The objective was to evaluate the feasibility and safety of conducting a randomised controlled trial comparing two initial continuous positive airway pressure (CPAP) levels during delivery room (DR) stabilisation of very preterm infants at risk for respiratory distress syndrome (RDS) and to explore their early physiological respiratory effects. In this pilot randomised controlled trial conducted at a tertiary neonatal intensive care unit, preterm infants born between 26 + 0 and 29 + 6 weeks' gestation requiring respiratory support at birth were randomised to receive CPAP at either 5 cmH2O or 8 cmH2O via face mask and T-piece resuscitator during the first 15 minutes of life. The primary objective was to assess trial feasibility and safety. Pre-specified exploratory outcomes included the preductal SpO2/FiO2 (S/F) ratio at 15 minutes after birth, need for positive pressure ventilation (PPV), surfactant administration, respiratory support requirements and respiratory morbidity. Fifty-six infants were enrolled and equally randomised between groups. The pre-defined sample size was achieved, protocol adherence was completed, and no participant was lost to follow-up, confirming the feasibility of trial conduct. Baseline characteristics were comparable. No significant differences were observed in pre-defined safety outcomes, including pneumothorax, pulmonary interstitial emphysema, or DR intubation. The S/F ratio at 15 min was similar between groups (271 +/- 101 vs. 269 +/- 111; p = 0.95). The proportion of infants requiring PPV was identical in both groups (35%). Although the overall surfactant administration rate did not differ, infants receiving 5 cmH2O reached surfactant treatment threshold earlier than those receiving 8 cmH2O (2.2 +/- 1.7 vs 3.5 +/- 2.1 h; p = 0.03). Trends towards shorter MV duration and lower BPD incidence were observed in the 8 cmH2O group, without statistical significance.Conclusion: This pilot randomised trial demonstrated that comparing two initial CPAP strategies during DR stabilisation of very preterm infants is feasible and no significant adverse events have been reported. While higher initial CPAP was associated with delayed achievement of the FiO2 threshold for surfactant administration, exploratory physiological and clinical findings should be considered hypothesis-generating. Adequately powered multicentre trials incorporating physiological bedside assessment of lung aeration are needed to determine the optimal initial CPAP strategy during neonatal transition.
Electrolyte disturbances are common in pediatric sepsis. This study aimed to identify early electrolyte patterns and evaluate their association with hospital mortality. A retrospective cohort of 1,589 pediatric sepsis patients (30 days–18 years) from the Shanghai Children's Hospital PICU sepsis database (2014 to present) was analyzed. Based on the first electrolyte panel (sodium, potassium, chloride, magnesium, calcium, and phosphate) measured within 24 h of PICU admission, patients were classified into three clusters using k-means clustering. Five Cox proportional hazards regression models were used to assess the association between the three cluster subtypes and hospital mortality. Three distinct clusters were identified: Cluster 1 (high sodium, and chloride; n = 436), Cluster 2 (balanced electrolytes; n = 713), and Cluster 3 (low sodium, chloride, and calcium; n = 440). Overall mortality was 9.63
Over the past two decades, non-invasive ventilation (NIV) has transitioned from being primarily used in specialist intensive care units to becoming a standard intervention in high dependency units, general paediatric units, emergency departments, and increasingly, patients’ homes. Despite this expansion, many general paediatricians still perceive NIV as outside their primary expertise. With this review, we aim to address that gap and equip general paediatricians with the knowledge and confidence to appropriately initiate NIV, monitor its effectiveness, and recognise when escalation of care is required. We narratively reviewed the physiological rationale for non-invasive respiratory support (NRS), including high-flow nasal cannula (HFNC) and the two principal modalities of NIV—continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP)—and summarised disease-specific evidence from recent literature, including randomised trials, systematic reviews, and international consensus statements. This is a narrative rather than a systematic review: we searched PubMed/MEDLINE and Paediatric Respiratory Reviews for English-language publications from January 2018 to June 2026 using the terms “non-invasive ventilation”, “high-flow nasal cannula”, “CPAP”, “BiPAP”, and “children”, supplemented by references already known to the authors, and selected articles for relevance and recency, prioritising randomised trials, systematic reviews, and consensus statements. HFNC is an oxygenation device rather than a ventilatory device, and its mechanism, clinical applications, and therapeutic goals differ from CPAP and BiPAP. We introduce the Indications, Contraindications, Equipment, Mode and settings, Assessment and monitoring, Next steps (ICEMAN) framework as a practical tool for structured and safe initiation of NIV in routine clinical practice, and apply it across bronchiolitis, acute severe asthma, pneumonia and hypoxaemic respiratory failure, neuromuscular disease, and obstructive sleep apnoea. Conclusion: The essential requirements to initiate NIV outside the PICU are well-trained staff, appropriate monitoring, a reliable oxygen supply, and a clear plan for escalation to a higher level of care. Selection of patients for NIV outside the PICU requires careful attention to indication, contraindications, equipment, monitoring, and escalation pathway by using frameworks like ICEMAN.
CFTR-related metabolic syndrome (CRMS)/CF screen-positive inconclusive diagnosis (CFSPID), cystic fibrosis (CF) carrier, and CFTR-related disorder (CFTR-RD) are assigned both after newborn blood screening (NBS) and, in children who were screen-negative or never screened, after a later diagnostic work-up; longitudinal data from low-F508del populations remain scarce. We describe the classification and follow-up of children with an unresolved CFTR diagnosis. We reviewed every child evaluated for CRMS/CFSPID, CF carrier status or a CFTR-RD at a single center in 2018–2025, tested locally by CFTR sequencing and multiplex ligation-dependent probe amplification (MLPA) or referred through NBS. All diagnoses, including those of children already labeled as CF, were reassessed against current criteria. Diagnoses followed 2017 and 2021 consensus criteria. We described serial sweat chloride test (SCT) changes over time where repeated measurements were available. Of 563 children, 20 (3.6
Systematic screening for sexually transmitted infections (STI), beyond serology, is not standard in arrival protocols for unaccompanied migrant minors (UMM). In 2020, our center incorporated urine-based nucleic acid amplification tests (NAAT)-based screening into the existing serology-based protocol (HIV, syphilis, hepatitis B/C), and we describe the additional diagnoses of STI identified through NAAT. We conducted a retrospective observational descriptive study (2020–2025) of 226 UMM (99.6
