Belgian Journal of Paediatrics

Dental Caries as a Predictive Factor for Childhood Obesity

2025-08-28T10:49:42-04:00

Introduction

The objective of this study is to investigate the relation between dental caries and childhood obesity, with sugar intake suspected as a common risk factor.

Methods

We developed a cohort prospective study, of 5-18 year olds with a dental consultation at the HUDERF in Brussels, Belgium between January 2018-March 2018.

We collected data regarding BMI, diet, dental scores, exercise, parents’ BMI and education, socioeconomic status. These were considered potential confounding factors related to dental caries and childhood obesity.

Results

216 children were asked to participate in this study and 200 participated. 116 participants were female and 84 were male. According to children’s BMI, 2% were underweight, 57% had a normal weight, 25% were overweight and 16% were obese. Mean dfm-t and DFM-t were 4 and 1.46 respectively.

Conclusion

We did not find a statistically significant association between dental caries and BMI. However, we did find a higher prevalence of overweight and obesity amongst children with a dental appointment compared to the general population. A school based longitudinal study should be performed to further investigate these findings.

Prevalence, Natural History and Risk Factors of Neonatal Prolonged Icterus of Newborns in a Preventive Setting in Flanders.

2025-11-13T07:19:28-05:00

Background

Prolonged jaundice is a symptom that requires further investigation. Early diagnosis of severe underlying causes can prevent harm and improve outcomes. Currently, there are no known data on the prevalence, risk factors, outcomes, and prognosis of children with prolonged jaundice in Flanders. This study aimed to provide more information on the natural history, prevalence and risk factors of prolonged icterus in order to optimize newborn screening.

Methods

We reviewed the records of 65497 newborns who consulted Kind & Gezin, a preventive public health service in Flanders. Neonates from the Brussels-Capital region and one with an error in gestational age were excluded. Jaundice was assessed visually by care providers. Prolonged jaundice was defined as jaundice persisting beyond the fourteenth day of life. Stool colour was assessed using a stool colour card.

Results

On day 15, 21.1% of the children were found to have jaundice, with a progressively decreasing frequency thereafter. A significant association was found between prolonged jaundice and male sex (p<0.001), prematurity (p<0.001), breastfeeding (p<0.001), maternal country of origin (p<0.001), lower socioeconomic status (p<0.001), and the province of residence (p<0.001). Logistic regression revealed a significant effect of gender, prematurity, breastfeeding at 2 weeks, and socioeconomic status on prolonged jaundice (p<0.001).

Conclusions

Prolonged jaundice in neonates born in Flanders is prevalent and is mainly linked to established risk factors for neonatal jaundice. However, only 5.4% of the variance in prolonged jaundice could be explained by the studied variables. Therefore, population screening is recommended regardless of the presence of underlying characteristics.

Comparison of a Paper-Based Perinatal Infection Risk Score and the Neonatal Sepsis Calculator by Kaiser Permanente

2025-08-28T10:43:56-04:00

Objective

We aimed to compare a paper-based perinatal infection risk (PIR) score with a validated computer-based early onset sepsis calculator by Kaiser Permanente (KP-EOSC) to assess the their respective performance on neonatal sepsis detection.

Methods

All newborn babies admitted at the department of neonatology with an increased infection risk between January 2019 and December 2021 were retrospectively included. The PIR score was designed to support the decision whether to perform additional monitoring, tests, and/or administer antibiotics. A PIR score and KP-EOSC score were calculated and compared. A PIR score ≥6 or a KP-EOSC score ≥1/1000 would trigger further investigations and observation.

Results

A total of 105 babies were included, corresponding to 3.4% of the local newborn population. Of all patients born at Jan Palfijn Hospital (Antwerp, Belgium), culture proven sepsis incidence was 0.09%. When comparing the PIR score and KP-EOSC score for well appearing children, a minimal correlation was seen (Cramér’s V 0.199, Cohen' Kappa -0.014, p=0.077) but scores tended to yield similar outcomes more frequently when clinical appereance shifted to equivoqual (Cramér’s V 0.180, Cohen’ Kappa 0.022, p=0.190).

Conclusion

When comparing the PIR tool and the KP-EOSC tool, the PIR tool looks less specific but has an overall good sensitivity in identifying children with neonatal sepsis. In this pilot study, it appears that neonatal risk stratification can be done based on several scores, while the need for a computer and/or clinician might limit the KP-EOSC tool in certain circumstances. Additional studies are warranted to validate these findings.

Public Health Impact of Implementing the 20-valent Pneumococcal Conjugate Vaccine for Routine Paediatric Vaccination in Belgium

2026-01-20T16:00:59-05:00

Objective: In 2024, serotypes covered by 20-valent pneumococcal conjugate vaccine (PCV20) were among the most prevalent in invasive pneumococcal disease (IPD) in Belgium. This study assessed the public health impact of implementing PCV20 into Belgium’s paediatric national immunization programme (NIP) over 10 years and foregone public health benefits delayed PCV20 implementation versus the current standard of care – 13-valent PCV (PCV13).

Methods: A Markov structure comprising of active disease, non-disease, and death states estimated IPD, inpatient- and outpatient-pneumonia, and otitis media (OM) cases and deaths for each vaccine over 1, 2, and 10 years. This population-based study considered a vaccinated cohort (<2 years), and unvaccinated cohorts benefiting from indirect effects. The base-case included only individuals aged <18 years. Several scenarios were tested including indirect effect exclusion and exploring serotype replacement.

Results: Over 10 years, PCV20 was estimated to prevent 185,512 more disease cases and 30 more deaths versus PCV13. Delaying PCV20 implementation by one year resulted in 8,141 disease cases that could have been prevented, more than doubling in second year. PCV20 health gain was reduced in scenarios without indirect effects or with serotype replacement, though PCV20 remained favoured in all scenarios.

Conclusions: Paediatric PCV20 implementation could have greater public health benefit in Belgium compared to PCV13 and a 2-year delay in PCV20 implementation could result in substantial foregone public health gains. A limitation of this study is that the base case did not account for serotype replacement due to limited evidence, although scenario analyses suggest that the overall conclusions are robust.

Children, Adolescents and ChatGPT: A Journey Fraught with Danger

2026-01-14T11:22:07-05:00

A significant minority of young people use ChatGPT, often on a regular basis, for emotional purposes in the broadest sense of the term: seeking life advice, seeking friendship, relief from emotional distress, sexual questions, etc. The mere existence of this dynamic, directed towards a machine, is already cause of concern.
Our field experience, as well as tests we conducted on ChatGPT without its knowledge, show that its response quality is unpredictable. Sometimes the responses are acceptable, even very acceptable, sometimes they are unhealthy, toxic and antisocial, spreading illusions about the reality of what a human relationship is... In the sexual domain, while some responses are valid, there is also a general libertarian atmosphere.
The risks for young people are high: loss of lucidity and confusion of ideas; encouragement of antisocial behaviour; addiction; increased feelings of insignificance and loneliness; despair and suicide.

Evolution of Pediatric Psychology in Flanders, Belgium: Historical Roots to Future Trends

2025-12-08T15:05:41-05:00

Pediatric psychology is a dynamic and evolving field that involves both clinical practice and scientific research. It addresses a broad spectrum of physical and psychological aspects related to children’s health, disease and development. This manuscript explores the evolution of pediatric psychology in Flanders, Belgium, by describing its historical development and investigating its current clinical practices through a review of existing literature, interviews and a survey of current practices. It highlights the growing recognition of psychological care within pediatric medicine and underscores the valuable contributions of pediatric psychologists, who are experienced and highly trained in psychological care. However, despite this recognition, pediatric psychology in Flanders has developed through decentralized, hospital-specific initiatives, resulting in variability in clinical practice. Fragmentation is further exacerbated by funding models that do not cover all pediatric conditions, a lack of formal coordination between hospitals and limited specialized training in the specific field of pediatric psychology. It is well proven that children with acute and chronic disease benefit from pediatric psychological care. Therefore, the provision of pediatric psychological services would benefit from coordinated efforts, inclusive funding models and increased collaboration across healthcare institutions, which would ensure more consistent, equitable and high-quality care for children with acute and chronic medical conditions in Flanders.

A Rare Myelodysplastic Neoplasm of Children: Childhood Myelodysplastic Syndrome with Low Blasts

2025-10-29T05:21:58-04:00

Myelodysplastic syndromes are rare in children, with refractory cytopenia of childhood (RCC) being the most common subtype. We present the case of a 22-month-old boy diagnosed with RCC, initially suspected of having recurrent infections. The child exhibited anemia, thrombocytopenia, leukocytosis, and splenomegaly, with a bone marrow aspiration revealing poor cellularity, dysplasia, and hematogones, but no blasts. Further analysis excluded hereditary and clonal leukemic abnormalities. Despite ongoing mild cytopenia, the child’s condition remained stable without transfusions, and hematopoietic stem cell transplantation was not recommended. This case highlights the diagnostic challenges of RCC and the importance of early detection for improved outcomes.

Case Report of Dual Diagnosis of Chronic Intervillositis and Helsmoortel-Van der Aa Syndrome in an Infant with Intrauterine Growth Restriction and Premature Birth

2025-09-11T10:42:09-04:00

Chronic intervillositis of unknown etiology (CIUE) is a rare placental pathology associated with intrauterine growth restriction. Helsmoortel-Van der Aa syndrome (HVDAS) is a neurodevelopmental disorder caused by heterozygous mutations in the Activity-Dependent Neuroprotective Protein (ADNP) gene.

We describe an extreme preterm infant born due to CIUE, presenting with proportionate microcephaly, facial dysmorphism, failure to thrive, and neurodevelopmental delay. Whole-exome sequencing (WES) identified a pathogenic variant in the ADNP gene.

Our findings suggest that the dual diagnosis of CIUE and HVDAS contributed to the proband’s clinical presentation. This case highlights the importance of WES in evaluating complex neonatal phenotypes.

Pilomatrixoma: Variation in Presentation. Case Report

2025-10-21T06:46:50-04:00

A pilomatrixoma, or benign calcifying epithelioma of Malherbe, is a benign skin tumor that is usually found in the head and neck region. It primarily affects children and adults over 50 years of age and presents as a solitary pink-to-purple lesion less than 1cm. Clinical diagnosis is often straightforward and can be confirmed by a combination of ultrasound imaging and histopathological examination. However, variability in clinical presentation can complicate the diagnosis of pilomatrixoma. Here, we present two atypical cases in children that could easily lead to misdiagnosis. We discuss clinical presentation, diagnostic confirmation and treatment approaches.

The Use of Probiotics for Prevention of Late Onset Sepsis in Very Preterm or Very Low Birth Weight Infants: A Scoping Review

2026-01-25T11:01:32-05:00

Background: Neonatal late-onset sepsis (LOS) is a major cause of morbidity and mortality in very preterm and/or very low birth weight (VLBW) infants. Immaturity of the gut and immune system, together with microbial dysbiosis, increases susceptibility to bacterial translocation. Probiotics have been proposed as a preventive strategy, but evidence for their efficacy remains uncertain.

Objective: This scoping review aimed to collect and analyse existing information regarding the prophylactic effect of probiotics on the incidence of LOS in very preterm (gestational age (GA) <32 weeks) and/or VLBW infants (birth weight <1500 grams).

Design: A search was conducted on 06/08/2023 in the PubMed (Medline) database, yielding 1073 articles after deduplication. Randomised, double-blinded, and placebo-controlled, with a population consisting of very preterm and/or VLBW infants, and with incidence of LOS as primary or secondary outcome, were included. In total, twelve articles met the criteria.

Results: Three studies reported a significant reduction in LOS with probiotic supplementation. In one of these studies, this difference was observed only in the subgroup with GA ≥ 28 weeks. However, eight studies, including the one with the largest study population (N=1310), did not yield significant results, and one study did not provide results from statistical analysis.

Conclusion: Due to clinical and statistical heterogeneity, it is difficult to draw a conclusion about the efficacy of probiotics in preventing LOS in very preterm and/or VLBW infants. Additionally, no clear answer could be provided regarding the optimal probiotic strain, dosage, and duration of treatment. Further, more homogeneous research is needed.

Fertility after Treatment of Childhood Cancer: A Narrative Literature Review

2025-12-05T11:02:44-05:00

Advances in the treatment of childhood cancer have markedly improved survival rates over the past decades. Consequently, there is growing concern regarding the long-term effects of the different therapeutic modalities, including the potential for impaired fertility. This literature review summarizes current evidence on fertility outcome in childhood cancer survivors (CCS), focusing on the impact of chemotherapy, radiotherapy and immunotherapy. Fertility outcome in CCS is influenced by age at diagnosis and treatment modality, with the highest infertility rates observed in patients treated with high cumulative doses of alkylating agents and/or abdominal/pelvic radiotherapy. This review also emphasizes the importance of early counselling on infertility risk and fertility preservation methods as an essential component of comprehensive cancer care.

Exposure to Plasticizers in the Neonatal Intensive Care Unit: A Case of Primum Non Nocere

2025-12-14T14:01:12-05:00

Preventing Early-life Exposure to Endocrine Disrupting Chemicals: Rationale and Design of the Belgian National Awareness Campaign

2026-01-27T09:25:31-05:00

Sowing the Seeds of Change: An Experience From Intensive Care Green Teams

2026-03-06T08:46:57-05:00

Introduction

Our health care system are huge contributors to the climate crisis. Several medical societies have recommended implementing green teams to increase practical sustainability projects and awareness.

Action and Aim

Both in Amsterdam University Medical Centre (AUMC) and University Hospital Antwerp (UZA) green teams were started by physicians and nurses. During the meetings ideas were shared and translated into projects.

Results

In both centres several projects were initiated; bedside sustainable skin products for children, increased duration of iv-line use, decrease of pharmaceutical spilling and ICU based waste sorting. Ideas were difficult to implement due to lack of hospital structures and lack of unit specific data. Other experts increasingly participated in the teams.

Lessons learned

Green teams are based on managing sustainability practices from a clinical perspective, although there are plenty of ideas, prioritizing and feasibility can be challenging. Also time and people are scarce and behavioural change in your own unit is difficult. It can be useful to identify several key members for a green team to improve efficiency and efficacy. The focus for sustainable medical societies should to stimulate the step from practical to evidence-based recommendations by supporting and publishing practical research.

In Tune with the Seasons

2026-04-23T12:17:59-04:00