Genotype-Guided Asthma Treatment Reduces Exacerbations in Children: Meta-Analysis of Two RCTs.

Background: Long-acting beta2-agonists (LABA) in combination with inhaled corticosteroids (ICS) are commonly used to treat asthma, however, some children lack response to the addition of LABA. This might be partially due to the presence of the Arg16Gly polymorphism, encoded by rs1042713 G>A in the ADRB2 gene. Carrying the A allele (Arg16) at this variant has been associated with an increased risk of exacerbations despite LABA treatment.

Comparison of Double-Blind and Open Food Challenges for the Diagnosis of Food Allergy in Childhood: The ALDORADO Study.

Background: Double-blind placebo-controlled food challenge (DBPCFC) is widely regarded as the "gold standard" to diagnose food allergy. Maximum efforts are made to reduce bias, yet DBPCFCs are costly, time-, and resource-intensive. Less demanding open food challenges are increasingly used in clinical practice.

Serum proteomics reveals hemophagocytic lymphohistiocytosis-like phenotype in a subset of patients with multisystem inflammatory syndrome in children.

Children with Multisystem Inflammatory Syndrome in Children (MIS-C) can present with thrombocytopenia, which is a key feature of hemophagocytic lymphohistiocytosis (HLH). We hypothesized that thrombocytopenic MIS-C patients have more features of HLH. Clinical characteristics and routine laboratory parameters were collected from 228 MIS-C patients, of whom 85 (37%) were thrombocytopenic.

Eliciting and stop dose during oral food challenges for peanut and common tree nuts in different age groups.

Background: Oral food challenges (OFCs) are used to confirm or reject a diagnosis of food allergy. However, younger children may encounter difficulties in consuming all offered doses during an OFC in the absence of symptoms, resulting in inconclusive outcomes. Our aim is to assess the eliciting dose for objective symptoms among various age groups and determine the necessity of consuming the final dose step during an uneventful OFC to avoid false negative outcomes.

Conservative Treatment of Parapneumonic Effusion in Children: Experience From a 10-Year Consecutive Case Series.

Background: In children with parapneumonic effusion (PPE), it remains unclear when conservative treatment with antibiotics suffixes or when pleural drainage is needed. In this study we evaluate clinical features and outcomes of children with PPE.

Methods: A retrospective, multicentre cohort study at 4 Dutch pediatric departments was performed, including patients 1-18 years treated for PPE between January 2010 and June 2020.

Can the Childhood Physical Activity Questionnaire Be Used to Identify Physical Activity Levels in Children With Asthma?

Children with asthma who are physically active have a better quality of life, emphasizing the importance of activity monitoring and promotion in daily life. The validity of self-reported activity measurements has been questioned in pediatric populations. In this study, we aim to compare the Physical Activity Questionnaire for Children (PAQ-C) with objectively measured PA using accelerometry.

Detection of Salivary Tryptase Levels in Children following Oral Food Challenges.

Background: Oral food challenge (OFC) is commonly used to diagnose food allergy. This test is time and resource intensive, and conclusions are not always unequivocal as this relies on the interpretation of symptoms. Therefore, an objective marker would improve the accuracy of the diagnostic workup of food allergy.

The dilemma of open or double-blind food challenges in diagnosing food allergy in children: Design of the ALDORADO trial.

Background: It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double-blind placebo-controlled food challenge (DBPCFC) has been regarded as the 'gold standard' for decades.

Nurse-driven Clinical Pathway Based on an Innovative Asthma Score Reduces Admission Time for Children.

Unlabelled: We recently demonstrated that an innovative asthma score independent of auscultation could accurately predict the requirement for bronchodilator nebulization compared to the physician's routine clinical judgment to administer bronchodilators. We aimed to standardize inpatient care for children with acute asthma by implementing a clinical pathway based on this innovative asthma score.

Methods: We designed a nurse-driven clinical pathway.

Multicentre study found that adherence to national antibiotic recommendations for neonatal early-onset sepsis was low.

Aim: Our aim was to evaluate adherence to the Dutch neonatal early-onset sepsis (EOS) guidelines, adapted from UK guidance. We also looked at the effect on antibiotic recommendations and duration.

Method: This was a multicentre, prospective observational cross-sectional study carried out in seven hospitals in the Netherlands between 1 September 2018 and 1 November 2019.

Successful introduction of milk after a negative double-blind placebo-controlled food challenge test is independent of the total dose and milk product used during the challenge test.

Background: Failure of milk introduction after a negative food challenge test is reported in a substantial number of patients. For this reason, guidelines recommend that the total dose of milk protein for a food challenge test should be comparable to a normal serving.

Objective: Our aim is to compare the success rate of milk introduction after a negative double-blind placebo-controlled challenge test performed with different doses of milk protein and different milk products.

An innovative childhood asthma score predicts the need for bronchodilator nebulization in children with acute asthma independent of auscultative findings.

Background: We sought to compare the accuracy of a newly developed childhood asthma score (CAS) with routine clinical assessment of respiratory status in children with acute asthma in predicting requirements for bronchodilator nebulization.

Methods: In this prospective observational study in children 2-18 y old with acute asthma, we evaluated the association between the CAS and routine clinical assessment as well as inter-rater agreement.

Results: The need for bronchodilator nebulization was assessed during 134 episodes of acute asthma in 47 children.

Children with asthma have significantly lower long-term cortisol levels in their scalp hair than healthy children.

Aim: Noninvasive measurement of long-term cortisol levels is a useful way of evaluating the effect of chronic disease on the hypothalamic-pituitary-adrenal axis in children. The aim of this pilot study was to compare hair cortisol levels in children using inhaled corticosteroids for asthma and healthy children and to determine the association with short-term salivary cortisol levels.

Methods: Cortisol levels were measured in the scalp hair and saliva of prepubertal children with asthma (n = 10) and without asthma (n = 10).

A rare presentation of cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is a rare skeletal dysplasia characterised by a defect in ossification. Frequently reported clinical findings are delayed closure of the fontanelles and cranial sutures, hypoplastic clavicles, dental abnormalities and short stature. Our patient suffered from complete absence of ossification of both parietal bones.

Non-invasive measurement of adrenal response after standardized exercise tests in prepubertal children.

Objective: To determine the feasibility of non-invasive evaluation of adrenal response in healthy prepubertal children by standardized exercise tests.

Methods: On separate occasions, healthy prepubertal children performed a submaximal cycling test, a maximal cycling test, and a 20-m shuttle-run test. Salivary cortisol levels were determined before exercise, and 1 and 15 min after exercise.

Occult pneumonia in a child.

We describe the case of a 10-year-old boy who presented with high fever, vomiting and diarrhoea. There were no respiratory symptoms and auscultation and percussion of the lungs were normal. The combination of the clinical picture with a high C reactive protein value prompted us to perform a diagnostic work-up.

Arthritis associated with antithyroid therapy in a 15-year-old girl.

A 15-year-old white girl with autoimmune thyroiditis developed arthritis 3 weeks after starting therapy with the antithyroid drug thiamazole. Because an adverse drug reaction of thionamide therapy was suspected, thiamazole was withdrawn, and symptoms disappeared rapidly. Thionamide therapy is indicated for hyperthyroidism and has been widely used since 1948.

Salivary cortisol levels in prepubertal children using inhaled corticosteroids with or without concurrent intranasal corticosteroids.

Background: Inhaled corticosteroids (ICS) and intranasal steroids (INS) are frequently co-administered in children with asthma and rhinitis. In contrast to monotherapy with ICS or INS, little is known about the safety of concurrent use of topical steroids on hypothalamic-pituitary-adrenal (HPA) axis function in prepubertal children.

Objective: Comparison of morning salivary cortisol levels in prepubertal children using maintenance treatment with ICS with and without concurrent use of INS to steroid naïve control groups (healthy children, and children with constipation who are under pediatric care).

Necrotising enterocolitis in a term neonate with trisomy 21 exposed to maternal HIV and antiretroviral medication.

Necrotising enterocolitis (NEC) was diagnosed in a term infant with Down's syndrome exposed to maternal human immunodeficiency virus (HIV) infection and antiretroviral therapy.

Variation of peak inspiratory flow through dry powder inhalers in children with stable and unstable asthma.

Drug release from dry powder inhalers depends for a large part on a sufficiently high peak inspiratory flow (PIF). We determined the variation of PIF through two commonly prescribed dry powder inhalers in children with asthma. We analyzed the effect of inhaler device, age, and severity of asthma symptoms on variation of PIF.

Bronchodilator response in asthmatic children is significantly reduced when measured immediately after methacholine challenge.

Aim: Airway responses to a bronchodilator (BDR) and to methacholine are frequently measured in the assessment of childhood asthma and in pulmonary research. For practical reasons, we wondered whether it would be possible to obtain a reliable BDR immediately after completion of a methacholine challenge test. To this end, we compared BDR with and without a preceding methacholine challenge.