplementation group, but the clinical relevance of this difference is unknown. Based on the results of this study, oral iron supplementation is a sufficient way to treat maternal iron deficiency, when focusing on objective neonatal outcomes.</p><p><strong>Trial registration: </strong>PROSPERO 2024 CRD42024615533 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024615533 .</p><p><strong>What is known: </strong>• Iron-deficiency anemia during pregnancy is associated with preterm birth and neonatal complications. • Intravenous iron increases maternal hemoglobin faster than oral iron, but benefits for neonatal outcomes have been unclear.</p><p><strong>What is new: </strong>• This systematic review and meta-analysis shows that neonatal outcomes-including preterm birth, stillbirth, and mortality-do not differ between intravenous and oral iron supplementation. • Intravenous iron yields higher cord ferritin, but its clinical relevance remains uncertain.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"684"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging gaps in recommendations for the management of newborns with severe perinatal asphyxia or presumed hypoxic-ischemic encephalopathy: a French Delphi consensus.","authors":"Thulan Nguyen, Manon Michaud, Pierre-Yves Ancel, Paola Sikias, Gauthier Loron, Beatrice Harvey, Elisabeth Lyonnais, Priscille Sauvegrain, Anne Chantry, Isabelle Guellec","doi":"10.1007/s00431-025-06510-0","DOIUrl":"https://doi.org/10.1007/s00431-025-06510-0","url":null,"abstract":"<p><p>Neonatal hypoxic-ischemic encephalopathy (HIE) is a severe complication of perinatal asphyxia requiring timely and coordinated interventions. While international guidelines address early resuscitation and therapeutic hypothermia, key aspects of severe perinatal asphyxia and HIE management remain undefined, leading to practice variability in France. This study aimed to achieve national expert consensus on the first hour's perinatal care for infants with perinatal asphyxia or HIE using the Delphi method. A three-round Delphi survey was conducted between April and July 2021, involving 58 French perinatal care experts (neonatologists, pediatricians, midwives) from ten regions. A multidisciplinary team developed the questionnaire based on a literature review and national/international guidelines. Topics included delivery room equipment, resuscitation timelines, hypothermia protocols, and glycemic management. Consensus was defined as ≥ 70% agreement on Likert-scaled items. Of 165 items evaluated, 144 achieved consensus. Key agreements included mandatory delivery room equipment, the time limits after which certain resuscitative interventions were deemed to be delayed in case of severe perinatal asphyxia. Consensus supported passive hypothermia initiation in the delivery room with a target temperature of 35-35.5 °C and parenteral correction of hypoglycemia, with first glucose testing before 30 min of life in case of presumed hypoxic-ischemic encephalopathy. No consensus was reached for sedation, rectal temperature probes, or enteral glucose correction.</p><p><strong>Conclusions: </strong>This study highlights the necessity of a standardization in management practices. Consensus was achieved on several practices and terms, underscoring the need for further efforts to standardize care protocols and definitions.</p><p><strong>What is known: </strong>• The management of severe perinatal asphyxia and neonatal presumed hypoxic-ischemic encephalopathy (HIE) follows international guidelines, but certain practices remain center-specific and vary significantly.</p><p><strong>What is new: </strong>• Consensus was achieved on both the initial organizational framework and practical procedures for the management of HIE in the delivery room and during the early hours of neonatal care.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"681"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic inflammation during the neonatal period and BMI at 1 year in infants with gastroschisis: a retrospective cohort study.","authors":"Gaia Dimino, Agnès Giuseppi, Cristina Mastropietro, Nicolas Vinit, Victor Sartorius, Véronique Rousseau, Elsa Kermorvant-Duchemin, Alexandre Lapillonne","doi":"10.1007/s00431-025-06535-5","DOIUrl":"https://doi.org/10.1007/s00431-025-06535-5","url":null,"abstract":"<p><p>Growth faltering is a concern for infants with gastroschisis, yet factors influencing long-term growth remain unclear. This study explores the relationship between systemic inflammation during the neonatal period and growth outcomes in the first year of life. It is a monocentric retrospective study over a 10-year period. Neonates with gastroschisis admitted to our NICU and followed in our outpatient clinic were included. Data collection included perinatal and neonatal variables, complications, surgical interventions, feeding milestones, septic events, and C-reactive protein (CRP) values during hospitalization. The primary outcome was a body mass index (BMI) z-score ≤  - 1 SD at 1 year. Of 69 infants, 15 (22%) had a BMI z-score ≤  - 1 SD at 1 year, with a median z-score of - 1.48 (IQR: - 1.66; - 1.16), compared to a median z-score of - 0.23 (IQR: - 0.50; 1.10) for the remaining 54 infants. A BMI z-score ≤  - 1 SD was significantly associated with the use of a silo but not with other surgical or birth characteristics. All measures of systemic inflammation during NICU stay, including the number of days with CRP > 5 mg/L or CRP > 50 mg/L, maximum CRP levels, and the number of peak CRP above 50 mg/L, were significantly associated with BMI z-score ≤  - 1 SD at 1 year. Adjusted analyses confirmed that the number of days with CRP > 5 mg/L and peak CRP levels above 50 mg/L remained significant. Conclusion: Persistent and/or severe systemic inflammation related to medical-surgical management and its complications during the neonatal period is associated with impaired growth in infants with gastroschisis.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"683"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical appraisal of \"Effects of metabolic syndrome and its components on pulmonary function and functional capacity in children and adolescents with obesity\".","authors":"Maiza Naseer, Sameer Haider, Touqeer Rehman","doi":"10.1007/s00431-025-06501-1","DOIUrl":"https://doi.org/10.1007/s00431-025-06501-1","url":null,"abstract":"","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"685"},"PeriodicalIF":2.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving burden of childhood meningitis in low- and middle-income countries, 1990-2021: a decomposition and frontier analysis.","authors":"Taixiang Liu, Zheng Chen, Jiajing Ge, Hongfang Mei, Liping Shi, Jinxin Zheng","doi":"10.1007/s00431-025-06516-8","DOIUrl":"https://doi.org/10.1007/s00431-025-06516-8","url":null,"abstract":"<p><p>Despite vaccination advances, childhood meningitis remains a major global threat, disproportionately affecting low- and middle-income countries (LMICs). This study analyzes its burden trends from 1990 to 2021, with a focus on LMICs. Using data from the Global Burden of Disease Study 2021, we estimated mortality and disability-adjusted life years (DALYs) for children aged 0-14 years across 117 countries and territories grouped by low, low-middle, and middle Sociodemographic Index (SDI). Temporal trends were assessed with estimated annual percentage change (EAPC). We examined correlations between SDI and disease burden and applied decomposition analysis to attribute deaths and DALYs changes to aging, population growth, and epidemiological shifts. Frontier analysis was used to evaluate health system efficiency relative to SDI. Between 1990 and 2021, childhood meningitis deaths decreased in LMICs. Nevertheless, these regions accounted for 98.5% of global deaths in 2021, with low-SDI regions alone responsible for 61.0%. Streptococcus pneumoniae and Neisseria meningitidis were the leading pathogens. The disease burden was strongly inversely correlated with SDI, highlighting the key role of socioeconomic development. Decomposition analysis showed that in low-SDI regions, epidemiological improvements contributed substantially to mortality reduction (+ 513.02%), but were largely offset by population growth (- 417.38%), yielding only a modest net reduction. Frontier analysis revealed major health system inefficiencies in certain low-SDI countries, such as South Sudan and Nigeria.</p><p><strong>Conclusion: </strong>The concentrated burden of childhood meningitis in LMICs calls for context-specific strategies. Health system inefficiencies and rapid population growth threaten to offset intervention gains. Precision public health approaches that combine targeted vaccination, health system strengthening, and socioeconomic development are essential to reduce inequities and achieve global control goals.</p><p><strong>What is known: </strong>• Childhood meningitis remains a leading infectious cause of mortality and long-term disability globally, with the highest burden concentrated in low-income regions. • Significant progress has been made in vaccine development, leading to declines in mortality globally; yet implementation and coverage gaps persist in resource-limited settings.</p><p><strong>What is new: </strong>• Decomposition analysis quantifies for the first time how rapid population growth in low-SDI regions nearly cancels out the benefits of epidemiological improvements, whereas middle-SDI regions achieved reductions almost solely through epidemiological progress. • Frontier analysis identifies profound health system inefficiencies in specific low-SDI countries (e.g., South Sudan, Nigeria), where observed mortality and DALYs rates are higher than the optimum achievable given their SDI level.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 11","pages":"679"},"PeriodicalIF":2.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}