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Congenital CMV infection (cCMV) is the most common congenital infection with 10–15% of cases developing symptomatic disease. Early antiviral treatment is of essence when symptomatic disease is suspected. Recently, the use of neonatal imaging has been implicated as a prognostic tool for long term sequalae among asymptomatic newborns at high risk. Even though neonatal MRI is commonly used in neonatal symptomatic cCMV disease, it is less often used in asymptomatic newborns, mainly due to cost, access and difficulty to perform. We have therefore developed an interest in assessing the use of fetal imaging as an alternative. Our primary aim was to compare the fetal and neonatal MRIs in a small cohort 10 asymptomatic neonates with congenital CMV infection. We performed a single-center retrospective cohort study (case-series) on a convenience sample of children born from January 2014 to March 2021 with confirmed congenital CMV infection who had undergone both fetal and neonatal MRIs. We created a checklist of relevant cerebral abnormalities and asked 4 blinded radiologists to assess the MRIs (2 for each, namely fetal and neonatal) and then compared the findings between the fetal and neonatal imaging as well as the concordance in reporting of abnormalities within each category. Overall concordance between prenatal and postnatal scans was high (70%). When comparing the two blinded reports for each MRI, we found high levels of concordance: 90% concordance for fetal MRIs and 100% for neonatal MRIs. The most common abnormalities identified in both fetal and neonatal scans were "abnormal white matter hyperintensity" and "subependymal cysts." Even though this is a small descriptive study, it indicates that fetal MRI could potentially provide us with similar information as neonatal imaging. This study could form the basis for subsequent larger future studies. [ABSTRACT FROM AUTHOR]

A prospective observational study was conducted to examine whether asymptomatic VZV reactivation occurs in immunocompetent children hospitalized in an ICU and its impact on clinical outcome. A secondary aim was to test the hypothesis that vaccinated children have a lower risk of reactivation than naturally infected children. Forty immunocompetent paediatric ICU patients and healthy controls were enrolled. Patients were prospectively followed for 28 days. Clinical data were collected and varicella exposure was recorded. Admission serum levels of TNF-a, cortisol and VZV- Ig G were measured. Blood and saliva samples were collected for VZV- DNA detection via real-time PCR. As a comparison, the detection of HSV- DNA was also examined. Healthy children matched for age and varicella exposure type (infection or vaccination) were also included. VZV reactivation was observed in 17% (7/39) of children. Children with VZV reactivation had extended duration of fever ( OR = 1.17; 95% CI, 1.02-1.34). None of the varicella-vaccinated children or healthy controls had detectable VZV- DNA in any blood or saliva samples examined. HSV- DNA was detected in saliva from 33% of ICU children and 2.6% of healthy controls. Among children with viral reactivation, typing revealed wild-type VZV and HSV-1. In conclusion, VZV reactivation occurs in immunocompetent children under severe stress and is associated with prolonged duration of fever. [ABSTRACT FROM AUTHOR]

Highly active antiretroviral therapy (HAART) has significantly improved the prognosis of HIV(+) in children. Human immunodeficiency-associated lipodystrophy syndrome (HALS) is a side effect of HAART seen predominantly in adults and less often in children. Leptin is a protein thought to play an important role in body composition and has been shown to have immunomodulatory effects. We retrospectively studied serum levels of leptin in a cohort of eight HIV-infected children followed prospectively before and during HAART and investigated whether there is a correlation of these levels with the clinical, immunological, viral or nutritional changes observed during treatment in these children. None of our children developed HALS. In this small cohort of children, we found that serum leptin levels were appropriate to the nutritional status of the patient and that leptin/BMI increased in patients who responded to HAART. In conclusion, in HIV(+) children during HAART, leptin levels are related to the nutritional status of the child. [ABSTRACT FROM AUTHOR]

*Dr Ferentinos is currently an Attending Physician in the General Hospital of Chalkida, GreeceObjective. C‐reactive protein (CRP) is a reliable laboratory test that is useful in distinguishing between viral and bacterial infection. Although widely used, blood sampling and the need for a well‐organized laboratory are limiting factors. Recently, a rapid test for serum CRP (QuickRead CRP) has been developed that can use both venous and capillary blood. The aim of this study was to use QuickRead CRP in our Pediatric Emergency Department and to compare this method with the standard laboratory determination (CRP‐lab). Material and methods. All children with fever were given a quick CRP test simultaneously with venous (CRP‐V) and capillary blood samples (CRP‐C). A total of 127 children were included in the study (median age 2.5 years). Results. The QuickRead CRP test had an excellent correlation with the standard biochemical determination (CRP‐lab). More importantly, there was no difference in determination of CRP in the venous and capillary blood samples. Finally, there was no significant intra‐assay variability. Conclusions. The QuickRead CRP test is easy to use, provides reliable results and reduces the need for antibacterial therapy. [ABSTRACT FROM AUTHOR]

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE cell mediated food allergy triggered by the ingestion of specific food proteins that may manifest in an acute or chronic form. We report a case of an infant with severe chronic FPIES presenting in the neonatal period that failed to respond to amino acid-based formulas. The patient remained on total parenteral nutrition for 4 weeks and after that he could tolerate amino acid formula. Our case suggests that bowel rest for extended periods may be necessary for severe cases of FPIES, while endoscopy may be helpful in the differential diagnosis and the therapeutic management of these cases. [ABSTRACT FROM AUTHOR]

Objectives: To report the causative relationship of maternal COVID-19 with intrauterine fetal death, describe the specific placental pathology, findings of fetal autopsy and clinical characteristics, and identify potential risk factors.Methods: This is a prospective case series. A cohort of 165 placentas of non-vaccinated pregnant women affected by COVID-19 in Greece were histologically examined and six cases of intrauterine fetal death associated with SARS-COV-2 placentitis were retrieved. Complete fetal autopsy was performed in three cases. Gross, histopathological, immunohistochemical, molecular, and electron microscopy examinations were carried out in the stillbirth placentas and fetal organs. The histological findings of SARS-COV-2 placentitis were compared with the 159 cases, in which maternal COVID-19 resulted in livebirth. Regression analysis was used to identify predisposing factors for SARS-COV-2 placentitis.Results: All six stillbirth placentas showed severe and extensive histological changes of SARS-COV-2 placentitis, i.e. a combination of marked intervillositis with a mixed inflammatory infiltrate and massive perivillous fibrinoid deposition with trophoblast damage, associated with intensely positive immunostaining for SARS-COV-2 spike protein, the presence of virions on electron microscopy and a positive RT-PCR test in placental tissues. The histological lesions obliterated over 75% of the maternal intervillous space, accounting for intrauterine fetal death. Similar histological lesions affecting less than 25% of the placenta were recorded in 7 liveborn neonates, while the remaining 152 placentas of COVID-19-affected pregnancies with livebirths did not show similar findings. Complete fetal autopsy showed evidence of an asphyctic mode of death without evidence of viral transmission to the fetus. The mothers had mild clinical symptoms or were asymptomatic and the interval between maternal COVID-19 diagnosis and fetal death ranged from 3 to 15 days. Statistically significant predisposing factors for SARS-COV-2-placentitis included thrombophilia and IUGR. Multiple sclerosis was seen in one case.Conclusions: SARS-COV-2 placentits occurred uncommonly in COVID-19-affected pregnancies of non-vaccinated mothers and, when extensive, caused fetal demise, with no evidence of transplacental fetal infection. Thrombophilia and prenatally detected IUGR emerged as independent predisposing factors for the potentially lethal SARS-COV-2 placentitis. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

Objective:The objective of this study is to determine the potential effect of oral L-arginine supplementation on intestinal inflammation in very low birth weight (VLBW) neonates, as estimated by faecal calprotectin levels.Study Design:The study enrolled 83 VLBW neonates with birth weight 1500 g and gestational age 34 weeks. In this double-blind study, 40 neonates received daily oral L-arginine supplementation of 1.5 mmol kg−1 per day between the 3rd and 28th day of life, and 43 neonates placebo. Stool samples were collected on days 3, 14 and 28, and calprotectin was measured by enzyme-linked immunosorbent assay.Result:Calprotectin values significantly decreased over time in both groups (P=0.032). No difference in faecal calprotectin values was recorded between neonates receiving arginine supplementation and neonates receiving placebo at days 3, 14 and 28.Conclusion:Faecal calprotectin values decrease with increasing postnatal age in VLBW infants, but this is not related to arginine supplementation. [ABSTRACT FROM AUTHOR]

Background: Data on pandemic H1N1 influenza (pH1N1) virus infection in hospitalised children are limited. Aims and Objectives: To examine the epidemiological and clinical characteristics of children hospitalised with pH1N1 at a large tertiary-care centre in Athens and compare them with those of children hospitalised with seasonal influenza A in previous years. Methods: All children (n = 146) admitted with confirmed pH1N1 between October 2009 to February 2010 and January 2011 to May 2011 were included. Data on children ≧6 months of age (n = 109) were compared with those of 138 children admitted with seasonal influenza A who were examined during two previous influenza seasons (2002–2003 and 2004–2005). Results: The age distribution was similar between seasonal and pandemic H1N1. Bronchial asthma was significantly more common in the seasonal influenza group but the clinical presentation was similar in the two groups, except that fever was more common in patients with pH1N1. Children admitted with seasonal influenza were more likely to develop acute otitis media. There were no significant differences between the two groups for severe outcomes (admission to the ICU, mechanical ventilation or death). Only one child with seasonal influenza (0·6%) and three with pH1N1 influenza (2%) required admission to the ICU. Mean length of hospitalisation was longer in the seasonal influenza group. Conclusion: Clinical manifestations were similar between pH1N1 and seasonal influenza, and the pandemic virus did not appear to cause more severe disease in hospitalised children. [ABSTRACT FROM AUTHOR]

Background: Upper Respiratory Infections (URIs) are common in children. The cause is usually viral, but parents' attitude often contributes to inappropriate antibiotic prescribing, promoting antibiotic resistance. The objective is to describe the process of developing a questionnaire to assess parents' Knowledge, Attitude and Practices (KAP) concerning the role of antibiotics when children suffer from URIs, as well as to evaluate the response rates, the completeness and the reliability (Cronbach) of the questionnaires. Finally, to note any limitations of the study.Methods: Literature review, along with pre-testing yielded a questionnaire designed to assess the parents' KAP-level. A postal survey was set, in a national sample of 200 schools stratified by geographical region. The participants consist of a multistage geographical cluster sample of 8000 parents. The influence of demographic characteristics (i.e. sex, age, education) was analyzed. Cronbach index test and factor analysis were used to assess the reliability of the questionnaire.Results: The response rate of the parents was 69%. Islands presented the lowest response rate while in Northern Greece the response rate was the highest. Sixty-eight point nine percent of the sample returned questionnaires fully completed, while 91.5% completed 95% of the questions. Three questions out of 70 were answered in a very low rate which was associated mostly with immigrant respondents. The section describing parents' attitude toward antibiotic use was not completed as much as the sections of knowledge or practices. The questions were factor analyzed and 10 out of the 21 extracted factors were finally evaluated, reducing the number of independent variables to 46. The reliability of the questionnaire was 0.55. However, only items that increased the Cronbach when added were eventually included in the final scales raising the internal consistency to 0.68. Limitations of the study, such as the vocabulary and form of the questionnaire and the idiocycrancy of the respondents, emerged during the analysis.Conclusion: The response rate and the completeness of the questionnaires were higher than expected, probably attributed to the involvement of the teachers. The study findings were satisfactory regarding the development of a reliable instrument capable to measure parents' KAP characteristics. [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus (CMV) infection is a serious health problem. The obstacles for limiting this infection are the lack of public awareness on this issue, especially owing to the asymptomatic nature of CMV infections, the inefficacy of therapy, and the unsuccessful vaccine trials to date. It is therefore important to organize the current data to estimate the results and to report that the development of a vaccine against CMV must be of the highest priority. [ABSTRACT FROM AUTHOR]

Data on local epidemiology is necessary when deciding on the introduction of a vaccine. Parents of children attending 1st and 6th grades completed a questionnaire on demographical data and varicella history. Analyzing 70,226 questionnaires, varicella was reported in 63.6% and 78.6% of 1st and 6th grade children, respectively (mean age 4.75 years), indicating that a quarter of children entering adolescence are susceptible. Children attending day care and children with older siblings had contracted chickenpox at a younger age. In conclusion, in Greece, in addition to introducing universal varicella vaccination, it is necessary to identify older children at risk and offer catchup vaccination. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the psychometric properties of the Greek version of the Pediatric Quality of Life Inventory(TM) 4.0 (PedsQL(TM) 4.0) as a population health outcome measure.Methods: After cultural linguistic validation, a cross-sectional study with the participation of 645 children (8-12 years old) and their primary caregivers was conducted in a nation-wide representative school-based sample to evaluate the psychometric properties of the measure.Results: All PedsQL 4.0 scales showed satisfactory reliability, with Cronbach's alpha exceeding 0.70--except in self-reported Physical Functioning (alpha = 0.65). Test-retest stability intraclass correlation coefficients (ICCs) were above 0.60 in all subscales. No floor effects were detected in either the self-report or parent proxy versions. Ceiling effects ranged from 2.2% (self-report Total Score) to 31.1% (parent-report Social Functioning). Poor to moderate agreement between self report and proxy report was observed, especially for the younger age groups of children. Impact of gender, health status, and family affluence status were detected, as hypothesised from previous bibliography, with girls reporting lower health-related quality of life (HRQOL) than boys on the Emotional Functioning subscale, healthy children scoring significantly higher on all scales than those with chronic illnesses, and lower socioeconomic groups scoring significantly lower than higher socioeconomic groups. Factor analysis showed mainly comparable results with the original version.Conclusions: Present results support the reliability and validity of the PedsQL 4.0 Greek version. The instrument could be a valuable tool in HRQOL measurement in school health care settings and population-based studies in Greek-speaking children, though it should be stressed that when possible, the child should be considered the first informant of his/her HRQOL. [ABSTRACT FROM AUTHOR]

Goals Of Work: The goals of the study were the following: (1) to study the rate of burnout of the staff in Pediatric Oncology and compare it with that of a group of staff in other pediatric specialties, (2) to find out if job satisfaction, role clarity, staff support, and ways of coping are related to the burnout of these two groups, and (3) as a secondary aim, to identify other parameters, i.e., profession, experience, having children, etc., which might affect burnout, staff support, and ways of coping.Materials and Methods: The study group (n = 58) consisted of the staff of two Pediatric Oncology units and a Bone Marrow Transplantation unit, and the control group (n = 55) consisted of the staff of two Pediatric departments and one Pediatric Orthopedics department. The Maslach Burnout Inventory, the Staff Support Questionnaire, the Shortened Ways of Coping Questionnaire-Revised, and the Social Readjustment Scale were used.Main Results: No differences were found in burnout between Pediatric Oncology staff and that of other specialties, the existing staff support, and the ways of coping. Decreased role clarity and wishful thinking, as a way of coping, were positively correlated to emotional exhaustion, whereas a negative correlation of the lack of role clarity existed with personal accomplishment. Not having children and less experience increased burnout in both groups studied.Conclusions: The hospital management and the heads of departments should be knowledgeable of ways to prevent burnout in their staff. Strategies targeting role clarity and wishful thinking are useful toward this goal. [ABSTRACT FROM AUTHOR]

The article describes two cases of successful medical treatment of Candida endocarditis with liposomal amphothericin B without surgical intervention. The first case involves a 2-month-old boy who was admitted because of knee arthritis 20 days after an arterial switch operation. The second case involves a 3-month-old boy who was admitted to a hospital with the diagnosis of hip arthritis

Varicella is a common viral disease affecting almost the entire birth cohort. Although usually self-limiting, some cases of varicella can be serious, with 2 to 6% of cases attending a general practice resulting in complications. The hospitalisation rate for varicella in Europe ranges from 1.3 to 4.5 per 100,000 population/year and up to 10.1% of hospitalised patients report permanent or possible permanent sequelae (for example, scarring or ataxia). However, in many countries the epidemiology of varicella remains largely unknown or incomplete. In countries where routine childhood vaccination against varicella has been implemented, it has had a positive effect on disease prevention and control. Furthermore, mathematical models indicate that this intervention strategy may provide economic benefits for the individual and society. Despite this evidence and recommendations for varicella vaccination by official bodies such as the World Health Organization, and scientific experts in the field, the majority of European countries (with the exception of Germany and Greece) have delayed decisions on implementation of routine childhood varicella vaccination, choosing instead to vaccinate high-risk groups or not to vaccinate at all. In this paper, members of the Working Against Varicella in Europe group consider the practicalities of introducing routine childhood varicella vaccination in Europe, discussing the benefits and challenges of different vaccination options (vaccination vs. no vaccination, routine vaccination of infants vs. vaccination of susceptible adolescents or adults, two doses vs. one dose of varicella vaccine, monovalent varicella vaccines vs. tetravalent measles, mumps, rubella and varicella vaccines, as well as the optimal interval between two doses of measles, mumps, rubella and varicella vaccines). Assessment of the epidemiology of varicella in Europe and evidence for the effectiveness of varicella vaccination provides support for routine childhood programmes in Europe. Although European countries are faced with challenges or uncertainties that may have delayed implementation of a childhood vaccination programme, many of these concerns remain hypothetical and with new opportunities offered by combined measles, mumps, rubella and varicella vaccines, reassessment may be timely. [ABSTRACT FROM AUTHOR]