AIMS:The aims were as follows: (1) to adapt the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) screening tool for use in neonates (SOS-ND), (2) to estimate the accuracy of SOS-ND (used by nurses) compared to assessment by a child psychiatrist using an adapted version of Vanderbilt Assessment of Delirium in Infants and Children and (3) to compare the outcome of assessments of the child psychiatrist and neonatologists. METHODS:A descriptive and comparative design was used. An interdisciplinary group adapted the SOS-PD to develop the SOS-ND. We compared three assessments done on the same day in hospitalized neonates with postmenstrual age at 35-44 weeks in a Danish level IV neonatal intensive care unit. RESULTS:Twenty-six neonates were assessed and five were diagnosed with delirium by the child psychiatrist. An accuracy of 88% [CI 69.9-97.6] was found between SOS-ND screenings during the preceding 24 h and the child psychiatrist's assessment. Neonatologists did not positively identify delirium in the 26 neonates. CONCLUSION:The findings suggest that nurses and the child psychiatrist observe the same condition. By contrast, the absence of delirium diagnosed by experienced neonatologists suggests differences in the conceptualization of the underlying neuropsychological condition.
AIM:This study aimed to explore clinical and laboratory markers of omalizumab response in paediatric and adult chronic spontaneous urticaria (CSU) patients. METHODS:The study included 32 children and 67 adults with CSU receiving omalizumab, and 29 paediatric and 30 adult healthy controls; associations with treatment response were evaluated. RESULTS:In adults, higher baseline Systemic Inflammation Response Index (SIRI) (OR = 0.207, p < 0.001), monocyte count (OR = 0.276, p = 0.002), neutrophil-to-lymphocyte ratio (NLR) (OR = 0.455, p = 0.012), and Systemic Immune-Inflammation Index (SII) (OR = 0.487, p = 0.022) were associated with lower odds of treatment response. In paediatric patients, higher baseline SII was significantly associated with lower odds of response (OR = 0.349, p = 0.040). Interaction analyses showed nominally significant age interactions for baseline SIRI (B = -0.169, p = 0.027) and monocyte count (B = -0.193, p = 0.025). During follow-up, SIRI was lower in responders from baseline through 12 months in adults, and at 3 and 6 months in children. SII was lower in responders at baseline in adults, and at baseline, 3, and 6 months in children (all p < 0.05). CONCLUSION:Our findings suggest potential differences in the associations between inflammatory markers and omalizumab response across age groups, though further studies are needed to clarify age-related differences.
AIM:Respiratory rate is a key vital sign in paediatric assessment, but accurate measurement in emergency settings is difficult because conventional methods (manual counting, capnography) can be unreliable or impractical. Respiratory rate is frequently omitted in busy emergency departments. METHODS:We developed and evaluated a non-contact thermal imaging system that automatically measures respiratory rate and the inspiratory-to-expiratory ratio in paediatric patients. Thermal imaging detects temperature changes around the nostrils produced by inhaling cooler air and exhaling warmer air. Respiratory signals were obtained from 13 paediatric patients (14 datasets, aged 3-13 years) using an uncooled thermal camera. Automated image processing extracted respiratory waveforms and identified respiratory cycles and their inspiratory and expiratory phases using autocorrelation and peak detection. RESULTS:Clear respiratory signals were obtained for all patients, including those wearing masks. Several respiratory rate values were outside published reference percentiles, but all participants were clinically stable with values consistent with physiological variability. The mean inspiratory-to-expiratory ratio was 1.20 ± 0.23. CONCLUSION:These findings demonstrate the feasibility of a fully non-contact thermal system for automatic measurement of respiratory rate and the inspiratory-to-expiratory ratios during mask use. Further validation in larger cohorts with comparison to a gold standard is required before clinical adoption.
AIM:Cervical cancer elimination is a global public health goal, with vaccination against Human Papillomavirus (HPV) and HPV screening being two major prevention pillars. This review focuses on how vaccinations can be used in order to reach the timepoint of cervical cancer elimination faster. METHODS:The concepts in previously published reviews on 'faster cervical cancer elimination' are summarised and explained. RESULTS:Major concepts explained are: HPV vaccines prevent not only cancer precursors, but also the HPV infection itself resulting in public health gains that exceed the individual direct vaccine protection because of herd immunity. The effective population coverages of vaccine-induced immunity required to reach the critical extinction level for infection elimination are moderate, in particular when gender-neutral vaccination is used. Major suggested enabling strategies include catch-up vaccinations of adolescents, one-dose HPV vaccination and use of HPV prevalences to monitor and optimise HPV vaccination programs. Finally, cervical screening with HPV testing is predicted to be easier if there are no new HPV infections. CONCLUSION:The major challenge for faster cervical cancer elimination is to design HPV vaccination strategies that achieve an effective population immunity against the HPV infection as fast as possible.
AIM:To determine growth patterns and catch up potential in children with biliary atresia, in relation to liver disease severity and liver transplantation. METHODS:This retrospective cohort study was conducted at Copenhagen University Hospital between 1 January 2006 and 31 December 2024 and included 63 children. Anthropometry and paraclinical liver tests were assessed every 3 months until age 2, and every 6 months thereafter until age 18. Mixed linear models with 95% CI were used to assess anthropometry over time and its association with blood liver markers. Blood test variables were displayed in association with insulin-like growth factor-1. RESULTS:Children with biliary atresia reached their age-specific height-for-age z score after 7-8.5 years and catch-up growth lasted twice as long in those liver transplanted before versus after 2 years of age. Paraclinical liver parameters were shown to be correlated with weight-for-height and height-for-age in biliary children with and without a liver transplant. Results on IGF-1 revealed no association with paraclinical liver tests. CONCLUSIONS:Children with biliary atresia have the potential to catch up in growth with their age-specific height and weight. Paraclinical liver tests are linked to weight-for-height and height-for-age, suggesting liver disease as a contributing factor in the growth of children with biliary atresia.
AIM:To determine whether remote recruitment, electronic consent and at-home blood collection enabled enrollment of a geographically and socioeconomically diverse infant cohort in the United States (US). METHODS:We describe the demographics of 256 infants included in this analysis, drawn from 264 enrolled in the Infant Vaccine Biorepository (December 2022-April 2026). Participants were recruited via online advertising and electronic medical record messaging. Geographic distribution was assessed using US Census regions and Rural-Urban Commuting Area (RUCA) codes. Social vulnerability was characterized using the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) at census tract and county levels, with nationwide rankings. RESULTS:Infants were distributed evenly across the four US geographic regions; 9% resided in rural areas. Based on nationwide census tract-level SVI rankings, 39.8% of participants fell in the medium-high or high vulnerability categories. County-level SVI rankings indicated that 57.0% of participants fell in these same categories. Participants were 78% White and 20% Hispanic; 94.1% of mothers had received at least one COVID-19 vaccine. CONCLUSION:Fully remote recruitment, consent and specimen collection enabled enrollment of infants from diverse geographic and socioeconomic backgrounds across the US. SVI and RUCA provide richer characterization of study populations than traditional demographic measures alone.
AIM:To investigate parent-reported psychiatric, neurodevelopmental and adaptive functioning outcomes in children with congenital cytomegalovirus (cCMV)-related sensorineural hearing loss. METHODS:Parents of children aged 5-12 years were recruited nationwide in Sweden into three groups: children with congenital cytomegalovirus-related sensorineural hearing loss (n = 10), children with non-syndromic genetic hearing loss (n = 9) and typically developing controls with normal hearing (n = 23). Parents completed a background questionnaire, the Child Behaviour Checklist (CBCL) and the Five-to-Fifteen Revised (FTF-R). Group differences were analysed using non-parametric statistics. RESULTS:Children with congenital cytomegalovirus-related hearing loss had later identification of hearing loss, delayed onset of independent walking and a higher prevalence of neurodevelopmental conditions compared with children with genetic hearing loss. They also had significantly higher parent-reported psychiatric and developmental symptom levels than controls across all main clinical measures. Compared with the genetic hearing loss group, they demonstrated greater developmental difficulties, reduced social participation and poorer school functioning. CONCLUSION:Children with congenital cytomegalovirus-related hearing loss exhibit a substantial burden of psychiatric and neurodevelopmental symptoms extending beyond hearing loss alone. These findings highlight the importance of early identification, structured long-term follow-up and tailored interventions to support this vulnerable population.
AIM:Skin-to-skin contact stabilizes vital signs, particularly body temperature, in preterm infants. The aim was to determine whether there are differences in body temperature depending on whether preterm infants have skin-to-skin contact with their mother or their father. METHODS:In this crossover study, the body temperature of 18 preterm infants (gestational age 29.4 (±2.97) weeks) was measured every minute during two skin-to-skin contact sessions with their mother and two with their father. RESULTS:The infants' skin temperatures during skin-to-skin contact with their mother and father, respectively, were 36.47 (±0.33)°C and 36.44 (±0.38)°C at the start (p = 0.795), after 10 min 36.64 (±0.34)°C and 36.48 (±0.34)°C respectively (p = 0.196), after 60 min 36.93°C (±0.22) and 36.72°C (±0.25) (p = 0.010) and, after 80 min, 36.90°C (±0.29) and 36.70°C (±0.31) (p = 0.045). CONCLUSION:The results show that preterm infants do indeed exhibit different temperature profiles depending on which parent they have skin-to-skin contact with. These differences can be easily compensated for through nursing interventions and do not conflict with kangaroo care provided by fathers. Given the benefits of kangaroo care provided by fathers, it is essential to continue to support this practice unreservedly.
AIM:To assess long-term effects of Kangaroo Mother Care (KMC) on motor development in adults born with birth weights ≤ 1800 g, compared to conventional neonatal care. METHODS:This cohort analysis included 214 young adults with a history of birth weights ≤ 1800 g, mostly preterm, originally enrolled in a randomized controlled trial between 1993 and 1994 evaluating KMC. Motor system development was assessed using transcranial magnetic stimulation (TMS) to measure corticospinal excitability and interhemispheric communication. Fine motor skills were evaluated with the Nine Hole Peg Test (9HPT). A 50 term-born normal birth weight reference group provided TMS values to evaluate KMC effectiveness. RESULTS:Individuals with history of birth weights ≤ 1800 g, regardless of exposition to KMC, demonstrated longer completion times on the 9HPT and reduced grip strength compared to normative values. No significant differences in TMS measures were found between groups. However, in a multivariate logistic regression model, KMC was associated with a 78% effectiveness (95% confidence interval-CI: 4%-95%) on preventing the altered transcallosal conduction time. CONCLUSION:Motor deficits related to low birth weight (LBW) persist into adulthood. KMC may contribute to avoid interhemispheric motor connectivity issues in individuals with birth weights ≤ 1800 g, highlighting its potential for long-term neurodevelopmental benefit.
AIM:We investigated current practices of primary ventilation of preterm and term infants directly after birth in hospitals across all levels of neonatal care in Germany, Austria and Switzerland. METHODS:Invitations to an electronic survey were sent to all hospitals with maternity wards in these three countries. Results were compared across countries and gestational age (GA) groups. RESULTS:240 out of 769 (31%) contacted hospitals participated. Most hospitals used T-piece resuscitators for term infants (85%). Use of mechanical ventilators increased with decreasing GA (term: 7%, moderate-to-late preterm (MLP, GA 32-36 weeks): 11%, very preterm (GA < 32 weeks): 23%). In very preterm infants, extended inspiratory times of 1-5 s were the preferred method of initial ventilation (56%), followed by inspiratory times < 1 s (36%). Initial positive end-expiratory pressure (PEEP) increased with decreasing GA; median (interquartile range, IQR) PEEP for term infants 5.0 cmH2O (5.0-6.0 cmH2O), for MLP 6.0 cmH2O (5.0-6.0 cmH2O), and for very preterm infants 6.0 cmH2O (5.0-8.0 cmH2O). Laryngeal masks were used in 14% of centres as the preferred alternative airway for term infants. CONCLUSION:We found considerable differences across and within participating countries and GA groups in the primary respiratory support during delivery room stabilization of newborn infants.
AIM:To compare safety and clinical outcomes of two different oral immunotherapy (OIT) maintenance doses (150 mg vs. 300 mg) of peanut protein in children with peanut allergy. METHODS:This prospective study enrolled 44 children aged 4-17 years with confirmed peanut allergy. Following dose escalation, participants were allocated to receive either 150 or 300 mg of peanut protein daily for 8 weeks. Oral food challenges (OFCs) were conducted before and after OIT. The primary endpoint was the proportion of participants tolerating ≥ 300 mg of peanut protein post-treatment. Secondary outcomes included changes in immunologic markers (skin prick tests wheal size, sIgE, IgG4) and safety. RESULTS:Of the 44 enrolled children, 33 (75.0%) completed the full protocol. The primary outcome was achieved in 73.9% of the 150 mg group and 71.4% of the 300 mg group (p = 0.853). Both regimens were associated with reductions in immunological parameters. Adverse events were mainly mild to moderate. CONCLUSION:Peanut OIT using either 150 mg or 300 mg maintenance doses was associated with increased tolerance thresholds and immunological changes in highly allergic children. These findings support the feasibility of OIT in real-world clinical settings while highlighting the need for further multicentre research to determine optimal dosing strategies.
AIM:To review current evidence regarding the occurrence, clinical presentation, and management of gastrointestinal adverse events following administration of RV1 and RV5 rotavirus vaccines in the paediatric population. METHODS:A systematic literature search was performed between April and August 2025. The review included randomised controlled trials, meta-analyses, and relevant case reports published from 2007 onwards. Primary outcomes focused on gastrointestinal manifestations: Prolongeddiarrhoea, intussusception, and immune-mediated diseases. Secondary outcomes included clinical management of GI post-vaccination events. RESULTS:Out of 197 identified studies, 86 met the inclusion criteria. Mild gastrointestinal symptoms, such as transient diarrhoea and vomiting, were common but typically self-limited. No increased risk of prolonged diarrhoea was identified in healthy infants, although rare cases were reported in children with severe immunodeficiencies. Data showed no increased risk of intussusception or immune-mediated conditions like celiac disease or inflammatory bowel disease. Specific high-risk groups, including infants with a history of intussusception, severe combined immunodeficiency, or metabolic disorders, were associated with a higher incidence of adverse events. CONCLUSION:RV1 and RV5 vaccines maintain an excellent safety profile. In high-income settings, prolonged post-vaccination diarrhoea should be considered a clinical marker for underlying immunodeficiency rather than a risk factor for future immune-mediated intestinal disorders.
