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Sepsis remains a significant cause of neonatal morbidity and mortality in China. A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally. Literature cited in this review was retrieved from PubMed using the keywords \"neonatal sepsis,\" \"early-onset (EOS)\" and \"late-onset (LOS)\" in English, with the focus set on population-based studies. This review provides an updated summary regarding the epidemiology, pathogen profile, infectious work-up, and empirical treatment of neonatal sepsis within and beyond China. The incidence of neonatal EOS and the proportion of Group B Streptococcus (GBS) within pathogens causing EOS in China seem to differ from those in developed countries, possibly due to different population characteristics and intrapartum/postnatal health care strategies. Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable. The pathogen profile of LOS in China was shown to be similar to other countries. However, viruses as potential pathogens of neonatal LOS have been underappreciated. Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections. This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution. A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis. Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.

Ovarian torsion is rare in the pediatric population. Delayed diagnosis can significantly impact fertility. The aim of this review is to highlight current knowledge regarding clinical presentation, diagnosis, surgical management, and follow-up in the pediatric population. Whilst the presentation is often very unspecific, most children will present with sudden severe unilateral pelvic pain associated with vomiting. A key diagnostic test is pelvic ultrasonography, which may help demonstrate an asymmetric enlarged ovary with peripherally displaced follicles. In the pediatric population, ovarian torsion may occur in a normal ovary. However, underlying lesions can be found in half of cases. Benign neoplasms (teratomas or cystic lesions) represent the commonest etiology, with the risk of malignancy being less than 2%. Surgical management should be focused on fertility preservation. This is achievable through ovarian detorsion ± ovarian cystectomy ± oophoropexy to avoid recurrence. Follow-up studies demonstrate excellent recovery rates of detorsed ovaries including those with ischemic appearances. What is Known:• Ovarian torsion is a rare diagnosis in the pediatric population.• Aspecific symptoms and differential diagnoses lead to missed or delayed diagnosis increasing the risk of oophoprectomy and further infertility.What is New:• Reviewing the latest knowledge about clinical presentation, diagnostic, surgical management, and follow-up of ovarian torsion in the pediatric population.• Adiponectin was negatively associated with diastolic blood pressure and HOMA-IR, and chemerin was negatively associated with glucose.

Preterm birth places infants in an adverse environment that leads to abnormal brain development and cerebral injury through a poorly understood mechanism known to involve neuroinflammation. In this study, we integrate human and mouse molecular and neuroimaging data to investigate the role of microglia in preterm white matter damage. Using a mouse model where encephalopathy of prematurity is induced by systemic interleukin-1β administration, we undertake gene network analysis of the microglial transcriptomic response to injury, extend this by analysis of protein-protein interactions, transcription factors and human brain gene expression, and translate findings to living infants using imaging genomics. We show that DLG4 (PSD95) protein is synthesised by microglia in immature mouse and human, developmentally regulated, and modulated by inflammation; DLG4 is a hub protein in the microglial inflammatory response; and genetic variation in DLG4 is associated with structural differences in the preterm infant brain. DLG4 is thus apparently involved in brain development and impacts inter-individual susceptibility to injury after preterm birth. Inflammation mediated by microglia plays a key role in brain injury associated with preterm birth, but little is known about the microglial response in preterm infants. Here, the authors integrate molecular and imaging data from animal models and preterm infants, and find that microglial expression of DLG4 plays a role.

Importance Point-of-care ultrasonography (POCUS) allows to obtain real-time images to correlate with the patient’s presenting signs and symptoms. It can be used by various specialties and may be broadly divided into diagnostic and procedural applications. Objective We aimed at reviewing current knowledge on the use of POCUS in Pediatric Emergency Departments (PEDs). Findings US diagnostic capacity in paediatric patients with suspected pneumonia has been studied and debated whereas literature regarding the usefulness of point-of-care echocardiography in the pediatric setting is still limited. Similarly, Focused Assessment with Sonography for Trauma (FAST) has become a standard procedure in adult emergency medicine but it is still not well codified in the pediatric practice. Concerning procedural applications of POCUS we identified 4 main groups: peripheral vascular access, bladder catheterizations, identification and drainage of abnormal fluid collections and foreign body identification. Conclusions and relevance Bedside emergency ultrasound is routinely used by adult emergency physicians and in the last 10 years its application is recognized and applied in PED. Pediatric emergency physicians are encouraged to familiarize with POCUS as it is a safe technology and can be extremely helpful in performing diagnosis, managing critical situations and guiding procedures, which results in globally improving pediatric patients care.

Disorders of the developing brain represent a major health problem. The neurological manifestations of brain lesions can range from severe clinical deficits to more subtle neurological signs or behavioral problems and learning disabilities, which often become evident many years after the initial damage. These long-term sequelae are due at least in part to central nervous system immaturity at the time of the insult. The blood-brain barrier (BBB) protects the brain and maintains homeostasis. BBB alterations are observed during both acute and chronic brain insults. After an insult, excitatory amino acid neurotransmitters are released, causing reactive oxygen species (ROS)-dependent changes in BBB permeability that allow immune cells to enter and stimulate an inflammatory response. The cytokines, chemokines and other molecules released as well as peripheral and local immune cells can activate an inflammatory cascade in the brain, leading to secondary neurodegeneration that can continue for months or even years and finally contribute to post-insult neuronal deficits. The role of the BBB in perinatal disorders is poorly understood. The inflammatory response, which can be either acute (e.g., perinatal stroke, traumatic brain injury) or chronic (e.g., perinatal infectious diseases) actively modulates the pathophysiological processes underlying brain injury. We present an overview of current knowledge about BBB dysfunction in the developing brain during acute and chronic insults, along with clinical and experimental data.

Facial nerve palsy (FNP) is a common illness in the paediatric emergency department. Missed or delayed diagnosis can have a serious impact on a patient’s quality of life. The aim of this article is to give a recent overview of this pathology in terms of the causes, diagnosis, red flag symptoms, complementary examinations, treatments and follow-up in the child population. In cases of acquired, acute onset and isolated FNP, Bell’s palsy can be assumed, and no further investigation is required. In any other scenario, complementary examinations are required. Treatment depends on the aetiology. Corticosteroids, in addition to antiviral medication, are recommended to treat Bell’s palsy whenever a viral infection is suspected. However, the lack of randomised control trials in the paediatric population does not allow us to comment on the effectiveness of these treatments. In all cases, treated or not, children have a very good recovery rate. This review emphasises the necessity of randomised control trials concerning this frequent neurological pathology in order to better treat these children.

Headache is one of the most common pain syndromes in the paediatric population. Headaches are classified as primary (migraine, tension-type headaches, trigeminal autonomic cephalalgia and other primary headaches) or secondary (e.g. post-traumatic). Non-febrile, non-traumatic headaches represent 1% of all paediatric emergency departments (PED) visits. Many patients present with an acute, moderate to severe pain, sometimes with a sudden onset. Sudden onset headache can be the main symptom of life-threatening neurological conditions as well as a sign of primary headaches such as thunderclap or stabbing headaches. This review aims to describe the presentation of sudden primary headaches in children, in order to help the physician to provide effective management in the emergency setting.

BackgroundAn unprecedented reduction in paediatric emergency department (PED) attendances has been reported following the introduction of social distancing measures during the first wave of the SARS-CoV-2 pandemic in the UK. Emerging evidence also suggests changes in the type of acute presentations to urgency and emergency care.ObjectivesWe aimed to describe the patterns of children presenting to PEDs across Europe during the first wave of the SAS-CoV-2 pandemic, and compare these with historical data, to understand the timeliness of their presentations in relation to the disease severity, and to monitor for emerging disease entities.MethodsThe ‘Epidemiology, severity and outcomes of children presenting to emergency departments across Europe during the SARS-CoV-2 pandemic’ (EPISODES) - study collected data from 39 PEDs in 18 countries including 6 UK sites. Routine clinical data were extracted from electronic health records for all children aged <16 years from January 2018 – May 2020, and these were uploaded using a standardised data entry form on the validated online REDCap system. Standardised 28-day rates were calculated for PED attendance, hospital admission, and selected diagnoses; interrupted times series were performed. Ethics approval was obtained at all study sitesResultsPED attendances varied between 420 and 6,370 between sites for January 2020. Across sites, a reduction in PED attendances (March 2020 vs March 2021) ranged from 29.0% in children aged 5–12 years to 44.8% in children <14 days; a larger reduction was seen at the 6 UK sites. In a preliminary sample across sites, no increase was seen for appendicitis (standardised 28-day number of patients of 181 in April 2018 vs 219 in April 2019 vs 182 in April 2020) or diabetic ketoacidosis (27 vs 29 vs 28); a reduction was observed for otitis media (1628 vs 1538 vs 214), tonsillitis (3672 vs 3506 vs 776), and mental health issues (329 vs 300 vs 176). Reductions in hospital admissions were seen for any type of admission, including admissions >72 hours and to intensive care.ConclusionsThis multinational study confirms a dramatic reduction in PED attendances of all levels of severity observed during the first wave of COVID-19 across Europe. The reduction was consistent in all participating sites, despite the heterogeneity in social distancing measures introduced. We did not find an increase in appendicitis or diabetic ketoacidosis, and a decrease for mental health issues.

BackgroundThe year 2020 saw unparalleled global health care service upheaval in response to the CoVID-19 pandemic. Insights into the European Paediatric Emergency Department (PED) approach to organising health care for children with acute illness in response to infectious pandemics and global disasters are lacking.ObjectivesThis study aimed to understand the types of changes in PED service structure and care delivery which were implemented in response to the first wave of CoVID-19.MethodsThis multinational, cross sectional European survey was distributed online via the Research Electronic Data Capture (REDCap) platform as part of the EPISODES (‘the epidemiology, severity and outcomes of children presenting to emergency departments across Europe during the initial wave of the SARS-COV-2 pandemic) study.The survey explored baseline hospital demographics and pre and during CoVID-19 changes; focussing predominantly on service provision and referral pathways.ResultsThere were 39 study sites in 18 countries; 97% (n=38) of sites remained open during the pandemic. There were 6 UK based sites in 5 cities, the largest represented country within the survey. The capacity of 18/28 (68%) short-stay units (SSU) decreased, in contrast 2 units increased their capacity. All UK sites had SSUs with 5 (83%) reporting decreased or no availability during the pandemic period. As a result of restructuring of local healthcare services 12/39 (31%) sites acted as referral units from other hospitals which treated paediatric patients in non-Covid times.There was minimal change to the availability of consultant telephone advice services, direct or indirect consultant supervision or responsible specialists within the emergency departments. There was an overall decrease of 8% (n=3) in redirection of children with underlying co-morbidities away from ED during the pandemic.The number of changes implemented in the department was not directly related to the peak 14 day incidence of SARS-CoV-2 reported nationally during the first wave.ConclusionsOverall, there was minimal change to service organisation or delivery across PEDs during the first wave of the CoVID-19 pandemic. Combining the small changes made by some and learning from large scale changes adopted by a few may be essential in future disaster management.