Search Results (222)

Background: Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children. Severe complications are rare but may occur, particularly in older children or in the presence of concomitant conditions. Case Presentation: We report the case of an 11-year-old girl with acute hepatitis A with severe hepatic derangements who developed life-threatening upper gastrointestinal bleeding due to a previously undiagnosed duodenal ulcer. Emergency endoscopy confirmed active bleeding from a duodenal ulcer, and the patient survived the complications with treatment with a proton pump inhibitor and hemostatic management with blood products. Conclusions: Although hepatitis A is generally benign in children, this case highlights the potential for severe and life-threatening complications. Full article

Background/Objectives: The main goal of this study is to identify predictors associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seropositivity in children, including demographics, history of coronavirus disease 2019 (COVID-19) infection of the child and the household members, prevention practices, and maternal vaccination. Methods: This retrospective cross-sectional study within the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)/MeKiTamara cohort included 300 mother-child dyads recruited in Paramaribo and Nickerie, Suriname (February–April 2023). The total immunoglobulin G (IgG) anti-spike domain 1 (S1) and anti-nucleoprotein (NP) were quantified in dried blood spot (DBS) eluates from children using indirect enzyme-linked immunosorbent assays (ELISAs). Demographic information, COVID-19 prevention measures, history of viral infection of the child and the household members, and COVID-19 vaccination questionnaire data were recorded. Predictors of SARS-CoV-2 seroprevalence were determined using binary logistic regression. Results: Among 278 seropositive children in 2023, 73.4% were in the 5–6-year-old age group, 54.7% were female, 36.3% were of Asian descent, and 69.8% were recruited in Paramaribo. Seroprevalence increased from 33.8% in 2021–2022 to 93.3% in 2023, with a mean follow-up of 21.5 months. Of the 100 children previously tested by Polymerase Chain Reaction (PCR) or antigen test, 25 had confirmed COVID-19, as reported by mothers. Children from unvaccinated mothers were 6.11 times more likely to be seropositive (p = 0.022). Conclusions: This study shows a significant increase in SARS-CoV-2 seropositivity in Surinamese children aged 3–6 years between collection periods, indicating multiple exposures. Future public health interventions and policies should account for maternal vaccination status to reduce children’s exposure to COVID-19 during future outbreaks. Full article

Background/Objectives: Group A Streptococcus (GAS) pharyngitis is a frequent cause of morbidity in pediatric populations, which requires timely identification to prevent complications such as acute rheumatic fever. Rapid antigen detection tests (RADTs) are practical alternatives to throat culture. This study evaluates the diagnostic performance of the RapidFor™ Strep A test. Methods: This prospective clinical study enrolled 389 pediatric patients aged < 18 years with symptoms suggestive of streptococcal pharyngitis. Two throat swabs were collected from each patient: one for rapid antigen testing with RapidFor™ Strep A and one for culture. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Throat culture was positive in 95 of 389 patients (24.4%). The RapidFor™ Strep A test demonstrated a sensitivity of 98.95% (95% confidence interval [CI]: 94.28–99.81%) and a specificity of 96.26% (95% CI: 93.43–97.90%). The PPV was 89.52%, and the NPV was 99.65%. Agreement with culture was excellent (κ = 0.919); in particular, false-positive results accounted for 2.8% and false-negative results accounted for 1.05%. Fever was the strongest clinical indicator associated with positive results. Conclusions: The RapidFor™ Strep A test showed very high diagnostic accuracy compared with throat culture, including an excellent NPV (99.6%), which supports its reliability for ruling out GAS pharyngitis in pediatric settings. The test is an effective screening tool that facilitates timely antibiotic therapy. Full article

Background: Chronic sclerosing osteomyelitis of Garré (CSO) is a rare, non-suppurative form of primary chronic osteomyelitis characterized by reactive periosteal bone formation and cortical thickening. It most commonly involves the mandibular bones, whereas long-bone localization is uncommon. Material and Methods: We report a 4-year-old girl who developed progressive right thigh pain and limping six months after receiving intramuscular ampicillin injections. Subsequent evaluation revealed femoral changes consistent with chronic sclerosing osteomyelitis. Surgical decompression and targeted antimicrobial therapy were performed. Results: Microbiological analysis of intraoperative specimens obtained prior to antibiotic therapy yielded Staphylococcus epidermidis (S. epidermidis) and Staphylococcus capitis (S. capitis). After three years of follow-up, the patient exhibited no functional impairment or growth disturbance of the affected limb. Conclusions: Although coagulase-negative staphylococci (CoNS) are commonly regarded as skin commensals, their repeated isolation from deep surgical specimens, together with clinical findings and response to treatment, raises the possibility of their involvement in the disease process in this case. Full article

Background: Childhood vaccination remains one of the most effective public health interventions. Despite consistently high national coverage, vaccine hesitancy persists among parents and may undermine herd immunity. The Parent Attitudes about Childhood Vaccines (PACV) questionnaire provides a validated framework for identifying parental concerns and patterns of hesitancy. Methods: A cross-sectional online survey was conducted in May 2025 using the Croatian version of the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. The study included 1087 parents aged 18–65 years. PACV scores were transformed to a 0–100 scale, with values ≥50 indicating vaccine hesitancy. Associations between PACV scores and parental age and educational level were analysed using non-parametric statistical tests. Results: Most respondents were mothers (87.7%) and aged between 30 and 45 years (71.8%). Approximately one fifth of parents reported postponing vaccination (22.7%), and 19.2% indicated having refused at least one vaccine dose. While 63.7% expressed full acceptance of recommended childhood vaccines, a substantial proportion either refused vaccination (20.8%) or remained undecided (15.5%). Higher educational attainment was significantly associated with lower PACV scores, whereas no significant association was observed with parental age. Conclusions: Although overall vaccination acceptance in Croatia remains high, vaccine hesitancy continues to affect a considerable proportion of parents. Strengthening tailored communication strategies and reinforcing trust-based counselling—particularly within pediatric and community nursing services—may support informed decision-making and improve vaccine confidence. Full article

Background/Objectives: To summarize the available evidence on the use of corticosteroids in the treatment of pediatric Mycoplasma pneumoniae pneumonia, including severe and refractory forms. Methods: We conducted a narrative literature review of studies published between 2000 and 2024 that investigated corticosteroid therapy in children with Mycoplasma pneumoniae pneumonia, including various clinical presentations such as severe Mycoplasma pneumoniae pneumonia and refractory Mycoplasma pneumoniae pneumonia. Both randomized controlled trials and observational studies were included. Results: Early administration of corticosteroids, particularly within 24–36 h of hospital admission, was associated with improved clinical outcomes, including faster fever resolution, shorter hospital stay, and enhanced radiological recovery. High-dose regimens (≥5 mg/kg/day) or pulse therapy appeared effective in severe or refractory cases, while inhaled corticosteroids showed benefit in milder forms. Predictive factors for corticosteroid response included elevated C-reactive protein, lactate dehydrogenase, and ferritin levels. The overall safety profile was acceptable, with minimal adverse effects reported in most studies. Conclusions: Corticosteroids may play a beneficial role as adjunctive therapy in pediatric Mycoplasma pneumoniae pneumonia, especially in selected cases. However, further high-quality studies are required to define optimal timing, dosage, and patient selection. Full article

Background/Objectives: Macrolide is the first-line treatment in children with Mycoplasma pneumonia; however, macrolide-non-responsive Mycoplasma pneumoniae pneumonia (MNMP) has been increasing recently. We aimed to investigate serum inflammatory biomarkers that could identify children at risk of clinically defined macrolide non-responsiveness as early as possible. Methods: This retrospective cohort study included 93 children hospitalized with Mycoplasma pneumonia between September 2019 and January 2020. Patients were classified into macrolide-sensitive MP (MSMP) and MNMP groups based on clinical response to treatment. Clinically defined MNMP was defined as persistent fever and lack of clinical improvement after at least 3 days of macrolide therapy, reflecting macrolide non-responsiveness in routine clinical practice. By reviewing medical records, we compared laboratory findings at admission, including serum procalcitonin (PCT), C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and erythrocyte sedimentation rate (ESR), between the two groups to identify potential predictive biomarkers. Multivariable logistic regression analysis was used to estimate the risk for MNMP based on serum inflammatory biomarkers. Results: CRP, ferritin, and ESR levels at admission were higher in the MNMP group than the MSMP group. By multivariate analysis, elevated ferritin levels were significantly associated with an increased risk of macrolide non-responsiveness. In addition, when serum inflammatory biomarkers were elevated simultaneously at admission, the risk of MNMP was higher. Conclusions: Serum inflammatory biomarkers may assist in early risk stratification of children with clinically defined macrolide non-responsiveness following macrolide therapy. Furthermore, combined assessment of multiple inflammatory biomarkers may improve early risk evaluation. Full article

Background: In 2020, the World Health Organization declared a Public Health Emergency of International Concern due to the global outbreak of SARS-CoV-2. Recognized as a severe and highly contagious disease, it affected both the adult and pediatric population. However, due to the early timing of the pandemic, limited research was conducted in the perinatal field, leaving many questions regarding the true impact of maternal transmission to fetuses and its consequences during the neonatal period. Methods: In this case series, we reviewed data from ten newborns delivered in the Instituto Nacional de Perinatología (INPer) in Mexico City (tertiary referral institute), all from high-risk pregnancies, between November 2020 and January 2021, all of whom tested positive for SARS-CoV-2 at various points during their hospital stay. Results: Despite showing correct extrauterine adaptation after birth, several of them developed complications such as sepsis, superinfections, inadequate weight gain, and, in some cases, death. Conclusions: These results highlight the urgent need for targeted neonatal care protocols and further research to better understand the impact of persistent viral positivity and immune vulnerability in this population. Full article

Human cytomegalovirus (HCMV) and Human Immunodeficiency Virus (HIV) are two pathogens known to have dramatic consequences when contracted early in life. In addition to having a significant impact when acquired individually, these two viruses are known to frequently cause coinfections. Indeed, also in the modern era, HCMV remains one of the most prevalent coinfections in newborns of mothers living with HIV, including both HIV-positive children regardless of their immune status, and those exposed to HIV but uninfected (HEU). In children with HIV infection, HCMV coinfection has historically been associated with AIDS-defining disease, high mortality, and prolonged, elevated HCMV viral load. Although timely administration of antiretroviral therapy prevents immunodeficiency in people living with HIV and thus reduces the incidence of full-blown HCMV disease in cases of coinfection, emerging data suggest that HCMV-induced immune activation and aging persist, potentially contributing to long-term, non-AIDS-related comorbidities. Growing evidence indicates that also HCMV amplifies HIV susceptibility, disease progression, and immune dysregulation through multiple synergistic mechanisms. Moreover, congenital and early postnatal HCMV infections occur at significantly higher rates in HEU newborns than in HIV-unexposed children and are associated with worse clinical outcomes, particularly when HCMV viral loads are high. This review summarizes current knowledge on the epidemiology, clinical impact, and immunopathogenetic interactions of early HCMV–HIV coinfection in pediatric populations. By integrating recent findings with historical evidence, it highlights critical mechanistic and epidemiological gaps that warrant further investigation. Full article

Background and Objectives: Early identification of cardiac dysfunction in multi-system inflammatory syndrome in children (MIS-C) is crucial for effective management. Our primary objective was to predict left ventricular systolic dysfunction (LVSD) through a multicenter collaborative assessing admission laboratory data and echocardiogram findings. Methods: Laboratory and clinical data were collected by retrospective chart review from a cohort of pediatric patients admitted and treated for MIS-C in our institutions. Laboratory data including absolute lymphocyte count, albumin, sedimentation rate, C-reactive protein, procalcitonin, d-dimer, fibrinogen, ferritin, interleukin-6 level, and lymphocyte subsets (T, B and NK quantitation, TBNK) were collected. We built a LASSO logistic regression model to predict which MIS-C patients would have left ventricular systolic dysfunction LVSD using only laboratory data obtained within the first 24 h of admission. Results: Of the 1474 MIS-C patients evaluated, 297 had LVSD. The linear kinetic analysis found differences in albumin, lymphocyte count, C-reactive proteins and fibrinogen for systolic dysfunction patients, and of these C-reactive proteins, fibrinogen and procalcitonin were more predictive earlier. The best model for coronary artery abnormalities (CAAs) performed poorly, with a mean cross-validated AUC of 0.57. The model performed well with a cross-validated AUC of 0.845. Conclusions: This model identified widely available biomarkers to successfully predict systolic dysfunction in MIS-C patients. Those at high risk of systolic dysfunction had higher peak laboratory values for C-reactive protein, fibrinogen, and procalcitonin early on. A regularized logistic regression model was validated to provide excellent discrimination for LVSD. Full article

Background/Objectives: Evidence regarding the impact of COVID-19 vaccination on children and adolescents remains limited, particularly in Japan. Thus, this study aimed to estimate incidence rates of COVID-19-associated hospitalization by vaccination status and evaluate the association between COVID-19 vaccination and COVID-19-associated hospitalization among individuals aged 6 months to <18 years in Japan. Methods: We conducted a retrospective, population-based cohort study using linked health insurance claims data and municipal COVID-19 vaccination registry records from nine Japanese municipalities between 1 January 2022, and 31 March 2023, when the Omicron variant was dominant nationwide. Incidence rates of COVID-19-associated hospitalization were estimated among unvaccinated individuals and those who had received one dose (partially vaccinated) or at least two doses of an ancestral monovalent COVID-19 vaccine (fully vaccinated). Incidence rate ratios (IRRs) were calculated, adjusting for age group, sex, presence of underlying medical conditions, municipality, and calendar month. Results: Among 163,305 individuals, 93 COVID-19-associated hospitalizations were identified. Crude incidence rates were 4.5 (95% confidence interval [CI]: 3.6–5.6), 3.2 (95% CI: 0.1–18.0), and 2.3 (95% CI: 1.1–4.2) per 100,000 person-months in unvaccinated, partially, and fully vaccinated groups, respectively. The adjusted IRR for the fully vaccinated group was 0.429 (95% CI: 0.198–0.930). Among hospitalized patients, 30.1% had underlying medical conditions, and only 4.3% required oxygen administration during hospitalization. Conclusions: Receiving at least two doses of COVID-19 vaccine was associated with a lower incidence rate of COVID-19-associated hospitalization among children and adolescents during the Omicron-dominant period in Japan. Expanding vaccine uptake among eligible pediatric populations may help reduce the burden of severe disease. Full article

Background: Respiratory tract infections (RTIs) represent one of the most prevalent reasons for visits to Pediatric Emergency Departments (PEDs). Because viral and bacterial presentations frequently overlap, a substantial proportion of antibiotic prescriptions in pediatric acute care are potentially unnecessary, contributing to antimicrobial resistance. Rapid Diagnostic Tests (RDTs) for respiratory viruses have been suggested as tools to enhance diagnostic precision and support antimicrobial stewardship. However, evidence regarding their real-world impact in pediatric emergency settings is limited. Objectives: This study aimed to assess the association between point-of-care RDT results and antibiotic management in a tertiary PED, focusing on both the discontinuation of antibiotics in children already receiving treatment and the avoidance of new antibiotic prescriptions in untreated children. The secondary objective was to evaluate the short-term safety through 72-h return visits. Methods: A retrospective cohort study was conducted at a tertiary PED during two epidemic seasons (December–February 2023–2024 and 2024–2025). Children aged <18 years who underwent RDTs for febrile respiratory illnesses were included. Patients were stratified based on whether they were already receiving antibiotic therapy at presentation. The primary outcomes were antibiotic discontinuation among treated patients and initiation among untreated patients. Unplanned return visits to the PED within 72-h post-discharge were used as a pragmatic short-term safety outcome to capture early clinical deterioration. RDTs (SD Biosensor Standard F Antigen) were performed at the bedside with a turnaround time of 10–15 min. Results: A total of 1238 children were included, of whom 330 (26.6%) tested positive for influenza and/or adenovirus. Among the 234 children already receiving antibiotics, discontinuation was significantly more frequent in the RDT-positive group (p < 0.001; OR 0.044). Among the 1004 untreated children, antibiotic prescription was significantly lower in the positive group than in the negative group (p < 0.001; OR 0.097). Return visits within 72-h did not differ between the groups in either cohort. No invalid tests occurred. Conclusions: Influenza/adenovirus RDT positivity was associated with lower antibiotic initiation among untreated children and higher discontinuation among those already receiving antibiotics, with no differences in 72-h return visits. These findings suggest a potential role for bedside viral testing as a decision-support tool for antibiotic management in the PED. Full article

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies. Full article

Background/Objectives: Dengue is one of the leading causes of morbidity in children in endemic regions. Capillary leakage is the pathophysiological hallmark of severe dengue, and ultrasound has established as a sensitive tool for its early detection. However, evidence in the pediatric population remains limited. The aim of this study was to identify the presence of capillary leakage detected by ultrasound and its associations in children with dengue. Methods: Observational/descriptive/cross-sectional/retrospective study conducted in patients between 6 months and 14 years old with confirmed dengue and warning signs or severe dengue, treated at the Hospital Universitario del Valle in Cali, Colombia, between July 2019 and June 2020. Ultrasound examinations were performed and interpreted by radiologists following an institutional standardized protocol. Associations with capillary leakage were evaluated using the chi-square test and their respective OR and 95% CI. Results: A total of 132 children were included. Ultrasound capillary leakage was identified in 95.5%, mainly ascites (83.3%), pleural effusion (46.2%), hepatomegaly (40.9%), and vesicular thickening (39.4%). Associated factors were belonging to school/adolescent group (OR = 13.52; 95% CI = 1.41–646.51; p = 0.0031), elevated alanine aminotransferase (OR = 11.06; 95% CI = 1.32–94.82; p = 0.0007), and aminotransferase levels grades C–D (OR = 6.87; 95% CI = 0.82–54.59; p = 0.0110). Thrombocytopenia and hypoalbuminemia were common. Three deaths (0.9%) occurred in the initially confirmed cohort prior to ultrasound-based inclusion, all of whom presented multiple risk factors for capillary leakage. Conclusions: In this cohort ultrasound showed high sensitivity for detecting capillary leakage in pediatric dengue and was associated with school-age/adolescents and liver involvement. Its systematic use could improve early identification of severe forms and optimize clinical management in resource-limited settings. Full article

Background: Acute kidney injury (AKI) is increasingly recognised in children with acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C), yet the long-term renal consequences in younger paediatric populations remain unclear. Most studies focus on acute illness or mixed-age cohorts, with limited data specific to children aged 0–12 years. Objectives: This study aimed to systematically identify, evaluate, and synthesise evidence on post-acute (≥30 days) and long-term (≥90 days) kidney outcomes following SARS-CoV-2 infection or MIS-C in children aged 0–12 years, including chronic kidney disease (CKD), eGFR decline, proteinuria, haematuria, hypertension, and need for kidney replacement therapy. Methods: We searched MEDLINE, Embase, CINAHL, and PubMed (December 2019–30 November 2025), following PRISMA 2020 guidelines and a registered PROSPERO protocol (CRD420251241949). Observational studies reporting kidney outcomes ≥30 days post-infection in children aged 0–12 years were included. Risk of bias was assessed using the Newcastle–Ottawa Scale or ROBINS-I. Owing to heterogeneity and absence of ≥3 comparable datasets, a narrative synthesis was performed. Results: Seven studies met inclusion criteria (five MIS-C cohorts, two acute COVID-19 cohorts). Only a subset provided extractable data specific to children aged 0–12 years. Follow-up ranged from 30 days to 12 months; four studies reported outcomes ≥ 180 days. Across all studies, no incident CKD, sustained eGFR decline, or kidney replacement therapy were reported among children completing long-term follow-up; however, most long-term outcome data were derived from MIS-C cohorts with median ages around 8–11 years that included some adolescents, rather than exclusively children aged 0–12 years. One MIS-C study reported long-term hypertension in 14% of children. A cross-sectional Italian cohort of mild COVID-19 demonstrated hyperfiltration, proteinuria, and microhaematuria at ~3 months, though chronicity could not be assessed due to absence of baseline values. A large US EHR-based cohort identified increased CKD risk after COVID-19 in the broader < 21-year population; however, 0–12-year-specific event counts were not reported, preventing quantitative synthesis for young children. Conclusions: Evidence on long-term kidney outcomes after SARS-CoV-2 infection in children aged 0–12 years remains limited, and only a small subset of studies provided extractable, age-specific data. On the other hand, MIS-C cohorts generally show favourable renal recovery, small sample sizes, lack of control groups, and short follow-up restrict confidence in these findings. Large paediatric EHR studies suggest potential long-term renal risk in broader paediatric populations, highlighting the need for age-stratified, prospective cohorts with serial eGFR, urine studies, and blood pressure assessments. Until definitive evidence emerges, structured renal follow-up may be warranted for children with AKI or MIS-C during COVID-19. Full article