Belgian Journal of Paediatrics

Short Term Mortality and Morbidity in Extremely Preterm Babies Born before 27 Gestational Weeks: Comparison between Two Birth Cohorts (1999-2003 and 2010-2016) in a Belgian Third Level NICU

Agnese Vicari — 2025-07-07

Purpose
To compare mortality and morbidity in a third-level neonatal intensive care unit in 2010-2016 in order to assess changes in outcomes since 1999-2003 and to evaluate possible intervention improvement.

Methods
We retrospectively analyzed data collected between 2010 and 2016 on 109 patients born before 27 gestational weeks among infants hospitalized at the Cliniques Universitaires Saint Luc in Brussels. We compared them with a previous internal study cohort of 75 patients of the same age born between 1999 and 2003. We compared mortality and morbidity at unit discharge between the two periods.

Results
The overall mortality rate of extremely preterm infants decreased by 4% from 1999-2003 to 2010-2016. This is not statistically significant (p=0,66). Neonatal deaths occurred earlier in the period 1999-2003. Between 1999 and 2003 deaths were most often attributed to multiorgan failure. In the 2010-2016 period deaths were most frequently attributed to severe central nervous system injury.
The overall prevalence of survivors without major morbidities decreased by 2% from the 1999-2003 to the 2010-2016 period (p=0,78), also not statistically significant.

Conclusions
Our findings corroborate previous studies suggesting that improved outcomes for infants born before 25 weeks of gestation might be achieved by considering resuscitation before 24 weeks. In order to obtain more statistically significant data, future research should compare the Belgian EPIBEL 1999-2000 cohort with a more recent Belgian cohort, potentially clarifying the impact of advanced interventions and care strategies on mortality and morbidity rates in extremely preterm infants.

The Belgian Pediatric Clinical Research Network (BPCRN): Pediatric Trial Facilitation During and Beyond Conect4children

Levi Hoste — 2025-07-07

Objective
The Belgian Pediatric Clinical Research Network (BPCRN) aims to promote pediatric clinical research by enhancing collaboration among stakeholders and facilitating high-quality trials. This manuscript outlines BPCRN’s growth, its role in the Innovative Medicines Initiative 2 conect4children (c4c) project, and its contributions to pediatric drug development in Belgium.

Methods
Summary of BPCRN’s activities since 2018, including its role in the c4c project. Data were collected from progress reports, internal databases, and interviews with investigators. The analysis highlights BPCRN’s operational activities, trial facilitation, governance structure, and collaborations with international partners.

Results
BPCRN now includes 15 pediatric study sites across Belgium, utilizing a single-point-of-contact model for efficient communication. The network supported six commercial and non-commercial trials under the c4c project and facilitated over 20 additional studies through collaborations with global partners like I-ACT for Children. A new governance framework was introduced, including an Advisory Board and Steering Committee to guide future growth and sustainability.

Conclusion
BPCRN evolved to become a key contributor to pediatric clinical research in Belgium, overcoming barriers like recruitment difficulties and methodological challenges. The network’s collaborative model and strategic governance will enable its continued expansion, ensuring that children have access to innovative and safe treatments. BPCRN’s success positions Belgium as a leading hub for pediatric clinical trials and addresses the unmet needs of pediatric patients.

Posterior Urethral Valves: The Spectrum of Radiological and Clinical Presentations

Victoria Collet — 2025-07-07

Objectives: Posterior urethral valves (PUV) are the most common cause of congenital lower urinary tract obstruction (LUTO) and end-stage renal disease (ESRD) in boys. They are suspected on prenatal ultrasound (US) revealing bilateral ureterohydronephrosis, megabladder and posterior urethral dilatation. PUV presents with variable clinical severity and radiological images. This study aims to review the PUV cases in our center, describe the imaging aspects, assess renal and bladder outcome of prenatally and postnatally diagnosed.

Methods: We reviewed the medical records of all boys who underwent PUV ablation in HUDERF between 2006 and 2021. We recorded prenatal and peri-operative US, age and symptoms at diagnosis, cystourethrogram, outcome of renal and bladder function. Prenatally and postnatally diagnosed patients were compared.

Results: We included 50 boys treated for PUV with available antenatal data. Thirty-one patients (62%) presented an abnormal fetal screening: 90% showed the classic PUV antenatal presentation: bilateral ureterohydronephrosis and megabladder. Three patients had an uncommon fetal presentation with unilateral (uretero)hydronephrosis. Nineteen (38%) were postnatally diagnosed, median age of 9 months. The most common postnatal clinical presentations were urinary tract infections (84%) and voiding disorders (11%). 34% of patients, with similar proportion between antenatally and postnatally diagnosed, reached CKD grade 2-4; 6% progressed to ESRD, all antenatally diagnosed.

Conclusions: This study shows an improvement in fetal screening for PUV. Although most of those fetuses showed the classic antenatal presentation, 10% presented an unilateral dilatation with no sign of LUTO. Children diagnosed antenatally showed the worst prognosis in terms of renal and bladder function.

Acute Motor Axonal Neuropathy with Bulbar Symptoms- Case report

Emma Daeninck — 2025-07-07

Acute motor axonal neuropathy (AMAN), a rare variant of Guillain-Barré Syndrome (GBS) presents with rapid paralysis. A 14-year-old boy exhibited bulbar symptoms alongside limb weakness. Clinical examination revealed positive Gowers’s sign and inability to walk on toes. Sensory function was normal, with intact reflexes and sphincter control. Investigations including cerebrospinal fluid, viral serology, and magnetic resonance imaging of the brain and spinal cord yielded no abnormalities. Electromyography confirmed motor axonal polyneuropathy. Treatment with intravenous immunoglobulin led to symptom regression within two weeks. AMAN, lacking sensory involvement, often follows a severe course, necessitating consideration of IVIg due to hyperreactive humoral response.

Acquired Torticollis as Presentation of Langerhans Cell Histiocytosis: Two Contrasting Cases

Anneleen Beerten — 2025-07-07

Langerhans cell histiocytosis (LCH) is a rare disorder that primarily affects young children. Because LCH can affect multiple organs, particularly bone and skin, it presents with a wide range of symptoms. This article reports two different cases with acquired torticollis as the primary complaint. Acquired torticollis is an atypical and less common presentation of LCH. These case reports highlight the importance of identifying a cause for acquired torticollis, which includes LCH in the differential diagnosis. Adequate diagnosis of LCH is important for timely initiation of appropriate treatment to prevent complications and long-term consequences.

A Seven-Month-Old Girl with Hemophagocytic Lymphohistiocytosis Secondary to Systemic Juvenile Idiopathic Arthritis. A Case Report

Anna Cynthia van Breugel — 2025-07-07

Hemophagocytic lymphohistiocytosis (HLH) is characterized by an uncontrolled activation of immune cells. HLH can be primary, due to a genetic predisposition, or secondary, due to an underlying disease such as systemic juvenile idiopathic arthritis (sJIA). Primary or secondary HLH and sJIA present similarly. Clinical and biochemical parameters can be used to differentiate between them. In patients with a persistent fever, it is important to consider an underlying immune and/or rheumatologic problem. We present the case of a seven-month-old girl who presented with symptoms of HLH and was later diagnosed with underlying sJIA.

Blueberry Muffin Syndrome in a Newborn

Chloé Parulski — 2025-07-07

Blueberry Muffin Syndrome (BMS) is a rare condition in newborns characterized by distinctive skin lesions often associated with transient extramedullary hematopoiesis. We present a case of a newborn with BMS focusing on the diagnostic challenges, especially in distinguishing it from acute leukemia. Despite extensive investigations, no specific etiology was found. The skin lesions resolved spontaneously. This case highlights the importance of a multidisciplinary approach in diagnosing BMS and underscores the need for thorough evaluation to exclude severe underlying conditions.

Child Maltreatment - The Important Interface Between Healthcare and Child Protection Services

Oliver Berthold — 2025-07-07

Introduction

Healthcare professionals play a central role in preventing child maltreatment. However, major uncertainties remain regarding appropriate interventions and legal frameworks. In Germany, a 24/7 telephone helpline provides counselling to medical professionals. This article examines the topics raised by callers to the helpline and characteristics of cases.

Methods

The telephone counselling service is available to healthcare professionals, child and youth welfare workers and family court professionals. The counsellors are trained physicians who offer expert guidance on medical aspects related to cases of child maltreatment. A descriptive statistical analysis of calls from 2017 onward was conducted and free text case descriptions were assessed. Where possible, the characteristics of consultations were compared to the nationwide data of child protection service assessments of a risk to a child's wellbeing.

Results

Of 9,315 calls recorded, 78.0% (6,805) were from healthcare professionals, 10.0 % (999) from child and youth welfare professionals and 0.6 % (54) from professionals involved in court cases. Affected children were predominantly either of pre-school age or young adolescents, a majority was female (55.9%). The most prevalent form of child maltreatment was physical abuse and all forms of neglect.

Discussion

Most consultations originated from healthcare professionals, often regarding uncertainties with the threshold for reporting to the authorities. Although physical abuse was the most commonly reported form, sexual abuse was over-represented compared to data from child protection service. This suggests that this form causes particular concern in healthcare professionals. Uncertainty about child protection service involvement highlights the need for training.

The Radiological Investigation of the Skeleton in Suspected Non-Accidental Injury in Children – A Practical Guide for the Skeletal Survey

Marjolein A.C. Mattheij — 2025-07-07

Imaging plays an important role in the assessment of children with possible non-accidental injury. Studies have shown that there is significant variability in imaging performed to identify fractures in children with possible non-accidental injury. In 2013 the European Society of Paediatric Radiology (ESPR) voted in favour of adopting the RCR/SCoR/RCPCH guideline concerning the radiological investigation for non-accidental injury in children. We present a poster illustrating the required radiographic investigations of the skeleton in suspected non-accidental injury in children, that can serve as a practical tool to facilitate adherence to the guideline. We also provide a summary of the key points of the guideline, and discuss challenges and possible solutions for these challenges for implementation of the guideline in the Belgian context.

Partnership Envelope: a Therapeutic Dimension Relevant in Situations of Abuse

Emmanuel de Becker — 2025-07-07

Objectives

Societies often overlook that families can be where children face the highest risk of psychological, physical, or sexual violence. Child maltreatment undermines fundamental aspects of connection, relationships, and personal boundaries. This issue is multifaceted, including physical and psychological abuse, neglect, sexual abuse, exposure to spousal violence, conflictual parental separation, and institutional abuse. These forms of violence usually occur within the family, turning a supposedly safe environment into a source of trauma.

Methods

We explore the concept of psychic trauma, focusing on events that cause "injuries" to the psyche. A "traumatic" event involves confrontation with death, serious injury, or violent circumstances. Instead of a specific framework, we develop a therapeutic approach to support affected children and their environments.

Results

We propose three guiding principles for practitioners:

Defined Intervention Framework: Essential for any practice, especially strained in domestic abuse cases. It ensures a safe and trust-based environment.
Intermediate Space and Partnership: Creates a space for processing knowledge, representations, and emotions, mitigating dysfunction risks.
Network-Based Practice: Understands individuals within a broader social system, emphasizing relationships and network dimensions.

Conclusions

Multi-stakeholder collaboration is crucial, forming a "partnership envelope." Professionals create a dynamic group, requiring time to analyze relational dynamics. Multidisciplinary team meetings establish and refine this collective process, aiming to prevent fragmentation in caring for families experiencing abuse.

Multidisciplinary Assessment and Intervention in Sibling Maltreatment: Report of 4 Sibling Cases

Marie-Béatrice Vanderpas — 2025-07-07

This case report details the experiences of four siblings subjected to severe intrafamilial maltreatment, leading to significant physical and psychological distress, including ADHD symptoms and autistic traits. During their emergency admission to the paediatric ward, they underwent comprehensive medical and psychological assessments. The report emphasizes the importance of early maltreatment identification, multidisciplinary collaboration, and holistic care addressing both physical and psychological needs. It also highlights the challenge of balancing urgent protective measures with trauma mitigation during placement and the necessity of continuous post-treatment care to manage both immediate and long-term consequences.

Love is not Enough… The Need for Adapted Parenting

Michèle Loop — 2025-07-07

Parental maltreatment due to inadequacy, a form of inappropriate parenting, results in emotional, educational, and neglect-related deficiencies, severely impacting a child's physical and psychological development, though not necessarily intentional. This violates the UN Convention on the Rights of the Child. We present a case of a two-and-a-half-year-old boy brought to the emergency department by police, severely malnourished, with nutritional rickets and developmental delay, fed almost exclusively breast milk. His parents had a distorted perception of his needs. This case is discussed from paediatric, child psychiatric, and legal perspectives.

Vulvar Lesions in a 5-Year-old Girl

Sophie Bosteels — 2025-07-07

Vaccination as a Tool to Prevent Antimicrobial Resistance: Challenges and Opportunities in Belgium

Marie Hallin — 2025-07-07

Back to the Future …

Christophe Chantrain — 2025-07-07

Guest Editors' Editorial

Marjolein Mattheij — 2025-07-07

The Paediatrician: The Bridge between Help, Safety and Trust in a Family in the Event of (Suspected) Child Abuse or Neglect

Ann De Guchtenaere — 2025-07-07