European Journal of Pediatrics最新文献

{"title":"Climate change and child health in Europe: a scoping review of emerging impacts.","authors":"Sarah van den Berg, Daan van der Stadt, Shahriyar Shahbazi Khamas, Fleur Sondaal, Faridi Jamaludin, Lieke van Baardewijk, Susanne Vijverberg, Berber Kapitein","doi":"10.1007/s00431-026-06966-8","DOIUrl":"https://doi.org/10.1007/s00431-026-06966-8","url":null,"abstract":"<p><p>Children are extremely vulnerable to climate-related environmental impacts and air pollution due to both biological and behavioral factors. Despite the emerging evidence of the increasing effects of climate change on the world and on children's health, policies to drive change and halt the effects are lacking. Climate change is causing Europe to heat up faster than other continents. Here, we assessed the evidence-based effects of climate change and air pollution on child health in Europe. A scoping review was performed to map the impact of climate-related exposures on the health of children in Europe. A literature search was conducted in three bibliographic databases (PubMed, Embase.com, and Cochrane Database of Systematic Reviews/Cochrane Central Register of Controlled Trials), for studies published between January 1, 2014, and November 11, 2024. Studies were included if they met the following criteria: original studies performed in Europe, addressing climate-related exposures (i.e., the effects of air pollution, heat stress and/or wildfires) on clinical outcomes in neonates, infants, and children (<18 years). The literature search generated a total of 3838 unique articles; upon screening, 73 articles were included in this scoping review. Most studies were conducted in South and West Europe. Climate-related exposures were linked to negative neonatal outcomes, increased risk of respiratory and allergic disease, adverse neurological development, and a higher incidence of metabolic conditions in children. Most studies assessed the impact of air pollution (mainly particulate matter with a diameter smaller than 2.5 micrometers PM<sub>2.5</sub> and PM<sub>10</sub> exposure); few studies assessed other climate-related outcomes such as heat stress or wildfires.</p><p><strong>Conclusion: </strong> Climate change is an active driver of pediatric morbidity in Europe, posing urgent respiratory, neurological, and perinatal risks amplified by social inequality. Protecting future generations demands a paradigm shift in healthcare that moves beyond treating acute symptoms to addressing upstream environmental drivers, including the integration of environmental exposure data into clinical practice.</p><p><strong>What is known: </strong>• Children are biologically vulnerable to environmental hazards and more prone to climate-related exposures. • Europe is warming up faster than other continents; therefore, children in Europe are at increased risk of climate-related adverse health outcomes.</p><p><strong>What is new: </strong>• This scoping review confirms climate change may lead to increased pediatric morbidity in Europe, linking air pollution, heat stress, and wildfires to perinatal, respiratory, metabolic, and neurological risks. • European studies regarding climate change and children's health have mainly focused on the impact of air pollution, but hardly focused on the impact of heat stress, highlighting the need for broader research and a coordinated pa","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/PMC13144261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835324","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 between enteral formula type and nutritional failure in critically ill children: A single-center retrospective study.","authors":"Ayşe Aşık, Muhterem Duyu, Sinem Aydöner, Çiğdem Ulukaya Durakbaşa","doi":"10.1007/s00431-026-06968-6","DOIUrl":"https://doi.org/10.1007/s00431-026-06968-6","url":null,"abstract":"<p><p>Enteral nutrition is a fundamental component of care in critically ill children, yet uncertainty remains about the most appropriate formula. The aim of this study is to compare peptide-based formulas (PBF) and fiber-enriched polymeric formulas (FEF) with respect to feeding failure, intolerance, and progression toward nutritional goals in a PICU population. This study summarizes a single-center experience in a tertiary Pediatric Intensive Care Unit in Türkiye and included 225 children, aged 1-18 years, who received enteral nutrition for at least 48 h between 2021 and 2024. A total of 116 patients were started on PBF and 109 on FEF. Feeding failure was defined as discontinuation of enteral nutrition, switching formula, or failure to achieve ≥ 66% of prescribed caloric targets by day 7. Feeding intolerance rates were similar between groups. However, feeding failure occurred more frequently in the FEF group compared to the PBF group (43.1% vs. 29.3%, p = 0.037). After adjustment for relevant clinical variables, initiation with FEF remained independently associated with feeding failure (OR 2.18; 95% CI 1.22-3.88; p = 0.009). Nutritional risk scores improved earlier over the first 14 days in the PBF group. Patients receiving PBF also demonstrated higher protein delivery and reached caloric targets sooner.</p><p><strong>Conclusion: </strong> Our results showed that peptide-based formula was associated with lower rates of feeding failure and faster achievement of nutritional targets. While causality cannot be inferred from this retrospective design, formula selection may represent an important, potentially modifiable factor in nutritional management during the PICU stay.</p><p><strong>What is known: </strong>• Enteral nutrition is a fundamental component of care for critically ill children, yet achieving optimal gastrointestinal tolerance and meeting nutritional goals remains a significant clinical challenge. • Although specialized enteral formulas are developed to improve feeding tolerance, evidence directly comparing the efficacy of peptide-based versus fiber-enriched polymeric formulas in pediatric intensive care units is limited.</p><p><strong>What is new: </strong>• Initiation of enteral nutrition with a peptide-based formula is associated with a significantly lower rate of feeding failure compared to fiber-enriched polymeric formulas in critically ill children. • Patients receiving peptide-based formulas demonstrate earlier improvement in nutritional risk scores and achieve their prescribed caloric and protein targets more rapidly.</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/PMC13139206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835326","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":"Contrasting MRI patterns in early infant human parechovirus CNS infection: a brief report.","authors":"Aldo Naselli, Francesca Tota, Stefania Ielo, Valentina Folgheraiter, Umberto Rozzanigo, Giovanni Lorenzin, Giuliana Marchio, Anna Rosati","doi":"10.1007/s00431-026-06955-x","DOIUrl":"https://doi.org/10.1007/s00431-026-06955-x","url":null,"abstract":"<p><p>Human parechovirus (HPeV), particularly genotype A3, is a recognized cause of sepsis-like illness and central nervous system (CNS) infection in neonates and young infants. Brain magnetic resonance imaging (MRI) plays a key role in identifying CNS involvement, although neuroradiological findings may be heterogeneous. We report two infants with PCR-confirmed HPeV CNS infection presenting at 10 and 40 days of life, respectively, with contrasting MRI patterns. The first neonate showed the typical phenotype of bilateral fronto-parietal and periventricular white matter diffusion restriction despite minimal cerebrospinal fluid (CSF) pleocytosis. The second infant demonstrated isolated diffuse leptomeningeal enhancement without parenchymal lesions. Both patients experienced rapid clinical recovery and remained seizure-free; neurodevelopment was normal at follow-up in the case with white matter involvement. These observations highlight the spectrum of MRI findings in early infant HPeV CNS infection and reinforce that normal or near-normal CSF parameters do not exclude significant CNS involvement. Early MRI, combined with molecular testing, may improve diagnostic accuracy and inform follow-up strategies.</p><p><strong>Conclusion: </strong> These observations highlight the spectrum of MRI findings in early infant HPeV CNS infection and reinforce that normal or near-normal CSF parameters do not exclude significant CNS involvement. Early MRI, combined with molecular testing, may improve diagnostic accuracy and inform follow up strategies.</p><p><strong>What is known: </strong>• Human parechovirus (HPeV) CNS infection in young infants is commonly associated with white-matter diffusion abnormalities on MRI and minimal or absent CSF pleocytosis. • MRI is a key diagnostic tool in identifying CNS involvement, although neuroradiological findings may be heterogeneous.</p><p><strong>What is new: </strong>• This report describes two infants with HPeV CNS infection showing contrasting MRI patterns, including isolated leptomeningeal enhancement without parenchymal lesions. • These findings broaden the recognized neuroradiological spectrum of HPeV infection and highlight the diagnostic value of MRI even in clinically mild cases.</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/PMC13139296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of protocolized restrictive versus liberal/usual maintenance fluid strategy on fluid overload among mechanically ventilated children: an open-label randomized trial (ReLiSCh-II trial).","authors":"Sujith Mathew John, Suresh Kumar Angurana, Jayashree Muralidharan, Arun Bansal, Karthi Nallasamy, Sant Ram","doi":"10.1007/s00431-026-07015-0","DOIUrl":"https://doi.org/10.1007/s00431-026-07015-0","url":null,"abstract":"<p><p>Fluid overload (FO) is associated with poor clinical outcomes among critically ill children. The objective of this trial was to assess the impact of a protocolized restrictive maintenance fluid strategy on FO among mechanically ventilated children. This open-label randomized controlled trial was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in North India over 13 months (November 2023-November 2024). Hemodynamically stable mechanically ventilated children were randomized to protocolized restrictive (n = 64) (40-50% of maintenance fluids with diuretic infusion if FO% > 10%); and liberal/usual (n = 66) (70-80% of maintenance fluid) groups. The primary outcome was the proportion of children with cumulative FO% > 10% through day 5. Secondary outcomes were daily cumulative FO%; inferior vena cava variability index (∆IVC) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at 48 h; safety parameters (requirement of fluid boluses or vasoactive drugs); 28-day ventilator and PICU-free days (VFDs and PFDs), and mortality. Significantly fewer children in the protocolized restrictive group had cumulative FO% > 10% than in the liberal/usual group (22% vs. 47%, p = 0.003). Also, the restrictive group had significantly lower daily cumulative FO% on the first 5 days. ∆IVC and NT-proBNP levels at 48 h, as well as safety parameters, were similar between the two groups. Protocolized restrictive and liberal/usual groups had similar VFDs [20 (8-24) vs. 16 (0-23), p = 0.076], PFDs [16 (3-21) vs. 13 (0-19), p = 0.071], and mortality (14% vs. 24%, p = 0.14).</p><p><strong>Conclusion: </strong> A protocolized restrictive maintenance fluid strategy resulted in significantly lower FO among hemodynamically stable, mechanically ventilated children without a measurable impact on short-term clinical outcomes.</p><p><strong>What is known: </strong>• Fluid overload (FO) is associated with poor clinical outcomes among critically ill mechanically ventilated children.</p><p><strong>What is new: </strong>• Among hemodynamically stable, mechanically ventilated children, a restrictive maintenance fluid strategy may be a useful intervention to limit FO and improve clinical outcomes in LMICs.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812208","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":"Hospital organisation and healthcare providers' barriers in the management of fetuses and newborns affected by life-limiting or life-threatening conditions in Italy: a national survey.","authors":"Francesca Burlo, Lucia De Zen, Arianna Pagnini, Laura Travan","doi":"10.1007/s00431-026-07018-x","DOIUrl":"10.1007/s00431-026-07018-x","url":null,"abstract":"<p><p>The prevalence of children affected by life-limiting or life-threatening conditions has consistently increased over the last decade. Communicating to parents that their baby is affected by such conditions is always difficult. The aim of this study was to investigate the management of these infants among healthcare providers (HCPs) in Italy. This is a descriptive study involving HCPs working in neonatal departments. Participants were asked to. complete a questionnaire specifically created. 180 HCPs responded to the questionnaire. Overall, 62% of professionals believe they are not adequately trained in communicating with parents, and 53% believe their ethical and spiritual values ​​influence their work. Significant differences were found in the availability and involvement of pediatric palliative care services during the perinatal period across Northern, Central, and Southern Italy.</p><p><strong>Conclusion: </strong>This study highlighted the need to invest in training professionals, palliative care, and integrated care networks to ensure equitable and respectful care.</p><p><strong>What is known: </strong>• The prevalence of children affected by life-limiting or life-threatening conditions has consistently increased over the last decade. • Communication is a key aspect of care while dealing with parents in the perinatal setting.</p><p><strong>What is new: </strong>• A great number of physicians and nurses do not feel prepared enough in managing communication with parentsof newborns affected by life-limiting or life-threatening conditions. • Perinatal management and the availability of perinatal palliative care services and ethical consults are extremelyheterogeneous across Italy, with Northern regions offering greater care opportunities.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812183","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":"Comorbidity burden and treatment patterns in Tourette syndrome and persistent motor or vocal tic disorder.","authors":"Attilio Sica, Benedetta Puglisi, Silja Pintar, Paolo Dalena, Egidio Barbi, Aldo Skabar","doi":"10.1007/s00431-026-07009-y","DOIUrl":"https://doi.org/10.1007/s00431-026-07009-y","url":null,"abstract":"<p><p>This study compares Persistent Motor or Vocal Tic Disorder (PMVT) and Tourette Syndrome (TS) in a pediatric population, clarifying their relationship and exploring the validity of a continuous \"Tic Spectrum Disorder\" (TSD). We retrospectively analyzed data from 207 pediatric patients diagnosed with PMVT or TS. Analyses included group comparisons and multivariate ordinal logistic regression to identify factors independently associated with treatment burden. The cohort comprised 128 (61.8%) TS patients and 79 (38.2%) PMVT patients. The median age at tic onset was 7 years (interquartile range 6-9). Comorbidities were more frequent in TS than PMVT (p < 0.001). Specifically, ADHD, Obsessive-Compulsive Disorder, Specific Learning Disorders, Oppositional Defiant Disorder, Specific Phobias (all p < 0.001), and Intellectual Disability (p = 0.046) were all more prevalent in the TS group. TS patients required more therapeutic interventions compared to PMVT (p < 0.001). Notably, in multivariate analysis, the treatment burden was strongly associated with the cumulative comorbidity load, although a TS diagnosis also emerged as a significant independent factor. Within the TS group, patients with ADHD showed earlier tic onset (p = 0.021), higher comorbidity load (p < 0.001), and greater therapeutic needs (p < 0.001).</p><p><strong>Conclusion: </strong>Our study identifies the cumulative burden of comorbidities as the primary factor strongly associated with treatment requirements, with the specific tic diagnosis also contributing independently to the therapeutic burden. While these findings support the conceptualization of a continuous TSD, they shift the clinical focus toward comorbidity load as a major factor linked to healthcare demand.</p><p><strong>What is known: </strong>• Current classification distinguishes Tourette Syndrome (TS) and Persistent Motor or Vocal Tic Disorder (PMVT) based on tic types and duration, but this distinction often fails to predict therapeutic burden. • The existence of a continuous \"Tic Spectrum Disorder\" comprising both conditions is hypothesized but clinically debated.</p><p><strong>What is new: </strong>• The cumulative comorbidity load is strongly associated with patients' treatment requirements, although a TS diagnosis also independently contributes to the overall therapeutic burden. • This study expands upon recent pediatric comparisons of TS and PMVT by incorporating a broader, previously under-investigated range of neurodevelopmental comorbidities.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835269","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":"The evaluation of motor deficits in children with ulcerative colitis: a cross-sectional study.","authors":"Ulas Emre Akbulut, Atike Atalay, İshak Abdurrahman Isik, Nazlı Sivil, Memduha Sarı, Gokhan Birsen, Ozgun Kaya Kara, Koray Kara, Hazal Sonbahar Ulu, Hasan Ali İnal","doi":"10.1007/s00431-026-07014-1","DOIUrl":"10.1007/s00431-026-07014-1","url":null,"abstract":"<p><p>While the gastrointestinal symptoms of ulcerative colitis (UC) are well-defined, its impact on motor development in children remains poorly understood. We aimed to assess motor proficiency, handgrip strength, and physical activity levels in children with UC and to investigate associations with disease activity. In this cross-sectional study, 49 children with UC aged 8-17 years and 41 age‑ and sex-matched healthy controls were enrolled. Disease activity was assessed using the Pediatric Ulcerative Colitis Activity Index, and laboratory markers including C-reactive protein and erythrocyte sedimentation rate were measured. Motor proficiency was evaluated using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Handgrip strength was measured with a dynamometer, and physical activity was assessed via the Physical Activity Questionnaire (PAQ). Group comparisons were adjusted for age, sex, socioeconomic status, and body mass index, with False Discovery Rate correction for multiple testing. Children with UC scored significantly lower on the Total Motor Composite than controls (37.4 vs. 45.1, p < 0.001). Adjusted analyses revealed a specific pattern: fine motor skills were preserved, but significant deficits were found in gross motor domains, including bilateral coordination and strength and agility (all p < 0.001). Handgrip strength differences lost significance after adjustment for body mass index, and no difference was observed in physical activity. Within the UC group, a higher erythrocyte sedimentation rate correlated with lower non-dominant handgrip strength (ρ =  - 0.533, p < 0.001) and poorer agility (ρ =  - 0.414, p = 0.003).</p><p><strong>Conclusion: </strong> Children with UC exhibit significant gross motor deficits, even during clinical remission. These cross-sectional findings indicate that clinically well children may still have impaired motor proficiency compared to healthy peers. However, longitudinal studies are needed to determine whether these deficits predate diagnosis, emerge during active disease, or persist despite remission.</p><p><strong>What is known: </strong>• The primary treatment goal in ulcerative colitis with children is the resolution of symptoms and intestinal inflammation. • The potential effects of ulcerative colitis on a child's motor function are not routinely assessed in clinical practice.</p><p><strong>What is new: </strong>• Children with ulcerative colitis have significantly lower overall motor proficiency scores compared to their healthy peers. • Children in clinical remission may still have impaired motor skills, indicating a potential need for comprehensive functional assessment during follow-up.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812691","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":"Risk factors for severe post-COVID condition in children, adolescents, and young adults.","authors":"Quirin Donath, Matthias Haegele, Daniela Schindler, Tiziana Welzhofer, Catharina Christa, Annika Grabbe, Ariane Leone, Clara Ilhan, Carola Weidmann, Maria Eberhartinger, Sara Bechtold, Nicola Bursch, Hedwig Wolf, Hannah Hieber, Laura-Carlotta Peo, Lara A Bucka, Silvia Stojanov, Cordula Warlitz, Martin Alberer, Katrin Gerrer, Anna Hausruckinger, Kirstin Mittelstrass, Clemens-Martin Wendtner, Manuela A Hoechstetter, Armin Grübl, Nicole Toepfner, Rafael Pricoco, Carmen Scheibenbogen, Lorenz L Mihatsch, Uta Behrends","doi":"10.1007/s00431-026-06995-3","DOIUrl":"https://doi.org/10.1007/s00431-026-06995-3","url":null,"abstract":"<p><p>Post-COVID condition (PCC) in children and young people (CYP, PCCcyp) remains a significant health burden. Early identification of patients at risk for severe disease, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is crucial for timely and adequate care. This monocentric, observational registry study, performed at a tertiary pediatric hospital in Germany, included CYP aged 7-25 years with PCCcyp at diagnosis. Standardized clinical assessment tools and patient-reported outcome measures were applied, including the novel Munich Long COVID Symptom Questionnaire (MLCSQ). Severe PCC was defined by chronic symptom clusters, Fatigue Severity Scale (FSS), Total Composite Autonomic Symptom Score-31 (COMPASS-31), SF-36 composite scores, Bell Score, and confirmed ME/CFS diagnosis. Among 120 participants, severe PCCcyp was associated with a higher number of acute symptoms (OR_adj 1.22, P < 0.001), acute orthostatic intolerance (OR_adj 9.87, P = 0.002), acute trouble concentrating (OR_adj 11.8, P = 0.005), and female sex (OR 3.31, P = 0.031). Categorizing acute symptoms at a threshold of ≥ 12 yielded optimal model performance (AUC 0.857; sensitivity 65.6%; specificity 90.2%). ME/CFS was diagnosed in 24% of participants, all within the severe PCCcyp cluster, and was characterized by greater acute symptom complexity, more fatigue, more autonomic symptoms, and poorer function. Conclusions: The number and pattern of acute symptoms during SARS-CoV-2 infection may serve as early, specific predictors of severe PCCcyp. Patients with ≥ 12 acute symptoms should be closely monitored to enable early diagnosis of severe PCCcyp and ME/CFS. A distinct cluster of severely affected patients, frequently with ME/CFS, was identified.Trial registration: ClinicalTrials.gov: NCT05638724; Ethics approval (511/21, 2025-465-S-SB).</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835305","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":"Oral dextrose gel vs standard care for the treatment of hypoglycemia in high-risk neonates: an open-label randomized controlled trial.","authors":"Smriti Bhargava, Shruthi Kumar Bharadwaj, Leslie Edward Lewis, Sheila Samanta Mathai, Jayashree Purkayastha","doi":"10.1007/s00431-026-06988-2","DOIUrl":"https://doi.org/10.1007/s00431-026-06988-2","url":null,"abstract":"<p><p>To determine whether 40% dextrose gel with oral feeds reduces NICU admission for asymptomatic hypoglycemia compared with standard care with oral feeds in at-risk neonates within 48 h of life. Secondary objectives were to assess rebound and recurrent hypoglycemia, hyperglycemia, and exclusive breastfeeding at discharge and at 6 weeks. Open-label randomized controlled trial conducted at a tertiary hospital in South India between April 2023 and May 2024. Neonates born at ≥ 35 weeks of gestation with asymptomatic hypoglycemia within the first 48 h of life were randomly assigned to receive either 200 mg/kg of oral 40% dextrose gel with oral feeds or standard care with oral feeds alone. The primary outcome was NICU admission for hypoglycemia. A total of 193 neonates were enrolled, with 98 in the standard care group and 95 in the gel group. Baseline characteristics were comparable. NICU admission for hypoglycemia occurred in 4.2% in gel group and 12.2% in standard care group (RR 0.34, 95% CI 0.11-1.03; p = 0.06), with a number needed to treat of 13. Exclusive breastfeeding was higher in gel group at discharge (97% vs 76%; p < 0.001) and at 6 weeks (90% vs 69%; p < 0.001). Rebound hypoglycemia, recurrent hypoglycemia, and hyperglycemia were similar between groups.</p><p><strong>Conclusion: </strong>Oral dextrose gel was associated with fewer NICU admissions, but the primary outcome did not reach statistical significance. Improved breastfeeding rates were observed as secondary outcomes. These findings should be interpreted cautiously and confirmed in adequately powered studies.</p><p><strong>Trial registration: </strong>Clinical Trials Registry of India (CTRI/2023/02/050027).</p><p><strong>What's known: </strong>• Oral 40% dextrose gel is an eff ective fi rst-line treatment for neonatal hypoglycemia and has been shown to reduce treatment failure and intravenous glucose use in previous trials. • Existing evidence is predominantly from high-income settings, with limited randomized data from low- and middle-income countries assessing pragmatic outcomes such as NICU admission.</p><p><strong>What is new: </strong>• In this open-label randomized controlled trial, oral dextrose gel was associated with fewer NICU admissions for hypoglycemia (4.2% vs 12.2%) and higher exclusive breastfeeding rates at discharge and 6 weeks compared with standard care. • These fi ndings support the potential utility of dextrose gel as a simple, low-cost intervention for managing neonatal hypoglycemia in resource-limited settings.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835257","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 motivational interviewing on internet addiction and digital game addiction in adolescents: a randomized controlled trial.","authors":"Semra Seyhan Şahin, Sultan Ayaz-Alkaya","doi":"10.1007/s00431-026-06993-5","DOIUrl":"10.1007/s00431-026-06993-5","url":null,"abstract":"<p><p>The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests.</p><p><strong>Conclusion: </strong>The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled).</p><p><strong>What is known: </strong>• Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health.</p><p><strong>What is new: </strong>• Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 5","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812617","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}