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Aim: Indocyanine green (ICG) clearance, a sensitive biomarker for liver function, has not been validated in children. We assessed the association between ICG clearance and liver function in children with liver disease., Methods: ICG plasma disappearance rate (ICG-PDR, %/min) was measured in children with liver disease. Mixed linear regression was used to assess the relationship between ICG-PDR and liver function tests (international normalised ratio, INR; prothrombin-proconvertin clotting time, PP)., Results: We included 124 patients with 183 visits. Of the visits, 60.1% were female, 85% had chronic liver disease and 42.5% were liver transplanted. The most common diseases in those without transplantation were autoimmune disease (18.6%) and biliary atresia (10.9%). Median ICG-PDR was 23.9%/min (interquartile range 15; 30.3). Mixed linear regression showed ICG-PDR was associated with INR (β = -0.006, 95% CI [-0.010, -0.003]) and PP (β = 0.005, 95% CI [0.003, 0.008]). However, only five visits were with patients who had acute liver failure (INR ≥2.0)., Conclusion: ICG clearance is associated with standard measures of liver function in children. ICG may aid decision-making in paediatric liver disease together with other biochemical measures, imaging and clinical presentation. However, further studies are needed to assess the usefulness of ICG in paediatric patients with INR >1.4., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: Non-tuberculous mycobacteria (NTM) lymphadenitis typically resolves spontaneously, yet factors influencing the duration remain explored. We aimed to identify clinical parameters associated with shorter spontaneous resolution., Methods: This cohort study included children with NTM lymphadenitis from 1 January 2015 to 1 March 2021 at Copenhagen University Hospital. Time-to-event analysis assessed clinical parameters associated with the duration of NTM lymphadenitis., Results: Sixty children (57% boys) with a median age of 24 months (range 11-84) were included; 13 (22%) received primary surgery, 13 (22%) underwent surgery after a wait-and-see period and 34 (57%) received no intervention. In children without intervention, the median duration was 10 months (range 2-25). Faster resolution was associated with parental-reported lymph node enlargement within 2 weeks (HR 2.3, 95% CI 1.0-5.0; p = 0.044), abscess on ultrasound examination (HR 3.3, 95% CI 1.5-7.3; p = 0.003) and skin discoloration and/or perforation within 3 months of onset (HR 4.3, 95% CI 1.3-14.4; p = 0.017 and HR 3.7, 95% CI 1.5-9.1; p = 0.005)., Conclusion: Knowledge of predictors for shorter spontaneous resolution of NTM lymphadenitis, such as rapid initial lymph node enlargement, abscess on ultrasound examination, and skin discoloration and/or perforation within 3 months of disease onset, may guide clinical management decisions concerning surgery versus a conservative approach., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: To explore [fluorine-18]-fluoro-2-deoxy-d-glucose positron-emission-tomography/computed tomography ( 18 FDG-PET/CT) in patients where standard investigations were non-diagnostic., Methods: We reviewed medical records of previously healthy children who had 18 FDG-PET/CT performed at Copenhagen University Hospital in 2015-2020 due to unexplained fever., Results: Thirty-five of 819 paediatric 18 FDG-PET/CT were performed due to unexplained fever. The final diagnoses were malignancy (11%), infections (23%), inflammatory diseases (43%) and miscellaneous (26%). 18 FDG-PET/CT was diagnostic in six cases with Takayasu's arteritis, tuberculosis, Langerhans cell histiocytosis and Ewing sarcoma. Sixteen cases had focal 18 FDG-uptake, but 18 FDG-PET/CT could only differentiate malignancy, infection and inflammation in three cases. In six cases with inflammatory diseases and no focal signs, PET/CT was normal except increased non-specific 18 FDG-uptake in bone marrow and spleen in five cases. One case was false positive (suspicion of appendicitis) and two false negative (leukaemia and inflammatory disease)., Conclusion: 18 FDG-PET/CT was diagnostic, or contributed to the diagnosis, in several children with unexplained fever referred to a tertiary centre. Challenges comprised (i) only increased non-specific 18 FDG-uptake in bone marrow and spleen in half of cases with inflammatory diseases, (ii) no differentiation between complicated infections, malignancy and inflammation in most cases with focal processes and (iii) a small risk of false positive and false negative results., (© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)