European Journal of Pediatrics最新文献

{"title":"Non-operative versus operative management of high-grade pancreatic trauma in children: lessons from a Belgian long-term follow-up cohort.","authors":"Isabelle Scheers, Giulia Sonnino, Geert Roeyen, Frederik Berrevoet, Myriam Delhaye, Ilse Hoffman, Olivia Bauraind, Angélique Lhomme, Catherine de Magnée, Francis Zech, Alba Igual, Pierre H Deprez","doi":"10.1007/s00431-026-06913-7","DOIUrl":"https://doi.org/10.1007/s00431-026-06913-7","url":null,"abstract":"<p><p>Pancreatic trauma in children is rare but may result in severe complications, particularly in injuries involving duct transection. Optimal management-surgical versus conservative-remains debated. We aimed to compare long-term complications between both management approaches. This multicenter retrospective and prospective study analyzed children (< 18 years) with grade III-V pancreatic trauma treated between 2009 and 2019 at Belgian Level 1 trauma centers. Patient characteristics, management, and outcomes were assessed with long-term follow-up. Among 31 patients, 35% underwent surgery and 65% were managed conservatively. Pseudocyst formation was significantly higher in the non-operative group (85%) vs. surgical (18%, p = 0.0013). Long-term complications included pancreatic atrophy (35%), recurrent pancreatitis (19%), and exocrine dysfunction; no endocrine insufficiency was reported.</p><p><strong>Conclusion: </strong>Surgical and conservative management of grade III and IV trauma are safe for pediatric pancreatic trauma, though pseudocysts are common in the conservative approach and often require endoscopic drainage. Ongoing follow-up is essential to monitor for long-term complications such as pancreatitis and pancreatic atrophy.</p><p><strong>What is known: </strong>• Non-operative management of pancreatic trauma with complete duct transection is associated with a higher risk of pseudocyst formation compared with operative management. • Long-term comparative studies on outcomes of patients with pancreatic trauma and complete pancreatic duct transection are scarce, limited in time, and often retrospective.</p><p><strong>What is new: </strong>• Regardless of the initial management, children with grade III, IV, and V pancreas trauma are at risk to develop very long-term complications such as pancreatitis, pancreas atrophy, and exocrine insufficiency; clinical follow-up is therefore warranted.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766410","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":"Electrocardiographic dispersion parameters as markers of early cardiac involvement in children with β-thalassemia major.","authors":"Helen Bornaun, Damla Gökçeer Akbulut, Fatih Şap, Reyhan Dedeoğlu, Deniz Bornaun Kavak, Sina Aghdasi, Erkan Erfidan","doi":"10.1007/s00431-026-06945-z","DOIUrl":"https://doi.org/10.1007/s00431-026-06945-z","url":null,"abstract":"<p><p>Cardiac iron deposition remains a leading cause of morbidity and mortality in patients with beta-thalassemia major (β-TM). Early myocardial involvement may be difficult to detect using conventional echocardiography before overt systolic dysfunction develops. We aimed to evaluate early cardiac involvement in children with β-TM using electrocardiographic indices-P-wave dispersion (PWD) and QT dispersion (QTD)-and to examine their associations with markers of iron load. This retrospective study included 85 children with β-TM aged 6-17 years and 85 age-matched and sex-matched healthy controls. All participants underwent 12-lead electrocardiography and comprehensive echocardiography. PWD and QTD were measured manually from surface ECG recordings. Iron load was assessed using serum ferritin levels and cardiac magnetic resonance (CMR) T2* measurements; patients were stratified according to ferritin (< 2500 vs ≥ 2500 ng/mL) and T2* (> 20 ms vs ≤ 20 ms). Children with β-TM had significantly higher PWD, QTD, and corrected QT dispersion (QTcD) than controls (all p < 0.001), despite preserved left ventricular systolic function. Echocardiography demonstrated increased ventricular wall thickness, chamber dimensions, myocardial performance indices, and altered diastolic parameters in the β-TM group. PWD showed a positive correlation with left ventricular mass index (r = 0.295, p = 0.006) and a negative correlation with the tissue Doppler E/A ratio (r =  - 0.252, p = 0.020). QTD correlated negatively with both mitral inflow E/A and tissue Doppler E/A ratios (r =  - 0.247, p = 0.020). No significant correlations were observed between ECG dispersion indices and serum ferritin or CMR T2* values.Conclusion: PWD and QTD are significantly prolonged in children with β-TM even in the absence of clinical heart failure or overt systolic dysfunction, indicating early subclinical cardiac involvement. Given their simplicity, low cost, and noninvasive nature, these ECG indices may serve as practical and accessible tools for early cardiac screening in this population.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766365","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":"Serial assessment of pentraxin-3 and presepsin in pediatric sepsis: a prospective study.","authors":"Nursena Kologlu Ates, Fatma Deniz Aygun, Melek Karasu, Pınar Onal, Mine Kucur, Fatih Aygun","doi":"10.1007/s00431-026-06961-z","DOIUrl":"https://doi.org/10.1007/s00431-026-06961-z","url":null,"abstract":"<p><p>Early recognition of pediatric sepsis remains challenging due to the limited diagnostic performance of conventional biomarkers. This study aimed to evaluate the kinetic profiles of pentraxin-3 (PTX3) and presepsin and their associations with the Phoenix Sepsis Score (PSS) and hemodynamic support requirements. In this prospective single-center study, 40 children with suspected sepsis and 66 healthy controls were enrolled. Patients were classified according to the Phoenix Sepsis Score (PSS) as infection (PSS < 2), sepsis (PSS ≥ 2), and septic shock. Serum PTX3, presepsin, C-reactive protein (CRP), and procalcitonin (PCT) levels were measured at admission and at 48 h, and their temporal patterns and clinical correlations were analyzed. Baseline PTX3 levels were significantly higher in septic children than controls (p < 0.001), whereas presepsin showed no difference (p = 0.513). PTX3 varied across clinical severity groups (p < 0.001), while CRP and PCT did not. PTX3 showed high diagnostic accuracy (AUC: 0.872; 95% CI: 0.787-0.958), whereas presepsin performed poorly (AUC: 0.578). Admission PTX3 correlated with vasopressor requirement (r = 0.548, p = 0.042). At 48 h, PTX3 decreased significantly (p < 0.001), while presepsin increased (p = 0.034).Conclusion: Our results suggest that PTX3 may provide added diagnostic utility compared with presepsin for early detection and severity assessment of pediatric sepsis. Its pronounced variation across clinical categories and strong correlation with hemodynamic support indicate that PTX3 could serve as a dynamic biomarker of vascular endothelial activation and subsequent stabilization. What is Known: • PTX3 and presepsin have been proposed as emerging biomarkers for sepsis, however evidence in pediatric populations remains limited • Existing pediatric studies report heterogeneous diagnostic performance for presepsin, and data on early kinetic behavior of PTX3 are scarce What is New: • This study demonstrates distinct temporal biomarker dynamics: PTX3 levels decline rapidly with clinical stabilization, whereas presepsin shows a significant late-phase increase within 48 h • When validated against the Phoenix Sepsis Score, PTX3 exhibits higher diagnostic reliability and a stronger correlation with vasopressor requirements than presepsin, suggesting that it may serve as a more specific indicator of vascular endothelial stress.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766441","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":"Efficacy of bibliotherapy combined with games to reduce fear of the dark in young children: results from a clinical trial.","authors":"Mireia Orgilés, Àngela Belzunegui-Pastor, Víctor Amorós-Reche, Jose P Espada","doi":"10.1007/s00431-026-06918-2","DOIUrl":"10.1007/s00431-026-06918-2","url":null,"abstract":"<p><p>Intense fear of the dark is a common issue among children, which can interfere with their daily functioning at family, social, and academic levels. This study aims to analyze the effectiveness of a psychotherapeutic intervention based on bibliotherapy combined with play to overcome the fear of the dark in children between 4 and 8 years old. A total of 38 children participated, who were assigned to the experimental and control conditions on the waiting list. The bibliotherapy intervention in the experimental condition involved reading a book and playing the games proposed in each chapter. The intervention lasted 4 to 5 weeks. The results indicate a decrease in fears related to nighttime characteristics and imaginary stimuli in the experimental group, whereas no improvements were observed in the control group. Additionally, significant improvements were found in the nighttime behavior of children in the experimental group and their ability to act in dark situations.</p><p><strong>Conclusion: </strong>The findings demonstrate that play-based bibliotherapy is an effective treatment for overcoming children's fear of the dark. Furthermore, the relevant role of parents in addressing this type of problem is demonstrated.</p><p><strong>Trial registration: </strong>registered on https://ClinicalTrials.gov (ID: NCT07067320). Date of registration: 16/07/2025, retrospectively registered.</p><p><strong>What is known: </strong>• Fear of the dark is common in children and can negatively affect sleep, behavior, and daily functioning. • Bibliotherapy is a promising, low-cost intervention for addressing children's nighttime fears.</p><p><strong>What is new: </strong>• Provides evidence for the effectiveness of a home-based bibliotherapy program combined with games for children aged 4-8 in reducing fears and improving nighttime behavior, highlighting the key role of parents. • Evaluates an expanded version of the intervention with new components (e.g., gradual exposure, nightmare management).</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728597","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":"Overuse of abdominopelvic CT in pediatric emergencies: a large single-center study from a middle eastern tertiary hospital.","authors":"Roya Mohammadi, Behdad Gharib, Syed Mobashar Hussain, Iran Malekzadeh, Saeideh Abdolahpour","doi":"10.1007/s00431-026-06823-8","DOIUrl":"10.1007/s00431-026-06823-8","url":null,"abstract":"<p><p>Abdominopelvic CT scans are widely used in pediatric emergency departments (PEDs) but are frequently overused, often resulting in a high proportion of normal findings. To evaluate the diagnostic utility of abdominopelvic CT in acute pediatric emergencies and to identify patterns of use and potential overuse, particularly in relation to presenting symptoms and clinical context. This retrospective study of 399 children (56.6% male, mean age 6.54 ± 4.0 years) at a tertiary center in Tehran, Iran (2021), evaluated the diagnostic utility of abdominopelvic CT in acute pediatric emergencies. Abdominal pain was the most common symptom (46.9%), followed by diarrhea/vomiting (13.0%) and trauma (8.8%). Common CT diagnoses included mesenteric adenitis (8.5%), abdominal mass (7.5%), and appendicitis (6.0%), while nearly one-quarter of examinations (23.8%) demonstrated normal findings. Abdominal pain strongly predicted appendicitis (NPV 96.7%, sensitivity 89.5%, OR 10.87, 95% CI 4.12-28.67) and mesenteric adenitis (NPV 93.9%, sensitivity 80.9%, OR 5.44, 95% CI 2.31-12.82). Trauma cases exhibited the highest proportion of normal CT findings (74.3%), particularly among hemodynamically stable patients. Conclusion: While abdominopelvic CT remains valuable in selected pediatric abdominal emergencies, particularly in high-risk clinical scenarios, the high proportion of normal examinations-especially in trauma cases-highlights the need for more selective CT utilization. These findings support the adoption of ultrasound-first approaches, structured clinical decision-making tools, and locally adapted imaging guidelines to minimize unnecessary radiation exposure in pediatric patients, particularly in resource-limited settings.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728645","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":"Distinct early-life gut microbiota patterns across SGA, AGA, and LGA infants.","authors":"Jae Kyoon Hwang, Sung Min Lim, Min-Jin Kwak, Seung Hyun Kim, Yoongu Kang, Ghulam Mustafa, Rahul Sadashiv Tanpure, Byong-Hun Jeon, Jeong-Kyu Hoh, Hyun-Kyung Park","doi":"10.1007/s00431-026-06903-9","DOIUrl":"10.1007/s00431-026-06903-9","url":null,"abstract":"<p><p>Birthweight-for-gestational-age influences neonatal physiology and health, yet its role in shaping early gut microbiome development remains insufficiently defined. Small-for-gestational-age (SGA), appropriate-for-gestational-age (AGA), and large-for-gestational-age (LGA) infants may exhibit distinct microbial maturation patterns that could influence later metabolic and developmental outcomes. We conducted a prospective cohort study and enrolled 50 late-preterm and term infants and classified them into SGA (n=18), AGA (n=20), and LGA (n=12). Serial fecal samples were collected at four postnatal time windows (0-14 and 15-80 days). 16S rRNA gene sequencing using Oxford Nanopore MinION characterized microbial composition, diversity, and community networks. Bioinformatic analyses included alpha- and beta-diversity metrics, co-occurrence network analysis, and functional pathway inference using PICRUSt2 mapped to the MetaCyc database. Clinical variables, including feeding pattern and antibiotic exposure, were assessed. Gut microbiome development differed according to birthweight categories. Microbial diversity increased with postnatal age, with SGA infants showing distinct community structures over time. Firmicutes predominated across all groups, while specific taxa exhibited group-specific patterns, including enrichment of Streptococcus spp. in LGA infants and Klebsiella spp. in SGA infants. Co-occurrence network analysis revealed a stable gut microbiota in LGA infants.</p><p><strong>Conclusion: </strong>Birthweight-for-gestational-age status was associated with distinct trajectories of early gut microbial maturation. SGA infants exhibited delayed microbial stabilization and fragmented interaction networks, whereas LGA infants demonstrated relatively early establishment of stable, Streptococcus-enriched communities. These growth-specific microbial patterns may reflect differences in early metabolic programming and highlight the potential importance of tailored microbiome-targeted strategies to optimize neonatal development.</p><p><strong>What is known: </strong>• Abnormal fetal growth is associated with increased neonatal morbidity and long-term metabolic risk. • Early-life gut microbiota play an important role in immune and metabolic development.</p><p><strong>What is new: </strong>• This longitudinal study demonstrates growth-specific trajectories of early gut microbial maturation among SGA, AGA, and LGA infants born at ≥35-week gestation. • SGA infants exhibit delayed microbial stabilization and fragmented microbial interaction networks, whereas LGA infants show relatively earlier establishment of stable microbial communities.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728477","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":"Low awareness of proper use of cold and cough medication among Czech paediatricians: a questionnaire study.","authors":"Ľuboš Bača, Eva Fürstová, Monika Pecková, Kateřina Kotíková, Jan David, Patrik Konopásek","doi":"10.1007/s00431-026-06937-z","DOIUrl":"10.1007/s00431-026-06937-z","url":null,"abstract":"<p><p>Cough and cold medications (CCMs) are widely used in paediatric practice despite limited evidence of efficacy and concerns regarding safety in young children. This study aimed to evaluate Czech paediatricians' knowledge, attitudes, and recommendation practices related to CCMs and to identify factors associated with inappropriate use in children under 6 years of age. An anonymous questionnaire-based survey was distributed online to hospital paediatricians and general practitioners for children across the Czech Republic. The survey assessed demographic characteristics, patterns of CCMs use, knowledge of efficacy and safety, awareness of international recommendations, and attitudes toward potential restrictions and educational interventions. Associations were analysed using descriptive statistics, logistic regression, and Fisher's exact test where appropriate. Of 266 respondents, 74.1% reported using CCMs in children under 6 years and 40.6% in children under 2 years. Recommendation practices were not associated with age or postgraduate training but varied significantly by region and medical school attended. Reliance on international literature was associated with the lowest use of CCMs, whereas reliance on local sources or older colleagues predicted higher use. Lack of awareness of the unproven efficacy of CCMs, as well as recommendations from the American Academy of Pediatrics and Health Canada, were the strongest predictors of inappropriate recommendations. While knowledge of the Medicines and Healthcare products Regulatory Agency recommendation also showed association with a good recommendation practice, the association was not significant in the multivariable model.</p><p><strong>Conclusion: </strong> Despite robust international guidance, CCMs remain commonly used in Czech paediatrics. Knowledge gaps, entrenched habits, and reliance on outdated information sources contribute to inappropriate use. Targeted educational initiatives and harmonised national guidelines are needed to improve practice.</p><p><strong>What is known: </strong>● CCMs remain widely used in paediatrics despite limited efficacy and safety concerns in young children. ● International recommendations, including those from the AAP and Health Canada, advise against CCMs use in children under 6 years.</p><p><strong>What is new: </strong>● In the Czech Republic, CCMs are used by 74% of paediatricians in children < 6 years and 41% in children < 2 years. ● CCMs recommendation practices vary by region and medical school, but not by age or training level. Higher inappropriate use is associated with reliance on local sources and older colleagues.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728647","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":"Different doses of vitamin A supplementation as adjuvant treatment for pneumonia in children: a network meta-analysis of randomized controlled trials.","authors":"Cong-Jun Zhou, Zhi-Cheng Su, Song Li, Yu Jin, Hai-Chang Chen, Zi-Jun Li, Yun-He Tian, Yi-Die Lin, Tian-Ming Yan, Feng-Yi Wu, Zhen-Cen Liu, Ya-Dan Liu, Wei Zhang, Xin-Yi Lei, Man-Di Li, Jing Yang, Yi-Neng Mao, Cai-Rong Zhu","doi":"10.1007/s00431-026-06947-x","DOIUrl":"https://doi.org/10.1007/s00431-026-06947-x","url":null,"abstract":"<p><p>While previous meta-analyses have established a link between vitamin A supplementation and outcomes in children with pneumonia, the efficacy and safety of different dosing regimens remain unclear. Existing evidence is predominantly based on single-dose trials, creating a critical knowledge gap. We systematically searched PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP databases from their inception to December 2025. Study searches were independently carried out in December 2025 by two reviewers. Two researchers used the Cochrane risk of bias tool to independently assess the quality of the included studies. Data analysis was conducted through the \"netmeta\" package in R software (version 4.3.3). Twenty-five trials involving 3116 patients were included. Network meta-analysis revealed that medium-dose vitamin A supplementation was most effective in reducing the duration of fever and cough. Low-to-medium doses were consistently associated with better clinical outcomes than high-dose regimens. However, evidence regarding safety outcomes remained limited and inconclusive.</p><p><strong>Conclusion: </strong> Low-to-medium dose vitamin A supplementation appears superior to high-dose regimens for alleviating clinical symptoms in children with pneumonia. However, the evidence is limited by high heterogeneity, indirect comparisons between dose groups, and poor reporting of adverse events. Future trials should prioritize direct dose-comparisons and rigorous safety monitoring to refine dosing guidelines.</p><p><strong>What is known: </strong>• Pneumonia poses a significant threat to the health and lives of children. Vitamin A supplementation plays an adjuvant role in the treatment of pneumonia in children. • There are currently divergent conclusions in the research regarding the optimal dosage of vitamin A, particularly with regard to the safety of high-dose supplementation and the effectiveness of low-dose supplementation.</p><p><strong>What is new: </strong>• This study revealed that medium-to-low-dose vitamin A supplementation appears to be more effective than high-dose therapy in alleviating the primary symptoms of childhood pneumonia. • This study also suggests that children in developed regions have higher baseline serum retinol levels, which may diminish the marginal benefits of high-dose supplementation and may even predispose them to its immunosuppressive effects.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728466","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":"Social determinants of health screening and interventions in neonatal care pathways (NICU to follow-up): a scoping review.","authors":"Behrouz Nezafat Maldonado, Katie Evans, Martha Jones, Jessica Park, Elaine Wood, Hammad Khan, Paul Cawley","doi":"10.1007/s00431-026-06957-9","DOIUrl":"10.1007/s00431-026-06957-9","url":null,"abstract":"<p><p>Social determinants of health (SDOH) influence families' ability to engage with neonatal care and may contribute to inequities in outcomes. Whilst the neonatal period presents a unique opportunity to address SDOH, it is unclear how screening and related responses are implemented across the neonatal care pathway. This review aimed to (i)o map and characterise existing screening tools and interventions used in the neonatal period to address SDOH and (ii) identify gaps in effectiveness and equity impacts. We conducted a scoping review (PRISMA-ScR) of studies from high-income countries reporting SDOH screening tools and/or interventions delivered in neonatal inpatient settings, discharge/postnatal pathways, neonatal follow-up services, or early infancy primary care. We report setting, tool content and delivery, downstream actions (referral/navigation), outcomes reported, and whether measurement properties were reported. Eight studies were included (predominantly from the USA/Canada) from 3764 studies screened. Most evidence related to implementation of screening and referral workflows rather than evaluation of downstream clinical outcomes. Screening approaches identified high levels of reported social need and commonly triggered social work involvement and referrals; only one study reported a defined \"connection with resources\" outcome beyond referral. Two studies evaluated equity-relevant interventions beyond screening: a digital participation intervention to support attendance at family-centred rounds and a follow-up intervention addressing structural barriers through coordinated support. Across included neonatal applications, psychometric properties of instruments were not reported, and tools were commonly adapted from other settings or locally developed. Outcomes were heterogeneous and most frequently process-focused (uptake, referrals), limiting comparability.</p><p><strong>Conclusion: </strong> Evidence describing SDOH screening and responses across neonatal care pathways remains limited and largely descriptive. Future work should define a core set of SDOH domains with context-specific modules, use standardised outcome reporting, and apply a minimum reporting set for neonatal SDOH screening/intervention studies.</p><p><strong>What is known: </strong> • Studies mainly report screening/referral processes; neonatal-context psychometric evidence and standardised downstream outcomes are lacking.</p><p><strong>What is new: </strong> • We propose a minimum reporting set to improve how future neonatal SDOH screening/intervention studies are reported and evaluated.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722066","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":"Early post-operative hemodynamic recovery in infants with congenital diaphragmatic hernia.","authors":"Kamal Ali, Mahesh Nandunjappa, Abdulaziz Homedi, Fahad Ms Arattu Thodika, Raghavendra Subba-Rao, Mohammed Almahdi, Saif Alsaif, Ibrahim Ali, Ravindra Bhat, Christopher Harris, Theodore Dassios, Anne Greenough","doi":"10.1007/s00431-026-06907-5","DOIUrl":"10.1007/s00431-026-06907-5","url":null,"abstract":"<p><p>Pulmonary hypertension and cardiac dysfunction contribute to morbidity in infants with congenital diaphragmatic hernia (CDH). Although surgical repair relieves thoracic compression, post-repair hemodynamic recovery remains incompletely understood. We aimed to characterize changes in ventricular function and pulmonary hypertension indices using paired echocardiography. This retrospective cohort study included 52 infants with CDH who underwent echocardiographic assessments 24 h before and 24-48 h after surgical repair. Paired analyses were performed for the continuous and categorical variables. Predefined abnormal thresholds were applied to assess post-repair normalization. Associations between changes in pulmonary hypertension markers and ventricular function were examined using correlation analysis. Significant improvements were observed in echocardiographic measures following repair. Ejection fraction increased from 62 to 72%, and tricuspid annular plane systolic excursion (TAPSE) increased from 7 to 12 mm (all p < 0.001). The right ventricular systolic pressure decreased from 30 to 24 mmHg, and the eccentricity index improved from 1.2 to 1.1 (both p < 0.001). Normal septal morphology was restored in 58.3% of infants, and right-to-left ductal shunting resolved in all affected cases. Reductions in the eccentricity index correlated with improvements in left ventricular output (ρ = - 0.31, p = 0.024), left ventricular longitudinal strain (ρ = 0.43, p = 0.005), TAPSE (ρ = 0.37, p = 0.006), and right ventricular output (ρ = - 0.37, p = 0.007).</p><p><strong>Conclusion: </strong> Surgical repair of CDH is associated with early postoperative changes in echocardiographic indices of biventricular systolic performance and pulmonary vascular loading. Paired echocardiography allows quantification of early hemodynamic adaptation following repair.</p><p><strong>What is known: </strong>• Pulmonary hypertension and ventricular dysfunction are major contributors to early morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). • The early hemodynamic impact of surgical repair, assessed using paired preoperative and postoperative echocardiography within individual infants, has not been well characterized.</p><p><strong>What is new: </strong>• Surgical repair of CDH is associated with early postoperative changes in echocardiographic indices of biventricular systolic performance, septal geometry, and pulmonary hypertension. • Changes in pulmonary vascular loading were closely associated with directional changes in ventricular systolic performance indices, highlighting the importance of ventricular-vascular interaction in early postoperative hemodynamic adaptation.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728472","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}