European Journal of Pediatrics最新文献

{"title":"Outpatient drug therapy for children with heart disease in Switzerland: a survey.","authors":"Joel Bärlocher, Angela Caduff Good, Stefano Di Bernardo, Sebastiano A G Lava, Dominik Stambach, Cécile Tissot, Walter Knirsch, Julie Wacker, Anna Cavigelli-Brunner, Alessandra Bosch, Christian Balmer","doi":"10.1007/s00431-026-07024-z","DOIUrl":"https://doi.org/10.1007/s00431-026-07024-z","url":null,"abstract":"<p><p>Cardiovascular drug therapy in adults is steadily progressing. However, the extent to which children with heart disease in Switzerland benefit from this progress remains unknown. This survey aimed to investigate the current outpatient prescribing practices among paediatric cardiologists in Switzerland. We conducted a cross-sectional survey among Swiss paediatric cardiologists. The physicians were asked to state how often they administer drugs on a pre-defined list for the following indications: heart failure, arrhythmia and thromboembolism. Forty-three (56%) out of 77 eligible physicians completed the survey. For paediatric heart failure, the three most frequently prescribed drugs were hydrochlorothiazide ('often prescribed' by n = 25, 58%), lisinopril (n = 24, 56%), and spironolactone (n = 32, 74%). The most frequently prescribed drugs for arrhythmia and thromboembolism were propranolol (n = 26, 60%) and acetylsalicylic acid (n = 31, 72%), respectively. Newer drugs such as sacubitril/valsartan ('never prescribed' by n = 20, 47%), sodium-glucose cotransporter type 2 inhibitors (n = 40, 93%), and direct oral anticoagulants (n = 20, 47%) were rarely used.</p><p><strong>Conclusion: </strong> The drugs used to treat heart failure, arrhythmia, and thromboembolism in Switzerland largely reflect current international recommendations. Nevertheless, novel drugs are rarely used. In addition to the lack of large randomized controlled drug trials in children, important obstacles are lack of authorization, lack of reimbursement, and lack of suitable formulations. These issues should be addressed by both the industry and healthcare providers to continuously improve drug therapy for children with heart disease.</p><p><strong>What is known: </strong>• Evidence for drug use in Paediatric cardiology mostly relies on extrapolation from adult studies and pathophysiological considerations. • Drug choices are also influenced by drug approval, insurance reimbursement, and availability of age-appropriate formulations.</p><p><strong>What is new: </strong>• Swiss paediatric cardiologists predominantly rely on established drugs to treat cardiovascular diseases in children, with the use of newer drugs remaining limited. • On top of expert consensus, adult evidence, and drug availability, drug prescription appears to be strongly influenced by the availability of child-friendly formulations.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835369","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":"Piperacillin-tazobactam versus cefepime monotherapy in pediatric patients with febrile neutropenia: a systematic review and meta-analysis.","authors":"Bernardo Luís Giacomelli Fernandes, Allan Joseph, Vítor Honorato Andriazzi","doi":"10.1007/s00431-026-07003-4","DOIUrl":"https://doi.org/10.1007/s00431-026-07003-4","url":null,"abstract":"<p><p>The purpose of this study is to evaluate whether piperacillin-tazobactam therapy, compared with cefepime monotherapy, results in significant difference in treatment success, mortality, and duration outcomes in pediatric patients with febrile neutropenia (FN). A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched up to February 3. No starting limits for dates were used. We only included studies of pediatric patients with FN comparing piperacillin-tazobactam to cefepime monotherapy. Risk of bias was assessed using Cochrane RoB 2 tool. Meta-analysis was performed using random-effects model to calculate risk ratios (RR) and mean differences (MD). Five RCTs involving 470 episodes were included. The pooled analysis for treatment success showed no statistically significant difference between groups (RR = 1.02; 95% CI [0.89; 1.18]; P = 0.76) with low heterogeneity (I² = 0.0%). No significant differences for mortality (RR = 2.09; 95% CI [0.62; 7.03]; P = 0.23; I² = 0.0%). Duration of treatment was 0.9 day shorter for cefepime group (MD = 0.9 day; 95% CI [0.2; 1.6]; P < 0.1; I² = 0%).</p><p><strong>Conclusion: </strong> No statistically significant difference was found in treatment success or mortality between the groups. Patients receiving cefepime had a treatment duration 0.9 days shorter than those receiving piperacillin-tazobactam, although this finding should be interpreted with caution. The available evidence remains limited. Further RCTs are needed to elucidate potential differences in treatment success, mortality, and duration between the drugs.</p><p><strong>Registration: </strong>PROSPERO (CRD420261296621).</p><p><strong>What is known: </strong>• Cefepime and piperacillin-tazobactam are widely utilized as empirical monotherapy for febrile neutropenia, but evidence regarding their comparative clinical efficacy and safety in children remains inconclusive.</p><p><strong>What is new: </strong>• This meta-analysis quantifies differences in treatment success, mortality and duration of treatment outcomes in pediatric patients with febrile neutropenia.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835442","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":"Clinical characteristics and outcomes of children with measles requiring pediatric intensive care: a multicenter study in Istanbul.","authors":"Nihal Akçay, Demet Tosun, İlyas Bingöl, Mehmet Emin Menentoğlu, Esra Şevketoğlu, Fatih Varol, Gözde Alara Kurtiş, Murat Kanğın, Süleyman Bayraktar, Mehmet Arda Kılınç, Emrullah Aygüler, Ufuk Yükselmiş, Ülkem Koçoğlu Barlas, Abdulrahman Özel, Burcu Bursal, Servet Yüce","doi":"10.1007/s00431-026-07033-y","DOIUrl":"10.1007/s00431-026-07033-y","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Measles remains a major public health concern despite the availability of effective vaccines. Recent global resurgences, including in Türkiye, have been partly attributed to disruptions in routine immunization and declining vaccination coverage during the COVID-19 pandemic. Data on children with measles requiring pediatric intensive care are limited. We aimed to describe the clinical characteristics and outcomes of children with measles admitted to pediatric intensive care units (PICUs) in a large metropolitan area. This multicenter retrospective study included children &lt; 18 years with laboratory-confirmed measles admitted to ten PICUs in Istanbul, Türkiye, between January and December 2023. Demographic data, vaccination status, clinical features, laboratory findings, treatments, and outcomes were collected. Patients were stratified by vaccination status. Among 5,685 PICU admissions, 53 children (median age 1.3 years) had laboratory-confirmed measles. Ten (18.9%) were vaccinated and 43 (81.1%) were unvaccinated. The median rash duration was longer in vaccinated children (3 vs. 2 days; p = 0.027). Rash onset most frequently involved the face in vaccinated children (70%), whereas trunk onset predominated in unvaccinated children (51.2%) (p &lt; 0.001). Unvaccinated children were admitted closer to rash onset, indicating a more rapidly evolving clinical course. Rhinorrhea was more common in unvaccinated children (69.8% vs. 20%; p = 0.009). Median oxygen saturation at PICU admission was lower in unvaccinated patients (91% vs. 95%; p = 0.015). Although ARDS, inotropic support, and invasive ventilation were more frequent in unvaccinated children, these differences were not statistically significant. In multivariable analysis, abnormal chest radiographic findings showed a trend toward association with respiratory support, although this did not reach statistical significance. Overall mortality was 2.3% (1/53), occurring in an unvaccinated infant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Measles continues to cause critical illness in young children requiring PICU care. Unvaccinated children tended to present with lower oxygen saturation at admission, suggesting more pronounced respiratory involvement. Maintaining high vaccination coverage remains essential to reduce severe measles-related morbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Measles outbreaks persist in areas with suboptimal vaccination coverage, with unvaccinated children at higher risk of severe complications. • Data on critically ill children with measles, particularly those requiring intensive care, remain limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• This multicenter study provides contemporary PICU-based data from a recent measles outbreak in a large European metropolitan area, where most critically ill children were unvaccinated and very young. • Unvaccinated children showed trends toward lower oxygen saturation and more pronounced respiratory involvement, though findings should be inte","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of epicardial adipose tissue thickness and left ventricular functions in children with primary dyslipidemia.","authors":"Mohamed A Hassan, Mina Mamdouh, Faisal-Alkhateeb Ahmed, Khaled Mohammed Allam","doi":"10.1007/s00431-026-06997-1","DOIUrl":"10.1007/s00431-026-06997-1","url":null,"abstract":"<p><p>Epicardial adipose tissue (EAT) is a component of visceral adiposity and mediates cardiac function and atherosclerosis via expression of several bioactive molecules. To evaluate the significance and relationship between epicardial fat thickness (EFT) and familial dyslipidemia and left ventricular function. This prospective case-control study was conducted at Assiut University Children's Hospital between September 2023 and August 2025. Twenty-one children with familial dyslipidemia and twenty-one age-, sex-, and BMI-matched healthy controls underwent clinical evaluation, lipid profile assessment, and transthoracic echocardiography, including measurement of epicardial fat thickness and left ventricular systolic and diastolic function according to American Society of Echocardiography guidelines. Dyslipidemic patients showed significantly higher total cholesterol (332.9 ± 222.3 mg/dL), triglycerides (391.4 ± 251.6 mg/dL), and LDL (154.3 ± 130.4 mg/dL) than controls (p < 0.001). Mixed hyperlipidemia was the most common type (47.6%). Echocardiography revealed increased epicardial fat thickness (2.88 ± 0.94 mm vs. 2.29 ± 0.57 mm; p = 0.018), larger left atrial (21.45 ± 3.86 mm; p = 0.031) and aortic diameters (17.54 ± 3.12 mm; p = 0.013). Triglyceride level was the only independent predictor of epicardial fat thickness (β = 0.437, p = 0.028).</p><p><strong>Conclusion: </strong> Echocardiography revealed increased epicardial fat thickness and early cardiac remodeling. Serum triglycerides were the only independent predictor of EFT, suggesting its key role in subclinical cardiovascular risk among dyslipidemic children.</p><p><strong>What is known: </strong>• Epicardial adipose tissue is associated with cardiovascular risk factors in adults. • Children with primary dyslipidemia may develop early cardiac dysfunction.</p><p><strong>What is new: </strong>• This study demonstrates a signifi cant association between epicardial adipose tissue thickness and left ventricular function in children. • It highlights the potential role of epicardial fat as an early marker of cardiac involvement in pediatric dyslipidemia.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835319","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":"Prognosis of neonates receiving invasive mechanical ventilation in low-resource settings: a systematic review and prognostic meta-analysis.","authors":"Vijay Kumar Krishnegowda, Viraraghavan Vadakkencherry Ramaswamy, Prathik Bandiya, Tapas Bandyopadhyay, Thangaraj Abiramalatha, Abdul Kareem Pullattayil, Daniele Trevisanuto","doi":"10.1007/s00431-026-07016-z","DOIUrl":"10.1007/s00431-026-07016-z","url":null,"abstract":"<p><p>Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current evidence base being restricted to single-centre observational studies, thus limiting comparative analyses and effective healthcare planning. This study aims to estimate the pooled proportion of mortality and morbidity among neonates exposed to IMV in low-resource settings. Medline, Embase, and CENTRAL were searched until 22 August 2025. Randomised and non-randomised studies were included. Two reviewers, blinded to each other, extracted data independently. Proportion-based meta-analyses using random-effects model were performed. Risk of bias was assessed using ROBINS-E, and evidence-certainty was evaluated using the GRADE approach. One hundred of 117 studies were included, with most conducted in South Asia. In-hospital mortality was reported in 68 studies (7193 neonates), with a pooled estimate of 45% (39%-50%), evidence-certainty being very low. Among the secondary outcomes, the pooled rates were as follows: bronchopulmonary dysplasia, 10% (5%-18%); intraventricular haemorrhage (any grade), 10% (5%-19%); necrotising enterocolitis (any stage), 14% (6%-31%); retinopathy of prematurity (any stage), 33% (22%-46%); ventilator-associated pneumonia, 21% (14%-29%); sepsis, 32% (25%-40%) and pulmonary haemorrhage, 9% (6%-14%). Evidence-certainty for all the secondary outcomes was also very low. Subgroup analysis comparing two distinct time epochs revealed a significant difference in mortality, 43% (36%-50%) (I² = 93.5%) in the post-2010 epoch compared to 55% (48%-63%) (I² = 82.9%) in the pre-2010 epoch (p = 0.004). Heterogeneous outcome definitions and predominance of unadjusted analyses across studies limit the existing evidence.Conclusions: In LRS, the mortality and morbidity rates among neonates receiving IMV remain substantially high with a modest improvement in survival in the past decade. Improving outcomes mandates moving beyond access to the provision of IMV to investing in comprehensive training and scaling up critical auxiliary resources. Future research must adopt standardised outcome definitions and adjusted analyses to precisely quantify the impact of IMV in LRS.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13152968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835415","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":"Factors affecting the quality of life in children with joint hypermobility syndrome.","authors":"Tevfik Çevirici, Ayşegül Demir Çevirici, Naci Yılmaz, Furkan Kalaycı, Banu Çelikel Acar","doi":"10.1007/s00431-026-06959-7","DOIUrl":"https://doi.org/10.1007/s00431-026-06959-7","url":null,"abstract":"<p><p>Juvenile hypermobility syndrome can cause various symptoms in children, including widespread musculoskeletal pain, digestive issues, tingling sensations, urinary problems, sleep disturbances, fatigue, and anxiety. This study aimed to investigate how juvenile hypermobility syndrome and its associated symptoms affect the quality of life of children. The study involved 152 patients between the ages of 6 and 18 who experienced joint pain. The diagnosis of joint hypermobility syndrome was based on the Beighton criteria, and the quality of life was assessed using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Our study included 152 patients, of whom 96 (63.2%) were female. The average age of the patients was 11.2 ± 3.6 years. The knee was the most commonly affected area, with 92 patients (60.5%). The average Beighton score was 6.9 ± 1.3. Accompanying findings were observed in 146 patients; the most common finding was myalgia, which was observed in 32 patients (21.1%). The median PedsQL score reported by the children was 74 (17.7-95.8), with physical health at 78.1 (9.4-100), emotional functionality at 70 (0-100), social functionality at 79.2 (8.3-83.3), and school functionality at 70 (10-100). Similarly, the median PedsQL score reported by the parents for their child was 77.1 (8.3-95.8), with physical health at 75 (3.1-100), emotional functionality at 75 (0-100), social functionality at 83.3 (83.3-83.3), and school functionality at 80 (20-100).</p><p><strong>Conclusion: </strong>Many children diagnosed with juvenile hypermobility syndrome experience additional symptoms that affect not only their physical functionality, but also their school and social lives, which can impact their emotional well-being. This can cause concern for parents, and both the child and the family require appropriate support, especially in terms of emotional and social functionality. It is important to ensure that both the child and their family receive necessary support to deal with juvenile hypermobility syndrome.</p><p><strong>What is known: </strong>• Many children diagnosed with juvenile hypermobility syndrome experience additional symptoms that affect not only their physical functionality, but also their school and social lives, which can impact their emotional well-being.</p><p><strong>What is new: </strong>• This can cause concern for parents, and both the child and the family require appropriate support, especially in terms of emotional and social functionality. It is important to ensure that both the child and their family receive necessary support to deal with juvenile hypermobility syndrome.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835393","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 visitation policies and family information practices in pediatric intensive care units in Turkey: a national survey.","authors":"Serhat Emeksiz, Bayram Bayramov, Alper Oglakcioglu, Serhan Ozcan, Tanıl Kendirli","doi":"10.1007/s00431-026-07013-2","DOIUrl":"10.1007/s00431-026-07013-2","url":null,"abstract":"<p><p>Family-centered care, including open visitation and effective communication, is increasingly recognized as essential in pediatric intensive care. Despite growing international evidence supporting open visitation policies and family involvement, significant variation exists in implementation across different healthcare systems and cultural contexts. This study aimed to evaluate the current visitation policies and family information practices in pediatric intensive care units (PICUs) in Turkey. A web-based survey was conducted among 59 PICUs across Turkey, focusing on ICU characteristics, visitation policies, and the provision of family information. The survey was distributed through the Turkish Pediatric Intensive Care Society network, and responses were obtained from one designated representative per unit. The majority of the units (78%) allowed a parent to remain at the bedside for 24 h for non-intubated patients, adopting family-centered care. However, 91.5% of the units had at least one restrictive visitation policy. Sibling visitation was prohibited in 67.8% of units. Visitation restrictions were eased under certain circumstances, such as after a diagnosis of brain death (83.1%) or in end-stage illness (76.3%). Family information was provided regularly by physicians in 57.6% of the units, and 49.2% had a dedicated family meeting room. Statistically significant differences were observed between isolation room-only units and mixed-room units regarding 24-h bedside family presence, visit duration, and the location of family information provision (p = 0.012, p = 0.031, p = 0.023, respectively). None of the units permitted family presence during invasive procedures or cardiopulmonary resuscitation.</p><p><strong>Conclusion: </strong>While a substantial proportion of Turkish PICUs allow 24-h family presence for non-intubated patients, restrictive policies remain common for visitors and siblings. The prohibition on family presence during procedures represents an important gap in the implementation of family-centered care. These findings highlight opportunities for policy development and staff education.</p><p><strong>What is known: </strong>• Restrictive visitation policies in pediatric ICUs increase family stress and may prolong patient recovery. • Family-centered care with 24-hour family presence improves patient and family outcomes. • Visitation and family information practices vary widely between countries and institutions.</p><p><strong>What is new: </strong>• This is the first national survey evaluating visitation policies and family information practices in Turkish pediatric ICUs. • Most Turkish PICUs allow 24-hour family presence but maintain some visitation restrictions. • Significant differences exist between isolation-room-only and mixed-room units regarding visitation and family information provision.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835406","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":"LISA or INSURE: what should we use?","authors":"Anton H van Kaam","doi":"10.1007/s00431-026-07029-8","DOIUrl":"https://doi.org/10.1007/s00431-026-07029-8","url":null,"abstract":"","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835350","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":"Clinical features and therapeutic outcomes in pediatric patients with Castleman's disease: a retrospective cohort analysis.","authors":"Yuanyuan Wang, Zixin Qin, Shu Xin Chen, Ru Ting Shi, Jia Ning Liu, Yongcheng Fu, Jingyue Wang, Shangkun Li, Tan Xie, Da Zhang","doi":"10.1007/s00431-026-07011-4","DOIUrl":"https://doi.org/10.1007/s00431-026-07011-4","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Castleman disease (CD) is a rare lymphoproliferative disorder classified by anatomic site and clinical presentation. Pediatric CD is exceedingly uncommon, with only limited cases reported in the literature. This cohort study encompassed 30 pediatric patients (aged ≤ 18 years) diagnosed with CD. Statistical analyses and advanced modeling were conducted using SPSS version 25.0 and R version 4.3.2. Data collected included demographic information, histopathological findings, laboratory results, and imaging characteristics. Among 30 pediatric CD patients, 19 had unicentric CD (UCD) and 11 had multicentric CD (MCD). UCD patients (12 males, 7 females) had a median diagnosis age of 11 years (IQR, 7.25-13.75; range, 3-18), median diagnostic delay of 2.4 months (IQR, 1.1-8.5), and median follow-up of 16.5 months (IQR, 6.75-27); MCD patients (5 males, 6 females) had a median diagnosis age of 15 years (IQR, 12-16; range, 11-16); median diagnostic delay of 1.77 months (IQR, 0.63-4.17); and median follow-up of 9.5 months (IQR, 5.75-26.5). Compared with MCD, UCD patients had significantly higher MCV (85.04 ± 6.60 fL), ALC (2.67 ± 0.93 × 10⁹/L), Hb (130.03 ± 13.22 g/L), and serum albumin (45.12 ± 4.01 g/L), while MCD patients had higher diagnostic age, PLT (281.37 ± 67.06 × 10⁹/L), globulin (24.35 ± 3.54 g/L), and CRP. UCD had significantly lower incidences of multicentric involvement, hepatosplenomegaly, and systemic symptoms (p &lt; 0.05). Histopathologically, hyaline-vascular subtype predominated in UCD, and mixed hyaline-vascular-plasma-cell subtype was more common in MCD (p = 0.004). Surgery was the primary treatment for UCD, while chemotherapy predominated for MCD (p &lt; 0.001). Night sweats, dizziness, and headache did not affect diagnostic delay or maximum lesion cross-sectional area (p &gt; 0.05). Firth's penalized univariate exact logistic regression showed MCV, Hb, PLT, and somatic symptoms approached statistical significance for outcomes; LASSO regression identified fatigue, MCV, and medical history as core prognostic predictors, while Ridge regression indicated positive signs, fatigue, and MCV as high-risk variables, with globulin, albumin, and complications exerting protective effects, and both models had good predictive efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt; Significant differences (p &lt; 0.05) existed between single-center and multicenter CD cohorts in clinical and laboratory parameters. The single-center group had higher MCV, ALC, Hb, and albumin, and lower age, PLT, and globulin. It also had significantly lower rates of fever, hepatosplenomegaly, surgical biopsy, and systemic symptoms at initial diagnosis. Pathologically, hyaline vascular type predominated in the single-center group, while the multicenter group had mixed subtypes. The single-center group primarily underwent surgery, and the multicenter group favored chemotherapy. Subgroup analysis of symptoms showed no significant differences in delayed diagnosis time or maximum lesion cross","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835410","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":"The effect of virtual reality and buzzy® on pain, fear, and anxiety during skin prick testing in children: a randomized controlled trial.","authors":"Funda Gürbüz, Emine Geçkil, Şükrü Nail Güner","doi":"10.1007/s00431-026-07020-3","DOIUrl":"https://doi.org/10.1007/s00431-026-07020-3","url":null,"abstract":"<p><p>Skin prick testing (SPT), although minimally invasive, is frequently associated with procedural pain, fear, and anxiety in pediatric populations. This randomized controlled trial aimed to compare the effectiveness of immersive virtual reality (VR) and the Buzzy® device in reducing procedural distress during SPT. In this randomized pretest-posttest study, 90 children aged 7-10 years undergoing first-time SPT at a Turkish university hospital were randomly allocated to VR distraction (n = 30), Buzzy® (n = 30), or routine care (n = 30). Pain, fear, and state anxiety were assessed before and after the procedure using validated pediatric scales reported by children, parents, and researchers. Group differences were analyzed using one-way ANOVA and chi-square tests. A mixed-design ANOVA examined group-time effects with Bonferroni-adjusted comparisons. Statistical significance was set at p < .05. Groups were comparable at baseline (p > .05). Significant group-time effects were identified for pain (F: 27.06, p < .001, pη²: .38), fear (F: 33.14, p < .001, pη²: .43), and anxiety (F: 44.76, p < .001, pη²: .51). Post-procedure scores were lowest in the VR group, followed by Buzzy®, and highest in controls. Effect sizes were large across all outcomes, indicating clinically meaningful reductions in procedural distress. No adverse events occurred.</p><p><strong>Conclusion: </strong>Both VR and Buzzy® were associated with reduced procedural distress during SPT, with VR showing greater reductions than Buzzy® in this study. These findings suggest that structured, nurse-led distraction interventions may be beneficial; however, further studies are needed to confirm these results across different clinical settings. The findings suggest that integrating structured, nurse-led distraction strategies, particularly immersive VR, may substantially enhance atraumatic, child-centered care in pediatric allergy settings. The trial was registered at ClinicalTrials.gov in NCT06443060 (12/04/2025).</p><p><strong>What is known: </strong>•VR and Buzzy® both reduced pain, fear, and anxiety during SPT. •Both interventions were safe and feasible in clinical practice.</p><p><strong>What is new: </strong>•VR was more effective than Buzzy® in reducing these outcomes. •Findings support nurse-led, structured distraction strategies in pediatric allergy settings.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 6","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835477","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}