European Journal of Pediatrics最新文献

{"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}

{"title":"Allergic load and symptom severity in children with tic disorders: a cross-sectional study.","authors":"Duan Lin, Jiqiang Xie, Liangliang Chen, Yanting Lu, Yajun Tang, Xiumei Liu","doi":"10.1007/s00431-026-07510-4","DOIUrl":"10.1007/s00431-026-07510-4","url":null,"abstract":"<p><p>Tic disorders (TD) are associated with allergies, but the immune mechanisms and their impact on tic severity remain unclear. This study examined the immune profile in children with comorbid TD and allergic diseases (AD) to explore the graded association between allergic load index and tic severity. A total of 136 children with TD (aged 4 - 13 years) were divided into TD (n = 76) and TD + AD (n = 60) groups. Serum IgE levels were measured, tic severity was assessed by the Yale Global Tic Severity Scale (YGTSS), and a composite allergic load index was constructed. Its graded association with the YGTSS total tic score (0 - 50) was analyzed using correlation, trend, and regression methods. Compared with the TD group, the TD + AD group showed significantly greater vocal tic number, functional impairment, tIgE positivity, tIgE levels, sIgE positivity, and number of positive sIgE items (all p < 0.05). The moderate-to-severe tic group showed elevated positivity of allergic markers and more allergic diseases than the minimal/mild groups (p < 0.05). A graded association was observed, with each one‑standard‑deviation increase in the allergic load index corresponding to a 2.66‑point higher YGTSS total tic score (p < 0.001).</p><p><strong>Conclusion: </strong>The allergic load index was positively associated with tic severity, showing a graded relationship. Systematic assessment of allergic status may provide clinically useful information in the evaluation of children with TD.</p><p><strong>What is known: </strong>• Tic disorders (TD) and allergic diseases (AD) frequently co-occur in children. • Elevated IgE levels and Th2 immune bias have been observed in both conditions.</p><p><strong>What is new: </strong>• Allergic load index, a composite measure integrating IgE levels, sIgE count, and allergic disease count, shows a graded positive association with tic severity in children with TD. • Each one‑standard‑deviation increase in the index corresponds to a 2.66‑point higher YGTSS total tic score.</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":"149180136","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":"Mother-to-child transmission of HIV and risk of prematurity according to the time of art initiation.","authors":"Paula Mato-Amado, Sara Alcaide-García, Lara López-Rodríguez, Cristina Martín-Arriscado, Marta Illán Ramos, Sara Guillén Martín, Carlos Grasa, Cinta Moraleda, María Luisa Navarro-Gómez, José Tomás Ramos-Amador, Luis Manuel Prieto-Tato","doi":"10.1007/s00431-026-07481-6","DOIUrl":"10.1007/s00431-026-07481-6","url":null,"abstract":"<p><p>Antiretroviral therapy (ART) is recommended once the HIV infection is diagnosed during pregnancy. However, some antiretroviral regimens have been associated with an increased risk of preterm birth. This retrospective study aimed to assess the rates of prematurity in newborns according to the timing of ART initiation in a cohort of 1,062 mother-infant pairs. Early ART initiation was not associated with an increased risk of prematurity (ART initiation before conception: 16.8%; before 14 weeks of gestation: 15.6%; ART initiation between 14 and 27 weeks: 16.3%; ART initiation after 27 weeks: 21%; and no ART: 30.7%). Furthermore, exposure to INSTIs for more than 12 weeks during pregnancy was not associated with an increased risk of preterm birth (adjusted OR 1.65, 95% CI 0.46-5.95; p = 0.444). These results support current recommendations for early ART initiation during pregnancy.</p><p><strong>Conclusion: </strong>In conclusion, these results support current recommendations for early ART initiation during pregnancy.</p><p><strong>What is known: </strong>• Mother-to-child HIV transmission rates approach zero in women receiving ART before pregnancy and maintaining viral suppression. • Infants born to women living with HIV have been reported to have higher rates of prematurity, although the contribution of ART exposure and timing remains uncertain.</p><p><strong>What is new: </strong>• Early ART initiation was not associated with an increased risk of prematurity and rates were lowest among women who started ART before conception. • Prolonged exposure to INSTI-based ART was not associated with an increased risk of preterm birth, supporting their current recommendations for treatment during pregnancy.</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":"149180214","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":"Peripheral venous access in the neonate: current evidence, persistent uncertainties, and proposal of a structured insertion bundle.","authors":"Giovanni Barone, Vito D'Andrea, Gilda Pepe, Mauro Pittiruti","doi":"10.1007/s00431-026-07497-y","DOIUrl":"https://doi.org/10.1007/s00431-026-07497-y","url":null,"abstract":"<p><p>Peripheral venous access devices are the most frequently inserted invasive devices in neonatal intensive care, yet fewer than half of them complete the therapy for which they were placed, and their mean dwell time is between 32 and 36 h. Despite this, they have attracted far less attention than central venous access devices: insertion and maintenance practices remain heterogeneous, rarely neonate-specific, and almost never standardized. This narrative review examines the current evidence on indications, device choice, insertion technique, securement, surveillance, and complications of peripheral venous access in the newborn. Evidence suggests that polyurethane outperforms polytetrafluoroethylene; the largest available cohort study supports 26G as the default caliber, including for transfusion; cyanoacrylate securement, structured pre-procedural vein assessment, and dedicated vascular access teams are each associated with better outcomes. Much of this evidence, however, comes from retrospective single-center studies, and important questions-such as the potential advantages of integrated devices or of long peripheral catheters, the caliber-to-vein relationship, and objective detection of infiltration-remain open.</p><p><strong>Conclusion: </strong> On this basis, we propose a protocol for Safe Insertion of Peripheral Venous Catheters (SIPVeC), a seven-step insertion bundle formatted the same way as the protocols already available for umbilical and central devices in the neonate.</p><p><strong>What is known: </strong>• Peripheral venous access devices are the most used vascular access device in neonates, yet most fail before therapy is completed. • Insertion and maintenance practices remain heterogeneous and are rarely neonate-specific.</p><p><strong>What is new: </strong>• Evidence now favors polyurethane, 26G devices, structured vein assessment, and cyanoacrylate securement. • The SIPVeC protocol translates these elements into a reproducible seven-step insertion bundle for peripheral devices in neonates.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165109","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}