Search Results (259)

Children undergoing cancer treatment face repeated, prolonged hospitalisations carrying substantial risks of psychological distress, social isolation, and impaired development. Volunteers offering structured non-medical activities are widely employed to complement professional psychosocial care in paediatric oncology settings, yet empirical evidence examining their role specifically—as distinct from professionally delivered psychosocial interventions—remains sparse. This narrative review, conducted in accordance with SANRA criteria and drawing on a structured search of PubMed, PsycINFO, and Google Scholar (2000–2025), supplemented by a targeted verification search in July 2026, synthesises the theoretical and preliminary empirical basis for volunteer involvement, critically evaluates associated clinical risks, and proposes evidence-informed recommendations for paediatric oncology clinical practice. Three theoretical frameworks provide the conceptual grounding for volunteer activities: developmental psychological models (Piaget; Erikson), stress and coping theory (Lazarus and Folkman), and the biopsychosocial model (Engel). Indirect empirical evidence—derived predominantly from professionally delivered interventions—supports short-term benefits of structured distraction, play, and social activities on procedural anxiety, pain experience, and sense of social inclusion; the sole study examining volunteer-facilitated activities specifically in paediatric oncology reported meaningful reductions in distress and high family satisfaction. Eight categories of clinical risk are identified, including physical and psychological overload, erosion of child autonomy, suppression of authentic emotional expression, and inadequate coordination with healthcare staff. Six practice recommendations are proposed, centred on a working definition of the volunteer role, mandatory pre-access training, genuine individualisation including cultural adaptation, multidisciplinary-team-led coordination, and structured programme evaluation. Volunteer involvement can meaningfully complement professional psychosocial care when delivered within a structured, supervised, and multidisciplinary-team-coordinated framework. The paediatric oncology team occupies a pivotal role in realising the potential benefits while safeguarding children from associated risks. Prospective research employing standardised volunteer programme definitions and validated child-reported outcome measures is urgently needed to build an evidence base commensurate with the clinical importance of this practice. Full article

Objectives: Pediatric nasopharyngeal carcinoma (NPC) is rare and often presents at an advanced stage. Although multimodal treatment can achieve favorable survival, long-term survivors may experience substantial treatment-related morbidity. We aimed to evaluate survival outcomes according to stage and metastatic status and to characterize late toxicity in a 20-year single-center pediatric NPC series. Methods. We retrospectively reviewed 24 pediatric patients diagnosed with NPC between 2003 and 2023. Histology was classified according to WHO criteria, and tumors were staged using the AJCC TNM system. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan–Meier method. Survival distributions were compared using the log-rank test. Late treatment-related toxicities documented during follow-up were recorded descriptively. Results: Twenty-four patients with WHO type III NPC were included. Fourteen patients had stage III disease and 10 had stage IV disease; three had distant metastasis at diagnosis. The median follow-up duration was 50.5 months. At last follow-up, 19 patients were alive and five had died. The estimated 5- and 10-year OS rates were both 72.7%, and the corresponding EFS rates were both 63.7%. Stage IV disease and metastatic presentation were associated with inferior OS. Dysphagia, malnutrition, xerostomia, fibrosis, hypothyroidism, and deafness were the most frequently recorded adverse health effects. Conclusions: This 20-year single-center experience shows that AJCC stage and metastatic status remain key determinants of survival in pediatric NPC. The high burden of late treatment-related complications highlights the importance of integrating long-term multidisciplinary survivorship surveillance into the care of pediatric NPC survivors. Full article

Background: Iron deficiency is common in very-low-birth-weight (VLBW) infants because of limited iron stores, rapid postnatal growth and repeated phlebotomy. Early detection is essential to prevent anaemia and neurodevelopmental impairment. This study investigated the prevalence of, and factors associated with, iron deficiency at hospital discharge using serum ferritin and the reticulocyte haemoglobin equivalent (RET-He). Methods: In this prospective cohort study, iron status was evaluated in 68 VLBW infants admitted between April 2022 and March 2024 at 36 weeks post-menstrual age (PMA) or at discharge. Iron deficiency was defined as serum ferritin below 75 ng/mL or RET-He below 28 pg. Univariable and multivariable logistic regression analyses were performed to explore clinical factors associated with iron deficiency. Iron status and anaemia were reassessed at 6–12 months of age. Results: At 36 weeks PMA or discharge, 39.7% of the infants were iron deficient, whereas only 1.5% were anaemic. Higher gestational age (aOR 1.81, 95% CI 1.07–3.06) and lower haemoglobin at birth (aOR 0.63, 95% CI 0.42–0.96) were independently associated with iron deficiency. Bronchopulmonary dysplasia showed a possible association (aOR 14.02, 95% CI 1.23–160.34), though this estimate should be interpreted cautiously. At 6–12 months, 18.8% of the patients had anaemia and 50% had iron deficiency, with no significant associated factors identified, likely reflecting the limited sample availability. Conclusions: Iron deficiency is common in VLBW infants and often precedes anaemia. Assessment of iron status beyond haemoglobin before discharge may be clinically justified to guide early supplementation, though further prospective multicentre studies are needed to confirm whether routine dual-biomarker screening is warranted. Full article

Background: The use of low-molecular-weight heparins (LMWH) for the treatment and prevention of thromboembolic diseases in pediatric patients is increasing, although optimal dosing and monitoring strategies remain insufficiently defined. Methods: This study was conducted at the Clinic of Pediatrics, University Hospital “St. George”, and included 26 hospitalized patients aged 0–18 years with confirmed arterial or venous thrombosis receiving treatment or prophylaxis with enoxaparin. A total of 42 samples were analyzed. Anti-factor Xa activity was measured using an LMWH-calibrated anti-FXa assay (Innovance Heparin, Siemens Healthineers) on a Sysmex CS-2500 analyzer. Therapeutic and prophylactic dosing followed CHEST 2012 guidelines. The study evaluated age- and weight-based dosing, the number of dose adjustments required to achieve target Anti-Xa levels, and the relationship between Anti-Xa levels and anticoagulant response. Results: The mean baseline Anti-Xa level achieved with the initial weight-based dose (1.0 mg/kg/12 h) was significantly lower in children aged 1–2 years compared with older age groups. Older children, as well as patients with oncological and nephrological diseases, achieved higher anticoagulant levels with standard prophylactic dosing. Age under 1 year, oncological disease, and baseline Anti-Xa level < 0.3 IU/mL were identified as independent predictors of the need for more frequent dose adjustments to achieve a therapeutic response. Conclusions: Monitoring of Anti-factor Xa levels is essential in pediatric patients receiving LMWH for both treatment and prophylaxis. Standard dosing regimens may be insufficient in younger children and specific clinical subgroups, supporting the need for individualized dosing strategies. Full article

Importance: A comprehensive analysis of childhood cancer and cancer predisposition syndromes (CPSs) incidence can provide insights that lead to improvements and modifications in treatment protocols through personalized therapy, thereby reducing toxicity. Purpose: This study aimed to analyze age-specific hospital-based childhood cancer rates and the distribution of CPSs in a 20-year pediatric cohort from the region. Materials: A total of 2190 patients, aged from birth to 17 years, diagnosed with any type of neoplasm classified by ICD-10 codes at Karol Jonscher’s Clinical Hospital of Poznan University of Medical Sciences (KJCH PUMS) between 1 January 2000, and 31 December 2019, were included, with 193 (8.8%) having an underlying CPS. Results: The pediatric population of the Greater Poland Region has declined over the past two decades. The most common diagnoses can be grouped into three main categories: (1) leukemias, involving 704 patients (32.1%); (2) central nervous system (CNS) tumors, represented by 382 children (17.4%); and (3) lymphomas, including 279 patients (12.7%), together accounting for 1353 cases (61.8%). The age-specific hospital-based case rate for childhood cancer (all types combined) peaked in the 0–28 days age group at 71.8 per 100,000 person-years (95% CI: 52.2–96.4), with a trend to decrease with age and a slight increase among adolescents aged 16–17 years (13.6 per 100,000, 95% CI: 12.0–15.4). The age-specific incidence of CPS-positive cancers declined from 18.0 (95% CI: 8.2–29.4) per 100,000 person-years in the first month of life to 0.7 (95% CI: 0.3–1.2) in 16–17-year-olds. CPS-positive children were diagnosed at significantly younger ages for four cancer types: liver and intrahepatic bile duct tumors (C22: A = 0.097, adjusted p < 0.001), myeloid leukemia (C92: A = 0.179, adjusted p < 0.001), lymphoid leukemia (C91: A = 0.309, adjusted p = 0.007), and renal tumors (C64: A = 0.335, adjusted p = 0.013). Conclusions: CPSs likely play a significant and underestimated role in pediatric cancers, especially during early childhood. Improving access to genetic testing could greatly enhance risk assessment, personalized treatment, and long-term outcomes in pediatric oncology. Full article

Purpose: We aim to review our experience in treating children with ependymoma, the third most common malignant central nervous system tumor in children, at Ankara Bilkent City Hospital. Methods: We reviewed medical records of children <18 years old at diagnosis with ependymoma followed up between 2006 and 2024. Clinical, pathological, radiological, treatment, and outcome data were evaluated. Results: Thirty-two patients (56% males) were included. Median age at diagnosis was 6.8 years (range: 0.6–17 years). Sixteen tumors (50%) were Grade 2 histology. Resection extent was gross total resection (GTR, n = 16), subtotal resection (STR, n = 15), or biopsy (n = 1). Radiotherapy was given to 10 patients; chemotherapy to 3; and both to 11. Eight patients underwent surgery only. In univariate analysis, resection extent significantly impacted both event-free survival (EFS) (3-year EFS 79.0% in GTR vs. 38.9% in STR, p = 0.009) and overall survival (3-year OS 100% in GTR vs. 79.4% in STR, p = 0.035). Four patients (12.5%) died. Six patients remained alive with active disease; three were lost to follow-up. Conclusions: The best outcomes occurred in patients who underwent GTR. The EFS/OS rates were comparable to those in the literature. Our findings suggest that chemotherapy and radiotherapy in relapsed ependymoma may prolong survival. Full article

Background: An infantile hemangioma (IH) is a benign lesion that develops as a result of pathologically dysregulated proliferation of the endothelial cells of the capillaries, typically appearing within the first three years of life. The disease is found mostly on the skin and—less often—in the internal organs. Although IH generally has a good prognosis and may sometimes undergo spontaneous regression, certain types of IH with a specific form, localization, and size may lead to life-threatening conditions including impairment of vital functions. This determines the need for precise diagnostics and treatment. Case presentation: The paper presents a clinical observation of an infant in the first months of life with IH presenting as diffuse hepatic hemangiomatosis and a hemangioma of the left eyebrow area. The IH was associated with life-threatening conditions. However, effective treatment with the non-selective β-adrenoblocker propranolol led to a positive outcome and the resolution of complications. Conclusions: This case demonstrates the critical importance of timely diagnosis and treatment for lesions that, while benign, can lead to fatal complications if not addressed promptly. Full article

Sickle cell disease is the most common monogenetic disease worldwide and affects millions of children and adults. While supportive care practices have improved life expectancy, particularly in high income countries, sickle cell disease typically has adverse impact on quality of life and reduced life expectancy. As a result, patients and providers are increasingly seeking information regarding curative and transformative therapies and advocating for improved global access. This review will describe allogeneic hematopoietic cell transplantation eligibility, approaches to transplant, short and long-term outcomes and key supportive care considerations for providers who care for patients with sickle cell disease. Full article

Among the many complications that can occur in individuals with sickle cell disease (SCD), several studies have suspected an increased risk of cancer. While the effect of SCD on solid tumors remains unclear, multiple studies support a higher incidence of leukemia, especially acute myeloid leukemia (AML). This risk seems to appear in childhood and persist throughout life. Based on these features, should SCD be considered a cancer predisposition syndrome? Here, we explore this question by comparing the characteristics of SCD-associated AML and cancer predisposition syndromes. We show that some features are similar. As in cancer predisposition syndrome, increased cancer risk in SCD appears to be restricted to a defined type of malignancy. SCD-associated AML also has molecular specificities reminiscent of therapy-related AML. Many of the mechanisms contributing to SCD-associated leukemogenesis have been reported in cancer predisposition syndromes, including ineffective erythropoiesis, increased cell renewal, chronic inflammation, and oxidative stress. Nevertheless, SCD presents a unique combination of factors, and their magnitude may greatly vary from one individual to another. Strikingly, the relative risk of cancer in SCD is much lower than most cancer predisposition syndromes and closer to those conferred by common variations. This is a major difference, and indeed, the absolute risk of malignancy in individuals with SCD appears to be low. Moreover, SCD has great clinical variability, and the factors influencing AML risk are unclear. In sum, SCD has many specificities compared to cancer predisposition syndromes that should be considered and investigated. Clinicians should be aware of the increased risk of AML in patients’ management and counseling. Full article

Acute chest syndrome (ACS) is a common pulmonary complication in children with sickle cell disease, defined by a new pulmonary infiltrate on imaging accompanied by fever and/or respiratory symptoms. ACS pathophysiology is multifactorial and incompletely understood, involving vaso-occlusion, pulmonary infarction, inflammation, hypoventilation, and infection—the latter being a frequent trigger in children. While most pediatric cases are mild, ACS can be life-threatening and requires prompt diagnosis and management to prevent progression into respiratory failure. Mild cases are managed with pain control, IV hydration, empiric antibiotics, incentive spirometry, and supplemental oxygen when needed. More severe cases may require simple or exchange transfusion to reduce hemoglobin S levels and limit further vaso-occlusion. ACS is associated with neurologic events and long-term pulmonary complications, making prevention a clinical priority. Disease-modifying therapies include hydroxyurea and chronic transfusion. This review summarizes current evidence on the pathophysiology, risk factors, clinical presentation, diagnosis, acute management, and preventative therapies for ACS in children. Full article

Background/Objectives: Pediatric hematology and oncology patients are at increased risk for psychosocial and neurocognitive difficulties following treatment. Survivorship programs monitor late effects associated with disease and treatment history, with most programs focusing on screening and referring. Relatively less focus is placed on psychoeducation and intervention. The current paper describes the process of creating a novel psychology trainee-led consultation service embedded within a multidisciplinary survivorship clinic. Methods: A psychology intern collaborated with clinic staff and reviewed existing literature to inform the nature of the service. Patients seen in clinic met with the psychology intern for a 20-min visit focused on an area of concern identified during existing neuropsychology and/or social work assessment visits. Topics addressed included coping with stress, anxiety management, improving mood, sleep hygiene, parenting responses to common behavioral issues, and the acquisition of academic support. Pilot patient satisfaction data were collected via a questionnaire at the end of the visit, without any patient-identifiable factors attached to response data. Results: Most patients and families (90%) found the service helpful. Moreover, the majority of families (90%) found a 20-min service delivery to be adequate. The most common topic area addressed was anxiety management. Conclusions: Results demonstrate high patient satisfaction. Advantages of this service include rapid access to a no-fee support addressing common mental health and neurocognitive sequelae of childhood cancer and the expansion of psychology training opportunities. Future research should evaluate the service using validated outcome measures and examine its long-term effects. Full article

Background/Objectives: Sickle cell disease (SCD) is the most prevalent inherited pediatric hematologic disease. Pain is the most common complaint and primary reason for emergency care. Effective coping is critical to improved quality of life for individuals with SCD and other chronic illnesses. Hope, engendered by provision of comprehensive care, may explain the positive impact of effective coping and improved health outcomes. The relevance of effective coping skills and hope’s impact on repeated hospitalizations and/or length of hospitalization stay (LOS) among adolescents with SCD is considered. A regional, comprehensive pediatric sickle cell center (RCPSCC) provided the services. Methods: Patients with SCD, ages 13 through 21 years seen in a university RCPSCC (URCPCC-SCD), completed surveys: a general scale providing a broad range of positive and maladaptive coping-related issues, and KIDCOPE, a standardized scale measuring pediatric coping strategies. Medical records were reviewed for frequency of hospitalization and length of stay (LOS) for the eight months before study entry. Results: Thirty-four URCPCC-SCD outpatients, mean/median age of 16 years, entered the study, and data were analyzed for 33. All reported some sense of future hopefulness, and almost half reported feeling “tense or wound up” most of the time. Use of avoidant or negative coping strategies in response to daily stress correlated positively with increased LOS. Conclusions: Youths with SCD require effective coping strategies to improve self-efficacy and related hope for brighter futures. Individualized, comprehensive treatment and support to families and individuals at risk for sickle cell crisis are uniquely offered in a URCPCC-SCD. Their contributions to service delivery and clinical outcome are expected to enhance hope, mitigate prolonged hospitalizations, and improve adherence to treatment (N = 268). Full article

Background: Pediatric lymphadenopathy is a common reason for consultation, but information from secondary-level care in Latin American middle-income settings remains limited. Objective: The objective of this study is to describe the clinical profile, documentation quality, and use of complementary tests among pediatric patients with lymphadenopathy treated at a secondary-level hospital in Córdoba, Colombia. Materials and Methods: A retrospective descriptive study was conducted through a review of 246 medical records of children with lymphadenopathy evaluated between January 2020 and June 2024. Sociodemographic variables, lymph node characteristics, local inflammatory signs, associated clinical conditions, and complementary tests were extracted from the charts. An exploratory composite variable of predefined clinical assessment features recorded in the charts was analyzed descriptively. Results: The median age was 6 years, with 58.9% being male, and 79.7% lived in urban areas. Cervical involvement predominated (87.8%); most documented nodes were ≤1 cm (59.3%), and local inflammatory signs were uncommon (7.3%). Complementary testing was limited (complete blood count: 37.8%, serology: 17.9%, tuberculin skin test: 6.9%, ultrasound: 7.7%, and biopsy: 4.1%), without significant rural–urban differences. At least one predefined clinical assessment feature was recorded in 83.7% of charts, most often multiple nodes or bilateral involvement; these findings should be interpreted descriptively rather than as direct indicators of malignancy or infection. Conclusions: In this secondary-level, record-based series, pediatric lymphadenopathy was usually documented as small cervical node enlargement with limited complementary testing. The main contribution of this study is to describe documentation patterns and real-world initial work-up in a Colombian secondary-level hospital, which may inform standardized assessment and referral pathways. Full article

Background: Non-Wilms renal tumours (NWRTs) are rare paediatric malignancies and account for a small but clinically significant proportion of childhood renal cancers. Due to their low incidence and biological heterogeneity, outcome data are limited, and management is largely extrapolated from international collaborative protocols. No national data describing the incidence and outcomes of NWRTs in children in the Republic of Ireland (ROI) have previously been published. Objective: To determine the incidence, treatment strategies, and survival outcomes of NWRTs in children in the ROI. Methods: A retrospective cohort study was conducted of all children under 16 years of age with histologically confirmed renal tumours diagnosed and treated at Children’s Health Ireland (CHI) at Crumlin between January 2005 and December 2025. As CHI Crumlin is the single national paediatric oncology centre in the ROI, this cohort represents national case ascertainment for the study period. A total of 143 paediatric renal tumours were identified; Wilms tumours (n = 118) were excluded, leaving 25 children (17.48%) with NWRTs for analysis. No cases of bilateral renal tumours were identified. Histological subtypes included renal cell carcinoma (RCC), clear cell sarcoma of the kidney (CCSK), congenital mesoblastic nephroma (CMN), malignant rhabdoid tumour of the kidney (MRTK), and anaplastic sarcoma of the kidney. Demographic characteristics, treatment strategies, and survival outcomes were analysed. Results: Twenty-five children with NWRTs were identified: CCSK (n = 9), RCC (n = 7), CMN (n = 6), MRTK (n = 2), and anaplastic sarcoma of the kidney (n = 1). At a median follow-up of 107.9 months (range 4.5–181.3 months), overall survival for the cohort was 76%. Overall survival by histology was 100% for CMN, CCSK and anaplastic sarcoma, 43% for RCC, and 0% for MRTK. Treatment strategies varied by histology, with 68% undergoing upfront surgery, 32% receiving neoadjuvant chemotherapy, 60% receiving adjuvant systemic therapy, and 44% receiving radiotherapy. Tumour recurrence occurred in 4/25 patients (16%), confined to the RCC (3) and CMN (1) subgroups. Seven Event-Free Survival events were observed, comprising three RCC relapses and one RCC progression, one CMN relapse, and two MRTK progression-related deaths. No recurrences occurred in CCSK. Conclusions: NWRTs comprised 17.5% of all paediatric renal tumours diagnosed nationally during the study period and demonstrated marked heterogeneity in outcomes according to histological subtype. CMN showed excellent survival with six out of seven requiring surgery alone, whereas MRTK remained associated with dismal outcomes despite multimodal therapy. These national data support histology-driven, risk-adapted management and highlight the importance of continued international collaboration to improve outcomes in NWRTs. Full article

Background: Infantile hepatic hemangiomas (IHH) are common benign vascular tumors in infancy with diverse presentations. Methods: We report a 7-week-old infant presenting with hepatosplenomegaly, multiple skin and hepatic hemangiomas, anemia, and recurrent lung infections. Results: Treatment included propranolol, corticosteroids, and sirolimus, along with antifungal prophylaxis with fluconazole. The patient developed pneumothorax and pulmonary aspergillosis. Despite antifungal therapy with voriconazole and liposomal amphotericin B, along with surgical intervention, her condition deteriorated, resulting in multi-organ failure and death at 8.5 months of age. Conclusions: This case illustrates the complexity of IHH management and highlights the risk of severe infections during immunosuppressive therapy even when standard prophylaxis protocols are applied. Full article