Background Complete, high-quality cancer registration is essential for epidemiological research and evidence generation in children and adolescents, particularly for very rare entities. We compared population-based and pediatric clinical cancer registration in Germany and benchmarked the patterns against U.S. Surveillance, Epidemiology, and End Results data. Patients/methods We evaluated new cancer diagnoses in individuals younger than 18 years (2010-2022) from the German Center for Cancer Registry Data, the German Childhood Cancer Registry, and the U.S. Surveillance, Epidemiology, and End Results (SEER) program. As completeness varied by federal statse, German Center for Cancer Registry Data analyses focused on Baden-W & uuml;rttemberg and Bavaria. Age-standardized incidence rates were calculated using Segi World Standard Population. Results The German Center for Cancer Registry Data contained 27,425 new diagnoses (Baden-W & uuml;rttemberg and Bavaria: 8,366), the German Childhood Cancer Registry 30,051 (Baden-W & uuml;rttemberg and Bavaria: 8,747), and the U.S. Surveillance, Epidemiology, and End Results program 92,707. The overall incidence rates per 1,000,000 were 162.1 (German Center for Cancer Registry Data Baden-W & uuml;rttemberg and Bavaria), 174.4 (German Childhood Cancer Registry Baden-W & uuml;rttemberg and Bavaria), and 205.8 (U.S. Surveillance, Epidemiology, and End Results). Between the German Center for Cancer Registry Data and the German Childhood Cancer Registry, incidence rates for Baden-W & uuml;rttemberg and Bavaria diverged markedly for leukemias (41.1 vs. 52.5), central nervous system tumors (36.0 vs. 39.4) and epithelial malignancies (13.1 vs. 6.2). Age patterns showed a stronger contribution of late adolescence to epithelial entities in German Center for Cancer Registry Data and data from the U.S. Surveillance, Epidemiology, and End Results program. Conclusion We identified substantial discrepancies and under-ascertainment in pediatric cancer registration in Germany compared with the U.S. Surveillance, Epidemiology, and End Results data. Existing registries capture partly different segments of the pediatric cancer spectrum, with large gaps for adolescent epithelial malignancies. Improved completeness and cross-sector case ascertainment are needed for robust epidemiological research and evidence-informed, age-adapted care recommendations, especially for very rare pediatric tumors.
Background Kernicterus resulting from excessive bilirubin concentrations can be effectively prevented by early diagnosis and therapy. The postnatal rise of bilirubin peaks at a time of life most newborn infants have been discharged home while the next scheduled well baby visit is several weeks ahead. Aim Evaluating a post-discharge bilirubin follow-up program established in 2010. Methods Retrospective analysis of newborns seen 2010-2024 at the Berlin University Medical Center bilirubin outpatient clinic, exchange transfusions performed in the same time period, and infants admitted for phototherapy in 2022. Results The median annual number of infants consulting the outpatient clinic was 616 in 2010-2016, as compared to 1858 in 2017-2024. In 2022, 6% of newborns seen at the outpatient clinic were admitted for treatment of hyperbilirubinemia at a median age of 6 [5-7] days, with a total serum bilirubin concentration of 20.5 [19.3-21.4] mg/dl). The 2 top indications for the 81 exchange transfusions performed in 78 patients were rhesus incompatibility (n=44; 56%) and gestational alloimmune liver disease (n=24; 31%). The bilirubin level immediately prior to exchange transfusion was 15.5 [12.5-20.0] mg/dl (highest measured value 38.1 mg/dl). Conclusion A post-discharge program attached to a neonatal unit can effectively bridge the gap in care between discharge and scheduled well-baby visits several weeks ahead. A mandatory U2a could standardize follow-up care for neonatal hyperbilirubinemia in the future.
Background Intravenous immunoglobulin (IVIg) may cause transient autoantibody positivity, but its clinical significance in children is unclear. We evaluated post-IVIg autoantibody positivity and its association with later rheumatologic diagnoses. Methods T1 was defined as the first clinically indicated autoantibody measurement obtained within 6 months after IVIg, and T2 as the follow-up autoantibody measurement obtained approximately 6 months after IVIg. Antinuclear antibodies (ANA) were assessed by indirect immunofluorescence using the International Consensus on ANA Patterns (ICAP) classification, and extrac-table nuclear antigens (ENA) by immunoblot. Results Of 205 patients, 93 (45.4 %) were ANA-positive. Seven (3.4 %) developed rheumatologic disease (5 juvenile systemic lupus erythematosus, 1 dermatomyositis, 1 juvenile idiopathic arthritis), all within the ANA-positive group. ENA positivity oc-curred in 60/93 (64.5 %), most often DFS70 (51.7 %) and SSA/Ro (35.0 %). From T1 to T2, ENA intensity decreased significantly for DFS70, SSA/Ro, Ro52, histones, nucleosomes, AMA-M2, dsDNA, and Sm. ANA intensity was inversely associated with time since IVIg. Conclusions Most post-IVIg ANA/ENA positivities in children appear transient and clinically silent. Repeat testing at about 6 months may reduce misinterpretation, while further rheumatologic evaluation should be guided primarily by compatible clini-cal findings rather than persistent seropositivity alone
Abstract Occult hepatitis B virus infection is characterized by the presence of hepatitis B virus DNA despite the undetectable hepatitis B surface antigen. This study aimed to determine the prevalence of occult hepatitis B virus infection in children born to hepatitis B surface antigen–positive mothers who received complete immunoprophylaxis. This cross-sectional study included 99 children. All received hepatitis B vaccination and hepatitis B immune globulin within 24 hours after birth. Serological markers and serum hepatitis B virus DNA were assessed in children aged 9 months to 15 years. All children were negative for hepatitis B surface antigen and serum hepatitis B virus DNA. The prevalence of serum-detectable occult hepatitis B virus infection was 0% (95% confidence interval: 0–3.6%). Anti-hepatitis B surface antibody seropositivity (≥ 10 IU/L) was observed in 66.7% of the children. Four children older than 24 months were positive for anti-hepatitis B core IgG antibody and anti-hepatitis B e antibody, possibly reflecting previous exposure without evidence of active infection. In these children, serum hepatitis B virus DNA remained negative at the initial assessment and at the 6- and 12-month follow-up assessments. No serum-detectable occult hepatitis B virus infection cases were identified. Complete immunoprophylaxis appears effective in this population; however, larger prospective studies with serial hepatitis B virus DNA testing are needed.
