European Journal of Pediatrics最新文献

{"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}

{"title":"Accelerometer-based 24-h movement behaviours in children and adolescents with Down syndrome.","authors":"Valeria Calcaterra, Matteo Vandoni, Alessandro Gatti, Paolo Maugeri, Alessandra Gazzarri, Jonabel Dolor, Anna Odone, Maddalena Gaeta, Gianvincenzo Zuccotti","doi":"10.1007/s00431-026-07507-z","DOIUrl":"10.1007/s00431-026-07507-z","url":null,"abstract":"<p><p>Children and adolescents with Down syndrome (DS) may show altered 24-h movement behaviours. This study compared physical activity, sedentary behaviour, sleep and rest-activity rhythms in paediatric DS with those of peers with normal weight and obesity. This cross-sectional study included 51 participants aged 8-18 years: 17 with DS, 17 with normal weight and 17 with obesity. Seven-day accelerometry assessed activity, sedentary behaviour, sleep and rest-activity rhythms. Group differences were analysed using adjusted ANCOVA, PERMANOVA and principal component analysis. Compared with normal-weight peers, participants with DS had significantly greater sedentary time and lower light, moderate and moderate-to-vigorous physical activity (all p < 0.001). They also exhibited longer sedentary bouts (p < 0.001), shorter physical-activity bouts (p = 0.037), a lower probability of transitioning from sedentary time to physical activity (p < 0.001) and a higher probability of transitioning back to sedentary time (p = 0.027). Rest-activity rhythms were less stable, with lower interdaily stability (p = 0.030), greater intradaily variability (p = 0.008), lower M5 activity (p < 0.001) and later M5 timing (p = 0.015) and cosinor acrotime (p < 0.001). Most activity and rhythmicity outcomes were similar in the DS and obesity groups. Participants with DS slept longer but had poorer sleep continuity. Overall 24-h behavioural profiles differed significantly among groups (p < 0.001).</p><p><strong>Conclusion: </strong> Children and adolescents with DS display a sedentary, low-movement and less stable 24-h behavioural profile resembling that observed in obesity. Integrated assessment of activity, sedentary accumulation, sleep continuity and rhythmicity may support early identification of modifiable risk and guide individualized, family-centred interventions.</p><p><strong>What is known: </strong>• Youth with Down syndrome are generally less active and more sedentary than typically developing peers and frequently experience disrupted sleep. • Objective studies integrating activity, sedentary accumulation, sleep and rest-activity rhythms across 24 h remain limited.</p><p><strong>What is new: </strong>• Youth with Down syndrome showed a sedentary, low-movement, fragmented and less stable 24-h profile resembling that of peers with obesity. • Longer sleep did not indicate better sleep, as nocturnal wakefulness remained high and sleep efficiency was low.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165265","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":"Screening for financial vulnerability in a paediatric hospital setting: a pilot study of the Financial Risk Questionnaire (FRIQuest).","authors":"Ashley J P Smit, Bente Q Alderlieste, Lequisha G Suisse, Ingrid A Peters, Nicole Lucassen, Koen F M Joosten","doi":"10.1007/s00431-026-07474-5","DOIUrl":"10.1007/s00431-026-07474-5","url":null,"abstract":"<p><p>Growing up in poverty can significantly influence child health and access to healthcare. Paediatric healthcare providers can play an important role in identifying families experiencing financial vulnerability. However, various barriers prevent standard poverty screening in paediatric care. To support this, we developed a digital financial vulnerability screening questionnaire: the Financial Risk Questionnaire (FRIQuest). This study describes its development and evaluates its implementation, perceived usefulness, acceptability, and user friendliness. This mixed-methods implementation study was conducted in a tertiary paediatric hospital in Rotterdam, the Netherlands. Quantitative data included response rates, FRIQuest item responses, parent evaluation survey data, and healthcare provider compliance rates. Qualitative data were obtained through interviews with parents and paediatric healthcare providers. The FRIQuest was sent out to parents of 1206 unique patients. A total of 485 (40.2%) completed the FRIQuest, of whom 22.0% reported (sometimes) experiencing financial vulnerability. Parents generally found the questionnaire easy to complete and felt comfortable answering its questions. They considered it appropriate for healthcare providers to address financial vulnerability, preferably as part of a broader conversation about family wellbeing rather than as a stand-alone topic. Healthcare providers reported that the questionnaire was useful for identifying families in need and was feasible in clinical practice. However, various barriers affected response rates, healthcare compliance, and initiation of conversations.</p><p><strong>Conclusion: </strong> FRIQuest is a feasible, generally acceptable, and potentially useful digital questionnaire to support the identification of financial vulnerability in paediatric hospital care. This study highlights that successful implementation requires not only suitable questionnaires, but also inclusive implementation strategies, provider engagement and support, and access to social support. Future research should evaluate its impact on referrals to support services and socioeconomic inequalities in child health.</p><p><strong>What is known: </strong>• Growing up in poverty is associated with poorer health and reduced access to healthcare. • Paediatricians can contribute to improving child health outcomes by addressing financial vulnerability within clinical care. However, various barriers prevent standard financial vulnerability screening.</p><p><strong>What is new: </strong>• The Financial Risk Questionnaire is a feasible and generally acceptable digital questionnaire to support identification of financial vulnerability in paediatric hospital care. • Besides suitable questionnaires, successful financial vulnerability screening requires inclusive implementation strategies, provider support, and organisational embedding.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164588","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":"Innate and adaptive immunity pathways linking Mycoplasma pneumoniae to pediatric asthma phenotypes.","authors":"Filippos Filippatos, Athanasios Michos, Konstantinos Kakleas","doi":"10.1007/s00431-026-07514-0","DOIUrl":"10.1007/s00431-026-07514-0","url":null,"abstract":"<p><p>Mycoplasma pneumoniae (Mp) is repeatedly detected during pediatric wheeze and asthma exacerbations, but its clinical significance depends on the host-response context. This review evaluates the clinical and mechanistic evidence linking Mp to pediatric asthma phenotypes and examines approaches for distinguishing biologically meaningful infection from incidental detection. We narratively synthesized clinical, experimental, immunological, toxin, and proteomic literature addressing Mp-associated wheeze, asthma exacerbation, epithelial injury, allergic amplification, and inflammatory endotyping. Evidence was distinguished by population and experimental system. Experimental studies show that Mp adheres to airway epithelium; disrupts mucociliary function; activates TLR2/TLR4, NF-κB, autophagy, and inflammasome pathways; and promotes cytokine networks that overlap with allergic asthma. In experimental allergic-airway models, epithelial alarmins, IgE responses, mast cells, and type 2 inflammation may amplify Mp-driven signals, whereas IL-23/IL-17 pathways recruit neutrophils and suggest mixed endotypes; altered corticosteroid responsiveness has not been established in pediatric Mp-associated asthma. CARDS toxin induces eosinophilic inflammation, mucus metaplasia, airway hyperresponsiveness, functional IgE responses, and worsening allergen-driven disease in experimental models. Upper-airway PCR positivity, however, may reflect carriage or prolonged detection rather than active lower-airway infection.</p><p><strong>Conclusion: </strong> Quantitative pathogen testing, paired serology, viral co-detection, age, atopy, microbiome context, and host-response biomarkers merit integrated evaluation in research. Proteomic and multi-omics signatures may support precision endotyping, improve causal attribution, and strengthen pediatric asthma trial design. Their diagnostic and treatment-predictive value remains unvalidated.</p><p><strong>What is known: </strong>• M. pneumoniae is linked to pediatric wheeze and asthma exacerbations, but upper-airway PCR may reflect carriage rather than active lower-airway infection. • Epithelial injury, type 2/Th17 responses, and CARDS toxin can promote asthma-like inflammation in experimental systems.</p><p><strong>What is new: </strong>• This review integrates diagnostic attribution, toxin biology, immune crosstalk, and proteomic endotyping in one pediatric framework. • It proposes an unvalidated combined pathogen-load and host-response assessment to investigate clinically meaningful M. pneumoniae-driven endotypes and guide trials.</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":"149165165","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":"Phenotypic spectrum of 1q21.1 copy number variants in 42 children: genotype-phenotype correlations and clinical implications.","authors":"Gamze Mutlucan Köseoğlu, Ahmet Cevdet Ceylan, Büşranur Çavdarlı, Emel Ömercioğlu, Esra Çöp, Esra Kılıç","doi":"10.1007/s00431-026-07511-3","DOIUrl":"10.1007/s00431-026-07511-3","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Chromosome 1q21.1 copy number variants (CNVs) are associated with a broad and variable clinical spectrum encompassing neurodevelopmental, anthropometric, and systemic anomalies. The incomplete penetrance and variable expressivity of these rearrangements pose significant challenges for clinical interpretation and genotype-phenotype correlation. We retrospectively analyzed 42 pediatric patients with 1q21.1 CNVs, identified by chromosomal microarray analysis (CMA), evaluated at a single tertiary center between 2019 and 2025. Patients were classified according to CNV type and localization: distal deletions (n = 30), distal duplications (n = 7), proximal deletions (n = 3), and proximal duplications (n = 2). Clinical findings were compared according to CNV type, sex, inheritance pattern, parental origin, and deletion size. The median age at presentation was 27 months. Among distal deletion carriers, microcephaly (60.0%), short stature (40.0%), and developmental delay (39.3%) were the most frequently observed findings. Cardiac anomalies were present in 34.5% of deletion patients, with two patients dying due to severe cardiac complications during follow-up. Macrocephaly was identified exclusively in duplication carriers (28.6%), corroborating the mirror phenotype of reciprocal 1q21.1 rearrangements. Developmental delay was significantly more frequent in duplication compared with deletion carriers (85.7% vs. 39.3%; p = 0.041). Cardiac anomalies were significantly more common in female patients (p &lt; 0.05). No significant differences were identified according to inheritance status, parental origin, or deletion size, reflecting the variable expressivity of this locus. One proximal deletion patient was diagnosed with TAR syndrome through combined microarray and exome sequencing, confirming the two-hit molecular mechanism involving a 1q21.1 deletion and a pathogenic RBM8A variant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study delineates the broad phenotypic spectrum of 1q21.1 CNVs in a pediatric cohort, highlighting microcephaly and cardiac anomalies as clinically significant findings and reinforcing the mirror phenotype of reciprocal rearrangements. The absence of consistent genotype-phenotype correlations underscores the contribution of modifier factors beyond the CNV itself. Routine cardiac evaluation and multidisciplinary follow-up are recommended for all carriers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Distal 1q21.1 CNVs cause microcephaly, developmental delay, and cardiac anomalies with incomplete penetrance and variable expressivity. • Reciprocal rearrangements show a mirror phenotype: microcephaly in deletion and macrocephaly in duplication carriers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• This is among the few single-center cohorts characterizing all four 1q21.1 CNV subtypes in a pediatric series. • Cardiac anomalies were more frequent in female carriers, a sex-specific observation warranting further investigation. • Inheritance status, parental ","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":"149165654","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":"Primary care and idiopathic scoliosis: an evaluation of family physicians' roles.","authors":"Filiz Yildiz Tükel, Ogulcan Come, Gizem Limnili, Özden Gökdemir, Nilgün Özçakar","doi":"10.1007/s00431-026-07484-3","DOIUrl":"https://doi.org/10.1007/s00431-026-07484-3","url":null,"abstract":"<p><p>Idiopathic scoliosis (IS) can progress silently during growth. Early primary care detection prevents curve progression and reduces treatment burden. This study aimed to assess the role of family physicians in screening, diagnosis, counseling, and follow-up of adolescents with IS, and to evaluate primary care attributes using the Primary Care Assessment Survey (PCAS). This cross-sectional study included 150 patients with IS followed at a university orthopedics clinic in Türkiye. Data were collected via structured telephone interviews using a custom 13-item questionnaire and the validated Turkish PCAS. Descriptive statistics and bivariate parametric and non-parametric tests were used for the analysis (p < 0.05). Only 11% of participants were first diagnosed by family physicians, whereas 68% were diagnosed by orthopedic surgeons. Primary care involvement was low: scoliosis-focused examination (15%), counseling (15%), referral (15%), and exercise recommendations (19%) were infrequent. PCAS scores were highest for longitudinal continuity (79 ± 20) and trust (63 ± 12), and lowest for preventive services and counseling (44 ± 35). Late-onset scoliosis was associated with significantly higher scores in comprehensive knowledge, physical care, personal approach, accessibility, and communication (p < 0.05).</p><p><strong>Conclusion: </strong>Most patients with IS are diagnosed outside primary care, highlighting a substantial underutilization of opportunistic screening and early clinical evaluation in primary care settings. Standardizing scoliosis screening during routine adolescent well-visits, enhancing primary care awareness and guidance, and strengthening referral pathways are crucial for enabling earlier detection, modifying disease progression, and mitigating long-term clinical burdens.</p><p><strong>What is known: </strong>• Early detection of idiopathic scoliosis (IS) through opportunistic screening prevents curve progression, avoids invasive surgeries, and reduces long-term healthcare burdens..</p><p><strong>What is new: </strong>• Only 11% of IS patients are diagnosed in primary care, revealing critical gaps in screening, posture examination, and counseling despite high longitudinal trust in family physicians..</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165586","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":"Vitamin D status and adiposity in children with low-energy fractures: a prospective case-control study.","authors":"Andrea Cosentino, Daniel Weghuber, Pier Francesco Indelli, Nicole Fantini, Wilhelm Berger, Olaf Stefan Schmidt, Wolfgang Högler","doi":"10.1007/s00431-026-07509-x","DOIUrl":"10.1007/s00431-026-07509-x","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Fractures in children are influenced by both skeletal biology and mechanical factors. While alterations in vitamin D and other metabolic markers have been proposed as contributors to fracture risk, their role in predicting fractures in otherwise healthy pediatric populations remains unclear. This study aimed to determine whether biochemical markers of bone metabolism and body mass are independently associated with fracture occurrence and fracture patterns in children after low-energy trauma and to assess their impact on fracture patterns and anatomical distribution. We conducted a prospective case-control study including 100 children presenting after low-energy trauma (50 with radiographically confirmed fractures and 50 controls). Serum 25OH vitamin D (25OHD), parathyroid hormone (PTH), calcium, phosphate, and alkaline phosphatase (ALP) were measured within 1 week of presentation. Associations with fracture occurrence were assessed using multivariable logistic regression, including age, sex, body mass index z-score (BMI-z), an interaction term between 25OHD and BMI-z, and an additional exploratory model evaluating a 25OHD × season interaction. The discriminatory ability of 25OHD was evaluated using receiver operating characteristic analysis. Children with fractures had lower serum 25OHD concentrations and a higher prevalence of levels below 50 nmol/L compared with controls. Other biochemical markers were largely within normal ranges, although ALP levels were modestly higher in fracture patients. In multivariable analysis, 25OHD levels below 50 nmol/L were associated with increased odds of fracture, whereas age and BMI-z were not independently associated with fracture occurrence. However, a significant interaction between 25OHD and BMI-z was observed, indicating that the association between vitamin D status and fracture risk is influenced by adiposity. The overall discriminatory ability of 25OHD for fracture risk was modest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt; Lower 25OHD levels were observed in children with low-energy fractures. The association between vitamin D status and fracture risk appears to be modest and influenced by adiposity, with a more pronounced effect at higher BMI-z levels. Therefore, fracture susceptibility in otherwise healthy children is likely driven primarily by biomechanical and developmental factors rather than vitamin D status, supporting a targeted rather than routine laboratory assessment of metabolic markers in children presenting with fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinicaltrials: &lt;/strong&gt;gov Identifier: NCT07143552.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Lower serum 25-hydroxyvitamin D concentrations have been reported in children with fractures, but the relationship between vitamin D status and fracture risk remains controversial. • Childhood obesity is associated with lower circulating vitamin D concentrations and may independently influence fracture susceptibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• Vitamin D ","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135434","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":"Nirsevimab reduced acute otitis media infections in infants-a nationwide interrupted time-series analysis.","authors":"Niko Leskinen, Marjo Renko, Ilari Kuitunen","doi":"10.1007/s00431-026-07508-y","DOIUrl":"10.1007/s00431-026-07508-y","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is a major cause of acute respiratory tract infections in young children worldwide. Acute otitis media (AOM) is among the most frequent complications of RSV infection and the leading indication for antibiotic prescribing in this age group. The aim of this study was to evaluate the effectiveness of nirsevimab in reducing the incidence of AOM among infants. We conducted a nationwide register-based interrupted time-series study using data on live births, laboratory-confirmed RSV detections, and AOM diagnoses from four consecutive RSV seasons (2022-2023 to 2025-2026). Monthly infant populations at risk were reconstructed from birth cohorts to estimate incidence rates during the peak RSV seasons (December-March) which were compared between two pre-implementation and two post-implementation RSV seasons in infants aged < 12 months, stratified into age groups of 0-2, 3-5, and 6-11 months. The study population consisted of 181,999 infants and the follow-up consisted of 2,022,261 infant-months. A total of 3699 RSV-positive findings and 15,830 AOM diagnoses were included in the primary analysis. Following nirsevimab implementation, the incidence of AOM and RSV among infants aged < 12 months decreased by 44% (RR 0.56, 95% CI 0.54-0.58) and 83% (RR 0.17, 95% CI 0.15-0.18), respectively. The reduction was greatest in the youngest age (0-2 months) group.</p><p><strong>Conclusion: </strong> Implementation of a nirsevimab immunisation programme was associated with a substantial reduction in AOM incidence among infants aged < 12 months, suggesting that RSV immunisation may reduce the burden of AOM in early childhood.</p><p><strong>What's known: </strong>• RSV is a major cause of morbidity during infancy, and acute otitis media is among its most frequent complications. • Nirsevimab has demonstrated high efficacy in preventing severe RSV disease in young children; however, its effect on outpatient RSV-related complications has not been well established.</p><p><strong>What is new: </strong>• This study provides population-based real-world evidence on the impact of nirsevimab on acute otitis media. • Following the implementation of nirsevimab prophylaxis, the incidence of acute otitis media among infants decreased significantly.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147886","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":"Who fails the egg ladder? Predictors of reactions and clinical outcomes with individualized entry-step selection in 197 children with IgE-mediated egg allergy.","authors":"Canan Caka, Tugce Cagiran, Ceren Ustun, Melike Ocak, Aysegul Ertugrul, Umit Murat Sahiner, Bulent Enis Sekerel, Ozge Soyer","doi":"10.1007/s00431-026-07486-1","DOIUrl":"10.1007/s00431-026-07486-1","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Egg ladders provide a structured approach to graded egg reintroduction in children with IgE-mediated egg allergy; however, identifying children at risk of reactions remains challenging, particularly because recent evidence has questioned the predictive value of baseline sensitization and previous anaphylaxis. Large real-world studies evaluating individualized egg ladder approaches remain limited. In this retrospective cohort study, we evaluated children with IgE-mediated egg allergy managed with a structured egg ladder at a tertiary pediatric allergy center over a 10-year period. Starting steps were selected individually according to clinical history and sensitization results; children considered unsuitable for direct initiation with baked whole egg could begin with baked egg yolk. The primary outcome was the occurrence of at least one protocol-related allergic reaction during ladder progression at the patient level; ladder completion was evaluated separately. Factors associated with reactions and noncompletion were assessed using logistic regression. Among 197 children, completion outcomes were available for 175, of whom 144 (82.3%) achieved whole egg tolerance after a median ladder duration of 13 months. Twenty-four children (12.2%) experienced at least one protocol-related allergic reaction, including anaphylaxis during supervised OFC in 12 (6.1%). Previous egg-induced anaphylaxis was independently associated with protocol-related reactions and noncompletion, whereas higher baseline egg white-specific IgE was associated with noncompletion only. In unadjusted analyses, initiation before 18 months was associated with fewer protocol-related reactions (3.4% vs 15.9%; p = 0.014), more frequent ladder completion (92.2% vs 78.2%; p = 0.028), and achievement of tolerance at a younger age (25.5 months vs 49.0 months, p &lt; 0.001). However, age at initiation was not independently associated with reactions or noncompletion after adjustment.Conclusion: Previous egg-induced anaphylaxis identified children at increased risk of reactions and ladder noncompletion, while higher baseline egg white-specific IgE was associated with noncompletion. A baked egg yolk entry step was feasible in selected children considered unsuitable for direct baked whole egg initiation, although its comparative safety and clinical utility require prospective evaluation. The favorable unadjusted outcomes with initiation before 18 months were not confirmed after adjustment. What is Known: • Although egg ladders facilitate graded egg introduction in many children with IgE-mediated egg allergy, reliable identification of children at risk of reactions or ladder noncompletion remains challenging What is New: • Previous egg-induced anaphylaxis was independently associated with protocol-related reactions and ladder noncompletion, whereas higher baseline egg white-specific IgE was independently associated with noncompletion but not with reactions after adjustment. A baked egg yolk entry ","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149248","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":"Mediastinal lymphadenitis caused by Mycobacterium avium complex in children: a rare case of airway compression.","authors":"Vincent Fréret, Laureline Berteloot, Rola Abou Taam, Emmanuelle Bosdure, Harriet Corvol, Pierrick Cros, Jean-Christophe Dubus, Elsa Gachelin, Isabelle Gibertini, Eglantine Hullo, Clémence Mordacq, Nadia Nathan, Blandine Prévost, Charlotte Roy, Caroline Thumerelle, Jean-Laurent Casanova, Jérémie Rosain, Alice Hadchouel, Christophe Delacourt, Jacinta Bustamante","doi":"10.1007/s00431-026-07470-9","DOIUrl":"10.1007/s00431-026-07470-9","url":null,"abstract":"<p><p>Airway compression caused by intrathoracic non-tuberculous mycobacteria (NTM) lymphadenitis is particularly uncommon in otherwise healthy children and remains poorly characterized. We aimed to describe the clinical, radiological, microbiological, and immunological features of a French pediatric cohort diagnosed with mediastinal Mycobacterium avium complex (MAC) lymphadenitis. We conducted a retrospective multicenter study that included children diagnosed with bacteriologically confirmed intrathoracic MAC lymphadenitis in France between 2009 and 2024. Patients with HIV-related immunodeficiency or known inborn errors of immunity were excluded. Immunological investigations were performed, including the secretion of IL-12 and IFN-γ by a whole-blood assay. Ten children with intrathoracic MAC lymphadenitis with airway compression were included. In most cases, the diagnosis required invasive sampling. Mycobacterium avium was identified in nine patients and M. intracellulare in one patient. Main respiratory manifestations were dyspnea, persistent cough, and abnormal breath sounds. Chest computed tomography (CT) scans revealed mediastinal lymphadenopathies causing airway compression, ventilation disorders, and air trapping. Following prolonged antibiotic treatment, all patients showed clinical improvement and a reduction in lymph node size, although residual calcifications frequently persisted. IFN-γ secretion was impaired in all five patients who underwent specific immunological testing, consistently lower compared with healthy controls.</p><p><strong>Conclusion: </strong>This study highlights a rare presentation of airway compression in children characterized by MAC mediastinal lymphadenitis. These findings underscore the importance of considering NTM infections in the differential diagnosis of persistent mediastinal lymphadenitis in young children and highlight the frequent need for invasive sampling to establish a microbiological diagnosis. Although no overt immunodeficiency was identified, immune evaluation, particularly exploration of the IFN-γ-mediated immunity, may be relevant in these patients.</p><p><strong>What is known: </strong>• Mediastinal lymphadenitis caused by non-tuberculous mycobacteria (NTM) is a rare condition, mainly reported in immunocompromised patients, and often mimics tuberculosis on imaging. • Diagnosis is challenging due to nonspecific clinical and radiological findings, and it relies on microbiological confirmation.</p><p><strong>What is new: </strong>• In this cohort, intrathoracic MAC infection in young children presented as airway-compressive mediastinal lymphadenitis rather than classical parenchymal pulmonary NTM disease. • Bronchoalveolar lavage had a low diagnostic yield, and most cases required targeted lymph node or endobronchial granuloma sampling. • A subset of tested patients showed reduced IFN-γ secretion despite the absence of a known monogenic immunodeficiency.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"185 11","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135079","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}