European Journal of Pediatrics最新文献

{"title":"Associations between environmental chemical mixtures and anthropometric measures in Korean girls: a cross-sectional study.","authors":"Erdenetuya Bolormaa, Kyuwon Kim, Hoyol Jhang, Yong Min Cho, Undarmaa Enkhbat, Seung-Ah Choe","doi":"10.1007/s00431-025-06255-w","DOIUrl":"10.1007/s00431-025-06255-w","url":null,"abstract":"<p><p>The purpose of this study is to investigate the association between environmental chemicals and anthropometric indices using preliminary data from the Puberty and Environment in Adolescents Cohort Project. Random urine samples from 370 Korean girls aged 7-14 years were evaluated for 15 environmental phthalates, phenols, polycyclic aromatic hydrocarbon metabolites, and three heavy metals using growth metrics. We calculated the body mass index (BMI) z-score, weight z-score, height z-score, and waist-to-hip ratio (WHR) based on the World Health Organization growth references. Associations between environmental chemicals and weight and height indicators were assessed using single- and mixture-exposure models, controlling for the measured covariates. We identified 28 girls (7.6%) as overweight, 10 (2.7%) as underweight based on BMI z-scores, 17 (4.6%) as underweight based on weight z-scores, and 6 (1.6%) as having a low height status. Normal anthropometric measurements were reported in 85.9% of the girls. No positive associations between environmental chemical mixtures and BMI z-score, weight z-score, or WHR (β = -0.03, 95% confidence interval [CI]: -0.34, 0.26; -0.23, 95% CI: -0.51, 0.06; -0.00, 95% CI: -0.02, 0.02) were observed. A negative association was identified between environmental phthalate, phenol, and polycyclic aromatic hydrocarbons metabolites, and height z-score (β = -0.41, 95% CI: -0.63, -0.19). Heavy metal mixtures were negatively associated with weight and height z-scores (β = -0.20, 95% CI: -0.37 to -0.04; -0.21, 95% CI: -0.40 to -0.03).</p><p><strong>Conclusion: </strong>Exposure to environmental chemical mixtures was negatively associated with height in girls. The different patterns of association observed in the single and mixture analyses provide insights into the health impacts of multiple chemicals on children.</p><p><strong>What is known: </strong>• Environmental chemical mixtures including phenols, phthalates, PAHs, and heavy metals are associated with abnormal growth in children. • Exposure to these mixtures may influence body mass index and other anthropometric measures throughout childhood.</p><p><strong>What is new: </strong>• This study evaluated the effects of environmental chemical mixtures on anthropometric indices in Korean adolescent girls, using a mixture-exposure approach. • Exposure to phthalates, phenols, polycyclic aromatic hydrocarbons, and heavy metals was inversely associated with height, whereas associations with body mass index, weight, or waist-to-hip ratio were not observed.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"421"},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301410","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":"Prophylactic hydrocortisone and the risk of sepsis in neonates born extremely preterm.","authors":"Olivier Baud, Philippe Lehert","doi":"10.1007/s00431-025-06248-9","DOIUrl":"10.1007/s00431-025-06248-9","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia (BPD) is a serious complication of extreme prematurity and has few treatment options. The postnatal use of steroids to prevent BPD remains controversial, but prophylactic low-dose hydrocortisone (HC) has been shown to improve survival without BPD. However, an increased risk of late-onset sepsis (LOS) was also reported in extremely preterm neonates exposed to prophylactic HC treatment. Because its causal link remains unclear, our objective was to assess the effect of prophylactic HC exposure on LOS risk, adjusted for perinatal risk factors of LOS. We re-analyzed the PREMILOC trial to investigate the postnatal factors influencing the incidence of LOS occurring after day 3 from baseline conditions and to evaluate the potential interaction produced by prophylactic HC exposure. We used three different statistical models (poisson, Cox regression, competing risks) to test the effect of HC on LOS occurrence. LOS was reported in 64/264 (24%) and 77/255 (30%) in the placebo and HC groups, respectively (P = 0.12). A decreasing risk of LOS was observed with increasing gestational age (P < 0.001), vaginal delivery (P = 0.005), and supplemental corticosteroids given after a 10-day treatment with prophylactic HC but before the LOS (P < 0.001). A trend of higher risk of LOS was noted in infants exposed to perinatal asphyxia (P = 0.065). Adjusted for these covariates, we found a non-significant association between HC exposure and risk of LOS (relative risk, 1.041 (95% CI, 0.738 to 1.471]), P = 0.817). Using a survival competing risk analysis, we confirmed the lack of significant effect of HC on LOS (hazard risk ratio, 1.105 [95% CI, 0.787 to 1.552], P = 0.560), while competing death was significantly reduced by the treatment (hazard risk ratio, 0.427 [95% CI, 0.259 to 0.707], P < 0.001).</p><p><strong>Conclusion: </strong>The effect of prophylactic HC compared with placebo on LOS is summarized by a risk ratio varying within the interval [0.90-1.10] and this effect was never significant.</p><p><strong>Trial registration: </strong>EudraCT number 2007-002041-20, ClinicalTrials.gov number NCT00623740.</p><p><strong>What is known: </strong>• Prophylactic hydrocortisone improves survival without bronchopulmonary dysplasia in extremely preterm neonates. • It increases the risk of late-onset sepsis in the most immature infants. • Causality remains unclear.</p><p><strong>What is new: </strong>• A lower risk of late-onset sepsis was observed with higher gestational age at birth, vaginal delivery, and, more surprisingly, with supplemental corticosteroids administration after day 10. • Competing survival by Fine and Gray analysis suggests that death was reduced by prophylactic hydrocortisone, without a significant effect of treatment on the risk of late-onset sepsis.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"419"},"PeriodicalIF":3.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293483","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":"Evaluation of infectious complications in pediatric patients with armed conflict-related injuries referred to a tertiary hospital in Turkey.","authors":"Zeynep Savaş Şen, Deniz Güven, Nursel Atay Ünal, Ömer Güneş, Ferit Kulalı, Türkan Aydın Teke, Ayşe Kaman, Fatma Nur Öz","doi":"10.1007/s00431-025-06259-6","DOIUrl":"10.1007/s00431-025-06259-6","url":null,"abstract":"<p><p>Conflict-related injuries in pediatric populations are associated with significant infectious complications, particularly due to delayed medical care and invasive procedures. This study aimed to evaluate infection characteristics, causative microorganisms, antimicrobial resistance, and treatment approaches in children hospitalized with conflict-related injuries. This retrospective, single-center study included pediatric patients (1 month-18 years) hospitalized between November 2023 and June 2024 with armed conflict-related injuries and confirmed bacterial and/or fungal cultures. Demographic, clinical, and microbiological data were analyzed. Among 592 hospitalized pediatric patients, 39 (6.6%) had positive cultures, yielding 90 microbial isolates. Gram-negative bacteria predominated (71%), with Pseudomonas aeruginosa (40%), Klebsiella pneumoniae (10%), Acinetobacter baumannii (10%), and Escherichia coli (10%) being most common. P. aeruginosa was primarily isolated from wound sites (77.7%) and was significantly associated with internal fixators (p = 0.003). Multidrug resistance (MDR) was identified in 72.2% of P. aeruginosa isolates, and carbapenem resistance was notable in A. baumannii (77.8%) and K. pneumoniae (55.5%). Fungal isolates accounted for 13.3% of cultures, predominantly Candida albicans from urine samples. No fungal growth was observed in wound cultures. Median time from injury to positive culture was 59 days, shorter for P. aeruginosa (p = 0.039). No mortality occurred.</p><p><strong>Conclusions: </strong>Pediatric patients with armed conflict-related injuries exhibit high rates of infection with MDR gram-negative bacteria, notably P. aeruginosa. The findings underscore the importance of early intervention, infection control, and tailored antimicrobial therapy. Future multicenter prospective studies with advanced microbiological techniques are warranted to optimize management and outcomes.</p><p><strong>What is known: </strong>• Infectious complications are common in armed conflict-related injuries, especially in delayed admissions. Gram-negative bacteria and multidrug resistance are frequently observed in conflict-related wounds.</p><p><strong>What is new: </strong>• This study highlights high rates of multidrug-resistant Pseudomonas aeruginosa in pediatric armed conflict-related injuries. Early culture-guided treatment and infection control are critical for better outcomes.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"418"},"PeriodicalIF":3.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283080","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":"Improving shared decision‑making between paediatric haematologists, children with sickle cell disease, and their parents: an observational post-intervention study.","authors":"Ricardo O Wijngaarde, Samantha C Gouw, Dirk T Ubbink","doi":"10.1007/s00431-025-06241-2","DOIUrl":"10.1007/s00431-025-06241-2","url":null,"abstract":"<p><p>Children with sickle cell disease (SCD) suffer from a chronic disease that can lead to serious co-morbidity and impacts their quality of life. During the course of their disease, a variety of health-related decisions need to be made for and by SCD-patients, depending on their age and health status, together with their parents and paediatric haematology clinicians. Shared decision-making (SDM) may improve health outcomes of chronically ill children but is still not commonly applied. We assessed the level of SDM among paediatric haematologists after the introduction of SDM interventions. An observational post-intervention study was conducted in a paediatric outpatient clinic of a university hospital. After an SDM consultation training of the three paediatric haematologists and introduction of SDM-supporting tools for both paediatricians and (parents of) patients with SCD, two evaluators independently and objectively analysed the level of patient involvement in decision-making from audio-recordings of the consultations using the OPTION-5 instrument. SDM-Q-9 and SDM-Q-Doc questionnaires were used to measure the level of SDM as perceived by patients/parents and paediatricians, respectively. Scores were expressed as a percentage, ranging from 0% (no SDM observed) to 100% (exemplary level of SDM). Participants were 9 female and 9 male patients between 4 months and 17 years old, with a median age of 7.5 years (Interquartile Range [IQR] 2.5-12). Eighteen consultations (six per paediatrician) in which a decision was to be made about SCD treatment options were analysed. Median OPTION-5 score was 50 (IQR 40-65%). Median SDM-Q-9 and SDM-Q-Doc scores were 73% (IQR 52.2-91) and 62.2% (IQR 55.6-71.1), respectively.</p><p><strong>Conclusion: </strong>After the introduction of SDM training and tools, paediatric haematologists reached a moderately good level of SDM. This level had doubled as compared to the baseline level, as assessed in a previous study.</p><p><strong>What is known: </strong>• Children who suffer from sickle cell disease (SCD) are vulnerable to health inequities and suboptimal health outcomes. Hence, SDM seems an appropriate method of care for these children. • SDM tools and training may help paediatricians and children participate in a collaborative decision-making process about the children's preferred treatment options and improve their health outcomes.</p><p><strong>What is new: </strong>• After SDM training and decision support aids for paediatricians and patients, the level of involvement in the decision-making process by (the parents of) patients suffering from SCD reached a moderately good level. • A difference persists between paediatricians' perceived level of involving the child and parents in a shared decision-making process and the observed level of involvement.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"417"},"PeriodicalIF":3.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274534","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":"Impact of COVID-19 pandemic policies on ADHD medication prescriptions among children and adolescents in Portugal.","authors":"Célia Silva, Mariia Melnikova, Rui Santos Ivo, Cláudia Furtado","doi":"10.1007/s00431-025-06229-y","DOIUrl":"10.1007/s00431-025-06229-y","url":null,"abstract":"<p><p>This study aims to analyse the prescription of medication for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, by age group and gender, before and during the COVID-19 pandemic, as well as the impact of government policies during this period. This study was a retrospective cohort analysis using data from the Portuguese national prescription database and included all children and adolescents aged 5-19 years. We conducted an interrupted time series analysis, modelled using a seasonal autoregressive integrated moving average (SARIMA) approach, to evaluate the impact on prescription medications while considering two intervention points resulting from government policies: March 2020, marking the start of strict anti-pandemic measures, and May 2021, marking the beginning of their easing. Following the start of strict anti-pandemic measures, from March 2020 to May 2021, a 9% lower prescription rate than expected was observed, while from June 2021 to December 2023, the prescription rate was greater than expected (+ 32%, with a peak of + 41% in children 5-9 years old) and more pronounced in girls.</p><p><strong>Conclusions: </strong>These findings highlight the complex impact of the pandemic on different age groups and between genders on the prescription of ADHD medicines.</p><p><strong>What is known: </strong>• ADHD medications are considered effective and have been increasingly prescribed to children and adolescents in recent years.</p><p><strong>What is new: </strong>• Following the COVID-19 pandemic, the increase in ADHD medication prescriptions exceeded expected trends. • Stratification by age group and gender revealed gender differences, with a more pronounced rise in prescriptions observed among girls.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"415"},"PeriodicalIF":3.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274533","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":"Connexin 30 (GJB6) deletion as a cause of a false positive sweat test result.","authors":"Anna Rossell, Aleix Soler-Garcia, Loreto Martorell, Maria Antònia Claveria, Laura Valero, Sílvia Rodríguez, Cèlia Badenas, Maria Cols-Roig","doi":"10.1007/s00431-025-06220-7","DOIUrl":"10.1007/s00431-025-06220-7","url":null,"abstract":"<p><p>The sweat test (ST) is the gold standard for the diagnosis of cystic fibrosis. There are several reports in the literature regarding conditions that are known to be associated with a false positive result. The aim of this article is to describe a previously unreported cause of a false positive ST. An observational, cross-sectional single-center study was performed. We recruited three patients with a neurosensory deafness caused by a deletion in both alleles of connexin 30. The first-degree relatives of these three patients with hearing impairment due to other mutations were also included. A ST was performed in all the selected cases. Among the three patients with a deletion in both connexin 30 alleles, two had a positive ST, whereas the third patient had a close-to-positivity borderline result (57 mmol/L). Moreover, there were no positive sweat tests in individuals with other mutation patterns.</p><p><strong>Conclusion: </strong> Patients with affection of both alleles of connexin 30 were the only ones to show a positive ST, which may translate to a higher risk of hyponatremic dehydration. The reason for the ST positivity remains unclear and may be related to the fact that connexin 30 plays a role in modulating other molecules in both the inner ear and sweat glands.</p><p><strong>What is known: </strong>• The sweat test is the gold standard for the diagnosis of cystic fibrosis. However, the causes of false positives in the test are increasingly recognized.</p><p><strong>What is new: </strong>• This study describes a previously unreported cause of a false positive sweat test. Three patients with homozygous mutations in the connexin 30 gene are described. All of them had an abnormal sweat test, and two of them presented with severe hyponatremic dehydration.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"416"},"PeriodicalIF":3.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274532","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":"Italian validation of the SMA independence scale-upper limb module.","authors":"Chiara Bravetti, Giorgia Coratti, Maria Carmela Pera, Giulio Gadaleta, Tiziana Mongini, Michela Coccia, Amanda Ferrero, Emanuele Maria Costantini, Antonella Longo, Francesca Cumbo, Michela Catteruccia, Adele D'Amico, Simone Morando, Noemi Brolatti, Claudio Bruno, Lorenzo Verriello, Maria Elena Pessa, Laura Antonaci, Claudia Faini, Rocco Liguori, Veria Vacchiano, Lucia Ruggiero, Dario Zoppi, Anna Russo, Francesca Torri, Giulia Ricci, Roberto Chiappini, Gabriele Siciliano, Antonio Trabacca, Caterina Agosto, Francesca Benedetti, Marika Pane, Eugenio Mercuri","doi":"10.1007/s00431-025-06207-4","DOIUrl":"10.1007/s00431-025-06207-4","url":null,"abstract":"<p><p>Spinal muscular atrophy (SMA) is a progressive disorder caused by SMN1 mutations. While therapies have changed its course, current motor scales often miss aspects. This study aimed to validate the Italian SMA Independence Scale (SMAIS-ULM) for reliability, applicability, and expansion across diverse SMA phenotypes. Patients with genetically confirmed 5qSMA were recruited from 12 Italian centers. Analyses included Intraclass Correlation Coefficients (ICCs) for test-retest reliability, the Kruskal-Wallis for group comparisons, and the Spearman correlations with functional measures. Ceiling/floor effects were defined as ≥ 85% of a group reaching the maximum or minimum score. The study analyzed 472 completed questionnaires: 263 from caregivers (mean age 26.4 ± 17.6; 29 SMA I, 123 SMA II, 104 SMA III, 7 presymptomatic) and 209 from patients (mean age 33.1 ± 16.4; 3 SMA I, 101 SMA II, 104 SMA III; 1 SMA IV), including 195 matched caregiver-patient pairs. ICC was conducted in 29 caregivers and 31 patients; values ranged from 0.97 to 1.00. SMAIS-ULM scores differed by SMA type, with SMA III/presymptomatic subjects scoring higher than SMA I/II (p < 0.001) and walkers scoring higher than sitters/non-sitters (p < 0.001). Floor effects were found in 18.9% of non-sitters and 50% of walkers, with comparable patterns in patient responses. Strong correlations with functional measures were found, with no significant differences between caregiver and patient reports. Conclusion: The findings confirm the reliability and validity of the SMAIS-ULM as an effective tool for measuring functional independence in individuals with SMA, both from the caregiver and patient perspectives.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"410"},"PeriodicalIF":3.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257697","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":"Abnormal glymphatic system function in children with autism spectrum disorder: a diffusion kurtosis imaging study.","authors":"Pu Tian, Yang Xue, Xiaona Zhu, Zhuohang Liu, Bingyang Bian, Feiyong Jia, Le Dou, Xuerui Lv, Tianyi Zhao, Dan Li","doi":"10.1007/s00431-025-06246-x","DOIUrl":"10.1007/s00431-025-06246-x","url":null,"abstract":"<p><p>The glymphatic system, responsible for clearing metabolic waste in the brain, may be impaired in neurodevelopmental and neurodegenerative disorders. This study aimed to assess glymphatic system function in children with autism spectrum disorder (ASD) and explore its relationship with the severity of core ASD features and developmental level. This study employed diffusion kurtosis imaging analysis along the perivascular space (DKI-ALPS) to assess glymphatic system function in children with ASD, dividing the ASD group into mild and severe subgroups to compare intergroup differences and differences with the typically developing (TD) group. Correlations between DKI-ALPS indices and clinical assessments, including the Childhood Autism Rating Scale (CARS) and Griffiths Developmental Scales (Chinese version, GDS-C), were also analyzed. The DKI-ALPS and diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) indices were calculated separately for the left and right hemispheres, with the average defined as their arithmetic mean. The DKI-ALPS index was further compared with the DTI-ALPS index, and its directional kurtosis components were analyzed to investigate underlying microstructural differences. DKI-ALPS indices were significantly lower in children with ASD than in TD children, with lower values in the severe subgroup than in the mild subgroup. The right and average DKI-ALPS indices were negatively correlated with CARS scores, while the right index was positively correlated with Hearing-Language and Eye-Hand Coordination scores. DKI-ALPS showed greater sensitivity than DTI-ALPS in detecting group differences and clinical associations. Directional analysis revealed significant alterations in y-axis projection and z-axis association kurtosis metrics.</p><p><strong>Conclusion: </strong>This study provides preliminary evidence of glymphatic dysfunction in children with ASD, which is associated with the severity of core ASD features and developmental level. These findings offer novel imaging-based insights into ASD neurobiology.</p><p><strong>What is known: </strong>• Glymphatic system dysfunction has been implicated in neurodegenerative disorders. Its role in autism spectrum disorder (ASD), particularly in children, remains underexplored. Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) has limited sensitivity in detecting glymphatic changes.</p><p><strong>What is new: </strong>• This study is the first to apply diffusion kurtosis imaging analysis along the perivascular space (DKI-ALPS) in children with ASD, revealing significant glymphatic impairment correlated with the severity of core ASD features and developmental levels. DKI-ALPS demonstrated higher sensitivity than DTI-ALPS.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"411"},"PeriodicalIF":3.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257624","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":"Relieving the pediatric emergency department by referring low triaged patients using the Manchester Triage System.","authors":"Anna Sorz-Nechay, Franziska Leeb, Michaela Haas, Emina Djordjevic, Lusine Yeghiazaryan, Susanne Greber-Platzer","doi":"10.1007/s00431-025-06230-5","DOIUrl":"10.1007/s00431-025-06230-5","url":null,"abstract":"<p><p>In 2015, the pediatric emergency department (PED) of the Department of Pediatrics and Adolescent Medicine, Vienna General Hospital, reached its capacity with 25,000 patient visits, leading to delays in assessment and overcrowding. Self-referred patients constituted 95%, with 75% classified as low urgency level 4 (UL-4; green) and 5 (UL-5; blue) according to the Manchester Triage System (MTS). In 2016, a referral process was established in collaboration with local pediatric offices and the pediatric departments of the Vienna Hospital Association to refer low-triaged patients for medical assessment, reducing total visits to 16500 by 2017. This study aimed to evaluate patient safety, satisfaction, and diagnosis of referred patients. Between June 2017 and May 2018, UL-4 and UL-5 referred patients were included (n = 2394). Data on diagnosis, treatment, and satisfaction were collected via a survey from 568 patients (23.7%). Of all referred patients, 6 (1.1%) required hospitalization, with no significant differences in hospitalization rates across age groups (p = 0.861) or gender (p = 0.766). The most common medical issues were respiratory diseases, both in outpatients (n = 198/562, 35.6%) and inpatients (n = 4/6, 66.7%). Families' satisfaction levels with the process at the PED and external treatment were high (n = 530, 93.3% and n = 477, 84.0%, respectively). Dissatisfaction was higher with the PED (n = 26, 4.6% vs. n = 23, 4.0%), linked to unclear referral communication.</p><p><strong>Conclusion: </strong>The referral of low-urgency patients using the MTS can reduce PED congestion, without compromising patient safety and satisfaction levels.</p><p><strong>What is known: </strong>• The MTS is widely used as a valid and reliable tool in PEDs. • Overcrowding in PEDs is a common issue, leading to the need for alternative management strategies, particularly for nonurgent cases.</p><p><strong>What is new: </strong>• The burden on the overcrowded PED can be effectively alleviated by redirecting low-triaged pediatric patients (UL-4 and UL-5) using the MTS to primary or secondary care medical centers. • The study provides evidence that referred pediatric patients and their families experience satisfaction with provided care and that there is no relevant increase in hospitalization rates or adverse outcomes.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"412"},"PeriodicalIF":3.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265683","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":"Light at the end of the tunnel? Follow-up of cardiopulmonary function in children with post-COVID-19.","authors":"Annika Weigelt, Gunay Akhundova, Roman Raming, Jan-Philipp Tratzky, Adrian P Regensburger, Calvin Kraus, Wolfgang Waellisch, Regina Trollmann, Joachim Woelfle, Sven Dittrich, Rafael Heiss, Ferdinand Knieling, Isabelle Schoeffl","doi":"10.1007/s00431-025-06245-y","DOIUrl":"10.1007/s00431-025-06245-y","url":null,"abstract":"<p><p>Few studies have examined post-COVID-19 sequelae in children, particularly regarding cardiopulmonary capacity. Longitudinal data are especially scarce. This study aimed to retest pediatric patients previously assessed in a cross-sectional design. In this longitudinal study, children meeting post-COVID-19 criteria and an age- and sex-matched control group underwent cardiopulmonary exercise testing at baseline and after 6 months. Thirteen of 20 post-COVID-19 children (mean age: 13.6 ± 2.6 years, 48% female) and 23 of 28 controls (mean age: 11.9 ± 3.1 years, 62% female) completed follow-up testing. All participants completed a maximal treadmill test. No significant differences were found in peak oxygen uptake ( <math> <mrow><mover><mi>V</mi> <mo>˙</mo></mover> <msub><mi>O</mi> <mn>2</mn></msub> <mi>p</mi> <mi>e</mi> <mi>a</mi> <mi>k</mi></mrow> </math> 39.5 ± 11.0 ml/kg/min vs. 45.5 ± 8.4 ml/kg/min; p = 0.101). Over 6 months, cardiopulmonary performance improved significantly across all subjects. Subgroup analysis showed improvements in both groups, although changes were not statistically significant. Oxygen pulse also proved to be significantly higher and the half-time recovery of <math> <mrow><mover><mi>V</mi> <mo>˙</mo></mover> <msub><mi>O</mi> <mn>2</mn></msub> </mrow> </math> proved to be significantly longer after 6 months which was true for the overall group but not for the subgroups.</p><p><strong>Conclusion: </strong>This is the first longitudinal study to reassess cardiopulmonary capacity in children with post-COVID-19. The initially reduced <math> <mrow><mover><mi>V</mi> <mo>˙</mo></mover> <msub><mi>O</mi> <mn>2</mn></msub> <mi>p</mi> <mi>e</mi> <mi>a</mi> <mi>k</mi></mrow> </math> normalized, and all children showed improved cardiopulmonary capacity after 6 months. The primary improvement was observed in the O₂ pulse, a surrogate marker of stroke volume and, by extension, cardiac output. This finding suggests an enhancement in cardiovascular performance, reflecting improved central hemodynamic in all children 6 months after the pandemic. Deconditioning thus remains a plausible cause for the post-COVID-19 symptoms.</p><p><strong>Trail registration: </strong>ClinicalTrials.gov Identifier: NCT05445531.</p><p><strong>What is known: </strong>• Children with post-COVID-19 (PASC) may exhibit reduced cardiopulmonary function (V̇O2 peak). Fatigue and exercise intolerance are common but poorly understood and objectified. • Previous studies have provided valuable cross-sectional insights but have yet to include longitudinal follow-up data.</p><p><strong>What is new: </strong>• First longitudinal CPET-based study reassessing children with PASC after 6 months. • Cardiopulmonary performance, including V̇O2 peak and O2 pulse, improved significantly over time, probably due to reversible deconditioning rather than organ damage.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 7","pages":"413"},"PeriodicalIF":3.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265681","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}