Diagnostic accuracy of fibrosis tests in children with non-alcoholic fatty liver disease: A systematic review.

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in children. Even at young age, it can progress to liver fibrosis. Given the drawbacks of liver biopsy, there is a need for non-invasive methods to accurately stage liver fibrosis in this age group. In this systematic review, we evaluate the diagnostic accuracy of non-invasive methods for staging liver fibrosis in children with NAFLD. METHODS: We searched MEDLINE, Embase, Web of Science and the Cochrane Library, for studies that evaluated the performance of a blood-based biomarker, prediction score or imaging technique in staging liver fibrosis in children with NAFLD, using liver biopsy as the reference standard. RESULTS: Twenty studies with a total of 1787 NAFLD subjects were included, which evaluated three prediction scores, five simple biomarkers, two combined biomarkers and six imaging techniques. Most studies lacked validation. Substantial heterogeneity of studies and limited available study data precluded a meta-analysis of the few fibrosis tests evaluated in more than one study. The most consistent accuracy data were found for transient elastography by FibroScan®, ELF test and ultrasound elastography, with an area under the receiver operating characteristics curve varying between 0.92 and 1.00 for detecting significant fibrosis. CONCLUSION: Due to the lack of validation, the accuracy and clinical utility of non-invasive fibrosis tests in children with NAFLD remains uncertain. As studies have solely been performed in tertiary care settings, accuracy data cannot directly be translated to screening populations.

Safety of Rapid Infliximab Infusions in Children: A Systematic Review.

OBJECTIVES: The aim of the study was to assess whether the incidence of infusion reactions (IR) increases after rapid (≤1 hour) infliximab (IFX) infusions, compared with standard (2-3 hour) infusions in children. METHODS: Systematic review including studies describing the number of IR after rapid IFX infusion in children ages 0 to 18 years. RESULTS: Four records were included (3 retrospective, n = 498, 347 standard infusions, 3703 rapid infusions). Reported incidences of IR ranged from 0% to 2% of infusions in standard groups (reported 95% confidence intervals [CIs] ranged from 0% to 7%) and from 0% to 2% of infusions in rapid groups (reported 95% CIs ranged from 0% to 12%). None of the studies included reported a significant difference in incidence of IR between the 2 groups. CONCLUSIONS: There is insufficient evidence to conclude whether the rate of IR after rapid IFX increases. The consistent finding of no increase in IR in all studies and the low rate of observed IR suggests there is no significant difference in rate of IR.

[Intoxication of a child by an oral nicotine pouch]. / Intoxicatie van een kind door een nicotinezakje.

BACKGROUND: Oral nicotine pouches are pouches that contain varying amounts of nicotine. The use of nicotine pouches by adolescents has increased since 2020. Subsequently, there has been an increase in the amount of reports of nicotine intoxications. Acute nicotine intoxications have a biphasic clinical course, during which the initial symptoms may include agitation, tachycardia and vomiting. When large enough doses are used more serious symptoms may emerge. As well as the acute side effects, studies have shown that the use of oral nicotine pouches with tobacco is associated with a younger age at which cigarette smoking is initiated. PATIENT DESCRIPTION: A 9 year-old boy presented at the Emergency Department with symptoms of nausea, dizziness and shivering following the oral use of one nicotine pouch. Aside from tachycardia the physical examinations showed no abnormalities. The patient was diagnosed with an acute nicotine intoxication and was admitted to the paediatric department for 24 hours. CONCLUSION: Oral nicotine pouches are commonly used by adolescents. Aside from the addictive nature of nicotine, it is important that clinicians are aware of the symptoms of acute and late-phase intoxications.