European Journal of Pediatrics最新文献

{"title":"Risk factors associated with hypertension in patients attending a pediatric sleep clinic: a prospective cohort study.","authors":"Esther Huimin Leow, Zai Ru Cheng, Fan Wang, Ruochen Du, Jing Yi Ho, Celeste Jia Ying Yap, Sing Ming Chao, Indra Ganesan, Yong Hong Ng, Oon Hoe Teoh, Siew Le Chong, Jan Hau Lee","doi":"10.1007/s00431-026-07513-1","DOIUrl":"https://doi.org/10.1007/s00431-026-07513-1","url":null,"abstract":"<p><p>Pediatric patients with obstructive sleep apnea (OSA) are at risk of hypertension due to an interplay of factors. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is required to diagnose white coat hypertension (WCH) and masked hypertension (MH). However, ABPM is not routinely performed. We aim to detect hypertension using ABPM and to identify risk factors associated with hypertension. This was a prospective cohort study of pediatric patients (5-18 years of age) who had been referred to the sleep clinic. Polysomnography (PSG) or overnight pulse oximetry (OPO) were performed as per standard of care. ABPM was performed for all recruited patients. The primary outcome was hypertension, i.e., ambulatory hypertension or MH. Sixty-eight patients were recruited. Median age was 12.6 (interquartile range [IQR] 10.0-14.7) years. Fourteen (21%) did not return for the ABPM and ten (15%) had insufficient readings. Of the remaining 44 patients with complete ABPM data, hypertension was diagnosed in 18/44 (41%) with 10 (23%) having ambulatory hypertension and 8 (18%) having MH. Among the 18 patients with hypertension, one defaulted sleep study; 3/17 (18%) had primary snoring; 6/17 (35%), 4/17 (24%), and 4/17 (24%) had mild, moderate, and severe OSA, respectively. The prevalence of hypertension was 6/20 (30%), 4/10 (40%), 4/8 (50%), and 3/5 (60%) among patients with mild, moderate, and severe OSA and primary snoring, respectively. Age (relative risk [RR] 1.27, 95% confidence interval [CI] 1.07-1.52, p = 0.008) and primary snoring (RR 3.52, 95% CI 1.38-8.97, p = 0.004) were independently associated with hypertension.</p><p><strong>Conclusion: </strong> Increasing age and primary snoring may be independently associated with hypertension among pediatric patients attending the sleep clinic. Larger studies will be required to validate these risk factors.</p><p><strong>What is known: </strong>• Pediatric patients with obstructive sleep apnea (OSA) are at risk of hypertension which is often due to an interplay of multiple factors. • Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is required to diagnose white coat hypertension (WCH) and masked hypertension (MH).</p><p><strong>What is new: </strong>• In this prospective single-center study, ABPM was performed for all patients, classifying hypertension based on the 2022 update on ABPM in children from the American Heart Association. • Increasing age and primary snoring were independently associated with hypertension in pediatric patients attending the sleep clinic.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180188","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":"Postnatal evolution of electrocardiographic parameters in preterm infants: a prospective longitudinal cohort study.","authors":"Swasthi Kabi Satpathy, Sushil Choudhary, Choudri Muzafar Paswal, Arun Kumarendu Singh, Neeraj Gupta, Jai Prakash Soni, Raman Krishna Kumar, Rahul Choudhary","doi":"10.1007/s00431-026-07517-x","DOIUrl":"https://doi.org/10.1007/s00431-026-07517-x","url":null,"abstract":"<p><p>Electrocardiography (ECG), an indispensable bedside tool in neonatal intensive care, complements echocardiography by providing assessment of cardiac rhythm and conduction, and when advanced imaging is unavailable, serves as a screening tool. Preterm birth alters cardiac and autonomic maturation. Applying term-based ECG norms may misclassify physiological findings in preterm. We aimed to characterise serial ECG maturation in preterms from birth to term-equivalent age and define gestational- and postnatal-age-specific patterns relevant to clinical interpretation. In this prospective cohort, infants between 28⁰/₇ and 36⁶/₇ weeks' gestation without congenital heart disease underwent serial 11-lead ECG recording within 24 h of birth, on day 7, day 28 and at term-equivalent age. Postnatal and gestation-based differences in ECG parameters were analysed and centile charts were generated. Among 249 infants (mean gestation-33⁴/₇ weeks), 213 completed follow-up until term-equivalent age. ECG parameters demonstrated consistent maturation across time points. The mean QRS axis shifted leftward from 117° at birth to 82° at term-equivalent age (p < 0.001). PR-interval, QRS and P-wave duration remained stable across all time points. Mean QTc showed minimal overall change. Transient QTc prolongation occurred in 8.1% of infants and resolved by term-equivalent age. Right precordial R-wave amplitudes declined over time, whereas left precordial amplitudes increased. At term-equivalent age, very preterm infants exhibited a more leftward QRS axis compared with late preterm infants. Infants with bronchopulmonary dysplasia showed trends toward right ventricular dominance.</p><p><strong>Conclusion: </strong>Preterm ECG findings are dynamic, gestation-dependent markers of cardiovascular transition. This study characterises longitudinal ECG maturation in preterms and provides reference values, supporting improved decision-making in preterm care.</p><p><strong>What is known: </strong>• Electrocardiographic reference nomograms used in neonatal practice are primarily based on paediatric cohorts or cross-sectional studies of term infants. These references provide limited information on longitudinal electrophysiologic maturation in preterm neonates.</p><p><strong>What is new: </strong>• In a cohort of 249 preterm infants, serial ECG measurements demonstrated changes in axes, QTc, and precordial voltages from birth to term-equivalent age. • These gestation and age-specific trajectories support cautious interpretation of preterm ECGs using term-derived standards.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180124","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":"Temporal trends in the clinical presentation, management, and outcomes of children with congenital cytomegalovirus infection.","authors":"Jitka Bolchová, Despoina Gkentzi, Roberto Pedrero Tomé, Garyfallia Syridou, Antoni Noguera-Julián, María Ríos-Barnés, Serena Salomé, Francesco Raimondi, Serena Villaverde, Fernando Baquero-Artigao, Paula Rodriguez-Molino, Danilo Buonsenso, Laura Martino, Beatriz Álvarez-Vallejo, Jesús Saavedra, Yves Fougere, Hermione Lyall, Ina Foulon, Horst Buxmann, Simona Zanette, Olga Tsiatsiou, Jessica Wan, Daniel Blázquez-Gamero, Vana Papaevangelou","doi":"10.1007/s00431-026-07485-2","DOIUrl":"10.1007/s00431-026-07485-2","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Congenital cytomegalovirus (cCMV) is the most common congenital infection and a leading cause of sensorineural hearing loss as well as neurodevelopmental impairment. In recent years, awareness, screening, and management strategies for cCMV have evolved. This study aimed to assess temporal changes in the clinical presentation, treatment, and outcomes of children diagnosed with cCMV infection. We conducted a retrospective cohort analysis using data from the CCMVnet registry ( www.ccmvnet.org ), an international multicenter database collecting anonymized data on children with confirmed cCMV infection. A total of 1653 patients diagnosed between 2011 and 2024 were included and divided into two cohorts: 2011-2016 (n = 566) and 2017-2024 (n = 1087). The year 2017 was selected as a pragmatic cutoff, corresponding to the year of publication of the European expert consensus statement on congenital CMV. Children were identified through antenatal, clinical, hearing-related, and newborn screening pathways. Symptomatic cCMV at birth was defined by the presence of at least one predefined clinical, laboratory, hearing, or neuroimaging finding based on previously published criteria. A comparative analysis between two distinct time periods was conducted, encompassing neonatal clinical findings, neuroimaging results, treatment strategies, and long-term outcomes. Newborns classified as symptomatic at birth decreased in the more recent cohort, from 49.2% in P1 to 44.2% in P2 (p = 0.07). The use of intravenous ganciclovir decreased from 7.3% to 2.8% (p &lt; 0.001), while the use of oral valganciclovir alone increased from 43.8% to 78.7% (p &lt; 0.001). Differences in long-term outcomes were observed between the two periods, with motor impairment at 12 months decreasing from 16.5% to 6.2% (p &lt; 0.001) and any long-term sequelae at 36 months decreasing from 40.0% to 31.0% (p = 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt; This study highlights temporal differences in the clinical spectrum, management, and outcomes of children with congenital CMV infection in Europe. The higher proportion of asymptomatic and mildly symptomatic children in the latter period may reflect changes in maternal and neonatal screening practices. The observed temporal differences provide insight into the evolving clinical landscape of cCMV diagnosis and management, while their underlying causes cannot be determined from the present data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of sensorineural hearing loss and neurodevelopmental impairment in children. • Clinical management of cCMV has evolved substantially over the last decade, particularly following the publication of the European expert consensus statement in 2017 and alongside expanding screening strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• In our cohort, children diagnosed with cCMV after 2017 presented with milder clinical manifestations and experienced fewer long-","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180307","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":"Ultrasound-guided central venous access in the NICU: indications, insertion and management.","authors":"Giovanni Barone, Vito D'Andrea, Gilda Pepe, Mauro Pittiruti","doi":"10.1007/s00431-026-07496-z","DOIUrl":"10.1007/s00431-026-07496-z","url":null,"abstract":"<p><p>Ultrasound-guided cannulation of deep veins has advanced in little more than a decade from the operating room to the neonatal bedside and from a rescue maneuver to a planned procedure. Centrally inserted central catheters (CICCs) and femorally inserted central catheters (FICCs) are quite different from epicutaneo-cava catheters: they are 3-4 Fr power-injectable polyurethane catheters that are easy to tunnel, secured by subcutaneous anchorage, and suitable for blood transfusion, high-flow infusions, repeated blood sampling, and hemodynamic monitoring. This narrative review examines the indications, materials, insertion bundles for CICCs and FICCs in newborns, as well as their management, complications, and the training gap that now limits their diffusion more than any technical obstacle. In published studies, procedural success is 97-100%, immediate complications are absent or rare (when an insertion bundle is used), and the bloodstream infection rate is severalfold lower in infants below 1,500 g and below 1,000 g compared with the epicutaneo-cava catheter. Since the evidence comes mainly from a few high-volume centers with high procedural expertise, the priority for future research is to define strategies - structured programs, simulation, proctoring - to build and maintain the same level of competence in lower-volume units.</p><p><strong>Conclusion: </strong>Though the supporting evidence is observational, Ultrasound-guided CICCs (or FICCs, if in selected cases) appear to be the most appropriate central venous access for the critically ill newborn.</p><p><strong>What is known: </strong>• Ultrasound-guided CICCs and FICCs can be placed at the bedside in neonates, including extremely low birth weight infants, and outperform epicutaneo-cava catheters in safety, flow, dwell time, and range of use. • The adoption of insertion bundles reduces immediate and late complications of central venous catheterization in neonates and children.</p><p><strong>What is new: </strong>• Multicenter and comparative neonatal data show reproducible procedural success across centers and several-fold lower bloodstream infection rates in the smallest infants, compared with epicutaneo-cava catheters. • The limiting factor is no longer technical feasibility but structured training; tunneling remains the most frequently omitted step in the insertion bundle and the least easily replaced.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180222","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":"Does participation in a 1-year family-centered lifestyle intervention affect school absence in children with obesity? A 9-year cohort study.","authors":"Lærke Bjertrup Nielsen, Rasmus Møller Jørgensen, Camilla Raaby Benjaminsen, Jens Meldgaard Bruun","doi":"10.1007/s00431-026-07503-3","DOIUrl":"10.1007/s00431-026-07503-3","url":null,"abstract":"<p><p>Childhood obesity is associated with adverse health consequences and psychosocial outcomes including increased school absence. While lifestyle interventions have some effects in reducing BMI in children with obesity, little is known about potential effects on school absence after lifestyle interventions. This observational cohort study examined changes in school absence among 778 children aged 5-8 years living with obesity, comparing those enrolled in a 1-year family-centered lifestyle intervention (n = 287) with those not invited (n = 491). Data collected from 2010 to 2020 were analyzed using linear regression models to investigate total school absence, illness-related absence, and illegal absence for each year following inclusion. No significant differences in school absence were found between groups in the adjusted model in any of the years following the intervention. In both groups, total school absence peaked in year 7 (6.2% (CI = 4.52-7.86) vs 5.0% (CI = 3.67-6.37), respectively). Illness-related absence accounted for the largest proportion of total absence.</p><p><strong>Conclusion: </strong> This study did not identify differences in school absence for children with obesity participating in a lifestyle intervention as compared to children not invited to participate. Future research should examine the effects of longer interventions and interventions more targeted towards school absenteeism.</p><p><strong>What is known: </strong>• Children with obesity are more likely to be absent from school than their peers. • Lifestyle interventions have shown some effect in reducing BMI in children with obesity.</p><p><strong>What is new: </strong>• No difference in school absence was found between children living with obesity participating in a 1-year family-centered lifestyle intervention, compared to children with obesity not invited to participate in the intervention. • Danish children with obesity experience higher rates of school absence than their peers.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167720","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":"Decoding functional cough in pediatrics: differentiating tic, psychogenic, and compulsive phenotypes for targeted intervention.","authors":"Xiaoxuan Fan, Xiuli Sun, Wanling Zhang, Ying Li, Shunying Zhao, Aihua Wang","doi":"10.1007/s00431-026-07466-5","DOIUrl":"10.1007/s00431-026-07466-5","url":null,"abstract":"<p><p>Chronic cough without clear cardiopulmonary pathology poses diagnostic and therapeutic challenges in children and adolescents. While psychosocial factors play a crucial role in its pathogenesis, historical labels such as \"habit cough\" or \"psychogenic cough\" have often been vague and stigmatizing. Despite contemporary consensus guidelines advocating for the term \"somatic cough syndrome,\" unified diagnostic criteria and standardized care pathways remain lacking. A rapid review approach was employed to search the PubMed database for empirical studies published between 2021 and May 2026 on chronic cough related to psychological factors, using terms including \"psychogenic cough,\" \"somatic cough,\" \"habit cough,\" \"somatic cough syndrome,\" and \"tic cough.\" After screening 2134 records, 20 articles were included. The literature showed substantial heterogeneity in chronic cough presentations and provided complementary evidence regarding psychological morbidity, cough-related sensations and triggers, tic-like features, and behavioral treatment response. Most studies involved adults, and direct pediatric evidence was limited. Integrating these findings with established cough guidelines and relevant literature on tic, somatic symptom, and obsessive-compulsive disorders, we propose an evidence-informed tripartite framework comprising three candidate phenotypes: tic cough, psychogenic (somatic) cough, and compulsive cough. The framework emphasizes distinct sensory, affective, and cognitive-behavioral drivers and their implications for multidisciplinary management. Grounded in the clinical realities of pediatric general hospitals, this review provides a practical framework for non-mental health specialists, such as pulmonologists, to facilitate the early identification of psycho-behavioral drivers in functional cough. We call for a clinical paradigm shift from a passive \"diagnosis of exclusion\" to active \"phenotypic identification,\" thereby promoting truly integrated, multidisciplinary management. What is Known: • Chronic cough without clear cardiopulmonary pathology may be associated with psychosocial factors. • Terms such as habit cough, psychogenic cough, somatic cough syndrome, and tic cough are inconsistently applied. What is New: • We propose a pediatric tripartite framework: tic, psychogenic (somatic), and compulsive cough. • This framework links distinct psycho-behavioral drivers to targeted multidisciplinary management.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180126","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":"Tailoring discharge planning after pediatric febrile urinary tract infection: a cohort study.","authors":"Pierluigi Marzuillo, Stefano Guarino, Luigi Annicchiarico Petruzzelli, Milena Brugnara, Giusy Capasso, Ciro Corrado, Anna Di Sessa, Gabriele Malgieri, Marco Pennesi, Giulio Rivetti, Floriana Scozzola, Francesca Taroni, Paola Tirelli, Claudio La Scola, Andrea Pasini, Giovanni Montini","doi":"10.1007/s00431-026-07479-0","DOIUrl":"10.1007/s00431-026-07479-0","url":null,"abstract":"<p><p>Febrile urinary tract infections (fUTIs) are a common cause of hospitalization in children and may recur in predisposed patients. Although current recommendations define indications for imaging and specialist referral, limited guidance is available to help hospital pediatricians identify, during hospitalization, children with clinical features associated with recurrent fUTI and tailor discharge planning accordingly. We conducted a retrospective, nationwide Italian cohort study including children aged 2 months to 3 years who were hospitalized for fUTI. Routinely collected clinical, laboratory, microbiological and imaging data were analyzed. Patients were stratified by sex and by the presence or absence of previously diagnosed congenital anomalies of the kidney and urinary tract (CAKUT). Adjusted multivariable logistic regression analyses were performed to identify factors associated with recurrent fUTIs. A total of 570 children were included, with a median age of 0.55 years. In the overall cohort, recurrent fUTIs were independently associated with older age, previously diagnosed CAKUT, acute kidney injury (AKI), and hydronephrosis with anterior-posterior diameter of the pelvis 5-15 mm. Among males with previously diagnosed CAKUT, recurrent fUTIs were independently associated with phimosis. Among males without previously diagnosed CAKUT, they were independently associated with AKI and non-E. coli infection. Among females, AKI was independently associated with recurrent fUTIs regardless of CAKUT status.</p><p><strong>Conclusions: </strong>In children hospitalized for fUTIs, readily available clinical, laboratory, microbiological, and imaging findings are associated with recurrent fUTIs. Considering these elements during hospitalization may help hospital pediatricians identify children who may benefit from targeted interventions and tailored discharge planning.</p><p><strong>What is known: </strong>• Current Italian recommendations provide guidance on imaging and specialist referral after pediatric febrile urinary tract infection (fUTI) but offer limited guidance for discharge planning. • Several clinical factors are associated with recurrent fUTI.</p><p><strong>What is new: </strong>• In boys, recurrent fUTIs were independently associated with phimosis in those with known CAKUT and with AKI and non-E. coli infection in those without known CAKUT, whereas in girls AKI was the only independent factor regardless of CAKUT status. • These findings were translated into a practical framework to support tailored discharge planning for hospital pediatricians.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180210","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":"Exercise management in pediatric type 1 diabetes: a multicenter study of healthcare professionals' perspectives.","authors":"Hilla Reznik, Avivit Brener, Mohamad Sharkia, Marianna Rachmiel, Yonatan Yeshayahu, Ilana Zalmon-Koren, Lior Carmon, Dikla Pivko-Levy, Marie Mouler, Liat de Vries, Orit Pinhas-Hamiel, Floris Levy-Khademi, Michal Cohen","doi":"10.1007/s00431-026-07472-7","DOIUrl":"10.1007/s00431-026-07472-7","url":null,"abstract":"<p><p>Regular exercise is an important component of care for children with type 1 diabetes (T1D), supporting both physical and psychological health. However, many do not meet recommended activity levels, and exercise does not consistently improve glycemic control. Exercise management in T1D is complex and influenced by multiple factors, including child, activity, and treatment characteristics. These challenges highlight the importance of comprehensive exercise-directed guidance (EDG). This study aimed to characterize EDG practices in pediatric T1D and identify key challenges faced by healthcare professionals (HCPs). Physicians, nurses, and dietitians from 11 pediatric diabetes centers participated. Participants completed anonymized electronic questionnaires assessing current practices, content, and perceived challenges related to EDG. Response rate was 87.2%; 130 HCPs participated; all reported providing EDG to patients. Considerable variability was observed in the timing, content, and educational resources used. While the majority (85.9%) reported offering guidance to all patients, others indicated guiding only when specific needs arose. The most frequently addressed topics included the immediate effects on blood glucose, adjusting carbohydrate intake, and general preparations for exercise. Less frequently discussed topics were planning exercise regimens and encouraging involvement of family or peers. Challenges by order of prevalence were insufficient teaching aids (42.3%), EDG complexity (40.0%), visit duration (36.2%), and knowledge gaps (33.1%).</p><p><strong>Conclusion: </strong> Although HCPs acknowledge the importance of exercise in pediatric T1D and incorporate EDG into clinical care, substantial variability exists in its delivery. Improving the availability and usability of educational tools and strengthening social support components may enhance exercise education for children with T1D.</p><p><strong>What is known: </strong>• Exercise-directed guidance (EDG) is essential for children with type-1-diabetes, yet challenging to implement. • Knowledge of barriers to EDG is growing, but evidence remains limited across healthcare settings and professional groups.</p><p><strong>What is new: </strong>• In this national multicenter study of healthcare professionals, all participants reported providing EDG, yet its timing,content, and availability of educational tools varied. • Limited teaching aids, the complexity of EDG, and time constraints were the main barriers; addressing family and peer involvement and exercise-specific planning were identified as areas for improvement.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180121","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":"Use of the NIPE monitor to continuously assess the nociception-comfort balance in mechanically ventilated, sedated, preterm infants: An observational study.","authors":"Anne Wojtanowski, Kevin Le Duc, Emeline Cailliau, Julien De Jonckheere, Laurent Storme, Mathilde Flocteil, Mohamed Riadh Boukhris","doi":"10.1007/s00431-026-07492-3","DOIUrl":"10.1007/s00431-026-07492-3","url":null,"abstract":"<p><p>To establish whether the Newborn Infant Parasympathetic Evaluation (NIPE) score provides information on the nociception-comfort balance during the routine care of mechanically ventilated, sedated, premature infants. A single-center, prospective, observational study in a tertiary neonatal intensive care unit. Premature infants born before 33 weeks of gestational age and who were mechanically ventilated and received continuous sedation or analgesics within the first 7 days post-partum. Continuous NIPE monitoring and repeated assessments of the Premature Infant Pain Profile-Revised (PIPP-R) score during routine care involving multiple potentially painful procedures. The NIPE score was recorded continuously from 10 min before the care procedure until 10 min after the end of the care procedure. The PIPP-R score was rated before, during, and after care by trained nurses blinded to the NIPE score. Fifty infants were included. The PIPP-R score increased significantly during care and decreased afterwards; conversely, the NIPE score decreased during care and increased afterwards (both p < 0.0001). Higher PIPP-R scores were significantly associated with lower NIPE scores in a linear mixed-effects model accounting for repeated measurements (p < 0.001). Discriminant performance varied according to the PIPP-R threshold considered, with an AUROC of 0.67 [95% confidence interval: 0.58-0.76] for the lower PIPP-R threshold and 0.79 [95% confidence interval: 0.70-0.88] for the higher threshold.</p><p><strong>Conclusion: </strong> In mechanically ventilated, sedated, premature infants, the NIPE score provides continuous autonomic information during routine care and may complement multidimensional clinical pain assessments in critically ill newborns.</p><p><strong>What is known: </strong>• Mechanically ventilated, sedated preterm infants frequently undergo painful procedures in NICU, while their behavioral responses may be attenuated by sedation, making pain assessment challenging. • The NIPE monitor continuously provides assessment of autonomic activity, reflecting the balance between nociception and pain.</p><p><strong>What is new: </strong>• In mechanically ventilated, sedated preterm infants, NIPE scores decreased during routine care and increased afterward. • NIPE showed dynamic changes during prolonged care episodes and provided continuous autonomic information that complemented behavioral scales.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180279","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":"Preterm birth, body mass index trajectories, and risk of thinness in early childhood: the Japan Environment and Children's study.","authors":"Yoshinori Aoki, Michikazu Nakai, Hirotake Sawada, Hiroshi Moritake","doi":"10.1007/s00431-026-07493-2","DOIUrl":"10.1007/s00431-026-07493-2","url":null,"abstract":"<p><p>This study aimed to examine whether preterm birth is associated with thinness and differences in body mass index (BMI) trajectories at ages 3-6 years. This cohort study used data from the Japan Environment and Children's Study, a nationwide birth cohort. Among 100,121 live births, 93,406 children were included. Preterm birth was defined as < 37 weeks' gestation. Thinness was defined as BMI-for-age < - 2 standard deviations according to World Health Organization criteria. Multivariable logistic regression was used to examine associations between preterm birth and thinness at each age. Longitudinal changes in BMI were analysed using linear mixed-effects models. Preterm birth was associated with higher odds of thinness at most ages: adjusted odds ratios were 1.35 (95% confidence interval [CI], 0.94-1.93) at age 3 years, 1.43 (95% CI, 1.02-1.99) at 4 years, 1.70 (95% CI, 1.29-2.25) at 5 years, and 1.52 (95% CI, 1.20-1.92) at 6 years. Findings were consistent with sensitivity analyses using an alternative definition of thinness. In the longitudinal analysis, mean BMI was consistently lower among preterm-born children, with mean BMI differences of 0.11-0.19 kg/m² across ages 3-6 years, and no evidence of convergence over time.</p><p><strong>Conclusion: </strong>Preterm birth was associated with lower BMI trajectories and higher odds of thinness during early childhood. These findings suggest that incorporating gestational age into growth assessment and monitoring body mass, in addition to linear growth, may help identify children with lower BMI trajectories.</p><p><strong>What is known: </strong>• Children born preterm have heterogeneous postnatal growth trajectories, with previous studies reporting both increased risk of obesity and lower body mass during childhood. • Large-scale longitudinal evidence on BMI and thinness during early childhood among children born preterm remains limited.</p><p><strong>What is new: </strong>• In this nationwide birth cohort, preterm birth was associated with higher odds of thinness at ages 4-6 years. • Children born preterm also had consistently lower BMI at ages 3-6 years, with no evidence of convergence with term-born children.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180132","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}