Interventional Bronchus Occlusion Using Amplatzer Devices – A Promising Treatment Option for Children with Persistent Air Leak

Background: Persistent air leak (PAL) is a severe complication of secondary spontaneous pneumothorax (SSP). Surgical interventions are usually successful when medical treatment fails, but can be associated with significant complications and loss of potentially recoverable lung parenchyma. Methods: Retrospective analysis of efficacy and safety of interventional bronchus occlusions (IBO) using Amplatzer devices (ADs) in children with PAL secondary to SSP. Results: Six patients (four males, 4–15 years of age) underwent IBO using ADs as treatment for PAL. Necrotizing pneumonia (NP) was the most common cause (n=4) of PAL. Three patients were previously healthy and three suffered from chronic lung disease. All patients required at least two chest tubes prior to the intervention for a duration of 15–43 days and all required oxygen or higher level of ventilatory support. In three cases, previous surgical interventions had been performed without success. All children improved after endobronchial intervention and we observed no associated complications. All chest tubes were removed within 5–25 days post IBO. In patients with PAL related to NP (n=4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5–94). Conclusion: IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.

When Your Ankle Becomes a Knee – Long-Term Functional Outcome and Quality of Life with a Rotationplasty after Resection of Malignant Limb Tumors

Background Increasing numbers of patients surviving malignant bone tumors around the knee joint have led to an increasing importance to investigate long-term results. This study assessed the long-term results of rotationplasty after resection of malignant bone tumors regarding functional outcome and quality of life to allow better comparison with other treatment options in bone cancer treatment. Procedure 60 participants who underwent rotationplasty due to bone cancer took part in this multicentric questionnaire-based study. The long-term functional outcome was measured by the Musculoskeletal tumor society score (MSTS) and the Tegner activity level scale. The health-related quality of life (HRQL) was assessed by using the Short Form Health Survey (SF-36). Results Patients treated with rotationplasty (median follow-up of 22 years, range 10–47 years) regained a high level of activity (median MSTS score of 24). Even a return to high level sports was possible (mean Tegner activity level scale of 4). Duration of follow-up did not influence the functional outcome. HRQL scores were comparable to the general German population. Concerns of psychological problems due to the unusual appearance of the rotated foot have not been confirmed. Conclusion Rotationplasty can be a good alternative to endoprosthetic replacement or amputation, either as primary surgery or as a salvage procedure. Especially for growing children and very active patients rotationplasty should be considered.

Einfluss von psychosozialen Belastungsfaktoren auf das Längenwachstum

Zusammenfassung Hintergrund Wachstum wird durch Hormone, genetische und exogene Faktoren beeinflusst. Fragestellungen Welche Bedeutung haben Psyche, Lebensumstände oder maternaler Drogenkonsum in der Schwangerschaft für das Wachstum von Kindern? Methoden Ergebnisse eines Arbeitstreffens pädiatrischer Endokrinologen mit aktueller Literaturrecherche. Ergebnisse Psychosoziale Deprivation kann bei Kindern mit Kleinwuchs und einem Wachstums-hormon (WH)-Mangel einhergehen, der bei Änderung der Umgebung und unter psychosozialer Unterstützung reversibel ist. Krieg und Migration gehen häufig mit Untergewicht, Wachstumsstörung und schlechter Gesundheitsversorgung einher. Diese bessern sich nach Konfliktende, die Kinder bleiben dennoch häufig zu klein. Alkohol- oder Drogenkonsum von Schwangeren sind mit einem niedrigeren Geburtsgewicht und einem erhöhten Risiko für Früh- und „small for gestational age“ (SGA)-Geburtlichkeit assoziiert. Kinder mit Aufmerksamkeitsdefizit-Hyperaktivitäts-Syndrom (ADHS) zeigten meist nach Beginn einer Stimulanzientherapie eine leichte Wachstumsverlangsamung, erreichen aber eine normale Endhöhe. Schlussfolgerungen Bei Kindern mit idiopathischem Kleinwuchs sollte differenzialdiagnostisch die psychosoziale Genese in Betracht gezogen werden. Eine Stimulanzientherapie bei ADHS wirkt sich demgegenüber auf das Wachstum kaum aus.

Ambulante Antibiotika-Verordnungsrate und Mastoiditis-Fälle bei Kindern und Jugendlichen im Saarland, 2014–2019

Zusammenfassung Hintergrund Infektionen der Atemwege sind die Hauptindikation für eine ambulante Antibiotikatherapie im Kindes- und Jugendalter. In den letzten Jahren ist die Antibiotika-Verordnungsrate (AVR) in der pädiatrischen Bevölkerung im Saarland deutlich zurückgegangen. Ziele und Fragestellung Ziel des retrospektiven Mastoiditis-Audits im PaedineSaar Netzwerk ist es, die Inzidenz der stationären akuten Mastoiditis (AM) im Saarland (2014–2019) im Hinblick auf die sinkende AVR bei Kindern zu untersuchen sowie Daten zum klinischen Verlauf der AM zu erheben. Methoden Es wurden alle stationären AM-Fälle (2014–2019) aus 6 Kliniken für Kinderheilkunde und/oder HNO-Heilkunde im Saarland und Trier retrospektiv ausgewertet. Patienten mit AM im Alter von 0–17 Jahren mit Wohnsitz im Saarland wurden in die Studie eingeschlossen. Ergebnisse Zwischen 2014 und 2019 wurden 53 stationär behandelte AM-Fälle erfasst. Während des Studienzeitraums gab es keinen signifikanten Anstieg der AM-Inzidenz (mittlere Inzidenz 2014–2019 6,1/100 000). 34% (18/53) der Patienten erhielten prästationär eine orale antibiotische Therapie. Mindestens eine Komplikation trat bei 30% der Patienten (16/53) auf. Es zeigte sich ein leichter Trend zu mehr Komplikationen bei Kindern ohne orale Antibiotikabehandlung vor der stationären Aufnahme (14/35 (40%) vs. 2/18 (11%) P=0,056). Diskussion Die Inzidenz der stationär behandelten AM im Saarland ist 2014–2019 trotz eines signifikanten Rückgangs der ambulanten AVR nicht gestiegen. Die Ergebnisse dieses Audits sollen zur Entwicklung eines standardisierten Vorgehens bei der Diagnostik und Behandlung von Kindern mit AM dienen.

Impact of School Closures on the Proportion of Children in the COVID-19 Pandemic: An Example from the Winter Lockdown in Germany

Background In addition to widely used basic hygiene measures in school, school closures are applied to contain SARS-CoV-2 spread, although the effect on the pandemic is unclear. We proposed a simple approach to disentangle the effect of school closures from other lockdown measures on the pandemic course based on publicly available data in Germany. Methods We used data on the number of SARS-CoV-2 cases from the onset of the pandemic to 14th April 2021. We compared the proportion of children (5–14 years old) in all cases prior to the lockdown measures, including school closure, to that during a ten-week lockdown in Germany. The total number of paediatric cases occurring during lockdown was compared to the number expected in absence of school closures. The latter was calculated based on the actual weekly number of all cases and the pre-lockdown proportion of paediatric cases. Results The proportion of children in all cases was 2.3 percentage points lower at the nadir than the proportion before the lockdown. The estimated total number of paediatric cases prevented by school closures was estimated at 13,246 amounting to 24% of the expected cases in absence of school closures. Conclusion School closure during the winter lockdown reduced the number of expected SARS-CoV-2 cases in children in absence of school closures. The contribution of these prevented cases to the total population incidence is small. These data might provide the basis to model the effect of school closures in addition to basic hygiene measures on the course of the COVID-19 pandemic.

Rare Tumors in Children and Adolescents – the STEP Working Groupʼs Evolution to a Prospective Registry

Background Very rare tumors (VRT) in children and adolescents have such a low incidence that until recently, they have not been integrated into the clinical and scientific network of pediatric oncology. Data is very limited and consistent treatment strategies are missing. Thus, VRTs are classic orphan diseases. To counteract this problem, the Arbeitsgemeinschaft für Seltene Tumorerkrankungen in der Pädiatrie (STEP) was founded. Here we report on patient recruitment during the first 10 years. Patients Patients aged up to 18 years and not included in any other clinical trial or GPOH registry were included in this analysis. Methods Data was collected from 2008 to 2018 by means of a standardized form. The recorded diagnoses were descriptively analyzed focusing on histology, localization, and year of report. Results A total of 623 patients with VRTs were registered. During 2008–2014, the annual number of registrations was around 40 and is around 90 since 2015. Most frequent diagnoses included tumors of the skin (n=150), tumors of the gastrointestinal tract (n=102), tumors of the gonads (n=77), the ENT region (n=68), and miscellaneous tumors (n=107). Discussion With the establishment of central structures for clinical consultation and documentation of VRTs, the number of registrations increased. Comprehensively, VRTs are as common as other classic pediatric oncology tumors, but extremely heterogeneous in terms of localization, histology, and prognosis. By a centralized and complete registration and analysis of VRTs, also in collaboration with international partners, it is possible to develop treatment strategies and thus greatly increase treatment quality.