The topics of prevention and therapeutic innovation in the management of infant, child, and adolescent health have progressively acquired global importance for their direct effects on the lifelong health and well-being of populations. If appropriately implemented, they have the potential to positively impact various areas of the public health sector,1Ehrich J. Namazova-Baranova L. Pettoello-Mantovani M. Introduction to Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations.J Pediatr. 2016; 177S: S1-S10Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar generating beneficial outcomes, which include major economic implications for local healthcare systems. Responding to the emerging preventive and health promotion needs of infants, children, and adolesents has become a priority for pediatrics, and together with therapeutic innovation, represents an important part of any strategic healthcare plan. The main objective of pediatric practice is to prevent disease and disability through primary, secondary, and tertiary methods,2Stiris T. Huss G. Namazova-Baranova L. Consensus on the improvement of community and primary care services for children, adolescents and their families in Europe 2016. A joint statement from the European Academy of Paediatrics (EAP) European Confederation of Primary Care Paediatricians (ECPCP) European Paediatric Association (EPA).http://www.epa-unepsa.org/EPA%20EAP%20ECPCP_A%20consensus%20on%20improvement%20of%20community%20and%20primary%20care%20services%20for%20children%20in%20Europe%20Novemeber%202016.pdfDate accessed: November 19, 2018Google Scholar and where prevention is not possible to provide up-to-date evidence-based treatment to optimize the health and well-being of the child and family. Prevention encompasses a range of factors including prenatal health, newborn screening, nutrition, early assessment and treatment, vaccine development, a healthy lifestyle including obesity prevention, physical activity, child surveillance, child protection, and promotion of children's rights to health, equity, and social justice.3Bundy D.A.P. Silva Nd Horton S. Jamison D.T. Patton G.C. Child and Adolescent Health and Development. 3rd ed. The International Bank for Reconstruction and Development/The World Bank, Washington (DC)2017Google Scholar This commentary briefly discusses prevention and therapeutic innovation in pediatrics, with the aim to further raise the attention of pediatricians to these topics, and to the importance of pursuing both an effective continuing exchange of high-quality clinical information, including basic science, and the promotion of efficient international collaboration in clinical practice, education, and research. As described by the World Health Organization,4World Health OrganizationMaternal, newborn, child and adolescent health.https://www.who.int/maternal_child_adolescent/child/en/Date accessed: January 22, 2019Google Scholar child health is a state of physical, mental, intellectual, social, and emotional well-being and not merely the absence of disease or infirmity. Children grow if they have the opportunity to live in families, communities, and environments that provide them with the right conditions and opportunities to reach their fullest developmental potential. A fundamental key factor supporting the achievement of an optimal health status for children is ensuring unrestricted access to good healthcare. The general perception is that children's health has improved greatly on many fronts over recent decades—from more effective interventions in the areas of cancer treatment and infectious diseases, along with better control of noncommunicable diseases. However, there is indisputable evidence that many diseases are increasing in frequency, including new and reemerging infectious diseases, as well as new pathologic conditions because of environmental contaminants. Prevention activities are typically categorized by 3 main areas of intervention: primary, secondary, and tertiary (Table). Individual, local, national, and international efforts to prevent environmentally and nonenvironmentally caused illness and disease have had some success. However, more comprehensive efforts, supported by increasing the awareness of pediatricians on these themes through continuing education activities, programs, and training courses, would be useful in combatting current and future health challenges in children's care.TablePrevention activities1.Primary prevention: intervening before health effects occur, through appropriate measures (ie, vaccinations), correcting detrimental behaviors (ie, poor nutritional habits), or educational programs directed to children and their caretakers (ie: banning substances or practices known to be associated with a disease or poor health condition)2.Secondary prevention: screening practices to identify diseases in the earliest stages, before the onset of signs and symptoms (ie, periodical health checkups)3.Tertiary prevention: management of diseases post diagnosis to slow or stop disease progression (ie, chemotherapy, rehabilitation, screening for complications) Open table in a new tab The need for better treatments and advanced therapeutic innovation for infants, children, and adolescents is universally acknowledged. From a public health perspective, the value of new treatment strategies in pediatrics lies in their therapeutic value, and in the health benefits, including survival rates, better quality of life or better drug tolerance, that they can generate for children, their families, and the community. Although evidence-based practice provides a framework for identifying and disseminating effective treatments, therapeutic innovation is more likely to come from translational research. As research progressively moves from the laboratory to clinical care, behavioral and social sciences are used to apply biomedical science, and multidisciplinary and interdisciplinary teams seem to be replacing single discipline investigators. In a general healthcare context in which research moves from the laboratory to clinics, an effective collaboration between basic science, community, and primary care is essential not only to provide optimal care, but also to help identify new treatment targets and promote the tailoring of new therapeutic agents and their dissemination in clinical practice. Educational and information programs and activities regarding advancements in therapeutic innovation are also an essential factor in achieving a valuable exchange of data between research and healthcare professionals providing clinical care. Children are not able to achieve optimal health alone. They are dependent upon adults in their family and community to ensure that they grow in a healthy milieu.5Ferrara P. Corsello G. Sbordone A. Nigri L. Ehrich J. Pettoello-Mantovani M. Foster care: a fragile reality needing social attention, and economic investments.J Pediatr. 2016; 173: 270-271.e1Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Because they are continually growing physically and mentally, monitoring the achievement of optimal child health will be challenging in the absence of healthcare systems favoring a close collaboration between families and healthcare professionals, and without the support of adequate information about optimal preventive programs and new therapeutic opportunities. The involvement of families in childcare is, therefore, an essential factor in pursuing child health. Even maternal health status, habits, and environment during and before pregnancy profoundly impact the health and well-being of a child. Pediatricians should be provided with high quality continuing educational opportunities to update them on relevant best practice preventive measures and on effective therapeutic innovations.6Pettoello-Mantovani M. Ehrich J. Romondia A. Nigri L. Pettoello-Mantovani L. Giardino I. Diversity and differences of postgraduate training in general and subspecialty pediatrics in the European Union.J Pediatr. 2014; 165: 424-426.e2Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar When children's health is suitably nurtured and appropriate opportunities are provided to acquire habits that support good health during childhood, the stage is set for a healthy adulthood less likely to include chronic health problems. The challenges posed by the growing importance of prevention and therapeutic innovation in the management of child health emphasize the value of exchanging experiences and the collaboration between pediatricians and health professionals caring for children. Enabling the exchange of experiences and the sharing of best practices is a key factor in responding effectively to the growing challenges of our society, such as the increasing incidence and prevalence of chronic diseases. The mission of the European Paediatric Association-Union of National European Paediatric Societies and Associations includes encouraging education of patients, families, and caregivers by sharing specialist knowledge with generalists, and promoting activities aimed at improving the quality of pediatric patient care in all European countries through excellent clinical research and the implementation of research into practice.7Ferrara P. Corsello G. Basile M.C. Nigri L. Campanozzi A. Ehrich J. et al.The economic burden of child maltreatment in high income countries.J Pediatr. 2015; 167: 1457-1459Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar The Ninth Europaediatrics meeting in Dublin on June 13-15, 2019 will focus on the question of how the effectiveness of prevention, medical research, and therapeutic innovation can be used to ensure the optimal health and well-being of children, and to widen opportunities and access to adequate innovative treatment options for all.

A common mantra is “as little as possible and as much as necessary.” This perception can be applied to all kinds of different projects in everyday life in order to help achieve a good outcome. It also applies to medicine, for example, “as little antibiotics as possible and as much/many antibiotics as necessary.” However, does this “rule” also apply to the pediatric workforce, that is, “as few pediatricians as possible and as many pediatricians as necessary”? How can we develop a sustainable pediatric workforce to meet the healthcare needs of children? We previously offered different equations for calculating the needed numbers of annually trained pediatricians to keep the actual number of pediatricians in a country stable in view of variable working conditions such as full-time or part-time working equivalents1Ehrich J. Pettoello-Mantovani M. Never ending stories: the loop in pediatrics. How many pediatricians need to be trained in European countries to keep the pediatric workforce stable?.J Pediatr. 2018; 196: 332-333Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 2Ehrich J. Fruth J. Jansen D. Gerber-Grote A. Pettoello-Mantovani M. The loop in pediatrics: how to calculate the risk of shortage and surplus of pediatric workforce?.J Pediatr. 2018; 199: 286-287Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar and weekly working hours and night shifts.3Machtey E. Ehrich J. Somekh E. Regulations of night shifts of pediatric residents: review of responses to a European survey.J Pediatr. 2018; 201: 302-303Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We now describe pediatric workforces in 2013-2018 in 16 European countries, 11 European Union and 5 non-European Union countries. National child healthcare systems are embedded in the underlying political and economic systems such as capitalistic, liberal, monarchic, socialistic, or social market system. National pediatric workforces can be analyzed according to the triangle of need–supply–demand. Our analysis neither intended to compare national pediatric workforces with the underlying political systems nor did it investigate the role of different types of health insurance systems, for example, financed by levies to insurance funds (Bismarck system) or by taxes (Beveridge system). We also tried to avoid a single-sided view of pediatricians whose understandable aim is to defend their own needs and to improve working conditions. Instead, we wanted to look at the child healthcare services through the eyes of families and their children. The priority of families is to have an available, adequate/appropriate, affordable, and easily accessible healthcare service provided by highly qualified personnel on all levels ranging from generalists to specialists. Families wish to have a well-functioning and competent child healthcare system that—if fragmented—should be well-coordinated. Different bodies and institutions involved in the care of children should communicate and cooperate well, reaching a consensus wherever and whenever possible. The factors that must be taken into account in the process of calculating the pediatric workforce include geography, population density, transport links, relationship between child health centers, political readiness for change, and cooperation between different types of clinicians. Critical to the discussion is the number of children requiring community care, hospital care, and public healthcare by pediatricians to adapt the different competences of pediatrics to the needs of young patients and their families. Responses to a questionnaire on national pediatric workforce were received from pediatricians (see author list) of 16 European countries and subsequently analyzed (data on individual countries will be published in an upcoming European Paediatric Association article). Results were also compared for the 3 subgroups of child healthcare systems as described by Katz et al4Katz M. Rubino A. Collier J. Rosen J. Ehrich J.H. Demography of pediatricprimary care in Europe: delivery of care and training.Pediatrics. 2002; 109: 788-796Crossref PubMed Scopus (80) Google Scholar and the World Health Organization5Weber M. Backhaus S. Chukwujana O. Fenski F. Henking G. Schatte L. et al.Pädiatrische Versorgungskonzepte in Europa.Monatsschrift Kinderheilkunde. 2018; 166: 131-140Crossref Scopus (4) Google Scholar: pediatric system = 6 countries (Croatia, Czech Republic, Germany, Israel, Russia, Spain), mixed care system = 6 countries (Armenia, Austria, France, Italy, Switzerland, Turkey), and general practitioner system = 4 countries (Bulgaria, Ireland, The Netherlands, Romania). In the 16 countries there were 95 559 853 children <14 years of age and the total number of pediatricians was 116 840, a ratio of 818:1. The mean percentage of primary care pediatricians was 41%; hospital pediatricians equaled 56%, and other types of pediatricians 3% (eg, working in public healthcare services). The mean proportion of trained and accredited pediatric subspecialists was 27%. The median of lifelong working years was 36 years. The median percentage of pediatricians working part time equivalents was 17%; 71% were female and the mean percentage of female pediatricians currently in training was 76%. Eight countries reported an increase of pediatricians from 2013 to 2018 ranging from 1% to 10%; 5 countries reported no change and 2 a decrease. No data were available for 1 country. In 6 of the 16 countries, the number of pediatricians leaving the national workforce and migrating exceeded the number of immigrating physicians; in 3 countries there was an equal balance of incoming and outgoing pediatricians, and there was a surplus of immigrating physicians in 5 countries; no data were available for 2 countries. Data on the influence of new medical technologies or increasing multidisciplinary care by other caregivers than pediatricians on the numbers of pediatricians were unknown. The annual number of active pediatricians leaving child healthcare services for other professions was negligible in all but 1 of the 16 countries. From 2013 to 2018, the mean number of annually trained pediatricians per country was 319. In 2018, there will be 347 trainees, reflecting the accuracy of the equations used when compared with 339 as predicted by using our previously published equations.1Ehrich J. Pettoello-Mantovani M. Never ending stories: the loop in pediatrics. How many pediatricians need to be trained in European countries to keep the pediatric workforce stable?.J Pediatr. 2018; 196: 332-333Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 2Ehrich J. Fruth J. Jansen D. Gerber-Grote A. Pettoello-Mantovani M. The loop in pediatrics: how to calculate the risk of shortage and surplus of pediatric workforce?.J Pediatr. 2018; 199: 286-287Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar In 2013, the presidents of national pediatric societies had been asked to predict the future numbers of pediatricians in their countries. Eight of the 16 presidents correctly predicted the number of pediatricians. The median ratio of children <14 years per pediatrician in 6 countries with a pediatric system was 722:1. This ratio was 1342:1 for primary care pediatricians and 1446:1 for hospital pediatricians. When comparing the mixed care system with the pediatric system, higher numbers of children were treated by 1 pediatrician working in a mixed system, 860:1 vs 722:1 for all pediatricians, 1625:1 vs 1342:1 for primary care pediatricians, and 2540:1 vs 1446:1 for hospital pediatricians. There were no major differences between these 2 groups concerning lifelong working years of pediatricians and percentages of subspecialists, primary care pediatricians, and hospital pediatricians. Countries with the general practitioner system had the highest percentage of hospital pediatricians (90%) and subspecialists (31%), and the highest mean ratio of children per pediatrician, namely 2250:1. What is the best model for testing how to calculate the ideal number of children in the community who should be cared for by a single pediatrician? We may be naive when using the existing statistics on numbers of pediatricians of 16 European countries as indicators for solving the challenges of a highly complex service system also including other caregivers for children.

This report describes a female infant with a rare chromosome defect, del. 12 (q22-24.1), who has severe pulmonary valve stenosis, an atrial septal defect, and a small muscular ventricular septal defect. At 4 months of age a balloon pulmonary valvuloplasty was performed in the cardiac catheterization laboratory. During the procedure, a large aberrant artery from the aorta to a sequestration of the right lower lobe of lung was found. The flow-off from the sequestration was into a dilated left atrium. The single artery supplying the sequestration was successfully occluded using an Amplatzer Duct Occluder device. There were no complications and the infant remains well at 1-year follow-up.