European Journal of Pediatrics最新文献

{"title":"Bosentan as adjunctive therapy in neonates with congenital diaphragmatic hernia-associated pulmonary hypertension: a case series.","authors":"Aster De Vadder, Lotte Lemloh, Bartolomeo Bo, Lennart Hale, Neil Patel, Andreas Mueller, Florian Kipfmueller","doi":"10.1007/s00431-025-06019-6","DOIUrl":"10.1007/s00431-025-06019-6","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension (PH) is associated with high morbidity and mortality. Pulmonary vasodilative management is challenging and some patients with CDH are unresponsive to inhaled nitric oxide or sildenafil. Bosentan, an enterally-administered endothelin-1 receptor antagonist, reducing pulmonary vascular resistance may play a role in the treatment of CDH-PH. The aim is to evaluate the efficacy and safety of bosentan as an adjunctive therapy for CDH-PH. We report a case series of all CDH neonates who received oral bosentan as an adjunctive therapy for treatment of PH between 2013 and 2021 at our institution. Bosentan was administered at a median enteral dose of 2 mg/kg/day. Main outcomes were improved PH severity on echocardiography, oxygenation, and respiratory support after starting bosentan. Patients were compared according to improvement in PH after 1 week of treatment (responder vs. non-responder). Fifty CDH neonates received oral adjunctive bosentan therapy. Survival to discharge was 58%. Improved PH was observed in 54 and 72% of patients after 1 and 2 weeks respectively (p < 0.001). Respiratory status ameliorated significantly after 2 weeks compared to baseline, with a reduction of ECMO treatment from 30 to 0% and an increase in patients receiving non-invasive or no respiratory support from 18 to 40%. Oxygenation did not improve over 2 weeks, possibly biased by the changes in the respiratory status and other contributing factors to the pathophysiology of CDH.</p><p><strong>Conclusion: </strong>Bosentan is effective in the treatment of neonates with CDH-PH and was associated with improved PH severity and respiratory status. Adverse effects were minimal and consistent with previous studies.</p><p><strong>What is known: </strong>• CDH neonates frequently suffer from pulmonary hypertension with inconclusive evidence regarding the benefit of pulmonary vasodilator treatment. • Increased endothelin-1 plasma levels have been associated with poor outcome in CDH neonates, however, there is minimal data on the use of endothelin receptor blockers, such as bosnetan, in this population.</p><p><strong>What is new: </strong>• This case series of 50 CDH neonates receiving bosentan demonstrates an improvement in PH severity based on echocardiographic assessment in 54% within one week of treatment. • Respiratory support modus (i.e. ECMO, mechanical ventilation, CPAP) improved significantly within two weeks of bosentan treatment in responders and non-responders.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"198"},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406397","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":"Parameters associated with the development of autoimmune diseases in pediatric onset celiac disease.","authors":"Firas Abu Hanna, Maia Sirkin, Bar Sofer Ilovich, Ranya Egbarieh, Sameh Tatour, Avishay Lahad, Sarit Peleg, Tal Almagor, Firas Rinawi","doi":"10.1007/s00431-025-06028-5","DOIUrl":"https://doi.org/10.1007/s00431-025-06028-5","url":null,"abstract":"<p><p>Patients with celiac disease (CeD) have an increased risk of developing other autoimmune diseases (ADs); however, risk factors and predictors for ADs remain unclear. The study objective is to assess predictors for development of ADs among pediatric onset CeD patients. The study included pediatric onset CeD patients, evaluated at Emek Medical Center, and followed for at least 2 years from April 2008 to April 2022. Data were collected from medical records and included baseline and follow-up data of demographics, clinical manifestations, laboratory variables, and subsequent development of ADs. Then, 930 children with CeD were included, and 790 fulfilled inclusion criteria. Patients were followed for a median of 4.9 years (range 2-16 years). During follow-up, 45%, 68%, and 80% normalized their tissue transglutaminase (TTG) levels by 6, 12, and 24 months, respectively. Among the entire cohort, 16 patients (2%) developed type 1 diabetes mellitus, 35 (4.4%) developed Hashimoto's thyroiditis, and 11 (1.3%) developed other ADs. Of 510 patients with sustained serological remission, 39 (7.6%) patients developed ADs compared to 23 (11.5%) of patients without sustained serological remission. In multivariate Cox models, shorter time to TTG normalization (hazard ratio (HR) 0.94 CI 95% 0.88-0.99) and sustained TTG levels less than three times the upper limit of normal (HR 0.87 CI 95% 0.72-0.96) were significantly associated with reduced risk of developing ADs.</p><p><strong>Conclusion: </strong>Effective management of celiac disease, including timely TTG normalization and sustained lower TTG levels, may be important for reducing the risk of subsequent development of ADs in pediatric-onset CeD.</p><p><strong>What is known: </strong>• Pediatric patients with celiac disease (CeD) are at an increased risk of developing autoimmune diseases (ADs). Risk factors contributing to the development of ADs in CeD patients are not well established, particularly in the pediatric population.</p><p><strong>What is new: </strong>• Timely TTG normalization and sustained low TTG levels (<3 times ULN) during follow-up are associated with a reduced risk of developing additional ADs in pediatric CeD patients.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"199"},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413824","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":"Exposure to clinical stressors during NICU admission in preterm infants.","authors":"Naomi J Meesters, Gerbrich E van den Bosch, Maria Luisa Tataranno, Chris H P van den Akker, Christ-Jan van Ganzewinkel, Judith A Ten Barge, Frank A B A Schuerman, Henriette van Zanten, Willem P de Boode, Marlou M A Raets, Peter H Dijk, Joost van Rosmalen, Marijn J Vermeulen, Wes Onland, Lotte Haverman, Irwin K M Reiss, Anton H van Kaam, Manon Benders, Monique van Dijk, Sinno H P Simons","doi":"10.1007/s00431-025-06018-7","DOIUrl":"10.1007/s00431-025-06018-7","url":null,"abstract":"<p><p>This study aims to quantify stress exposure related to clinical stressors in preterm infants during NICU admission and identify risk factors for high stress exposure. In this national cohort study, preterm infants (gestational age < 29 weeks) were prospectively followed during the first 28 days of their admission to one of the 10 NICUs in the Netherlands. The NeO-stress score, consisting of 38 clinical stressors graded with a severity index, was applied to describe stress exposure. We assessed the impact of infant characteristics at birth and postnatal age on NeO-stress scores using linear mixed modelling. In total, 446 infants were included with a median gestational age of 27⁺² weeks (IQR 26⁺²-28⁺²). The median NeO-stress score per day was 61 (IQR 39-87) and highest (74, IQR 52-101) on the day of admission. Nasal/oral (37%) and endotracheal (14%) suctioning were key contributors to the cumulative NeO-stress scores. Linear mixed modelling showed that lower gestational age (B = -0.69, 95% CI - 0.94-0.44, p < 0.001), no antenatal administration of corticosteroids (B = 13.2, 95% CI 3.2-23.1, p = 0.010) and lower 5-min Apgar score (B = - 1.6, 95% CI - 3.0-0.25, p = 0.02) were significantly related with higher daily NeO-stress scores. Our model predicts that the NeO-stress score increases over time for the youngest infants.</p><p><strong>Conclusion: </strong>Stress exposure in preterm infants during NICU admission varies over time with infants with the lowest gestational age at risk for experiencing the highest levels of stress throughout NICU admission. This highlights the importance stress reduction and provides opportunities for future interventions aimed at reducing stress exposure.</p><p><strong>What is known: </strong>• Preterm birth and admission to a Neonatal Intensive Care Unit is very stressful. • High stress exposure in neonatal life is associated with adverse long term outcome.</p><p><strong>What is new: </strong>• Stress exposure is highest in infants with the youngest gestational ages where it remains high or even increases during the first month of life. • Lower gestational age, no antenatal administration of corticosteroids and lower 5-min Apgar score were significantly related with higher daily NeO-stress scores.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"196"},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406402","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":"Understanding kinesiophobia in pediatric bone tumors: investigating its presence and predictive factors.","authors":"Güleser Güney Yılmaz, Müberra Tanrıverdi, Gözde Önal, Ayşenur Baysal Yiğit, Sedef Şahin, Fatma Betül Çakır","doi":"10.1007/s00431-025-06032-9","DOIUrl":"10.1007/s00431-025-06032-9","url":null,"abstract":"<p><p>Primary malignant bone tumors are significant health concerns in children. These tumors, often accompanied by pain, fatigue, and reduced physical function, can lead to the development of kinesiophobia, a fear of movement that can further complicate rehabilitation. Although factors associated with kinesiophobia have been examined in various adult cancer populations, there is limited research on kinesiophobia and its predictors in children with bone tumors. This study aims to investigate the factors contributing to kinesiophobia in pediatric bone tumor patients. This prospective cross-sectional study was conducted in children with primary malignant bone tumors aged 8-17 years who actively on treatment. The Tampa Scale for Kinesiophobia (TSK) was used to assess fear of movement. Other assessments included the numerical rating scale (NRS) for pain, the PedsQL™ Multidimensional Fatigue Scale for fatigue, the Children Depression Rating Scale-Revised (CDRS-R) for depression, manual muscle testing, and the TUG Test for functionality. Logistic regression was performed to identify predictors of kinesiophobia, while chi-square tests examined the relationship between muscle strength and kinesiophobia levels. One hundred children with bone tumors an average age of 11.83 years participated in the study. The logistic regression model indicated that surgery status, pain levels, and fatigue were significant predictors of kinesiophobia, with an R² value of 0.870, explaining 87% of the variance in kinesiophobia levels. Children who had surgery and were in more pain and had higher levels of depression were more likely to exhibit kinesiophobia.</p><p><strong>Conclusion: </strong>This study highlights the multifactorial nature of kinesiophobia in children with malignant bone tumors, emphasizing the roles of surgical status, pain, and psychological factors. Integrating biopsychosocial assessments and approaches into routine care may be important to reduce kinesiophobia, improve rehabilitation outcomes, and increase overall well-being.</p><p><strong>What is known: </strong>• Kinesiophobia has been studied in adult cancer populations and has been associated with decreased physical activity and poorer rehabilitation outcomes.</p><p><strong>What is new: </strong>• This study demonstrates that surgery status, pain levels, and fatigue are significant predictors of kinesiophobia in children with malignant bone tumors and highlights that, in addition to various cancer-related symptoms, kinesiophobia can also be present in this population.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"195"},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise and eating behaviors among Austrian transgender and gender-diverse adolescents.","authors":"Sarah Knaus, Friedrich Teutsch, Jo Steininger, Diana Esteve Alguacil, Stefan Riedl","doi":"10.1007/s00431-025-06014-x","DOIUrl":"10.1007/s00431-025-06014-x","url":null,"abstract":"<p><p>Transgender and gender-diverse (TGD) adolescent populations are at a higher risk for obesity. The aim of this study was to explore possible reasons, such as differences in eating and exercise behaviors. This was a prospective cross-sectional study of TGD adolescent patients at the pediatric endocrinology outpatient clinic of the Vienna General Hospital from January to July 2022. Patients were included in the World Health Organization's Health Behaviour in School-Aged Children (HBSC) survey, which assesses for multiple measures including exercise, eating, and mental wellbeing. We recruited 32 patients via the outpatient clinic, and a further 55 adolescents self-identified as TGD through the survey. Responses from the cohort of 87 TGD adolescents were compared to the Austrian sample containing 10,110 participants. TGD adolescents reported significantly lower levels of physical activity than the national sample, both in instances of vigorous activity (p = 0.002) and any physical activity lasting > 60 min (p < 0.001) per week. Gender variance was here demonstrated to be a strong predictor for physical inactivity levels, even when correcting for low mental health scores. Regarding body image, TGD participants were also more likely to describe themselves as feeling \"too fat\" (p = 0.001). No statistically significant difference in eating behavior was found.</p><p><strong>Conclusion: </strong>The results of this study point towards the complexity of healthcare needs in the TGD adolescent population. The interconnectedness of mental health and exercise behavior is well described. However, qualitative work is needed to understand the specific relationship between gender expression, body image, eating and exercise behaviors, as well as social inclusion.</p><p><strong>What is known: </strong>• Transgender and gender-diverse (TGD) adolescents are at an increased risk for obesity. The causes for this are most likely complex, and remain poorly understood. • Survey studies in the United States and New Zealand have reported reduced levels of physical activity in the TGD population. However, data is scarce, particularly regarding adolescents.</p><p><strong>What is new: </strong>• This prospective, national survey study is the first to demonstrate reduced levels of self-reported physical activity in a cohort of central European TGD adolescents.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"197"},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406399","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":"Correction to: Application of the TIDieR checklist to improve the HFNC use in bronchiolitis management.","authors":"Sara Manti, Antonella Gambadauro, Paolo Ruggeri, Eugenio Baraldi","doi":"10.1007/s00431-025-06027-6","DOIUrl":"https://doi.org/10.1007/s00431-025-06027-6","url":null,"abstract":"","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"193"},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398734","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":"Early assessment of clinical complexity and home care in patients affected by trisomy 13 and 18.","authors":"Anna Zanin, Matteo Patti, Isabella Rosato, Antuan Divisic, Francesca Rusalen, Irene Maghini, Caterina Agosto, Franca Benini","doi":"10.1007/s00431-025-06020-z","DOIUrl":"10.1007/s00431-025-06020-z","url":null,"abstract":"<p><strong>Purpose: </strong>Trisomy 13 and 18 consist of a recurrent pattern of multiple congenital anomalies. The aim of this study was to analyze the clinical characteristics and disease trajectory of a cohort of children with trisomy 13 and 18 followed up by an Italian pediatric palliative care service.</p><p><strong>Methods: </strong>A single-center retrospective observational study was conducted examining the medical records of patients with trisomy 13 and 18 seen in the Pediatric Palliatives Care (PPC) center of the University Hospital of Padua from 2007 to 2022.</p><p><strong>Results: </strong>Seventeen patients were included in the analysis. All were born alive; four children are still alive and only three (23%) died at home. All presented high care complexity, as estimated by ACCAPED index (median 86, range 38-129). The median time to receive care from PPC was 3 months (0-108). All patients' parents shared an advance care plan with the PPC team: 13/17 patients (76%) accepted a do not resuscitate (DNR) order. Approximately 12% of patients received at least one surgery. The trend of survival compared with other cohorts reported in the literature does not appear to differ significantly after the initial stages.</p><p><strong>Conclusions: </strong>The possible recognition of an early evolution toward medical complexity and the availability of home care resources and programs are crucial factors in the management of these children. These indices could become a driving factor in the definition of new outcomes that are more patient-oriented, in addition to mortality.</p><p><strong>What is known: </strong>• Trisomy 13 and 18 are serious genetic conditions with high mortality rates. In the last years medical interventions including surgery are being offered more frequently, though the appropriateness of these interventions is still debated.</p><p><strong>What is new: </strong>• The study emphasizes the crucial role of early referral to specialized pediatric palliative care teams and the coordination they provide enabling families to care for their children at home, even with complex medical needs.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"194"},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular adsorbent recirculating system (MARS®) and continuous renal replacement therapy for the treatment of paediatric acute liver failure - two-centre retrospective cohort study.","authors":"Romit Saxena, Emma C Alexander, Sander Bontemps, Raman Singla, Henkjan J Verkade, Vincent E de Meijer, Martin C J Kneyber, Akash Deep","doi":"10.1007/s00431-025-06013-y","DOIUrl":"10.1007/s00431-025-06013-y","url":null,"abstract":"<p><p>To describe outcomes of a cohort of patients with paediatric acute liver failure (PALF) treated with either one of two extracorporeal therapies (ECT) - continuous renal replacement therapy (CRRT) and molecular adsorbent recirculatory system (MARS®). Retrospective, observational, cohort study at two European paediatric intensive care units (PICUs) - UK (2006-2017, CRRT) and the Netherlands (2003-2017, MARS® and CRRT). Patients were children (0-18 years) admitted to the PICU with PALF who required CRRT or MARS®. Between each group, we compared baseline characteristics, biochemical parameters at 0 and 24 h after commencing MARS®/CRRT, and clinical outcomes. In total, 95 patients (23 MARS®, 72 CRRT) were included. The median age at admission for the whole cohort was 4.3 years (interquartile range (IQR) 1.0-12.1), and 47/95 (49.5%) of patients had an indeterminate aetiology. A lower proportion of patients in the MARS® group were on inotropes or were ventilated at admission, and they had a lower Pediatric Index of Mortality 3 risk % than the CRRT group (14.5% (7.5-22) vs 20.4% (16.8-26.4), p = 0.002). After treatment, there were no significant differences detected between groups in survival with native liver, or overall survival (15/23 (65.2%) for MARS® and 49/72 (68.1%) for CRRT, p = 0.998).</p><p><strong>Conclusion: </strong>We did not detect a significant difference in clinical outcomes between PALF patients treated with CRRT or MARS®, despite a relatively sicker cohort in the CRRT group. Further high-quality evidence is necessary regarding the role of extracorporeal therapies in PALF, with consideration of clinical outcomes, feasibility, and cost.</p><p><strong>What is known: </strong>• Outcomes for children with paediatric acute liver failure (PALF) have improved in recent years secondary to improved supportive care aimed at avoiding liver transplantation. • Extracorporeal therapies, in particular continuous renal replacement therapy (CRRT), are increasingly applied in the management of these children; however few studies have compared outcomes between different extracorporeal therapies.</p><p><strong>What is new: </strong>• In this retrospective study across two centres, outcomes between patients with PALF treated with CRRT were compared to patients treated with MARS®. • There was no significant difference in key clinical outcomes between groups, including survival with native liver and overall survival.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"192"},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive modeling of methadone poisoning outcomes in children ≤ 5 years: utilizing machine learning and the National Poison Data System for improved clinical decision-making.","authors":"Omid Mehrpour, Samaneh Nakhaee, Jafar Abdollahi, Varun Vohra","doi":"10.1007/s00431-024-05957-x","DOIUrl":"https://doi.org/10.1007/s00431-024-05957-x","url":null,"abstract":"<p><p>The escalating therapeutic use of methadone has coincided with an increase in accidental ingestions, particularly among children ≤ 5 years. This study utilized machine learning (ML) methodologies on data from the National Poison Data System (NPDS) to predict pediatric methadone poisoning outcomes to enhance clinical decision-making. We analyzed 140 medical parameters from pediatric patient records. Pre-processing steps, including synthetic oversampling, addressed the imbalanced distribution of the outcome variable. We evaluated various ML models in multiclass classification tasks. Random forest showed versatility with an accuracy of 0.96 and a strong receiver operating characteristic area under the curve (ROC AUC) (0.98). Meanwhile, the support vector machine (SVM) had the highest negative predictive value (NPV) (0.64). Shapley Additive exPlanation (SHAP) analysis identified key predictors such as coma, cyanosis, respiratory arrest, and respiratory depression for predicting serious outcomes.</p><p><strong>Conclusion: </strong>This research emphasizes the utility of ML in clinical settings for early detection and intervention in methadone poisoning events in children, highlighting the synergy between data science and clinical expertise.</p><p><strong>What is known: </strong>• The increased use of methadone for treatment has been associated with a rise in accidental ingestions, particularly in children under five years old. • Methadone poisoning in young children can lead to severe outcomes, including respiratory depression and coma, requiring urgent medical intervention.</p><p><strong>What is new: </strong>• Machine learning models, particularly Random Forest and Bagging, outperform traditional methods in predicting methadone poisoning outcomes in children. • SHAP analysis provides novel insights into key predictors of severe outcomes, enabling improved clinical decision-making and risk stratification.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"186"},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390576","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":"Can viral load predict a symptomatic congenital CMV infection? A systematic review and meta-analysis.","authors":"Serena Salomè, Roberta Gammella, Clara Coppola, Pasquale Dolce, Letizia Capasso, Daniel Blázquez-Gamero, Francesco Raimondi","doi":"10.1007/s00431-025-06015-w","DOIUrl":"10.1007/s00431-025-06015-w","url":null,"abstract":"<p><p>Cytomegalovirus (CMV) is the most common cause of congenital infection. Although only 10% of infected newborns are symptomatic at birth, a clinical disease may develop later in infancy. An early diagnosis of symptomatic congenital CMV is important for successful treatment. The aim of this study was to evaluate if a higher viral load in different biological fluids at the time of diagnosis correlates with symptomatic disease. A systematic search of Medline, Embase, and SCOPUS from 1976 to August 2024 was performed. Studies were included if the viral load was clearly identifiable as median and mean. Two independent reviewers completed screening, full-text review, data extraction, and quality assessment. Study results were reported as median and interquartile range (IQR: Q1-Q3), with group comparisons based on median differences. Pooled estimates of median differences with 95% confidence intervals were obtained using a median-based meta-analysis approach. Of 4558 studies identified, 11 were used in the meta-analysis with a total of 796 patients (376 symptomatic and 420 asymptomatic babies) for blood determinations and 919 patients for urine (331 symptomatic and 588 asymptomatic babies). Symptomatic infants showed significant higher viral load in blood (pooled difference of median = 1.77 × 10⁴, 0.82;2.72 IU/mL) and a trend in urine (pooled difference of median = 339.7 × 10⁴, - 22.2;701.43 IU/mL).</p><p><strong>Conclusion: </strong>In conclusions, we provide preliminary data that a high CMV load in blood and urine may be associated with symptomatic disease in newborns. Wider and more homogeneous evidence is warranted to confirm our conclusions and to identify a threshold for patients at risk of clinical disease.</p><p><strong>What is known: </strong>• CMV is the most common cause of congenital infection and an early diagnosis of symptomatic disease is important for successful treatment. A higher viral load in blood was supposed to correlate with symptomatic disease but with non-unique results and data are lacking for different biological fluids.</p><p><strong>What is new: </strong>• We provide preliminary data that a great CMV load in blood and urine may predict newborns at risk of symptoms. Wider and more homogeneous evidence is warranted to confirm our conclusions and to identify a specific viral load threshold for patients at risk of clinical disease.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"188"},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11814056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}