New kids on the CPET: age-appropriate outdoor cardiopulmonary exercise testing in preschoolers

Purpose Cardiopulmonary exercise testing (CPET) in preschoolers (4–6 years) represents a challenge. Most studies investigating CPET have been limited to older children (> 8 year). However, knowledge of the performance of small children is essential for evaluating their cardiorespiratory fitness. This study strives to compare a modified Bruce protocol with a new age-appropriate incremental CPET during natural movement running outdoors, using a mobile device. Methods A group of 22 4–6-year-old healthy children was tested indoor on a treadmill (TM) using the modified Bruce protocol. The results were compared with a self-paced incremental running test, using a mobile CPET device in an outdoor park. The speeds were described as (1) slow walking, (2) slow running, (3) regular running, and (4) running with full speed as long as possible. Results Mean exercise time outdoors (6,57 min) was significantly shorter than on the treadmill (11,20 min), $$\dot{V}{O}_{2peak}$$ V ˙ O 2 p e a k (51.1 ml/min/kg vs. 40.1 ml/min/kg), RER (1.1 vs. 0.98) and important CPET parameters such as $$\dot{V}E$$ V ˙ E max, O2pulse, heart rate and breath rate were significantly higher outdoors. The submaximal parameter OUES was comparable between both the tests. Conclusions Testing very young children with a mobile device is a new alternative to treadmill testing. With a significantly shorter test duration, significantly higher values for almost all cardiopulmonary variables can be achieved without losing the ability to determine VT1 and VT2. It avoids common treadmill problems and allows for individualized exercise testing. The aim is to standardize exercise times with individual protocols instead of standardizing protocols with individual exercise times, allowing for better comparability.

Off-label use of combined antiretroviral therapy, analysis of data collected by the Italian Register for HIV-1 infection in paediatrics in a large cohort of children

Background Early start of highly active antiretroviral therapy (HAART) in perinatally HIV-1 infected children is the optimal strategy to prevent immunological and clinical deterioration. To date, according to EMA, only 35% of antiretroviral drugs are licenced in children < 2 years of age and 60% in those aged 2–12 years, due to the lack of adequate paediatric clinical studies on pharmacokinetics, pharmacodynamics and drug safety in children. Methods An observational retrospective study investigating the rate and the outcomes of off-label prescription of HAART was conducted on 225 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results 22.2% (50/225) of included children were receiving an off-label HAART regimen at last check. Only 26% (13/50) of off-label children had an undetectable viral load (VL) before the commencing of the regimen and the 52.0% (26/50) had a CD4 + T lymphocyte percentage > 25%. At last check, during the off label regimen, the 80% (40/50) of patients had an undetectable VL, and 90% (45/50) of them displayed CD4 + T lymphocyte percentage > 25%. The most widely used off-label drugs were: dolutegravir/abacavir/lamivudine (16%; 8/50), emtricitbine/tenofovir disoproxil (22%; 11/50), lopinavir/ritonavir (20%; 10/50) and elvitegravir/cobicistat/emtricitabine/ tenofovir alafenamide (10%; 10/50). At logistic regression analysis, detectable VL before starting the current HAART regimen was a risk factor for receiving an off-label therapy (OR: 2.41; 95% CI 1.13–5.19; p = 0.024). Moreover, children < 2 years of age were at increased risk for receiving off-label HAART with respect to older children (OR: 3.24; 95% CI 1063–7.3; p = 0.001). Even if our safety data regarding off-label regimens where poor, no adverse event was reported. Conclusion The prescription of an off-label HAART regimen in perinatally HIV-1 infected children was common, in particular in children with detectable VL despite previous HAART and in younger children, especially those receiving their first regimen. Our data suggest similar proportions of virological and immunological successes at last check among children receiving off-label or on-label HAART. Larger studies are needed to better clarify efficacy and safety of off-label HAART regimens in children, in order to allow the enlargement of on-label prescription in children.

Suppositional Wh-Questions About Perceptions, Conversations, and actions are More Productive than Paired Yes-No Questions when Questioning Maltreated Children

Forensic interviewers are taught to pair yes–no questions with open-ended requests for recall in order to reduce the likelihood that they will be misled by false “yes” responses. However, yes–no questions may elicit false “no” responses. Questioning 112 6- to 11-year-old maltreated children about three innocuous events (outside activities, yesterday, last birthday), this study compared the productivity of paired yes–no questions about perceptions, conversations, and actions involving the hands and mouth (e.g., “Did you say anything?”) with wh-questions (e.g., “What did you say?”). The wh-questions presupposed that children had content to provide, but did not specify that content. Children were twice as likely to deny content and half as likely to provide novel information when interviewers asked them yes–no questions. Younger children were more inclined than older children to deny content and give unelaborated “yes” responses. The results support further research into the potential for suppositional wh-questions to increase child witnesses’ productivity.

Hospital revisits after paediatric tonsillectomy: a cohort study

Background Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort. Methods We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery. Results Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3–7) and readmission (IQR 3–8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery. Conclusions Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge. Graphical Abstract

Clinical and laboratory findings of COVID-19 in children younger than six months old; Neutropenia is more common not lymphopenia

Background: Studies on age-related differences in clinical and laboratory features on coronavirus disease 2019 (COVID-19) are limited. We aimed to evaluate the demographic, clinical, and laboratory findings of COVID-19 in children younger than six months old and compare them with older children. Methods: A single-center retrospective study, including 209 confirmed COVID-19 cases, was conducted between March 11, 2020, and September 1, 2021. The case group consisted of 47 patients younger than six months old, and the control group consisted of 162 patients older than six months old. Results: The mean age of the case group was 2.77±1.52 months, and the control group was 101.89±65.77 months. Cough was statistically higher in the control group, poor feeding was higher in the case group (P=.043, .010). The underlying disease ratio was statistically higher in the case group; however, the hospitalization rate was higher in the case group (P=.001, .036). The case group had significantly lower median values of the absolute neutrophil count, hemoglobin, and higher median values of white blood cell, absolute lymphocyte count, platelet than the control group (P<.05). C-reactive protein, fibrinogen values were significantly lower, and procalcitonin, D-dimer, troponin T, N‑terminal pro-B-type natriuretic peptide significantly higher in the case group (P<.05). Lymphopenia was more common in the control group, whereas neutropenia was more common in the case group (P= .001, .011). Conclusions: We showed that most children younger than six months old had mild and asymptomatic COVID-19; however, the hospitalization rate was higher, and neutropenia was more common than older children.

Emerging Self-Representation Presents a Challenge for Perspective Tracking in Infancy

The capacity to track another’s perspective is present from early in life, with young infants ostensibly able to predict others’ behaviour even when the self and other perspective are at odds. Yet, infants’ abilities are difficult to reconcile with the well-documented challenge that older children face when they need to ignore their own perspective. Here we provide evidence that it is the emergence of self-representation, from around 18 months, that likely creates a perspective conflict between self and other. Using mirror self-recognition as a measure of self-awareness and pupil dilation to index conflict processing, our results show that mirror recognisers perceive greater conflict than non-recognisers when viewing a scenario in which the self and other have divergent perspectives, specifically when the conflict between self and other is salient. These results suggest that infants’ perspective tracking abilities may benefit from an initial absence of self-representation.

The MacArthur-Bates CDI-III for Spanish-speaking Children

Parent report measures have been shown to be effective, valid and cost-effective means for obtaining information about early child language development. There are several measures available in multiple languages for children below the age of 3. There has been a need for such measures for older children. This study presents the development of a Spanish version of the MacArthur-Bates Communicative Development Inventory-III for children 2 ½ to 4 years of age. A total of 571 families of monolingual Spanish-speaking children from a diverse socio-economic group were asked to fill out the parent report measure in order to obtain a norming sample. Data are presented by age and socio-economic groups that show developmental growth curves for vocabulary production and sentence complexity. Norming tables that show variability by ages are presented. Additional information is given for a General Concepts section. This study presents a new parent report instrument that can be used both clinically and for research purposes.