European Journal of Pediatrics最新文献

{"title":"Association between preterm birth and asthma and atopic dermatitis in preschool children: a nationwide population-based study.","authors":"Jong Ho Cha, Jae Kyoon Hwang, Jae Yoon Na, Soorak Ryu, Jae-Won Oh, Young-Jin Choi","doi":"10.1007/s00431-024-05747-5","DOIUrl":"10.1007/s00431-024-05747-5","url":null,"abstract":"<p><p>Asthma and atopic dermatitis (AD) are representative chronic diseases in childhood. This study aimed to investigate the impact of preterm birth on the incidence and severity of asthma and AD in children, as well as to identify neonatal risk factors for asthma and AD. We used health claims data recorded between 2007 and 2014 in the Korean National Health Insurance Service database. We recruited 2,224,476 infants born between 2007 and 2014 and divided them into three groups: 3518 of extremely preterm (EP) infants (< 28 weeks of gestational age (GA)), 82,579 of other preterm (OP) infants (28-36 weeks of GA), and 2,138,379 of full-term (FT) infants (> 37 weeks of GA). We defined asthma as > 3 episodes of clinical visits in a year before 6 years of age, early asthma as onset at < 2 years of age, and severe asthma as > 1 event of status asthmaticus or admission to a hospital via an emergency room. AD was defined as ≥ 3 diagnoses in a year before 6 years of age, early AD as onset at < 2 years of age, and severe AD as prescription of high-potency topical steroids or immunosuppressants. An association of preterm birth with asthma and AD was assessed using inverse probability of treatment-weighted multivariable Cox regression analysis. Cardiorespiratory conditions, such as respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, and pulmonary hypertension, significantly increased the risk of asthma. Specifically, bronchopulmonary dysplasia emerged as a significant risk factor for both severe and early-onset asthma (odds ratio (OR) 1.36, 95% CI 1.21-1.37 for severe asthma; OR 1.55, 95% CI 1.30-1.85 for early asthma), while it was associated with a decreased risk of AD (OR 0.86, 95% CI 0.80-0.92). Neonatal sepsis, jaundice, and retinopathy of prematurity were also identified as significant risk factors for later asthma. A stepwise increase in the risk of asthma with an increasing degree of prematurity was observed, with the OP group showing an adjusted hazard ratio (aHR) of 1.24 (95% CI: 1.22-1.26) and the EP group showing an aHR of 1.51 (95% CI: 1.41-1.63). Conversely, preterm birth was inversely associated with the risk of AD, with aHRs of 0.73 (95% CI: 0.67-0.79) for the OP group and 0.88 (95% CI: 0.87-0.89) for the EP group. Conclusion Preterm children have a significantly higher risk of asthma and lower risk of AD, with cardiorespiratory conditions significantly increasing the risk of asthma. Thus, we highlight the need for targeted respiratory management strategies for this high-risk population. What is Known: •Asthma and atopic dermatitis are prevalent chronic diseases in childhood, reducing the quality of life of children. •Preterm birth was associated with an increased risk of asthma, but few large nationwide studies. •Research on the relationship between preterm birth and pediatric atopic dermatitis is controversial, with few large nationwide studies. What is New: • Preterm children, especially born before 28 weeks","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5383-5393"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406281","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":"In-hospital unfavorable outcomes of MIS-C during 2020-2022: a systematic review.","authors":"Giancarlo Alvarado-Gamarra, Katherine Alcalá-Marcos, Pía Balmaceda-Nieto, Fabriccio J Visconti-Lopez, Pedro Torres-Balarezo, Cristian Morán-Mariños, Victor Velásquez-Rimachi, Sandra S Chavez-Malpartida, Carlos Alva-Díaz","doi":"10.1007/s00431-024-05787-x","DOIUrl":"10.1007/s00431-024-05787-x","url":null,"abstract":"<p><p>Studies on the severity in multisystem inflammatory syndrome in children (MIS-C) show heterogeneous results and may not reflect a global perspective. This systematic review aims to estimate the frequency of in-hospital unfavorable outcomes in patients with MIS-C over the 3 years since the onset of the SARS-CoV-2 pandemic. A systematic search was conducted in Medline, Scopus, Embase, Cochrane, Web of Science, Scielo, and preprint repositories until December 15, 2022. Study selection and data extraction were evaluated independently. The primary outcomes were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and death. Additionally, we evaluated cardiovascular-related outcomes. We performed a random-effects model meta-analysis and assessed the certainty of the evidence. Fifty-seven studies (n = 13 254) were included. The frequency of ICU admission was 44.7% (95% CI 38.8-50.7), 11.9% for IMV (95% CI 9.6-14.4), and 2.0% for death (95% CI 1.3-3.0). The requirement of vasoactive/inotropic drugs was 40.1% (95% CI 35.9-44.4), 7.9% for coronary aneurysm (95% CI 4.1-12.7), 30.7% for decreased left ventricle ejection fraction (LVEF) (95% CI 26.3-35.4), and 29.7% for myocarditis (95% CI 18.4-42.4). We assess the included evidence as being of very low certainty. Finally, excess COVID-19 mortality by country and the diagnostic criteria for MIS-C (CDC compared to WHO) were associated with a higher frequency of ICU admissions. The year of study conduction (2022 compared to 2020) was associated with a lower frequency of IMV.</p><p><strong>Conclusion: </strong>The frequency of in-hospital unfavorable outcomes in patients with MIS-C was high. Well-designed studies are needed to explore other heterogeneity sources.</p><p><strong>Protocol registration: </strong>CRD42021284878.</p><p><strong>What is known: </strong>• Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious condition linked to SARS-CoV-2. Studies on the severity of MIS-C show heterogeneous results. These findings may not be representative of the reality in other regions, making it challenging to draw generalizable conclusions.</p><p><strong>What is new: </strong>• Over the 3 years since the onset of the SARS-CoV-2 pandemic, our systematic review has shown that the frequency of in-hospital unfavorable outcomes in patients with MIS-C is high, with a very low certainty of the evidence. Our results reflect the reality from a global perspective, across different countries with varying income levels. • The main sources of heterogeneity in the frequency of severe outcomes could be explained by the excess mortality due to COVID-19 in each country, the type of diagnostic criteria for MIS-C, and the year the study was conducted.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5071-5084"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344145","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":"Sport participation, weight status, and physical fitness in French adolescents.","authors":"Jérémy Vanhelst, Anne Le Cunuder, Luc Léger, Martine Duclos, Daniel Mercier, François Carré","doi":"10.1007/s00431-024-05796-w","DOIUrl":"10.1007/s00431-024-05796-w","url":null,"abstract":"<p><p>The primary objective of this study was to investigate the associations between sport participation and weight status with physical fitness among French adolescents. The secondary aim was to establish sex- and age-specific physical fitness percentiles for French adolescents. The sample comprised 8084 adolescents (4126 boys, 3958 girls), aged 10-14 years. Participants were tested on cardiorespiratory fitness and muscular strength using the following tests: 20-m shuttle run test and handgrip strength test. A questionnaire on organized sport participation was completed. Physical fitness levels were better in boys (P < 0.005). Handgrip strength increased with age whereas 20-m shuttle run performance decreased with age. Overweight and obese adolescents had significantly lower cardiorespiratory fitness levels than their normal-weight peers (P < 0.005), whereas normal-weight adolescents had lower cardiorespiratory fitness than thin adolescents (P < 0.005). Sport participation was higher for boys (57.2% boys vs. 52.8% girls) (P < 0.001). Adolescents who participated in at least one organized sport (either through a club or at school) were fitter than those who did not participate in organized sports (P < 0.005). Adolescents who engaged in organized sports were more active and physically fit than those who did not participate. The fitness benefits of club sports are greater than those provided by school-based sports, highlighting the potential of sports clubs as a key setting for promoting health. What is Known: • Physical fitness is a strong marker of health in children and adolescents. • The last French Report Card highlighted the lack of fitness data and the need for nationwide programs, while showing a significant decline in cardiorespiratory fitness among youth in recent decades.. What is New: • This study reveals that adolescents participating in organized sports have better physical fitness compared to their peers who do not, emphasizing the potential advantages of club sports over school-based activities. • We highlight the need for targeted strategies, particularly for overweight or obese adolescents and girls, to increase participation in organized sports and enhance health outcomes. • The study emphasizes the need to develop policies that improve access to organized sports clubs and expand physical education in schools, aiming to improve CRF in adolescents.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5213-5221"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361329","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 economic burden of varicella among children in France: a caregiver survey.","authors":"Salome Samant, Hervé Haas, Joana Santos, David R Mink, Richard Pitman, Tanaz Petigara, Manjiri Pawaskar","doi":"10.1007/s00431-024-05763-5","DOIUrl":"10.1007/s00431-024-05763-5","url":null,"abstract":"&lt;p&gt;&lt;p&gt;To estimate the economic burden of varicella among children in France from family and societal perspectives. We conducted an online cross-sectional survey of caregivers of 185 French children (≤ 17 years) diagnosed with varicella in the previous six weeks. Data collected included varicella-related healthcare resource use, out-of-pocket costs, missed school days, and workdays missed by either parents or other caregivers. Mean and median direct and indirect costs (2022 Euros) were calculated using survey data and published literature. The annual societal burden of pediatric varicella in France was estimated. Of the 185 children, 95.1% had ≥ 1 outpatient visit, 10.3% had ≥ 1 emergency room visit, and 2.2% were hospitalized. The median [interquartile range, IQR] number of outpatient visits/child was 1.0 [1.0 - 2.0]. The median length of hospital stay among those hospitalized (n = 4) was 5.0 [3.5 - 6.5] days. Caregivers of 185 children missed a median of 2.0 [0 - 5.0] workdays; 113 families (61.1%) had ≥ 1 parent miss work. A median of 5.0 [3.0 - 7.0] school days were missed by 170 children who attended preschool or school. The median direct out-of-pocket cost to the family was €30.0 [€17.0 - €60.0]. The median [IQR] societal costs per varicella case were €455.2 [€70.5 - €1013.5]; the median [IQR] direct and indirect costs per child were €60.8 [€39.0 - €102.7] and €364.7 [€0.0 - €911.7] respectively. The annual societal burden of varicella among children in France was estimated to be €450,427,578 (95% CI: €357,144,618 - €543,710,538), with indirect costs accounting for 85%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A substantial economic burden is associated with pediatric varicella in France, primarily due to the productivity loss among caregivers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known: &lt;/strong&gt;• Although varicella is considered a mild disease, it poses a significant burden on caregivers and society. Our study aimed to estimate the economic burden of varicella among children in France from family and societal perspectives to support policymakers in understanding the value of UVV in France.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is new: &lt;/strong&gt;• We conducted an online survey of caregivers of 185 French children (≤17 years) diagnosed with varicella and collected data on varicella-related healthcare resource use, missed school days and workdays. Our study estimated annual societal burden of pediatric varicella in France. Out of 185 children with varicella, most (95.1%) had at least one outpatient visit, 10.3% had at least one emergency room visit, and 2.2% were hospitalized. 61.1% of parents with sick child, missed work and median productivity loss was 2.0 workdays. Additionally, 170 children who attended school or preschool missed a median of 5.0 school days. • The societal burden of pediatric varicella in France was estimated to be €450,427,578 (95% CI, €357,144,618 - €543,710,538), with indirect costs accounting for 85%. Pediatric varicella is associated with a substantial eco","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5233-5243"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375333","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":"Normative computed tomography angiography values of the aortic root, aorta, and aortic arch in children.","authors":"Rakesh Donthula, Wen Li, Archita Duvvada, Dan Dyar, Santosh C Uppu","doi":"10.1007/s00431-024-05818-7","DOIUrl":"10.1007/s00431-024-05818-7","url":null,"abstract":"<p><p>Normative values for intracardiac and extracardiac vascular structures help in understanding normal growth and changes over time in children; this normative data is not currently available for ECG-gated computed tomography angiography (CTA). We sought to establish ECG-gated CTA-derived normative values for the aortic root, aorta, and aortic arch in children. Aortic root, ascending aorta, aortic arch, and descending aorta were measured in systole and diastole in 100 subjects who had ECG-gated CTA at our center between January 2015 and December 2020 and met our inclusion criteria. The allometric exponent (AE) for each parameter was derived, and the parameter/body surface area^AE (BSA^AE) was established using the previously described methods. Using this data, normalized mean, cross-sectional area, and standard deviation were calculated. Z-score curves were plotted in relation to the BSA for all measurements.</p><p><strong>Conclusion: </strong>Our study reports systolic and diastolic ECG-gated CTA Z-scores along with normative curves in relation to BSA for the aortic root, aorta, and aortic arch in children.</p><p><strong>What is known: </strong>• Normative data for intracardiac and extracardiac vascular structures in the pediatric population are available for echocardiography, cardiac MRI and non-ECG gated CTA. • Z-scores with standard deviations are commonly used in children, but SDs are not constant across body sizes due to heteroscedasticity.</p><p><strong>What is new: </strong>• Allometric exponent was derived for each parameter and the parameter/body surface area (BSA) was established. • This is the first ECG-gated CTA study to provide normative en face systolic, diastolic diameters and cross-sectional areas along with Z-scores and normative curves for the aortic root, aorta and aortic arch in children.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5425-5439"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461118","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":"Risk factors for multidrug-resistant bacteria in critically ill children and MDR score development.","authors":"Cristina González-Anleo, Mònica Girona-Alarcón, Alba Casaldàliga, Sara Bobillo-Perez, Elena Fresán, Anna Solé-Ribalta, Eneritz Velasco-Arnaiz, Manuel Monsonís, Mireia Urrea, Iolanda Jordan","doi":"10.1007/s00431-024-05752-8","DOIUrl":"10.1007/s00431-024-05752-8","url":null,"abstract":"<p><p>Antimicrobial resistance and healthcare-associated infections (HAIs) are major health concerns in the pediatric intensive care unit (PICU). Device-associated HAIs (DA-HAIs) produced by multidrug-resistant (MDR) bacteria are especially worrying, as they can lead to an inappropriate empirical antibiotic therapy, worsened outcomes and increased mortality. The MDR score was designed to enable the prompt identification of patients at high risk of developing an MDR infection. This was a single-center, prospective, observational study, conducted between January 2015 and December 2022, including PICU patients with a microbiologically confirmed DA-HAI. Demographic, clinical characteristics and outcomes were compared between patients with a DA-HAI caused by MDR and non-MDR-associated DA-HAI, and a risk score for multi-resistance was designed. In total, 257 DA-HAI cases were included, 86 (33.46%) caused by an MDR microbe. In the univariate analysis, comorbidity (p = 0.002), previous MDR colonization (p < 0.001), previous surgery (p = 0.018), and previous antibiotic therapy (p = 0.009) were more frequent among MDR-associated DA-HAI (MDR DA-HAI). In addition, days from device insertion to infection and from PICU admission (p < 0.005) to infection were longer in patients with MDR. In the multivariate analysis, previous comorbidity (OR 2.201), previous MDR colonization (OR 5.149), and PICU length of stay longer than 9 days (OR 1.782) were independently associated with MDR-DA-HAI. Using these three independent risk factors for MDR, a risk score was created: the MDR score. Three risk groups were obtained: low risk (0-2 points), intermediate risk (3-7 points), and high risk (8-12 points). Seventy-one patients with MDR-DA-HAI (82.6%) were classified in the intermediate or high-risk group, with a global sensitivity of 82.6%. The specificity in the high-risk group was 91.8%, and 81.0% of patients who were stratified into the low-risk group had non-MDR-associated infections, so they were correctly classified. Conclusions: The MDR score can be a useful tool to stratify patients in risk groups for MDR-DA-HAI. It may help to guide the choice of empirical therapy, leading to early optimization and avoiding delays in establishing appropriate treatment. This study reinforces the importance of stratifying patients based on their individual risk profile for MDR infection.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5255-5265"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380317","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":"Homoeopathy vs. conventional primary care in children during the first 24 months of life-a pragmatic randomised controlled trial.","authors":"Menachem Oberbaum, Anupriya Chaudhary, Hima Bindu Ponnam, Reetha Krishnan, Dinesh V Kumar, Mohammed Irfan, Debadatta Nayak, Swati Pandey, Akula Archana, Sai Bhargavi, Divya Taneja, Mohua Datta, Navin Pawaskar, Ravindra Mohan Pandey, Anil Khurana, Shepherd Roee Singer, Raj Kumar Manchanda","doi":"10.1007/s00431-024-05791-1","DOIUrl":"10.1007/s00431-024-05791-1","url":null,"abstract":"<p><p>To compare the difference between primary homoeopathic and conventional paediatric care in treating acute illnesses in children in their first 24 months of life. One hundred eight Indian singleton newborns delivered at 37 to 42 weeks gestation were randomised at birth (1:1) to receive either homoeopathic or conventional primary care for any acute illness over the study period. In the homoeopathic group, conventional medical treatment was added when medically indicated. Clinicians and parents were unblinded. Children in the homoeopathic group experienced significantly fewer sick days than those in the conventional group (RR: 0.37, 95% CI: 0.24-0.58; p < 0.001), with correspondingly fewer sickness episodes (RR: 0.53, 95% CI: 0.32-0.87; p = .013), as well as fewer respiratory illnesses over the 24-month period. They were taller (F (1, 97) = 8.92, p = .004, partial eta squared = 0.84) but not heavier than their conventionally treated counterparts. They required fewer antibiotics, and their treatment cost was lower.</p><p><strong>Conclusion: </strong>Homoeopathy, using conventional medicine as a safety backdrop, was more effective than conventional treatment in preventing sick days, sickness episodes, and respiratory illnesses in the first 24 months of life. It necessitated fewer antibiotics and its overall cost was lower. This study supports homoeopathy, using conventional medicine as a safety backdrop, as a safe and cost-effective primary care modality during the first 2 years of life.</p><p><strong>Trial registration: </strong>Clinical Trial Registry-India (2018/09/015641). https://ctri.nic.in/Clinicaltrials/login.php What is Known: • Due to their holistic nature, many Complementary and Alternative Medical (CAM) modalities are not readily amenable to assessment by head-to-head RCT for a given Indication. • We propose a pragmatic, RCT comparing homoeopathic with conventional medicine as a system.</p><p><strong>What is new: </strong>• Homoeopathic was apparently superior to conventional primary care in preventing sick days, sickness episodes, and respiratory illness episodes and was significantly associated with growth in height but not weight and required fewer antibiotics in children from birth to 24 months of age.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5455-5465"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461114","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":"Associations between sedentary types, sedentary patterns and cognitive ability in preschool children.","authors":"Dan Li, Michael Chia, Seow Ting Low, Terence Chua, Jiameng Ma, Hyunshik Kim, Lifang Zhang, Lili Tian, Xianxiong Li","doi":"10.1007/s00431-024-05813-y","DOIUrl":"10.1007/s00431-024-05813-y","url":null,"abstract":"<p><p>The preschool years are a critical period for developing cognitive abilities such as reasoning, memorization, comprehension, quick thinking, and problem-solving. Sedentary behavior (SB) is known to be associated with cognitive development in preschool children. However, limited research has focused on how different types of SB (active, passive) and sedentary patterns (bouts, breaks) affect preschool children's cognitive abilities. This cross-sectional study aimed to investigate: (1) the relationship between sedentary types and preschoolers' cognitive abilities; and (2) the relationship between sedentary patterns and preschoolers' cognitive abilities. Preschoolers aged 3 to 6 years (n = 353) were recruited from 5 kindergartens in Changsha, Hunan, China. Sedentary types were reported by parents, sedentary patterns were measured by preschoolers wearing an ActiGraph wGT3X-BT for seven consecutive days, and cognitive abilities were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV). The relationships between variables were analyzed using multiple linear regression models. Non-screen-based active SB was associated with higher full-scale IQ and fluid reasoning index in boys and higher visual spatial index in girls. Screen-based active SB was negatively associated with overall cognitive ability. Passive SB potentially had a negative effect on overall cognitive ability, but screen-based passive SB was positively associated with higher fluid reasoning indices in girls. Preschoolers' cognitive ability was positively associated with sedentary breaks, but not with sedentary bouts.</p><p><strong>Conclusions: </strong>Not all types of SB are equal when examining optimal cognitive development in preschoolers. Frequent breaks from sedentary time were associated with better cognitive development. Encouraging more frequent breaks to interrupt prolonged SB may be a viable strategy for reducing sedentary time to promote optimal cognitive development. These findings should be further validated in larger prospective studies.</p><p><strong>What is known: </strong>• Sedentary behavior is not advantageous for cognitive development.</p><p><strong>What is new: </strong>• Not all types of sedentary behavior are harmful. • Active sedentary behaviors are beneficial to overall cognitive development, but screen-based active sedentary behaviors may negatively impact some areas of cognitive performance. • Cognitive abilities in preschoolers are associated with sedentary breaks, but not with sedentary bouts.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5351-5362"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461128","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":"Predictive factors and risk scoring system for acute kidney injury (aki) in sick neonates-a prospective cohort study.","authors":"Kagnur Ramya, Kanya Mukhopadhyay, Jogender Kumar","doi":"10.1007/s00431-024-05816-9","DOIUrl":"10.1007/s00431-024-05816-9","url":null,"abstract":"<p><p>Neonatal AKI (acute kidney injury) is an underreported entity in sick neonates associated with significant morbidity and mortality. This was a prospective cohort study, to study the incidence, risk factors, and outcomes of AKI among sick neonates. We included sick inborn neonates admitted at a level III neonatal intensive care unit. Neonates with congenital anomalies and who died within 72 h of life were excluded. AKI was defined and categorized as per KDIGO guidelines. Two hundred and seventy-six neonates were enrolled over 1 year, of which 115 (42%) had AKI. The incidence of AKI was highest n = 27/38 (71%) among extremely preterm (< 28 weeks) infants. On Cox regression analysis, sepsis, invasive ventilation, acidosis, and perinatal asphyxia were significantly associated with AKI with a hazard ratio (95% CI) of 4 (1.21-13.42), 2.3 (1.32-4.03), 1.9 (1.13-3.36), and 1.5 (1.04-2.31), respectively. The risk prediction model, using the 4 predictors mentioned above, had good diagnostic accuracy (area under the curve, 83.6%) with a sensitivity and specificity of 77% and 80%, respectively. Infants with AKI have significantly higher mortality, compared to those who did not have AKI n = 45/115 (39%) vs. n = 5/161 (3%), p < 0.01.</p><p><strong>Conclusions: </strong>Nearly half of sick neonates admitted to NICU have AKI, which is maximum in extremely preterm infants. Sepsis, invasive ventilation, acidosis, and perinatal asphyxia have good diagnostic accuracy in identifying neonates likely to develop AKI.</p><p><strong>What is known: </strong>• Asphyxia, prematurity, sepsis, shock, hypotension, drugs, congenital heart diseases contribute to neonatal AKI.</p><p><strong>What is new: </strong>• Our simple risk prediction model can be used in sick neonates to identify infants who are at risk for developing AKI.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5419-5424"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461121","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":"Palpable signs of skull fractures on physical examination and depressed skull fractures or traumatic brain injuries on CT in children.","authors":"Silvia Bressan, Daniel Tancredi, Charles T Casper, Liviana Da Dalt, Nathan Kuppermann","doi":"10.1007/s00431-024-05807-w","DOIUrl":"10.1007/s00431-024-05807-w","url":null,"abstract":"<p><p>To assess the actual presence of underlying depressed skull fractures and traumatic brain injuries (TBI) on computed tomography (CT) in children with and without palpable skull fractures on physical examination following minor head trauma. This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children < 18 years old with Glasgow Coma Scale scores ≥ 14 following blunt head trauma. A palpable skull fracture was defined per the treating clinician documentation on the case report form. Skull fractures and TBIs were determined on CT scan by site radiologists. Palpable skull fractures were reported in 368/10,698 (3.4%) children < 2 years old, and in 676/31,613 (2.1%) of older children. Depressed skull fractures on CT were observed in 56/273 (20.5%) of younger children with palpable skull fractures and in 34/3047 (1.1%) of those without (rate difference 19.4%; 95%CI 14.6-24.2%), and in 30/486 (6.2%) vs 63/11,130 (0.6%) of older children (rate difference 5.6%; 95%CI 3.5-7.8%). TBIs on CT were found in 73/273 (26.7%) and 189/3047 (6.2%) of younger children with and without palpable skull fractures (rate difference 20.5%; 95%CI 15.2-25.9), and in 61/486 (12.6%) vs 424/11,130 (3.8%) of older children (rate difference 8.7%; 95%CI 6.1-12.0).Conclusions: Although depressed skull fractures and TBIs on CT are more common in children with palpable fractures than those without, most of these children do not have underlying depressed fractures. The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":" ","pages":"5321-5330"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461120","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}