European Journal of Pediatrics最新文献

{"title":"Characterisation and non-pharmacological treatment of Complex Regional Pain Syndrome in under-18-year-olds: a scoping review.","authors":"Mahira Budhraja, Ryan Purvis, Katrina Tang, Jennifer Lewis","doi":"10.1007/s00431-026-07027-w","DOIUrl":"https://doi.org/10.1007/s00431-026-07027-w","url":null,"abstract":"<p><p>The aim of this review was to explore the published literature describing the presentation, characteristics, and non-pharmacological treatments of Complex Regional Pain Syndrome (CRPS) in under 18-year-olds. This scoping review was conducted in line with the Preferred Reporting Guidelines for Scoping Reviews (PRISMA-ScR). Five online databases (AMED, CINAHL + , EMBASE, EBSCO, and MEDLINE) were systematically searched with identified key terms for relevant records and screened against the eligibility criteria. Extracted data from the included studies informed a narrative synthesis. The PAGER framework was used to succinctly present gaps in the field and recommend future directions for research. Online searches yielded 140 articles. Following screening, 30 articles were included for review. Findings suggest primary symptoms included extreme pain, allodynia, and nail changes. The Budapest criteria, radiography, bone scans and laboratory examinations were commonly used diagnostic methods. Various non-pharmacological interventions were used, such as physiotherapy (home exercise), hydrotherapy, desensitisation, and cognitive behavioural therapy.</p><p><strong>Conclusion: </strong> The most common symptom in children is severe pain that is disproportionate to the inciting event. Critical gaps in the evidence base such as the absence of age appropriate, validated diagnostic criteria, lack of research understanding the lived experience and impact of the condition or exploring treatment efficacy, were identified as knowledge gaps within the field.</p><p><strong>What is known: </strong>• Complex Regional Pain Syndrome is a difficult to diagnose and hard to treat pain condition. Among children, it is not well documented or understood, there are no agreed diagnostic criteria or treatment guidelines.</p><p><strong>What is new: </strong>• This scoping review summarises and presents the published research regarding presentation, diagnosis and non-pharmacological treatment of paediatric CRPS. • Issues relating to the use of treatments lacking demonstrable efficacy and the need for quick and reliable diagnoses are discussed. • Using the PAGER Framework, this review exposes critical gaps in both research (the lack of research around condition experience and treatment efficacy) and practice (the lack of validated diagnostic criteria and treatment pathways) outlining clear and urgent recommendations.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835253","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":"Diagnostic accuracy of artificial intelligence versus 263 pediatric clinicians for childhood exanthems.","authors":"Mustafa Gençeli, Özge Metin Akcan, Gonca Başak Soran, Abdulkerim Çokbiçer, Uğur Saraç, Talha Üstüntaş, Mehtap Yücel, Methiye Doğan, Ezgi Yılık Kömür, Sipil Gençeli, Hatice Yılmaz Dağlı, Memduha Sarı, Ahmet Osman Kılıç, Süleyman Şahin, Abdullah Akkuş","doi":"10.1007/s00431-026-07044-9","DOIUrl":"https://doi.org/10.1007/s00431-026-07044-9","url":null,"abstract":"<p><p>Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents (P = .001; ε² = 0.13).Conclusions: AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856018","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":"Rate and timing to clinical remission in celiac children on a gluten-free diet.","authors":"Francesca Sbravati, Carolina Arsani, Davide Gori, Beatrice De Palo, Irene Frigo, Chiara Del Bono, Sara Brintazzoli, Gilda Barbieri, Flavio Labriola, Patrizia Alvisi","doi":"10.1007/s00431-026-07035-w","DOIUrl":"https://doi.org/10.1007/s00431-026-07035-w","url":null,"abstract":"<p><p>This observational retrospective study describes the rate and time of symptom resolution in celiac disease (CD) in a cohort of pediatric patients following a gluten-free diet (GFD). We evaluated the rate and time to symptom resolution after starting a GFD, as well as associated predictive factors (age, gender, comorbidities, familial history, IgA anti-transglutaminase antibodies (TGA-IgA) at diagnosis, dietary adherence), in children diagnosed with CD between 2014 and 2022 at the Gastroenterology Unit of Maggiore Hospital, Bologna. The minimum follow-up period was 6 months. Of 421 symptomatic patients at diagnosis, 77.4% presented gastrointestinal symptoms (GIs) (40.6% recurrent abdominal pain, 19.5% diarrhea, 21.6% constipation, 17.3% bloating), 47.5% extra-intestinal symptoms (EISs) (16.4% neurological symptoms, 9.0% anemia), and 33.5% growth retardation (31.6% failure to thrive, 17.8% short stature). 96.7% had a high GFD adherence through follow-up. The overall symptom resolution rate was 84.8% (GIs 89.0%, EISs 92.6%, growth retardation 87.4%). Constipation had a significantly lower resolution rate compared to other GIs (p = 0.02) or diarrhea (p = 0.03). In total, 81.7% of patients achieved symptom resolution within 12 months. Short stature and anemia resolved more slowly compared to other symptoms. TGA-IgA normalization and GFD adherence were significant predictors of symptom resolution.</p><p><strong>Conclusion: </strong> Most symptoms resolved within the first year of diagnosis. The lower resolution rate for constipation compared to other GIs suggests a functional etiology, while the delayed recovery of anemia and short stature likely reflects their complex etiology. Serological normalization and GFD adherence are confirmed as predictors of clinical remission.</p><p><strong>What is known: </strong>• Time to clinical remission in celiac children after starting a gluten-free diet may vary between different symptoms. • Clinical remission is associated with serological normalization and adherence to diet.</p><p><strong>What is new: </strong>• Constipation has a significantly poorer rate of resolution among other gastrointestinal symptoms, due to its functional etiology, while anemia and short stature resolve slightly slower. • Most patients reach clinical remission within the first year on a gluten-free diet; serological normalization and diet adherence are confirmed to be predictors of clinical remission.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856054","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":"A multidisciplinary paediatric endocrine genetic clinic: experience from a single tertiary centre.","authors":"E Chen, R McGowan, M G Shaikh","doi":"10.1007/s00431-026-06982-8","DOIUrl":"https://doi.org/10.1007/s00431-026-06982-8","url":null,"abstract":"<p><p>Multidisciplinary care is vital to the smooth running of patient-centred care, especially in the context of rare conditions. This service evaluation aimed to determine the potential benefits of a combined paediatric endocrine genetic clinic at a tertiary hospital, including increased diagnostic rates. Retrospective review of case notes of patients who attended the combined clinic at the Royal Hospital for Children, Glasgow, between 2022 and 2024 was done. Data collected included the type of genetic testing which had been performed, diagnostic yield and clinical outcomes. The data were evaluated qualitatively. A total of 21 patients (median age 5.3 years, range 6 months to 21 years) were included. Then, 43% were given a new genetic diagnosis, the greatest diagnostic yield occurring from whole-exome sequencing and MS-MLPA, with 67% of patients referred for further specialist input or investigations after attendance at the clinic.</p><p><strong>Conclusion: </strong> This study brings to light the benefits of a multidisciplinary endocrine-genetics clinic in the management of an under-researched patient cohort. It offers a streamlined diagnostic pathway with high diagnostic yield and improved patient experience. This clinic also highlighted the need for specialist input after genetic diagnoses were made to improve long-term health outcomes. However, limitations are its retrospective nature and absence of patient-reported outcomes; there is a need for future prospective research.</p><p><strong>What is known: </strong>• The results of genetic testing can be challenging to interpret without specialist input. • MDT clinics improve care coordination and diagnostic decision-making in complex multisystem conditions.</p><p><strong>What is new: </strong>• This study is the first UK-based study evaluating a combined paediatric endocrine-genetics clinic. • The clinic streamlined care by reducing the need for multiple appointments, directed genetic testing and tailoring management plans.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835280","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":"Cerebral gliomas in adolescents and young adults: a scoping review of evidence gaps in diagnosis, treatment, and prognosis.","authors":"Venanzi Maria Sole, Galli Elia, Pesaresi Alessandro, Pavanello Marco, Piatelli Gianluca, Fiaschi Pietro, Zona Gianluigi, Gaggero Gabriele, Bianconi Andrea","doi":"10.1007/s00431-026-07041-y","DOIUrl":"https://doi.org/10.1007/s00431-026-07041-y","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Cerebral gliomas represent a heterogeneous group of tumours that pose unique diagnostic and therapeutic challenges. Adolescents and young adults (AYAs, 15-39 years) often fall into a clinical gap, receiving care modelled on paediatric or adult oncology, which may not address their distinct biological and psychosocial needs. A review was conducted to systematically map the existing literature on cerebral gliomas in AYAs and identify evidence gaps in diagnosis, treatment, and prognosis. Our scoping review was conducted following PRISMA-SR guidelines, using PubMed and Scopus to identify studies on gliomas in AYAs. Eligibility criteria consisted of articles focused on gliomas in AYAs, published in English between 2000 and 2024. Studies exclusively focused on AYA populations, as well as studies including AYAs within mixed populations, were considered eligible. Extracted data included study characteristics, population, interventions, and outcomes (survival, quality of life, molecular markers), which were synthesised thematically into epidemiology, molecular/histological profiles, treatments, outcomes, and psychosocial impacts. Our systematic review identified 33 studies on gliomas in AYAs. Most of the included studies (62.5%, n = 20) were published between 2020 and 2024. Geographically, the studies were primarily conducted in the USA (25%, n = 8), followed by Canada (9.4%, n = 3) and Europe (9.4%, n = 3). From an epidemiological perspective, gliomas were the most common cerebral tumours. Molecular analyses revealed overlap between pediatric- and adult-type alterations, emphasising diagnostic ambiguity and the need for comprehensive profiling. Treatment reports underscored surgery as central, with emerging roles for proton therapy, targeted agents, and immunotherapy, although the lack of AYA-specific trials remains a barrier. Prognostic and psychosocial studies highlight survival disparities associated with molecular markers and socioeconomic factors, as well as unmet needs related to fertility preservation, neurocognition outcomes, and palliative care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The review identified major gaps, such as heterogeneous adoption of advanced diagnostic approaches, the absence of age-specific treatment protocols, and scarce research on long-term outcomes and quality of life in AYAs with gliomas. Addressing these issues requires AYA-focused clinical trials within a multidisciplinary care framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Gliomas in adolescents and young adults (AYAs) present overlapping molecular and clinical features of paediatric and adult-type gliomas, determining diagnostic and therapeutic challenges in everyday care. • Current management of glioma in AYAs is usually extrapolated from paediatric or adult populations, with limited AYA-specific trials, without the presence of evidence-based guidlines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• Our review has the aim to map the existing literature on cerebral gliom","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856081","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":"Feasibility, reproducibility, clinical value of the VExUS score after pediatric cardiac surgery and main differences from adults' perspective.","authors":"Daniel Palanca Arias, Marcos Clavero Adell, Aida Lorente López, Ariadna Ayerza Casas, Victoria Estabén Boldova, Irene Gil Hernández, Almudena Alonso Ojembarrena","doi":"10.1007/s00431-026-06999-z","DOIUrl":"https://doi.org/10.1007/s00431-026-06999-z","url":null,"abstract":"<p><p>The venous excess ultrasound score (VExUS) is a promising method to assess venous congestion in adults, but evidence in children is scarce. This study aimed to evaluate the feasibility, reproducibility, and clinical usefulness of VExUS in pediatric patients. We also explored whether portal venous Doppler (PVD) alone could serve as a faster alternative and assessed the role of inferior vena cava (IVC) measurements. In this prospective single-center study, 35 pediatric patients were enrolled between 2022 and 2024. Associations between clinical variables and VExUS grades at admission (VExUS-0), 24 h (VExUS-24 h), and 48 h (VExUS-48 h), as well as PVD at corresponding time points, were analyzed. The relationship between IVC diameter and VExUS was also evaluated. VExUS demonstrated perfect reproducibility (κ coefficient and intraclass correlation coefficient = 1). Patients with VExUS-0 or VExUS-24 h grades 2-3 had longer aortic cross-clamp times (p = 0.03; 0.04) and higher vasoactive-inotropic scores (p = 0.01) than those graded 0-1. A higher incidence of acute kidney injury was observed in VExUS-24 h grades 2-3 (p = 0.04). Similar associations were found with PVD. Most patients with VExUS grades 2-3 had non-dilated IVCs according to pediatric reference values.</p><p><strong>Conclusion: </strong> VExUS is a feasible, reproducible, and clinically relevant bedside tool for detecting venous congestion in children. Its association with morbidity markers suggests prognostic potential, with optimal performance 24 h after PICU admission. PVD may provide comparable information in less time, while IVC diameter appears unreliable for this purpose.</p><p><strong>What is known: </strong>• VExUS enables bedside assessment of venous congestion and is associated with adverse outcomes in adults, particularly after cardiac surgery. • However, pediatric evidence is limited, and its clinical applicability remains uncertain.</p><p><strong>What is new: </strong>• This study shows that VExUS is feasible, reproducible, and associated with morbidity after pediatric cardiac surgery, with the highest prognostic value at 24h. • Portal Doppler may provide comparable performance, whereas IVC diameter is is not a reliable marker of venous congestion in this population.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856060","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":"Pediatric continuous reference intervals of coronary artery diameter by echocardiography in healthy Chinese children population.","authors":"Lin Zheng, Ya-Guang Peng, Jiao Yang, Jing-Ya Li, Xin Zhang, Yan Sun, Guo-Wen Liu, Ning Ma","doi":"10.1007/s00431-026-07012-3","DOIUrl":"https://doi.org/10.1007/s00431-026-07012-3","url":null,"abstract":"<p><p>The aim of this study was to establish body surface area (BSA)-dependent Z-score continuous reference intervals of coronary artery diameter measured by Echocardiography in healthy Chinese children population. Echocardiography measured 1221 healthy Chinese children's coronary artery diameters, including the LMCA, LAD, LCX, RCA-pro, RCA-mid, and RCA-dis. We employed the LMS (Lambda-Mu-Sigma) method for the model and the Haycock equation for the BSA estimation. The coronary artery diameter Z-score continuous reference intervals were established using the LMS method and passed the internal and external validation.</p><p><strong>Conclusions: </strong> The study outcome provides BSA-dependent Z-score continuous reference intervals for the coronary artery diameters in healthy Chinese children. There is a web Z-score calculator with convenient application for clinicians and ultrasound doctors, facilitating subsequent external validations in a larger population.</p><p><strong>What is known: </strong>• Echocardiography is the primary non‑invasive modality for assessing coronary artery (CA) diameter in children, and body surface area (BSA)‑dependent Z‑scores provide a more objective evaluation than absolute values. • The LMS (Lambda‑Mu‑Sigma) method is an internationally accepted approach for establishing continuous reference intervals, as used in the WHO child growth standards.</p><p><strong>What is new: </strong>• This study establishes BSA‑dependent Z‑score continuous reference intervals for six coronary artery segments (LMCA, LAD, LCX, RCA‑pro, RCA‑mid, RCA‑dis) specifically in healthy Chinese children aged 0 days to 18 years. • It provides a validated, LMS‑based model along with an online Z‑score calculator and a fully reproducible computational procedure, addressing the lack of updated, ethnicity‑specific continuous reference intervals for the Chinese pediatric population.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856071","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":"Pulse oximetry in infants with Robin sequence.","authors":"Sonia Khirani, Adrien Kerfourn, Lucie Griffon, Pauline Adnot, Clément Poirault, Nancy Vegas, Marine Dosso, Meryl Vedrenne-Cloquet, Agnès Giuseppi, Véronique Soupre, Romain Luscan, Laurianne Coutier, Véronique Abadie, Brigitte Fauroux","doi":"10.1007/s00431-026-07026-x","DOIUrl":"https://doi.org/10.1007/s00431-026-07026-x","url":null,"abstract":"<p><p>Infants with Robin sequence (RS) are at high risk for obstructive sleep apnea (OSA), but screening with poly(somno)graphy (P(S)G) is challenging. The aim of the study was to assess the relationships between different pulse oximetry (SpO₂) parameters and the mixed obstructive apnea-hypopnea index (MOAHI) in these infants. We also compared the findings to infants having other comorbidities (OSA-III). Different SpO₂ parameters were correlated with MOAHI in infants with RS and with OSA-III having similar OSA severity. The SpO₂ parameters were also compared between the 2 groups. Half of the infants with RS had nap studies. Mean MOAHI did not differ significantly between the 2 groups, and the proportion of infants with MOAHI > 10 events/h or ≥ 3% oxygen desaturation index (ODI 3%) > 10 events/h was also similar. Overall, the different SpO₂ parameters correlated better with MOAHI in infants with OSA-III than in those with RS. The best correlation was observed between ODI 3% and MOAHI in RS patients (r = 0.536, p < 0.001), and between the total hypoxic burden and MOAHI in OSA-III patients (r = 0.720, p < 0.0001). Mean ODI 3% was significantly lower in infants with RS (15.8 ± 22.3 (range 0.0-137.0) vs. 21.5 ± 18.3 (range 0.4-93.6) events/h for OSA-III, p = 0.024). Moreover, infants with OSA-III presented deeper desaturations and greater hypoxemic burdens.</p><p><strong>Conclusion: </strong> SpO₂ parameters correlated better with MOAHI in infants with OSA-III compared to RS. These findings question the presence of a different OSA phenotype in infants with RS. Future studies should further investigate the potential role of the different SpO₂ parameters to screen for OSA in infants.</p><p><strong>What is known: </strong>• Infants with Robin sequence (RS) are at high risk of obstructive sleep apnea (OSA). Polysomnography (PSG) is the gold standard for OSA diagnosis, but may be challenging due to its limited access, and the fact that it is time consuming and requires an experienced team. Pulse oximetry (SpO2) represents a simpler alternative and is used in some centers to screen for OSA. However, no pathological thresholds have been validated. Moreover, the oxygen desaturation index (ODI), which is commonly used, was found to correlate only moderately with the mixed and obstructive apnea-hypopnea index (MOAHI).</p><p><strong>What is new: </strong>• We correlated different SpO2 parameters, such as the hypoxemic burden and the Δ12s index, to the MOAHI in infants with RS and compared the findings to infants with OSA associated to other comorbidities. It seems that infants with RS have a less severe OSA-related hypoxemic profile than infants with OSA-III. These findings question if different obstructive patterns exist according to the disorders.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835384","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":"Thyroid-metabolic interactions in pediatric epilepsy: insights from central sensitivity indices and peripheral hormone markers.","authors":"Valeria Calcaterra, Lucia Labati, Ilaria Anna Maria Scavone, Barbara Scelsa, Pierangelo Veggiotti, Gianvincenzo Zuccotti","doi":"10.1007/s00431-026-07045-8","DOIUrl":"https://doi.org/10.1007/s00431-026-07045-8","url":null,"abstract":"<p><p>Childhood epilepsy is often linked to endocrine and metabolic disturbances, partly from prolonged antiseizure treatment. While thyroid dysfunction is known in this population, routine tests may miss subtle changes in hormone sensitivity or peripheral metabolism. This study seeks to thoroughly assess central and peripheral thyroid hormone regulation in pediatric epilepsy and explore its connection to metabolic health. In this cross-sectional study, 152 children and adolescents with epilepsy and 116 age- and sex-matched controls underwent assessment of thyroid function (TSH, FT4, FT3), central thyroid hormone sensitivity indices (TFQI, PTFQI, TSHI, TT3RI, TT4RI), peripheral thyroid hormone metabolism (FT3/FT4 ratio), and metabolic parameters (fasting glucose, insulin, and lipid profile). Stratified and multivariable regression analyses were performed to identify independent associations, and correlation analyses were used to explore thyroid-metabolic relationships. Children with epilepsy had higher fasting insulin and a worse lipid profile than controls. Thyroid function markers (TSH, FT4) and central thyroid sensitivity indices were similar between groups, but FT3 and the FT3/FT4 ratio were elevated, suggesting altered peripheral thyroid metabolism despite preserved central regulation. Multivariable analyses identified BMI z-score as a major independent determinant of metabolic alterations and thyroid hormone sensitivity, while antiepileptic drug exposure and disease duration showed variable and modest associations.</p><p><strong>Conclusions: </strong> Pediatric epilepsy is characterized by preserved central thyroid regulation but altered peripheral thyroid hormone metabolism, as reflected by an increased FT3/FT4 ratio. These findings suggest a multifactorial and potentially adaptive endocrine-metabolic remodeling influenced by adiposity and treatment exposure, warranting further investigation in longitudinal studies.</p><p><strong>What is known: </strong>• Pediatric epilepsy and antiseizure medications are associated with subtle thyroid alterations and increased metaboli crisk, commonly assessed using TSH and FT4.</p><p><strong>What is new: </strong>• Children with epilepsy show increased FT3 and FT3/FT4 ratio despite preserved central thyroid regulation, suggesting altered peripheral thyroid metabolism. • BMI z-score emerged as a major independent determinant of thyroid sensitivity indices and metabolic impairment.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856044","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":"Design, implementation, and evaluation of an educational-interactive telenursing web application for mothers of high-risk neonates.","authors":"Raziyeh Beykmirza, Marjan Ghofrani, Elahe Rastkar Mehrabani, Arman Giv, Malihe Nasiri, Maryam Varzeshnejad","doi":"10.1007/s00431-026-06949-9","DOIUrl":"https://doi.org/10.1007/s00431-026-06949-9","url":null,"abstract":"<p><p>The transition of high-risk neonates from the neonatal intensive care unit (NICU) to home remains a complex process, often hindered by inadequate and fragmented discharge education. This study aimed to develop, implement, and evaluate an interactive telenursing web application designed to enhance discharge education for mothers of high-risk neonates. A multi-method study with a three-phase approach (design, implementation, and evaluation) was conducted to develop and assess a bilingual telenursing web application. The application was developed using the waterfall model. Implementation and evaluation phase in this study was conducted as a quasi-experimental study, involving 60 mothers of high-risk neonates. These mothers were randomly assigned to either an intervention group (N = 30), which received interactive, multimedia-based discharge education via the web application, or a control group (N = 30) that received standard discharge education. Maternal knowledge and user satisfaction were the primary outcome measures. The findings are structured into two distinct components: (1) web application design and (2) implementation, and its evaluation. This application was designed as a bilingual (Persian/English) platform. Its various components include the following: A- Login Page (this web application has three user roles: Mother, nurse, and Supervisor (Editor)), B- Home Page, C- Educational Icons Page, D- multiple questions to assess mothers' understanding of the educational content. E- Nurses' Page, F-Messages Page. Evaluation of the Intervention on maternal knowledge showed that the mean knowledge score in the intervention group was significantly higher than in the control group (p = 0.008). User Satisfaction and Usability questionnaire results showed that the overall mean satisfaction score was 3.90 ± 0.77 out of 5. The highest-scoring domain was Information Quality (Mean ± SD = 4.13 ± 0.63), followed by Aesthetics (Mean ± SD = 3.96 ± 0.66) and Functionality (Mean ± SD = 3.90 ± 0.84). The lowest-rated domain was Subjective Quality (Mean ± SD = 3.63 ± 0.73). Conclusion: The findings indicate that the bilingual, competency-driven bilingual telenursing web application is an effective tool for improving maternal knowledge and engagement in post-NICU care. The platform's features, including real-time nurse-mother communication and adaptive learning modalities, facilitate better discharge preparedness and may contribute to reduced emergency healthcare utilization. Future research should explore integration with electronic health record systems to enable personalized and continuous care pathways.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856051","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}