European Journal of Pediatrics最新文献

{"title":"Magnetic resonance signs of intracranial hypertension in children: a retrospective case-control study.","authors":"Luz Angela Moreno-Gómez, Daniel Quintero-Pulgarín, Oscar Mauricio Espitia Segura, Leidy Carolina Chiquiza-Garzón, Juan David Farfán-Albarracín, Cristina Lorena Ramírez-Sierra, Yenny Carolina Zuñiga-Zambrano, Leydi Alexandra Ceballos-Inga","doi":"10.1007/s00431-025-06025-8","DOIUrl":"10.1007/s00431-025-06025-8","url":null,"abstract":"<p><p>The diagnostic accuracy of magnetic resonance (MRI) signs of intracranial hypertension (ICH) in children remains unclear. This study aims to assess how brain MRI signs of ICH correlate with cerebrospinal fluid opening pressure (CSFOP). A retrospective case-control study was conducted with 77 children aged 1 to 18 years, who underwent brain MRI and lumbar puncture with CSFOP measurement. A blinded radiologist evaluated key ICH signs, including distension of the perioptic subarachnoid space, optic nerve (ON) tortuosity, posterior scleral flattening, intraocular protrusion, and enhancement of the prelaminar ON, among others. Odds ratios, likelihood ratios, predictive values, sensitivity, specificity, and the area under the ROC curve (AUROC), were calculated in relation to CSFOP, adjusted for age and sex. The ICH group included 38 patients (49.3%) and the control group 39 (50.7%). The presence of four or more MRI signs of ICH provided the best diagnostic performance (specificity 92%, sensitivity 40%, AUROC 0.759) for identifying elevated CSFOP, particularly with intraocular protrusion of the prelaminar ON (p = 0.006, median CSFOP 49.6 cm H₂O, p < .001) and papilledema (p = 0.042).</p><p><strong>Conclusion: </strong>The presence of four or more MRI signs is associated with elevated CSFOP in children with non-structural ICH.</p><p><strong>What is known: </strong>• The diagnostic accuracy of magnetic resonance imaging (MRI) signs of intracranial hypertension (ICH) in children remains unclear. • In children, there is no consensus about the most appropriate diagnostic criteria or robust evidence regarding the diagnostic performance of imaging signs for ICH.</p><p><strong>What is new: </strong>• The presence of four or more MRI signs is associated with elevated cerebrospinal fluid opening pressure (CSFOP) in children with non-structural ICH. • Intraocular protrusion of the prelaminar ON, and papilledema are particularly relevant signs for identifying elevated CSFOP.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"218"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537005","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":"Retrospective bi-centric observational study comparing primary anastomosis or suturing vs enterostomy for spontaneous intestinal perforations in extremely preterm infants.","authors":"Emeric Genet, Erasti Gounfle, Arnaud Bonnard, Olivier Jaby, Xavier Xu Wang, Camille Jung, Valérie Biran, Aline Rideau, Xavier Durrmeyer","doi":"10.1007/s00431-025-06043-6","DOIUrl":"10.1007/s00431-025-06043-6","url":null,"abstract":"<p><p>The purpose of this study was to compare two initial surgical strategies for spontaneous intestinal perforation (SIP) in a bi-centric cohort of extremely preterm and/or extremely low birthweight infants. Observational, retrospective study including infants born before 28 weeks of gestation and/or with birthweight < 1000 g, born between 2010 and 2020, operated for SIP in two type 3 centers. Infants were attributed to groups according to the surgical technique of the first intervention: primary anastomosis or suturing (PAS) or enterostomy (ES). The primary endpoint was the duration of parenteral nutrition (PN) analyzed using multivariate Cox model. Secondary endpoints included total number of surgeries under general anesthesia, morbidity and mortality at discharge, and outcomes at 2 years. Among 65 included patients, those in the PAS group (n = 46) had a higher median [IQR] CRIB II score than those from the ES group (n = 19) (11.5 [10-13] vs 8 [4-10], p = 0.01) and were more frequently operated in Robert Debré (78% vs 21%, p < 0.001) but had comparable other clinical characteristics at birth and at the time of surgery. As compared to the ES group, infants from the PAS group had a significantly higher probability of NP weaning after adjustment (adjusted hazard ratio 3.05, 95% CI [1.43-6.49]) and a significantly lower median [IQR] number of general anesthesia (1 [1-1] vs 2 [2-2], p < 0.001). At discharge and at age 2, there was no significant difference in outcomes between groups. Conclusion: Initial one-stage surgery for SIP in extremely preterm infants was associated with shorter NP duration and fewer general anesthesia in this study.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"215"},"PeriodicalIF":3.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522907","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":"A snapshot of country-specific dietary habits and obesity in European children: the Feel4Diabetes study.","authors":"Lubna Mahmood, Luis A Moreno, Peter Schwarz, Ruben Willems, Greet Cardon, Soukaina Hilal, Imre Rurik, Violeta Iotova, Yuliya Bazdarska, Roumyana Dimova, Kostas Anastasiou, Yannis Manios, Esther M Gonzalez-Gil","doi":"10.1007/s00431-025-06037-4","DOIUrl":"10.1007/s00431-025-06037-4","url":null,"abstract":"<p><p>This study assessed the dietary intake of European children by country, gender, and obesity degree across six European countries participating in the Feel4Diabetes study. It also compared food group intakes with European food-based dietary guidelines. The Feel4Diabetes study included 9,847 children (50.4% girls) from six European countries. Families provided baseline data on energy balance-related behaviors and socioeconomic factors via questionnaires. Children's dietary intake and breakfast consumption were assessed using semi-quantitative food frequency questionnaires, and anthropometric measurements were taken. Intake from 11 food groups was analyzed by country, gender, and obesity degree. Chi-square analyses compared food intake with dietary guidelines. \"Nutrient-dense \" foods (e.g., fruits, vegetables, whole grains) and \"energy-dense, low-nutrient\" foods (e.g., high in added sugars, saturated fats) were categorized based on the European food-based guideline. Over 85% of children consumed breakfast 5-7 days a week, with no significant differences by Body Mass Index (BMI) or country. Mean intakes of nutrient-dense food groups fell below recommendations, while the intake of energy-dense, low-nutrient foods exceeded limits, particularly in children with overweight/obesity (p = 0.048). No significant gender differences were observed in most food groups.</p><p><strong>Conclusions: </strong> Dietary intake varied by country and obesity degree among European children. Across the six countries, children's diets did not align with food-based dietary guidelines. These findings underscore the need for interventions promoting healthier eating habits among European children.</p><p><strong>Trial registration: </strong>The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872),  http://clinicaltrials.gov What is Known: • Childhood obesity is a growing concern across Europe, with some variations in food consumption observed between European countries • Previous studies have highlighted the role of diet in childhood obesity, but few have examined cross-country comparisons while accounting for gender and BMI status.</p><p><strong>What is new: </strong>• This study provides a comprehensive cross-country analysis of children's dietary intake, considering gender, BMI status, and adherence to European dietary guidelines. • New insights into gender differences in sweets consumption and the positive association between BMI and food intake (such as soft drinks and sweets) are presented, which can inform targeted dietary interventions.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"214"},"PeriodicalIF":3.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522905","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":"Multiple office blood pressure monitoring for the diagnosis of hypertension in children.","authors":"Letizia Dato, Maria Cristina Mancuso, Thomas Ria, Laura Viola, Patrizia Salice, Matteo Vidali, Daniele Rossetti, Giacomo Tamburini, Teresa Nittoli, Chiara Tamburello, Teodora Munteanu, Chiara Orsenigo, Loredana Simionato, Andrea Gualtieri, Elena Sacchini, Gianluigi Ardissino","doi":"10.1007/s00431-025-06040-9","DOIUrl":"10.1007/s00431-025-06040-9","url":null,"abstract":"<p><p>The measurement (M) of blood pressure (BP) in children may be challenging, and the ideal approach, free of critical issues (such as the interference due to the white coat effect or to the high variability), has yet to be identified. Herein, we compare BP as measured with multiple office BP monitoring (mOBPM) with the standard approach as suggested by guidelines. A cohort of healthy children underwent two mOBPMs 1 year apart. Mean systolic and diastolic values obtained by mOBPM were compared with the 1st, 2nd, 3rd, and 4th measurements (repeated measures ANOVA). mOBPMs with a coefficient of variation (CV) > 15% were excluded. The number of children with BP > 90th centile was determined based on (a) each of the initial three readings, (b) the mean of the 2nd and 3rd Ms, (c) the 4th M, (d) the mOBPM at baseline, and (e) 1 year apart. Out of 164 enrolled children, 13 (7.9%) were excluded because of a CV > 15%. The analysis on the remaining 151 children showed that the first three Ms provided a significantly higher BP than the mOBPM. The 4th M was the first one to be aligned with the results of the mOBPM. Based on the 1st, 2nd, 3rd, and 4th Ms, a BP > 90th centile was observed in 29, 20, 21, and 16 children, respectively. The mean of the 2nd and 3rd Ms identified 12 children with high BP, while the mOBPM revealed elevated BP in only 6 children and this finding was confirmed only in 3 of them 1 year later.</p><p><strong>Conclusion: </strong>The first three readings systematically overestimate BP, while the 4th one better aligns with the mOBPM. If the 4th reading is abnormal, the complete mOBPM will likely offer a more reliable BP assessment.</p><p><strong>What is known: </strong>• Blood pressure measurement may be challanging and initial readings systematically overestimate real values.</p><p><strong>What is new: </strong>• The 4th blood pressure reading better aligns with the mean of 10 measurements. In daily clinical practice, if the 4th reading is abnormal, the complete mOBPM (www.mobpm.com) will likely offer a more reliable BP assessment.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"213"},"PeriodicalIF":3.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515045","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":"\"Cut umbilical cord milking (C-UCM) in preterm twin gestational births-a randomized controlled trial\".","authors":"Ashadur Zamal, Rajib Losan Bora, Saugata Chaudhuri, Bijan Saha, Sambhunath Bandyopadhyay, Abhijit Hazra","doi":"10.1007/s00431-025-06042-7","DOIUrl":"10.1007/s00431-025-06042-7","url":null,"abstract":"<p><p>Delayed cord clamping (DCC) is now the standard of care in singleton vigorous neonates. But consensus is lacking on the appropriate approach to placental transfusion in multifetal gestational births. In this study, we tried to determine the effect of cut umbilical cord milking (C-UCM) as compared to early cord clamping (ECC) on hematological and clinical hemodynamic parameters in preterm twin neonates of 30-37 weeks gestation. The primary outcome assessed was venous hematocrit (Hct) at 48 (± 4) h of postnatal age. Venous Hct at 6 weeks of age, mean blood pressure during the transitional period, significant neonatal morbidities, and possible sequelae were the significant secondary outcomes evaluated. In this single-center stratified randomized controlled trial, 84 pairs of twin births of 30-37 weeks gestation were allocated in a 1:1 ratio to either C-UCM (n = 84) or ECC (n = 84). For statistical analysis, unpaired Student t and Chi square or Fisher's exact test were used. The C-UCM group had a higher mean Hct at 48 h than the control group, 49.74 (4.463) vs. 41.11 (4.898), p < 0.0001. The mean Hct at 12 h and 6 weeks was also significantly greater in the milked group (p < .0001). Additionally, the milked arm had significantly higher mean blood pressure at 1, 6, and 48 h of life. Similar statistically significant differences were also observed in subgroup analysis (stratified according to gestational age of 30-34 weeks, 34-37 weeks). The groups did not differ significantly in terms of potential complications.</p><p><strong>Conclusion: </strong>C-UCM raises the venous hematocrit and stabilizes initial blood pressure. For twin preterm neonates born between 30 and 37 weeks of gestation, it may be a useful placental transfusion technique. Further large multicentric studies are needed to fully establish its efficacy and safety.</p><p><strong>Trial registration: </strong>CTRI/2024/01/061865; registration date January 25, 2024.</p><p><strong>What is known: </strong>• DCC is the standard of care for singleton vigorous neonates, but no consensus exist for multifetal gestation. • C-UCM is feasible, but studies are lacking in the preterm multifetal population.</p><p><strong>What is new: </strong>• C-UCM is an effective placental transfusion strategy in preterm neonates of 30-37 weeks born out of twin gestation. • C-UCM can serve as a substitute for DCC in multifetal gestation especially in low resource settings.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"212"},"PeriodicalIF":3.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515030","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 delayed cord clamping on early cardiac and cerebral hemodynamics, mortality, and severe intraventricular hemorrhage in preterm infants < 32 weeks: a systematic review and meta-analysis of clinical trials.","authors":"Eman Aljohani, Medha Goyal","doi":"10.1007/s00431-025-06026-7","DOIUrl":"10.1007/s00431-025-06026-7","url":null,"abstract":"<p><p>The purpose of this study is to evaluate the impact of DCC (> 30 s) compared to immediate cord clamping (ICC) or umbilical cord milking (UCM) on early cardiac and cerebral hemodynamics, mortality, and severe intraventricular hemorrhage (IVH) in very preterm infants. We searched Ovid Medline, EMBASE, and Cochrane CENTRAL from inception to September 28, 2023, and included randomized controlled trials (RCTs) comparing preterm infants < 32 weeks who received DCC to ICC or UCM. The results were obtained using the Mantel-Haenszel and pooled with a random-effects model. Fifteen articles (2967 patients) were selected, comparing DCC to ICC (10), DCC to UCM (4), and one three-arm study. DCC resulted in a slight increase in superior vena cava (SVC) flow compared to ICC (MD 16.09 ml/kg/min, 95% CI = 4.03 to 28.15, I² = 20%; low-certainty evidence). There was little to no difference in right ventricular output (RVO) after DCC compared to ICC (MD - 2.09 ml/kg/min, 95% CI = - 26.20 to 22.02, I² = 17%; low-certainty evidence). DCC resulted in a large reduction in mortality compared to ICC (RR 0.64, 95% CI = 0.47 to 0.88) but was very uncertain compared to UCM. DCC may reduce severe IVH compared to UCM (RR 0.54, 95% CI = 0.28 to 1.06).</p><p><strong>Conclusion: </strong>DCC improves outcomes in preterm infants < 32 weeks when compared with ICC, as indicated by an increase in SVC flow and regional cerebral oxygenation (rSO2) (moderate- and low-certainty evidence) and reduced mortality. There is low- and very-low-certainty evidence to suggest little to no difference in mortality and cardiac and cerebral hemodynamics after DCC compared to UCM.</p><p><strong>What is known: </strong>• DCC or UCM assists the physiological transition from intrauterine to extra-uterine life by increasing the amount of circulating blood at birth in preterm neonates. • In comparison to ICC, DCC or UCM were shown to reduce mortality, NEC, and infection in preterm infants < 32 weeks; however, a higher incidence of severe IVH was a concern in the UCM group.</p><p><strong>What is new: </strong>• Although DCC has been associated with a large reduction in mortality for preterm infants < 32 weeks compared to ICC, the current evidence is of moderate certainty. However, there appears to be little or no difference in early cardiac hemodynamic parameters and cerebral near-infrared spectroscopy parameters (low or very-low certainty evidence). • Current evidence, which is of low and very low certainty, suggests that there is little or no difference in cardiac and cerebral hemodynamics, mortality, and severe IVH with DCC compared to UCM.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"210"},"PeriodicalIF":3.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500088","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":"Impact of placental pathology on the risk of bronchopulmonary dysplasia in preterm infants: The role of gestational age and sex.","authors":"C Ramos-Navarro, R Gregorio-Hernández, A Pérez-Pérez, E Rodríguez-Corrales, S Vigil-Vázquez, M Arriaga-Redondo, A Merino-Hernández, M Sánchez-Luna","doi":"10.1007/s00431-025-06016-9","DOIUrl":"10.1007/s00431-025-06016-9","url":null,"abstract":"<p><p>To analyze the impact of placental histological findings on the development of bronchopulmonary dysplasia (BPD) in preterm infants, this prospective, observational, single-center study included infants born before 32 weeks of gestation between 2012 and 2023. Perinatal variables were collected and correlated with mortality at hospital discharge and the diagnosis of grade 2-3 BPD at 36 weeks postmenstrual age (PMA). Placental histology was categorized into three groups: inflammatory pathology, vascular malperfusion, and no pathology. A total of 1128 preterm infants were enrolled, with placental histology results available for 899 cases. Inflammatory placental pathology was associated with a lower gestational age (GA) at birth (- 1.4 weeks, 95% CI - 1.74 to - 1.11). The increased mortality linked to placental inflammation was no longer significant after adjusting for GA. In preterm infants born at 27 weeks' GA or later, the effect of vascular malperfusion on BPD showed sexual dimorphism. In males, placental malperfusion was associated with a 2.25-fold increased risk of developing BPD (95% CI 1.10 to 4.57), independent of GA and exposure to mechanical ventilation. No significant differences were observed in females born at 27 weeks or later.</p><p><strong>Conclusions: </strong>The impact of placental histological abnormalities on BPD development is influenced by gestational age and sex. While placental inflammation increases mortality by triggering extremely preterm birth, it does not appear to increase respiratory morbidity compared to cases with normal placental histology at similar GAs. In males, however, placental malperfusion appears to affect lung development and contributes to BPD independently of GA and exposure to mechanical ventilation.</p><p><strong>What is known: </strong>• Bronchopulmonary dysplasia (BPD) is a common respiratory complication among preterm infants, strongly influenced by prenatal events. • The placenta plays a crucial role in fetal lung development, and its analysis provides objective insight into antenatal conditions.</p><p><strong>What is new: </strong>• Placental malperfusion affects lung development in a sex-specific manner, with male infants born at or after 27 weeks of gestation being more specifically affected and showing a higher susceptibility to BPD, independent of gestational age or mechanical ventilation. • These findings highlight the importance of considering sex differences in BPD pathophysiology and the role of placental pathology.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"211"},"PeriodicalIF":3.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500087","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":"Vincristine-induced ptosis in pediatric patients: a systematic review and practice recommendations.","authors":"H Shafeeq Ahmed, Chinmayee J Thrishulamurthy","doi":"10.1007/s00431-025-06039-2","DOIUrl":"10.1007/s00431-025-06039-2","url":null,"abstract":"<p><p>Vincristine, a chemotherapy drug primarily used in pediatric cancer treatments like acute lymphoblastic leukemia and Wilms' tumor, is known for neurotoxic side effects, including a rare but under-discussed manifestation-vincristine-induced ptosis. This systematic review (PROSPERO: CRD42024617946) analyzed data from three databases, identifying 379 articles. Of these, 28 articles encompassing 31 unique pediatric cases were included, with Turkey contributing the highest number of cases (9 cases, 29.03%). The median age was 3 years (IQR: 2 - 5.5), with 58.06% male (18 cases) and 41.93% female (13 cases). Ptosis appeared bilaterally in 61.29% (19 cases) and unilaterally in 38.71% (12 cases), showing a left-side predominance in unilateral cases. The median time to symptom onset after the last vincristine dose was 6 days (IQR: 2 - 12). Treatment protocols varied; 74.19% (23 cases) adjusted or discontinued vincristine, with 34.78% (8 cases) restarting after skipping doses. Pyridoxine with or without pyridostigmine was used in 70% (14 of 20 treated cases), and recovery was generally favorable, with symptoms resolving within 28 days (IQR: 22.75 - 42) in most cases. Mild residual ptosis was noted in 9.67% (3 cases). Our review shows the significant variability inherent to management approaches in this patient demographic and highlights the need for standardized documentation and treatment approaches, proposing \"VINTOSIS-3\" as a practical treatment protocol. Furthermore, the VICTORIA (Vincristine-InduCed pTOsis cRIteriA) Grading is introduced to standardize ptosis severity evaluation. We further emphasize the importance of early detection, vigilant monitoring, and tailored interventions to balance neurotoxicity management with chemotherapy efficacy. What is Known: • Vincristine, a widely used chemotherapeutic agent in pediatric oncology, is associated with toxic side effects, primarily peripheral neuropathy. • Ocular complications of vincristine, including ptosis, have been reported but remain under-recognized. What is New: • Vincristine-induced ptosis is predominantly bilateral, but when unilateral, it shows a left-sided predominance and typically appears after a median of four doses. • The proposed VICTORIA Grading standardizes severity assessment, and the VINTOSIS-3 protocol provides a structured approach to management.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"209"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491397","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":"Febrile Infection-Related Epilepsy Syndrome (FIRES) in children: a retrospective cohort study.","authors":"Khaled Saad, Amir M Aboelgheet, Yasser Hamed, Thamer A M Alruwaili, Mohamed Fahmy M Ibrahim, Amira Elhoufey, Hamad Ghaleb Dailah, Sherin A Taha, Abdulrahman A Al-Atram, Samaher Taha, Osama Abu-Elnaga, Alaa-Eldin Hassan, Eman F Gad","doi":"10.1007/s00431-025-06047-2","DOIUrl":"10.1007/s00431-025-06047-2","url":null,"abstract":"<p><p>This study aimed to analyze the clinical and electroencephalogram (EEG) data of a cohort of children diagnosed with Febrile Infection-Related Epilepsy Syndrome (FIRES) to provide a comprehensive evaluation of the acute and chronic phases of the disease and their associated clinical outcomes. A retrospective cohort study involved 19 pediatric patients admitted to two tertiary centers in Egypt. Data collection encompassed clinical manifestations, laboratory investigations, brain magnetic resonance imaging (MRI), and EEG findings. The study included 19 children with FIRES, with a median age at onset of 7 years, and 68.4% were male. All patients presented with fever before the onset of illness, followed by early convulsions that rapidly progressed to status epilepticus (SE). Seizures began 2-9 days after fever onset, with the acute phase lasting a median of 29 days and SE lasting a median of 20 days. Seizure types were primarily focal (52.6%). Abnormal MRI findings were observed in 84.2% of cases. During the acute phase, EEG showed a complete loss of normal background activity in all patients. In the chronic phase, EEG background activity gradually normalized, and epileptiform activity remained prevalent in all patients, with multifocal spikes and slow waves in 94.7% and extreme delta brush noted in 36.8% of patients. FIRES in children is associated with significant morbidity and mortality, characterized by prolonged refractory seizures and enduring neurological impairments. Early recognition and aggressive management are crucial in improving clinical outcomes. What is Known: • Febrile Infection-Related Epilepsy Syndrome (FIRES) is a rare, severe, and often fatal form of epileptic encephalopathy that has been a focus of significant attention in medical literature over the past two decades.  What is New: • This study provides a detailed analysis of clinical and EEG data in children with FIRES, highlighting distinct characteristics of the acute and chronic phases. •The findings underscore the critical need for early recognition and aggressive management to address prolonged refractory seizures and mitigate enduring neurological impairments.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"206"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482511","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":"Thoracic electrical bioimpedance in preterm newborns with and without respiratory distress syndrome: an exploratory observational study.","authors":"Giulia Paviotti, Matteo Pavan, Marco Driutti, Yvonne Beorchia, Luigi Castriotta, Francesco Maria Risso, Jenny Bua","doi":"10.1007/s00431-025-06049-0","DOIUrl":"10.1007/s00431-025-06049-0","url":null,"abstract":"<p><p>To test the hypothesis that thoracic fluid content (TFC) by thoracic electrical bioimpedance would be higher in preterm infants with respiratory distress syndrome (RDS) both at birth and in the first 48 h of life than in those without RDS and that TFC measured at birth would be associated with RDS diagnosis and need for surfactant. Cross-sectional exploratory observational study including infants ≤ 34 weeks of gestation admitted to two level three NICUs. TFC, clinical, and respiratory data were recorded at 5 timepoints: within the first 2 h of life, before surfactant therapy, and at 4, 12, 24, and 48 h of life. TFC was compared between infants with and without RDS. A ROC curve was calculated to assess the association between TFC at birth and the need for surfactant. TFC was higher in infants with RDS than in infants without RDS at all timepoints. The ROC AUC of TFC measured at birth for the need for surfactant was 0.817 (95% CI 0.64-0.93, p < 0.001); a TFC cut-off of 20.4 1/KOhm/Kg yielded a sensitivity of 83% and specificity of 80% for the need for surfactant. Conclusion: TFC in the first 48 h of life was higher in preterm infants with RDS than in infants without RDS. TFC measured within the first 2 h of life had a good association with the need for surfactant. What is known: • Thoracic electrical bioimpedance can be used to measure thoracic fluid content (TFC) non invasively in newborns What is new: • TFC was higher in premature newborns with respiratory distress syndrome (RDS) that in those without RDS in the first 48 h of life. A high TFC in the first 2 h was associated with the need for surfactant.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 3","pages":"208"},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482512","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}