European Journal of Pediatrics最新文献

{"title":"Awareness, attitudes, and practices concerning the use of indirect evidence in pediatrics: a cross-sectional survey of healthcare professionals in China.","authors":"Yueyan Li, Ying Wang, Ruobing Lei, Qi Zhou, Qiu Li, Yaolong Chen, Janne Estill","doi":"10.1007/s00431-026-07539-5","DOIUrl":"https://doi.org/10.1007/s00431-026-07539-5","url":null,"abstract":"<p><p>The \"evidence gap\" in pediatrics often requires healthcare professionals to use evidence that is not fully direct for the target population, intervention, or context. Despite its critical clinical relevance, the conceptual understanding and practice patterns surrounding indirect evidence among healthcare professionals remain poorly characterized. This study aimed to evaluate the awareness, attitudes, practice patterns, and unmet needs regarding the use of indirect evidence among pediatric healthcare professionals in China. A cross-sectional survey was conducted among clinicians, pharmacists, technicians, researchers, and other professionals working in the field of pediatrics in China. This survey assessed four domains: self-reported awareness, attitudes, practice behaviors, and perceived barriers or support needs. Multivariable proportional-odds ordinal logistic regression was the main analysis of four single-item ordinal outcomes; linear regression was a sensitivity analysis. Multi-item matrix sections were examined using internal-consistency coefficients and exploratory factor analysis. A total of 571 valid responses were included in the final analysis. After reading a brief definition of indirect evidence, 57 participants (10.0%) rated themselves as extremely familiar with the concept. Respondents reported greater confidence in evidence from similar diseases (41.0% reporting high or extremely high confidence) than in adult data (25.0%) or animal studies (20.0%). In a separate item, 295 participants (51.7%) reported being required to base decisions on indirect evidence in their professional routine at least several times per week, and 55.7% reported often or always consulting peers or experts when assessing applicability. In adjusted ordinal models, tertiary-hospital affiliation was associated with a higher category of reported frequency of needing to base decisions on indirect evidence (adjusted OR 1.95, 95% CI 1.25 to 3.03), whereas master's or doctoral education was associated with a lower category than bachelor's degree or below (adjusted OR 0.58, 95% CI 0.38 to 0.89). The most frequently reported barrier was the absence of unified, standardized evaluation processes or tools.</p><p><strong>Conclusion: </strong> Our findings suggest a substantial perceived need for structured guidance and tools to support the appraisal and application of indirect evidence in pediatric practice. Pediatric healthcare professionals in China reported awareness of the evidence gap and willingness to consider indirect evidence, but also reported low confidence, limited use of standardized methods, and substantial reliance on informal, experience-based approaches. These findings identify perceived needs that may inform the development and evaluation of user-friendly frameworks, targeted training programs, and supportive institutional policies.</p><p><strong>What is known: </strong>• Pediatric evidence gaps often require professionals to consider indirect evid","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227489","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":"Carbapenem resistance and mortality in pediatric Acinetobacter bloodstream infections: determinants from a 12-year tertiary-care cohort study.","authors":"Suleyman Emre Karauzum, Ece Erci, Gulizar Koc, Pinar Yazici Ozkaya, Ezgi Kiran Tasci, Miray Karakoyun, Gulcihan Ozek, Eda Ataseven, Demet Terek, Melike Yasar Duman, Fatma Feriha Cilli, Zumrut Sahbudak Bal, Gulhadiye Avcu","doi":"10.1007/s00431-026-07518-w","DOIUrl":"https://doi.org/10.1007/s00431-026-07518-w","url":null,"abstract":"<p><p>Carbapenem-resistant (CR) Acinetobacter spp. bloodstream infections (BSIs) are difficult to treat in children, yet pediatric data on factors associated with resistance and mortality remain limited. We aimed to identify factors associated with carbapenem resistance and 30-day mortality in pediatric Acinetobacter BSIs. We retrospectively analyzed children with monomicrobial Acinetobacter BSIs at a tertiary-care university hospital between January 2014 and September 2025. Factors associated with carbapenem resistance were assessed using co-primary logistic regression analyses in the full cohort and within A. baumannii; 30-day mortality was assessed using Cox regression. Among 128 episodes, median age was 2.0 years (IQR 0.76-8.01), 60.2% (77/128) were male and 90.6% (116/128) had comorbidities. Carbapenem resistance was identified in 54/128 episodes (42.2%), all caused by A. baumannii (54/87, 62.1%). Increasing age, longer hospitalization before BSI onset, mechanical ventilation (MV), and prior meropenem exposure were associated with resistance in both co-primary models. Adjusted ORs for MV were 23.77 (95% CI, 7.54-74.92) in the full cohort and 23.20 (95% CI, 5.39-99.95) within A. baumannii. Overall 30-day mortality was 13.3% (17/128) and was higher in CR than carbapenem-susceptible episodes (22.2% versus 6.8%; p = 0.011). Exploratory comparisons across CR A. baumannii treatment categories were inconclusive (exact p = 0.256). Thrombocytopenia (aHR, 6.12; 95% CI, 2.13-17.61) and carbapenem resistance (aHR, 3.01; 95% CI, 1.04-8.71) were associated with mortality in the primary Cox model.</p><p><strong>Conclusion: </strong> Thrombocytopenia and carbapenem resistance were associated with 30-day all-cause mortality in the primary adjusted analysis; the resistance association was not statistically significant in A. baumannii-restricted and first-episode-only sensitivity analyses.</p><p><strong>What is known: </strong>• Acinetobacter BSIs mainly affect medically complex hospitalized children. • Pediatric evidence on factors associated with carbapenem resistance and mortality remains scarce.</p><p><strong>What is new: </strong>• Increasing age, longer hospitalization before BSI onset, mechanical ventilation, and prior meropenem exposure were associated with carbapenem resistance in both the full Acinetobacter cohort and within A. baumannii. • Carbapenem resistance was associated with 30-day mortality in the primary model, but this finding was not consistently supported in sensitivity analyses; thrombocytopenia remained associated with mortality.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223605","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":"Impact of ¹³¹I-MIBG dose escalation (12 vs. 18 mCi/kg) during conditioning for autologous hematopoietic stem cell transplantation in pediatric neuroblastoma: a retrospective cohort study.","authors":"Amirali Kalantari, Maryam Behfar, Zahra Karimizadeh, Atieh Karimzadeh, Zeinab Paymani, Saeed Farzanehfar, Mehrshad Abbasi, Arghavan Tajalli, Sarina Ansari, Pooya Ashkevari, Rashin Mohseni, Najibe Karami, Amir Ali Hamidieh","doi":"10.1007/s00431-026-07523-z","DOIUrl":"https://doi.org/10.1007/s00431-026-07523-z","url":null,"abstract":"<p><p>This study aimed to evaluate whether dose escalation of ¹³¹I-meta-iodobenzylguanidine (¹³¹I-MIBG) from 12 to 18 mCi/kg improves survival, engraftment, or toxicity profiles in children with high-risk neuroblastoma undergoing autologous HSCT. We retrospectively analyzed 56 pediatric patients under 18 years of age with high-risk, MIBG-avid neuroblastoma who underwent autologous HSCT between 2016 and 2025. Patients received either 12 mCi/kg (n = 17) or 18 mCi/kg (n = 39) of ¹³¹I-MIBG as part of a myeloablative chemotherapy conditioning regimen. Outcomes included engraftment, overall survival (OS), and event-free survival (EFS). Twenty-one deaths had occurred (8/17 [47.1%] in the 12 mCi/kg group; 13/39 [33.3%] in the 18 mCi/kg group). OS at 1 and 5 years was 76.5% and 59.5% for the 12 mCi/kg group, compared with 76.6% and 58.2% for the 18 mCi/kg group (log-rank p = 0.786). EFS at 1 and 5 years was 45.3% and 38.8% for the 12 mCi/kg group, compared with 69.1% and 36.2% for the 18 mCi/kg group (log-rank p = 0.656). Furthermore, at 1-year post-HSCT, the 18 mCi/kg group demonstrated a significantly higher rate of normal MIBG scans (83.3% vs. 46.2%, p = 0.024). Neutrophil engraftment was faster in the 18 mCi/kg group (median 10 vs 12 days; p = 0.001). Platelet engraftment was also more frequent in the 18 mCi/kg group (92.3% vs 70.6%; p = 0.047), with similar time to engraftment (16 vs 16.5 days).</p><p><strong>Conclusion: </strong> In this retrospective cohort, escalation from 12 to 18 mCi/kg was associated with faster neutrophil engraftment and a higher rate of normal MIBG scans at 1 year, without a significant difference in OS or EFS. The study was underpowered, and did not demonstrate a significant benefit of either the lower or the higher dose; the optimal dose remains undetermined and requires prospective evaluation.</p><p><strong>What is known: </strong>• ¹³¹I-MIBG is incorporated into conditioning regimens prior to autologous HSCT for high-risk pediatric neuroblastoma, with doses up to 18 mCi/kg being tolerable, but the optimal dose and its impact on long-term survival remain unclear.</p><p><strong>What is new: </strong>• In this direct retrospective comparison (12 vs. 18 mCi/kg), the higher dose was associated with faster neutrophil engraftment and a higher platelet engraftment rate and a higher rate of normal MIBG scans at year, but without a significant difference in OS or EFS, and with a non-significant trend toward more renal and thyroid toxicity. The study was underpowered and did not demonstrate a significant benefit of either dose; the optimal MIBG dose remains undetermined.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223632","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":"TasTY: Development and evaluation of a taste test for quantifying taste sensitivity among preschool children-test-retest reliability, application, and comparison between children with and without prior SARS-CoV-2 infection.","authors":"Johannes Weißenfeld, Christoph Maier, Christine H Meyer-Frießem, Anna Teresa Hoffmann, Thomas Lücke, Anne Schlegtendal","doi":"10.1007/s00431-026-07534-w","DOIUrl":"10.1007/s00431-026-07534-w","url":null,"abstract":"<p><p>Taste dysfunction gained attention during the coronavirus disease 2019 (COVID-19) pandemic; however, validated objective tests for preschool children remain limited. We aimed to develop a feasible, reliable test quantifying taste sensitivity among children aged 3-6 years and to compare performance between children with and without prior SARS-CoV-2 infection. We included 68 symptom-free children (median age 5.1 years; interquartile range (IQR) 3.9-5.9): 36 without known SARS-CoV-2 infection (control group, CG) and 32 with confirmed prior infection (SARS-CoV-2 infection group, C19-G), tested 79 days after infection (median; IQR 56-112). Children completed a self-developed Taste Test for Young Children (TasTY), a double-blind, playful two-alternative forced-choice test with 10 samples in randomized order (sweet, sour, and salty at three concentrations each; water served as a control). Twenty controls were retested a median of 62 days later (IQR 38-64). Outcomes were total score (0-10), feasibility, task comprehension, and test-retest reliability, assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest real difference (SRD). Feasibility was high (3% dropout), and 89.4% correctly classified water. Total score test-retest reliability was good (ICC = 0.73; pooled SEM = 0.76; SRD = 2.11). Total scores were similar between CG and C19-G (8.37 ± 1.5 vs. 8.19 ± 1.5; p = 0.63). Descriptively, three-year-olds (n = 17) had lower, more variable scores.</p><p><strong>Conclusion: </strong>TasTY provides an age-appropriate, reliable, objective method for quantifying taste sensitivity among preschoolers, supporting standardized group comparisons and longitudinal assessment.</p><p><strong>What is known: </strong>• COVID-19 increased awareness of taste dysfunction; however, evidence among young children relies mainly on surveys and parental reports. • Objective taste tests for preschool children remain limited.</p><p><strong>What is new: </strong>• TasTY is a feasible, standardized, and objective test for quantifying taste sensitivity among children aged 3-6 years and goes beyond parental and subjective reports. • Its standardized 0-10 score showed good test-retest reliability and may support group comparisons and longitudinal assessment of preschool children with taste-related conditions.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220091","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":"Noninvasive urinary biomarkers 3-bromotyrosine and leukotriene E4 in assessing asthma control and flare-up in children: a case-control study.","authors":"Krishna Kumar Yadav, Nitesh R Gupta, Sunita Yadav, Manish Raj Kulshrestha, Dipti Agarwal, Lalit Takia","doi":"10.1007/s00431-026-07516-y","DOIUrl":"https://doi.org/10.1007/s00431-026-07516-y","url":null,"abstract":"&lt;p&gt;&lt;p&gt;To assess urinary biomarkers 3-bromotyrosine and leukotriene E4 (LTE4) levels in children with asthma and their association with asthma control and flare-up. This was a prospective study which applied a case-control design with 2:1 ratio. Children aged 3 to 15 years diagnosed with asthma according to the GINA 2022 guidelines were included. Measurements of urinary 3-bromotyrosine and LTE4 values were done using liquid chromatography-mass spectrometry. The asthma group (n = 146) had significantly higher urinary 3-bromotyrosine levels (22.58 ± 8.15 ng/mg creatinine) compared to healthy controls (n = 73) (14.53 ± 1.27 ng/mg creatinine, p &lt; 0.001). Children with asthma flare-up exhibited significantly higher urinary 3-bromotyrosine levels (32.14 ± 7.76 ng/mg creatinine) compared to those with well-controlled asthma (17.16 ± 5.48 ng/mg creatinine, p &lt; 0.001). Levels of 3-bromotyrosine decreased significantly after symptom control in hospitalized flare-up cases. Similarly, urinary LTE4 levels were significantly higher in the asthma group (308.40 ± 90.13 pg/mg creatinine) than controls (84.54 ± 18.27 pg/mg creatinine, p &lt; 0.001). A significant difference in LTE4 levels was observed between well-controlled and flare-up cases. Urinary LTE4 levels also decreased following symptom control in hospitalized children. Both 3-bromotyrosine and LTE4 levels showed similar patterns of increase and decrease across asthma subgroups (well-controlled and flare-up). The Pearson's correlation coefficient between 3-bromotyrosine and LTE4 was r = 0.58 (p &lt; 0.001). The ROC curve analysis demonstrated that both biomarkers moderately predict severity of asthma. The area under the curve for predicting flare-up was higher for LTE4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt; Noninvasive urinary biomarkers, 3-bromotyrosine, and LTE4 were elevated in asthma and flare-up. Both biomarkers exhibited similar trends, with levels rising or falling according to asthma control status. The area under the curve to severity of asthma was higher for LTE4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Asthma in children is associated with airway inflammation; several inflammatory biomarkers correlate with disease activity. Non-invasive biomarkers are increasingly preferred in children because blood sampling and invasive procedures can be difficult. • Urinary biomarkers have been investigated in asthma, particularly markers related to oxidative stress, leukotriene metabolism, eosinophilic inflammation, and mast-cell activation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• Demonstrates that both non-invasive urinary biomarkers, 3-bromotyrosine and LTE4, are significantly elevated in children with asthma compared with healthy controls, and their higher levels are associated with poor disease control and flare-up. Both 3-bromotyrosine and LTE4, levels showed similar patterns of increase and decrease across asthma subgroups. • The Pearson's correlation coefficient between 3-bromotyrosine and LTE4 was r=0.58. The ","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220054","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":"Paediatric Helicobacter pylori infection and allergic and inflammatory diseases: a contemporary systematic review with meta-analysis.","authors":"Marta Tavares, André Ferreira, Ema Campo, Ermelinda Santos Silva, Rosa Lima, Ana Isabel Lopes","doi":"10.1007/s00431-026-07512-2","DOIUrl":"https://doi.org/10.1007/s00431-026-07512-2","url":null,"abstract":"<p><p>Helicobacter pylori (H. pylori) infection is prevalent worldwide, and its potential protective role in allergic and immune diseases has been a topic of speculation. This systematic review aims to analyse recent literature to establish a consensus on this relationship. Articles published in the past 12 years regarding association of H. pylori and various allergic diseases were screened. Thirty-five articles from three databases were assessed for bias using the ROBINS-E tool. Objective data from each article were collected for this review. Among the reviewed articles, 14 focused on asthma, 10 on eliac disease(CeD), 5 on eosinophilic esophagitis (EoE), 7 on inflammatory bowel disease (IBD), and 8 on mixed conditions. In the asthma meta-analysis, H. pylori infection was not significantly associated with asthma overall (OR 0.75, 95% CI 0.54-1.05; I² = 67.3%). Subgroup analyses showed an inverse association in studies using UBT/SAT, whereas histology-based studies showed no association. Low-risk-of-bias studies likewise showed no significant association. Results for celiac and IBD were mixed. No clear trends were observed for the other conditions analysed.</p><p><strong>Conclusion: </strong> Current paediatric evidence does not demonstrate a significant overall association between H. pylori infection and asthma. Apparent inverse associations were confined to specific diagnostic and risk-of-bias subgroups. Evidence for celiac disease, IBD, EoE, and other immune-mediated disorders remains inconsistent. More prospective paediatric studies are needed to understand the immune modulation of H. pylori infection.</p><p><strong>What is known: </strong>• The relationship between Helicobacter pylori infection and allergic or immune-mediated diseases remains complex and incompletely understood. • Previous studies, including mixed studies with adult and paediatric populations, have reported inconsistent and sometimes conflicting associations.</p><p><strong>What is new: </strong>• This is the first comprehensive paediatric review covering multiple conditions simultaneously, synthesising evidence on the association between Helicobacter pylori infection and allergic and immune-mediated diseases. • Analysis of paediatric data found no overall association between H. pylori infection and asthma risk. Histology-based studies confirmed this finding, whereas a slight inverse association was observed only in studies using non-invasive diagnostic methods (UBT or SAT) and in those with a higher risk of bias.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223547","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":"Family screening for genetic cardiomyopathies in ECG-positive phenotype-negative adolescents: a joint clinical and genetic approach.","authors":"Mark Abela, Jessica Debattista, Jeanesse Scerri, Tiziana Felice, Victor Grech, Christian Scerri","doi":"10.1007/s00431-026-07524-y","DOIUrl":"10.1007/s00431-026-07524-y","url":null,"abstract":"<p><p>Adolescents may present with abnormal ECG findings despite having no structural or electrical evidence of cardiomyopathy. The value of extending family screening to this subgroup remains uncertain. To evaluate the impact of family screening in ECG-positive phenotype-negative adolescents, and determine whether a joint clinical-genetic approach improves the diagnostic yield. In this prospective cohort study, adolescents with an abnormal ECG identified through a nationwide screening program underwent comprehensive clinical/genetic evaluation. Phenotype-negative individuals were included. Relatives underwent clinical screening, with cascade genetic testing offered when probands carried a likely/definite pathogenic (LP/P) cardiomyopathy variant. Abnormal screening outcomes included relatives with (i) de novo cardiomyopathy diagnosis, (ii) early cardiomyopathic traits, or (iii) gene-positive/phenotype-negative (G + P -) status. Sixteen adolescents (0.6%) met inclusion criteria, and 3 (18.8%) were G + (MYBPC3, MYH7, ACTC1). One in five relatives (n = 13/71, 18.3%; 95% CI 11.0-28.9%) were referred, most having an abnormal ECG (12.7%). Nine relatives (12.7%; 95% CI 4.9-20.4%) exhibited early cardiomyopathy traits at baseline. One (1.4%) relative was G + /P - . Cardiomyopathy was diagnosed in 3 (4.2%, 95% CI 0.9-11.8%) relatives at baseline (n = 2 HCM, n = 1 DCM). One relative with early cardiomyopathy traits underwent phenoconversion (NDLVC) during follow-up at 77 months, yielding an overall diagnostic rate of 5.6% (95% CI 2.0-13.8%) in 4 unrelated families. A joint clinical-genetic approach enabled personalized surveillance in 6 relatives (8.5%), including 2 (2.8%) diagnoses that would otherwise have been missed with conventional clinical screening.Conclusion: One in five relatives of ECG‑positive phenotype‑negative adolescents received a cardiomyopathy diagnosis or had early cardiomyopathy traits. A joint clinical-genetic approach in this subgroup may aid early cardiomyopathy detection in selected families, though findings remain exploratory and require validation in larger cohorts. What is Known - What is New: •Resting ECG can identify individuals harboring conditions linked to sudden cardiac death •The penetrance of cardiomyopathy is age dependent, which explains why screened adolescents may exhibit abnormal ECG patterns in the absence of a cardiomyopathy diagnosis •Our data indicate that extending screening to relatives of ECG-positive, phenotype-negative adolescents is justified, with one in five relatives receiving a new cardiomyopathy diagnosis (5.6%) or exhibiting early cardiomyopathy traits (11.3%) •A joint clinical/genetic evaluation in this context may help personalize screening strategies.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13680340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223579","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":"Association between PM_2.5 and coronary artery dilatation with Kawasaki disease in China.","authors":"ZhiMeng Huang, ShuHan Huang, YaXuan Lin, WenXing Guo, YiRong Li, JinXuan Fang, MengNan Chen, Guixia Chen, Xiaoqing Yang, JinZhun Wu, LiLin Zhong","doi":"10.1007/s00431-026-07527-9","DOIUrl":"https://doi.org/10.1007/s00431-026-07527-9","url":null,"abstract":"<p><p>Kawasaki disease is an acute febrile systemic vasculitis that predominantly affects children and can lead to coronary artery dilatation (CAD), coronary artery aneurysm, and/or thrombosis. This study aimed to investigate whether exposure to particulate matter with a diameter of 2.5 µm (PM_2.5) is associated with an increased risk of CAD. A case-crossover study was conducted to investigate the relationship between PM_2.5 exposure and coronary Z value in children. The study included 847 participants from 2017 to 2021. The Z value was calculated for each participant, and PM_2.5 exposure levels were assigned. The risk effect of PM_2.5 on the Z value was assessed using the distributed lag Poisson generalized linear model. Correlation and mediation analyses were performed to explore the mechanisms underlying CAD, and sensitivity analysis was conducted to verify the stability of the model. PM_2.5 exposure was found to increase the risk of CAD at lag 2-4 days. On the 3rd day of lag, PM_2.5 exposure led to the highest risk of CAD, with RR = 1.11, (95%CI = 1.02, 1.21). Mediation analysis showed that PM_2.5 may induce CAD through C-reactive protein (CRP), alanine aminotransferase (ALT) and hemoglobin (HB), and the effect size was significant, indicating that CRP, ALT and HB were the main mediating factors between PM_2.5 and CAD.</p><p><strong>Conclusion: </strong> Our results suggest that PM_2.5 exposure is a potential risk factor for CAD in children. CRP, alanine aminotransferase, and hemoglobin were identified as the main mediators regulating the relationship between PM_2.5 and CAD.</p><p><strong>What is known: </strong>• PM2.5 may lead to an increased incidence of Kawasaki disease in children.</p><p><strong>What is new: </strong>• We found that inhalation of PM2.5 may cause coronary artery dilatation in Kawasaki disease through a population-based cohort study. • This process may be mediated by increasing C-reactive protein. • The model results remained stable after sensitivity analysis.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223609","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":"Complete blood count-derived inflammatory indices versus C-reactive protein for identifying complicated appendicitis in children: a retrospective cohort study.","authors":"Sabri Cansaran, Özlem Balcı, Serdar Moralıoğlu","doi":"10.1007/s00431-026-07528-8","DOIUrl":"https://doi.org/10.1007/s00431-026-07528-8","url":null,"abstract":"<p><p>The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are increasingly proposed for identifying complicated appendicitis in children, yet reported cut-offs vary widely and are seldom externally validated. We aimed to test the limits of these indices for identifying complicated appendicitis in a large pediatric cohort, using C-reactive protein (CRP) as the benchmark. This study evaluates the laboratory ceiling of these indices rather than complete diagnostic risk stratification. We retrospectively studied 422 children with histopathologically confirmed appendicitis (2012-2026), of whom 158 (37.4%) had complicated disease defined by intraoperative findings. Discrimination for complicated appendicitis was assessed by the area under the ROC curve (AUC) and compared with CRP (DeLong test). We additionally applied previously published pediatric cut-offs to our cohort, examined discrimination across developmental age strata and after age-normalization, assessed added value over CRP, and tested temporal stability across two consecutive periods. CRP discriminated complicated appendicitis better (AUC 0.812) than NLR (0.641), SII (0.641), or PLR (0.604; all p < 0.001 versus CRP), and the white cell count alone performed as well as the indices. None of five published cut-offs transported to a clinically useful accuracy (45.7-63.5%). In children aged 2-7 years-those with the highest proportion of complicated disease (52.7%)-the indices showed no evidence of discrimination (AUC 0.475-0.495), whereas CRP retained its highest discrimination (0.863); age-normalization did not help. Added to a CRP-based model, NLR and SII contributed statistically but slightly (ΔAUC + 0.018 and + 0.016), while PLR did not. Between the two periods, index values fell significantly despite an unchanged proportion of complicated disease, and an earlier-derived threshold lost approximately ten points of sensitivity in the later period; the CRP threshold instead lost specificity while retaining sensitivity, so no marker was fully stable, although discrimination was preserved for all and the median CRP was unchanged. Conclusion: NLR, PLR, and SII offer limited and unstable value for identifying complicated appendicitis in children. They are consistently outperformed by CRP, discriminate poorly in the youngest children in whom the distinction matters most, and depend on thresholds that transport poorly between settings and over time. These indices are best regarded as continuous adjuncts to CRP rather than standalone tests.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215398","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":"Aspirin dose and coronary artery lesions in Kawasaki disease: a two-center retrospective comparative effectiveness study.","authors":"B N Zhao, L X Ai, H L Huang, Y Liu, H J Ma, Q Gao, X P Lei","doi":"10.1007/s00431-026-07521-1","DOIUrl":"https://doi.org/10.1007/s00431-026-07521-1","url":null,"abstract":"<p><p>Coronary artery lesions (CAL) are the most common complication of Kawasaki disease (KD). Chinese guidelines recommend aspirin at 30-50 mg/kg/day during the acute phase, yet whether the dose within this range affects coronary outcome remains unclear. We retrospectively analyzed 997 children with complete or incomplete KD who received IVIG plus aspirin at two tertiary hospitals in Sichuan, China, from January 2017 to December 2025. Low-dose aspirin (30 to < 40 mg/kg/day; n = 630) was compared with high-dose (40 to 50 mg/kg/day; n = 367). Confounders were selected by intersecting a directed acyclic graph (Supplementary Fig. S1) with univariate screening at P < 0.10, yielding a final multivariable model of 7 predictors (136 CAL events; events-per-variable ratio of 19.4). Linearity of the continuous covariates and the absence of multicollinearity were verified (Supplementary Tables S1-S2). The dose-response relation was examined with restricted cubic splines, and inverse probability of treatment weighting (IPTW) was added as a sensitivity analysis. CAL at 4 weeks occurred in 13.5% of the low-dose group and 14.7% of the high-dose group (P = 0.658), with an adjusted OR of 0.94 (95% CI 0.64-1.38; P = 0.752). IVIG non-response was similar (4.1% vs 3.8%; P = 0.940), whereas aspirin-related adverse drug reactions were twice as frequent with high-dose aspirin (3.0% vs 6.3%; P = 0.021). The spline showed no significant linear (P = 0.253) or non-linear (P = 0.547) dose-response trend. IPTW yielded an OR of 0.95 (95% CI 0.65-1.38), and the doubly robust estimate was 0.95 (95% CI 0.65-1.40).</p><p><strong>Conclusions: </strong> Within the guideline-recommended 30-50 mg/kg/day window, no significant differences were detected between low- and high-dose aspirin in coronary or IVIG non-response outcomes, while the lower dose halved adverse drug reactions. Although equivalence cannot be formally demonstrated in an observational study, these data suggest that 30 to < 40 mg/kg/day may be the preferable choice during the acute phase of KD in Chinese children.</p><p><strong>What is known: </strong>• Chinese guidelines recommend aspirin at 30-50 mg/kg/day during the acute phase of KD, yet comparative coronary outcome data within this dose range remain limited.</p><p><strong>What is new: </strong>• In a two-center cohort of 997 children, low-dose (30 to < 40 mg/kg/day) and high-dose (40 to 50 mg/kg/day) aspirin produced similar coronary artery lesion rates and IVIG non-response rates, whereas the lower dose halved the rate of adverse drug reactions.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215450","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}