Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis, is a growing global health challenge, with approximately 25% of cases diagnosed before the age of 20. These chronic immune- mediated disorders result from complex interactions between genetic predisposition, environmental triggers, gut microbiome alterations, and immune dysregulation. Pediatric IBD presents with more extensive disease than adult-onset cases, with unique manifestations including growth failure and delayed puberty. Diagnosis relies on clinical assessment, fecal calprotectin, and endoscopic evaluation. Contemporary management emphasizes treat-to-target strategies using exclusive enteral nutrition (60–80% remission rates) and biologic therapies for moderate- to-severe disease. Anti-TNF agents remain first-line biologics, while ustekinumab has recently received Food and Drug Administration and European Medicines Agency approvals for pediatric CD based on the UNITI Jr trial, and emerging data on JAK inhibitors further expand the therapeutic landscape. This review provides a comprehensive overview of disease subtypes, pathophysiology, diagnostics, and evidence-based treatment strategies.
Introduction The aim of this study was to identify clinical, demographic, and laboratory factors associated with the initiation of antibiotic therapy in children hospitalized with confirmed adenoviral upper respiratory tract infection, as well as to assess determinants of potentially avoidable antibiotic use. Material and methods A retrospective, single-center observational study was conducted based on medical records of children aged 0–18 years hospitalized between 2019 and 2025 in a pediatric infectious diseases department. Inclusion required a diagnosis of adenoviral infection confirmed by antigen testing. Patients with concomitant bacterial infections requiring antibiotics were excluded. Collected data included age, sex, day of illness at admission, and C-reactive protein (CRP) levels. Antibiotic use before and during hospitalization was analyzed. Statistical analysis included the Mann-Whitney U test and χ2 test, with p < 0.05 considered significant. Results Eighty children were included in the analysis. Overall, 60% of patients received antibiotics, most frequently prior to hospital admission. No statistically significant difference in CRP levels was observed between children treated and not treated with antibiotics (p = 0.24). In contrast, age was significantly associated with antibiotic administration; antibiotics were used in 84% of children older than 2 years compared with 40% of younger patients. A decreasing trend in antibiotic use was observed over the study period, from 89% in 2019–2022 to 50% in 2025. Conclusions Antibiotic use in adenoviral infections was primarily driven by clinical presentation rather than objective inflammatory markers. C-reactive protein was not a reliable predictor of antibiotic initiation. The observed temporal decline in antibiotic use suggests improving stewardship practices. Early and wider implementation of rapid adenoviral diagnostics may further reduce unnecessary antibiotic therapy.
Introduction Safety data regarding remdesivir in pediatric populations remain limited, particularly for those with complex comorbidities. This study evaluated the hepatic and systemic safety of remdesivir in hospitalized children with COVID-19 by comparing treated patients to a control group receiving no antiviral therapy. Material and methods This single-center, retrospective case-control study included 76 hospitalized children: 42 children treated with remdesivir and 34 controls. Clinical and laboratory parameters, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, creatinine, and C-reactive protein were asse- ssed at baseline and at peak during hospitalization. Clinical severity was evaluated using the World Health Organization clinical progression ordinal scale. To isolate treatment-emergent hepatotoxicity, patients presenting with baseline transaminase elevations > 2 × the upper limit of normal (ULN) were excluded from hepatic sub-analyses. Results The treated group was significantly older (median 12.3 vs. 2.3 years; p < 0.001) and required longer hospitalization (median 10 vs. 5 days; p < 0.001). Baseline disease severity was comparable (p = 0.173), though all patients requiring mechanical ventilation were in the treated cohort. Peak ALT and AST values were significantly higher in the remdesivir group (ALT: 51.0 vs. 22.5 U/l, p = 0.006; AST: 47.0 vs. 38.0 U/l, p = 0.033). Treatment-emergent ALT elevation > 2 × ULN occurred in 19.0% of treated patients vs. 5.9% of controls (p = 0.039). However, all elevations were transient and not associated with clinically significant hepatic dysfunction or treatment discontinuation. No significant differences were observed in bilirubin or creatinine levels between groups. Mortality (7.1%) occurred only among critically ill patients with severe comorbidities and was not attributed to remdesivir toxicity. Conclusions Remdesivir is associated with transient, manageable elevations in liver enzymes but demonstrates a favorable safety profile in hospitalized children. These findings support its use in pediatric COVID-19 management, even among those with significant underlying comorbidities.
Due to their rarity and often large size at diagnosis, abdominal teratomas in newborns are often challenging to diagnose and treat. We would like to present the case of a newborn with a massive abdominal mass, initially misdiagnosed as a microcystic mesenteric lymphatic malformation, which revealed to be immature teratoma. This case report highlights the challenges associated with the differential diagnosis and surgical management of neonatal abdominal teratomas. It contributes to the literature by presenting diagnostic dilemmas that ultimately led to the accurate identification of this condition.
Introduction This study is aimed to evaluate the effects of total daily energy expenditure (TDEE) on fat mass (FM) reduction in children with obesity and to develop nomograms to support the planning of weight reduction programs in children. Material and methods A total of 219 children with obesity aged 12–15 years participated in a 4-week summer camp weight reduction program. The intervention combined dietary energy restriction with various activities to increase exercise levels. Total daily energy expenditure was measured using continuous 24/7 HR monitoring. Changes in body weight and body composition – including fat mass, fat-free mass, and total body water – were measured using the bioelectrical impedance analysis. Results On average, TDEE exceeded dietary energy intake by approximately 2590 kcal per 24 h, resulting in significant body weight and FM reductions. Fat mass loss was greater in boys (3.3 kg) than in girls (1.8 kg). The prescribed physical exercise lasted 3–4 h per day and accounted for an average of 32% of total daily expenditure. Boys’ total energy expenditure was markedly higher than that of girls, which corresponded to their significantly greater FM losses. Conclusions The weight reduction program proved effective for reducing FM in obese children. Fat mass loss was significantly affected not only by TDEE but also by the proportion of energy expended during therapeutic exercise, the energy cost of physical activity, and the overall daily energy balance of the participants. Individual engagement in physical activity was dependent on the degree of obesity at the start of the program. The results and the prepared nomogram can be used to develop recommendations for weight loss.
