Belgian Journal of Paediatrics

Systematic Review on the Gastrointestinal Microbiome in the Diagnosis and Treatment of Anorexia Nervosa

Emilie Mousson — 2026-10-26

Introduction:

Anorexia nervosa is a common eating disorder, with a lifetime prevalence of 0,8-6,3% in women and 0,1-0,3% in men. Recently, increasing literature has emerged on insights regarding the gastrointestinal microbiome in these patients. Scientific studies suggest a potential link between the composition of this microbiome and psychological traits such as body dissatisfaction, as well as the influence of this composition on weight evolution.

Objectives:

This systematic literature review aims to present the available information on the gastrointestinal microbiome in patients with anorexia nervosa. Based on these findings, future research may focus on potentially externally modulating the gastrointestinal microbiome to enhance treatment and/or weight gain.

Methodology:

The articles included in this literature review were obtained by consulting scientific databases (PubMed, Embase, CINAHL, and Google Scholar). Out of the 1.189 resulting articles, a selection procedure led to the inclusion of fourteen articles in this review.

Results:

This literature review shows that the gastrointestinal microbiome of patients with anorexia nervosa at the time of diagnosis exhibits reduced richness (Chao1 index, alpha diversity) and an altered composition (beta diversity) compared to healthy individuals. After treatment, alpha-diversity seems to be increased. The microbiome composition evolves but does not normalize after treatment. The altered microbiome composition appears to have significant implications regarding weight gain.

Conclusion:

This literature review highlights a clear deviation in both the composition and richness of the gastrointestinal microbiome in patients with anorexia nervosa compared to healthy individuals. External modulation of the microbiome offers a potential complementary therapeutic approach for these patients.

Efficacy and Safety of Therapeutic Options in Children and Adolescents With Persistent or Chronic Primary Immune Thrombocytopenia: A Systematic Review

Emma Van Den Dorpe — 2026-10-26

Background

Currently, there is no consensus on the treatment of persistent and chronic primary immune thrombocytopenia (ITP) in children. This systematic review evaluates the safety and efficacy of current therapeutic options.

Methods

A comprehensive literature search was performed across MEDLINE/PubMed, Elsevier databases (EMBASE, Scopus), Web of Science (WoS; core collection), and Cochrane (CENTRAL). We included articles published between 1995 and 2026, reporting on safety and/or efficacy of therapies in children and adolescents (<18 years) with persistent or chronic primary ITP.

Results

Ninety-four studies were included. Watchful waiting resulted in a complete remission rate of 14-76%. Of note, thrombopoietin receptor agonists demonstrated the best efficacy/safety balance: acceptable and durable response rates (40-78%) with favourable safety profiles. Splenectomy also yields high complete response rates, but carries a risk of life-threatening complications. Besides, rituximab, sirolimus and mycophenolate mofetil show good efficacy but safety data are scarce. In contrast, first-line therapies (corticosteroids, IVIG and anti-D) provide only short-term benefit whereas cyclosporine A, dapsone and interferon-alpha demonstrate inconsistent efficacy in addition to relevant side effects.

Conclusion

The choice of therapeutic options in paediatric persistent and chronic ITP is extensive. While watchful waiting may be appropriate for many patients, thrombopoietin receptor agonists emerge as the preferred option when pharmacological treatment is indicated. Long-term safety evaluation and comparative studies focusing on patient-centred outcomes remain warranted.

Quality Assessment of the Collaboration and Experiences of General Practitioners and Allied Healthcare Providers Supported by a Liaison Team in Paediatric Palliative Care: A Single-centre Survey

Kato Dens — 2026-10-26

Background: Paediatric palliative care is a holistic approach to the care for children with life-limiting or life-threatening conditions and involves collaboration among general practitioners, home care nurses, and physiotherapists. However, many of these healthcare providers lack experience in paediatric palliative care. In our centre, this care is coordinated by the liaison team KITES.
Aim: To evaluate the quality of collaboration between primary healthcare providers and KITES, and to identify perceived needs and opportunities for improvement.
Design: A cross-sectional survey study using a validated questionnaire.
Setting/participants: General practitioners, home care nurses, and physiotherapists who provided palliative care to a child (< 18 years) in collaboration with the palliative liaison team KITES in the past three years.
Results: Response rate was 38%. Overall, only 3% had received training in paediatric palliative care. Almost all health care providers considered symptom control and emotional support very important. Bereavement care was more important for general practitioners than for allied health care providers. Support provided by KITES was mainly focused on symptom management and organization and coordination of care. Psychological support provided was more constrained. Collaboration and communication between general practitioners, nurses and KITES was well-established, while contact with the treating paediatrician was limited.
Conclusions: Health care providers lack training in paediatric palliative care. Support by the liaison team focused mainly on symptoms and organization of care. The psychological support provided by the liaison team and the involvement of the treating paediatrician could be improved.

Bridging the Gap: A Survey of Emergency Staff Perspectives on Paediatric Pain Management

Saar Borloo — 2026-10-26

Background

Paediatric pain is a common reason for emergency department (ED) presentation, yet pain assessment and management remain inconsistent despite the availability of evidence-based interventions. Limited data exist on clinicians’ perspectives regarding barriers to optimal paediatric pain care.

Methods

We conducted a monocentric cross-sectional survey among physicians and nurses working in a tertiary-care ED. The questionnaire assessed paediatric pain assessment practices, pharmacological and non-pharmacological management, procedural analgesia, clinician confidence, and perceived barriers. Quantitative data were analysed descriptively and by subgroup comparison.

Results

Of 225 eligible staff members, 108 responded (48% response rate), and 87 completed questionnaires were included (38.7% inclusion rate). While 91% of respondents reported routinely assessing pain at presentation, only 18% consistently reassessed pain after interventions or procedures. Familiarity with paediatric-specific pain scales was limited, with only 10% and 7% reporting use of the Wong–Baker FACES and FLACC scales, respectively. Only 16% of participants reported high confidence in paediatric analgesic administration, whereas lack of formal training was identified as the most important barrier (47%). Procedural pain management showed substantial variability; 52% of respondents reported no analgesia or anxiolysis during bladder catheterization, and 46% reported none during cast application. Non-pharmacological interventions, particularly distraction techniques, were widely used and perceived as effective. Most participants emphasized the need for improved training and standardized protocols.

Conclusion

Significant gaps persist in paediatric pain reassessment, clinician confidence, and procedural pain management in the ED. Standardized protocols, targeted education, and multimodal approaches may improve guideline-concordant and child-centred paediatric pain care.

Evolution of Cerebral Palsy Diagnosis in a High-Risk Neonatal Population: A Cohort Study over Two Decades

Ruth Demerre — 2026-10-26

Background: Early diagnosis of cerebral palsy (CP) enables timely intervention and improved outcomes. International guidelines recommend standardized tools such as magnetic resonance imaging (MRI), the Hammersmith Infant Neurological Examination (HINE), and the Prechtl General Movements Assessment (GMs). In Belgium, a structured and reimbursed neonatal follow-up program for preterm infants (prematurity convention) was introduced in 2012. This study evaluated how the diagnostic process of CP has evolved in this context.

Methods: We conducted a retrospective cohort study including children with CP admitted to the Neonatal Intensive Care Unit of University Hospitals Leuven. Two birth cohorts were compared: pre-implementation (2006-2010) and post-implementation (2016-2020). Clinical and neurodevelopmental data were extracted from medical records. Primary outcomes were age at diagnosis and use of standardized tools. Secondary outcomes included timing of parental communication, referral to specialized care, and initiation of early interventions.

Results: Seventy-eight children were included (38 in 2006-2010; 40 in 2016-2020). Median age at diagnosis did not differ significantly between cohorts (12.0 vs. 10.5 months; p=0.564). Children with higher Gross Motor Function Classification System (GMFCS) levels were diagnosed earlier (p=0.003). The more recent cohort showed earlier communication of motor concerns, earlier referral, and earlier initiation of interventions such as constraint-induced movement therapy and home guidance.

Conclusions: Despite the introduction of structured follow-up, age at diagnosis did not decrease. However, diagnostic age was comparable to international programs with full guideline implementation. Improvements in communication, referral, and intervention timing were observed over time. Further integration of standardized tools may enhance early detection and outcomes.

Heated Cot Use during the First Postnatal Days in Term Neonates: A Multicentre Retrospective Observational Study

Liselot De Cloedt — 2026-10-26

Purpose: Maintaining normothermia is a key component of optimal neonatal care, as both hypothermia and hyperthermia are associated with increased morbidity and mortality across gestational ages. This study evaluated the relationship between the use of heated cot and thermal outcome during the first postnatal days.

Methods: This multicentre retrospective comparative study included healthy neonates (N= 1371) born at ≥36 weeks gestation and weighing >2.2 kg in two maternity units using different thermoregulatory protocols: heated cot care versus standard cot care. The primary outcome was normothermia; secondary outcomes included hypothermia and hyperthermia.

Results: Heated cot use was associated with significantly more normothermia (OR 1.48, 95% CI 1.28–1.72) and less hypothermia (OR 0.51, 95% CI 0.42–0.63), but significantly more hyperthermia (OR 1.72, 95% CI 1.28–2.31). These associations were time-dependent, as demonstrated by a significant interaction between heated cot use and postnatal age for normothermia and hypothermia. In neonates small for gestational age, heated cot use was associated with both higher odds of normothermia (OR 2.0, 95% CI 1.35–2.95) and lower odds of hypothermia (OR 0.42, 95% CI 0.26–0.67). Similar non-significant trends were observed with lower birthweight and gestational age.

Conclusion: Heated cot use was associated with more normothermia and less hypothermia, but also more hyperthermia. Routine use in all healthy neonates may not be warranted, although selected high-risk neonates may benefit.

Genomic Newborn Screening in Belgium: Opening the Debate of Public Health Evaluation

Valerie Jacquemin — 2026-10-26

Accumulating evidence from international and Belgian pilot studies suggests that genomic newborn screening has reached a level of maturity that now justifies structured evaluation within a public health framework. Recent international pilot studies, including large Belgian data, now provide evidence that first-tier or adjunct genomic screening is technically feasible, clinically informative, and highly acceptable to parents.

Belgium has played a leading role in this field. The BabyDetect program has shown that targeted next-generation sequencing can be implemented in a maternity setting with high parental uptake and a meaningful added diagnostic yield beyond conventional screening. At the same time, the rapid development of international programs has exposed major unresolved questions regarding gene selection, variant interpretation, health-economic evaluation, data governance, and equitable access.

In this Insight, we argue that the debate should now move beyond whether gNBS is technically possible and instead focus on how it can be evaluated and governed responsibly within the Belgian healthcare system. We review the current evidence, highlight the specific Belgian contribution, and outline the principal challenges that must be addressed before broader public implementation can be responsibly considered.

Paediatric Pharmacotherapy for Common Obesity: Position Statement of a Tertiary Multidisciplinary Paediatric Rehabilitation Centre for Chronic Diseases

Silke Stalpaert — 2026-10-26

The dramatic prevalence of paediatric obesity demands innovative, evidence-based approaches that go beyond lifestyle interventions alone. This position paper presents the rationale and framework for integrating obesity management medication (OMM) into our tertiary paediatric rehabilitation care, with a particular focus on Glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Drawing on the latest high-quality meta-analyses, real-world data, and clinical observations, we explore the efficacy, safety, metabolic, functional and quality of life implications of pharmacologic therapy. We advocate for an equitable access to the medications within specialized centres.

Impacts of Antenatal Exposure to a Mixture of Endocrine Disruptors on Cognitive and Neuromotor Functions in Preschool Children

Christophe Barrea — 2026-10-26

Congenital Erosive and Vesicular Dermatosis (CEVD): A Rare Case and Review of the Literature

Paulien Driesen — 2026-10-26

Congenital erosive and vesicular dermatosis (CEVD) is a rare neonatal dermatosis characterized by erosive and vesicular lesions that develop at or shortly after birth and heal with reticulated scarring. The presented case highlights a localized erosive-vesicular eruption followed by cribriform scarring, clinically suggestive of CEVD. Recognition of the CEVD phenotype is important while maintaining a broad differential diagnosis that includes congenital infections, trauma, anetoderma of prematurity, and inherited blistering disorders.

An Obstructing Ileal Duplication Cyst Masked by Campylobacter Gastroenteritis: a Rare Case Report

Giliam March — 2026-10-26

Enteric duplication cysts are rare congenital anomalies. We report an 8-month-old girl presenting with symptoms of acute gastroenteritis and a stool PCR positive for Campylobacter. Clinical deterioration prompted additional imaging, revealing mechanical small bowel obstruction caused by a thick-walled pelvic structure. Subsequent explorative laparoscopy uncovered an ileal enteric duplication cyst. A segmental ileal resection was performed, and histopathology confirmed the diagnosis. The patient recovered uneventfully and was discharged on day 10.

This case highlights the diagnostic challenge posed by the coexistence of infectious gastroenteritis and surgical pathology, emphasizing the need for clinical reassessment and a low threshold for further investigations.

Cervical Dystonia as an Underrecognised Feature of Gaucher Disease Type 3

David Aktan — 2026-10-26

Cervical dystonia is an uncommon but significant manifestation of Gaucher disease type 3, where abnormal neck postures are often reported without detailed characterisation. We describe two brothers with genetically confirmed disease who developed severe retrocaput in early childhood, causing major gait, balance, and social difficulties. Both showed typical neurological signs, including supranuclear gaze palsy, parkinsonian features, and pyramidal involvement; one also had juvenile myoclonic epilepsy. Due to severe dystonia, botulinum toxin injections were performed under ultrasound and electromyography guidance with light sedation. Both improved clearly and durably, underscoring the need to recognise treatable dystonia in this condition.

Isolated Foetal Ascites Associated with a Urachal Cyst and Posterior Urethral Valves: A Case Report and Literature Review

Hayat El Kaddouri — 2026-10-26

Background

Prenatal detection of isolated ascites in combination with an abdominal cyst poses a diagnostic challenge. The diagnosis of urachal remnants may be particularly difficult, as imaging findings can mimic other urinary tract anomalies. Furthermore, their rarity has resulted in a lack of clear evidence-based management guidelines.

Methods

A literature review was conducted to understand this clinical presentation. The Medline database (PubMed) was searched using the MeSH terms “Ascites/congenital,” “Urachal Cyst,” and “Urethral Obstruction/congenital.” A total of 979 publications were screened.

Results

Urachal cysts are rare embryological remnants that are often asymptomatic and may regress spontaneously, supporting conservative management in selected paediatric cases. In contrast, posterior urethral valves require prompt diagnosis using voiding cystourethrography, followed by valve ablation. Long-term follow-up of these patients is essential, as up to 20% of affected patients may progress to end-stage renal disease.

Discussion

Early recognition of this rare combination of findings may facilitate timely diagnosis of posterior urethral valves and guide appropriate postnatal management. In this case, the urachal cyst may have acted as a pressure-relieving “pop-off” mechanism. This might explain the absence of hydronephrosis and could have potentially protected the renal function. Clinical follow-up will be necessary to determine whether this presumed pressure-relief mechanism translates into a more favourable long-term renal prognosis.

Newborn Screening

François Eyskens — 2026-10-26

Paracetamol Syrups and Propylene Glycol Exposure in Children: A Reflection on the Current Belgian Context

Karel Allegaert — 2026-10-26

Dafalgan Pédiatrique/Dafalgan Kind recently adapted its syrup. This new formulation contains propylene glycol as excipient, as mentioned in the product information in accordance with the European Commission guideline (> 1 mg/kg/day in neonates). The guideline’s thresholds relate to the specific information that should appear in the package leaflet, not similar to safety thresholds. There is a 28-fold difference in propylene glycol exposure between both currently marketed products (Dafalgan versus Perdolan, 7 versus 293.5 mg/kg/day), so that there is an opportunity to limit exposure below clinical relevance, without full avoidance. The current knowledge on propylene glycol in children is summarized.

The Silent Troublemakers…Disruptors !

Christophe Chantrain — 2026-10-27

Minutes of the General Assembly, 20 March 2026

Stephane Moniotte — 2026-10-26