Pediatric Review 3/2026

RECOMMENDATIONS

Myocarditis in Children—A Practical Approach to Diagnosis and Treatment According to the Latest 2025 Guidelines from the European Society of Cardiology

Myocarditis in Children: A Practical Perspective on Diagnosis and Treatment According to the Latest 2025 Guidelines of the European Society of Cardiology

Lidia Ziółkowska

Pediatr Rev 2026; 55 (3): 5-16

DOI: 10.26625/10259

SUMMARY

Myocarditis in children is a heterogeneous inflammatory disease of the heart muscle with a wide range of clinical presentations—from mild symptoms to severe heart failure, life-threatening arrhythmias, and sudden cardiac death. According to the 2025 guidelines of the European Society of Cardiology (ESC), diagnosis is based on a comprehensive clinical evaluation, including medical history, physical examination, measurement of biomarkers of myocardial injury, electrocardiography, echocardiography, and cardiac magnetic resonance imaging, which remains the primary method for the noninvasive diagnosis of ZMS. In selected cases, particularly in severe disease, deteriorating cardiac function, or when a specific etiology is suspected, an endomyocardial biopsy is recommended to confirm the diagnosis and identify the cause of the inflammation. Treatment of children with ZMS should be individualized and based on the clinical presentation and etiology of the condition. The foundation of treatment is management of heart failure in accordance with current standards, as well as monitoring and treatment of arrhythmias. In cases of fulminant ZMS, temporary mechanical circulatory support may be necessary. Immunosuppressive therapy is recommended only for specific forms of the disease confirmed by histopathological diagnosis; however, the routine use of immunosuppression is not recommended. The guidelines also emphasize the importance of limiting physical activity for at least 3–6 months and the need for long-term cardiological follow-up. Early diagnosis, the use of modern imaging methods, and a multidisciplinary therapeutic approach remain the most important factors in improving the prognosis for children with myocarditis.

Keywords: myocarditis , multimodal diagnosis, cardiac magnetic resonance imaging, treatment, children

ABSTRACT

Myocarditis in children is a heterogeneous inflammatory disease of the myocardium characterized by a broad clinical spectrum, ranging from mild symptoms to severe heart failure, life-threatening arrhythmias, and sudden cardiac death. According to the 2025 European Society of Cardiology (ESC) Guidelines, the diagnosis is based on a comprehensive clinical assessment, including medical history, physical examination, measurement of biomarkers of myocardial injury, electrocardiography, echocardiography, and cardiac magnetic resonance imaging, which remains the cornerstone of non-invasive diagnostic evaluation. In selected cases, particularly in patients with severe disease, worsening cardiac function, or suspected specific etiologies, endomyocardial biopsy is recommended to confirm the diagnosis and identify the underlying cause of myocardial inflammation. The management of pediatric myocarditis should be individualized and tailored to the clinical presentation and etiology of the disease. Standard heart failure therapy, in accordance with current guidelines, along with monitoring and treatment of cardiac arrhythmias, forms the foundation of management. In cases of fulminant myocarditis, temporary mechanical circulatory support may be required. Immunosuppressive therapy is recommended only for selected histopathologically confirmed forms of myocarditis; routine use of immunosuppression is not advised. The guidelines also emphasize the importance of restricting physical activity for at least 3 to 6 months and the need for long-term cardiology follow-up. Early diagnosis, the use of advanced cardiac imaging modalities, and a multidisciplinary therapeutic approach remain key determinants of improved outcomes in children with myocarditis.

Key words: myocarditis , multimodal diagnostics, cardiac magnetic resonance imaging, treatment, children

 

Patients with asplenia or hyposplenism—current strategies for preventing infections

Contemporary Strategies for Infection Prevention in Patients with Asplenia or Hyposplenism

Bożena Mikołuć, Małgorzata Pac, Ewa Bernatowska, Piotr Kosiorek, Elżbieta Berdej-Szczot, Rafał Becht, Anna Duliban-Wojnar, Elżbieta Grześk, Ewelina Grywalska, Aleksandra Lewandowicz-Uszyńska, Agnieszka Stelmach-Gołdyś, Hanna Suchanek, Joanna Sulicka-Grodzicka, Aleksandra Szczawińska-Popłonyk, Krzysztof Zeman, Jacek Roliński, Teresa Jackowska, Sylwia Kołtan

Pediatr Rev 2026; 55 (3): 18-35

DOI: 10.26625/10260

SUMMARY

Asplenia and hyposplenism, whether congenital or acquired, significantly increase the risk of severe, potentially fatal infections, especially those caused by encapsulated bacteria. Congenital asplenia may occur as an isolated defect or as part of genetic syndromes, whereas hyposplenism most often develops secondary to hematologic, autoimmune, or inflammatory diseases, or following splenectomy. Impaired spleen function leads to disturbances in humoral and phagocytic immunity and increases the risk ofoverwhelming post-splenectomy infection (OPSI ).

Infection prevention is based on vaccinations, antibiotic prophylaxis, and patient education. Early initiation of vaccination and appropriately selected antibiotic prophylaxis significantly reduce morbidity and mortality and are an essential component of long-term care for patients with asplenia and hyposplenism.

Keywords: asplenia , hyposplenism, prevention, vaccinations, education

ABSTRACT

Asplenia and hyposplenism, whether congenital or acquired, are associated with a markedly increased risk of severe and potentially life-threatening infections, particularly those caused by encapsulated bacteria. Congenital asplenia may occur as an isolated developmental defect or as part of genetic syndromes, whereas hyposplenism most commonly develops secondary to hematological, autoimmune, or inflammatory diseases, or following splenectomy. Impaired splenic function results in defective humoral and phagocytic immunity and predisposes patients to overwhelming post-splenectomy infection (OPSI).

Infection prevention rests on three key pillars: appropriate vaccination, antibiotic prophylaxis, and patient education. Early implementation of recommended immunizations and tailored antibiotic prophylaxis significantly reduce infection-related morbidity and mortality and constitute a cornerstone of long-term care for patients with asplenia and hyposplenism.

Key words: asplenia , hyposplenism, prevention, vaccination, education

 

 

REVIEW ARTICLES

Dental Care for Children with Congenital Heart Defects—Current Guidelines for the Prevention of Infective Endocarditis and a Model for Interdisciplinary Care

Dental Care for Children with Congenital Heart Disease: Current Recommendations for the Prevention of Infective Endocarditis and an Interdisciplinary Model of Care

Agata Drozd, Michał Kwiatkowski, Martyna Narloch, Aida Kusiak, Joanna Kwiatkowska

Pediatr Rev 2026; 55 (3): 37-42

DOI: 10.26625/10261

SUMMARY

Introduction. Congenital heart defects (CHD) constitute the most common group of developmental abnormalities in children and are among the most important risk factors for the development of infective endocarditis (IE). Advances in diagnosis, cardiac surgery, and cardiological care have significantly improved patient survival rates, making long-term prevention of complications increasingly important. Maintaining good oral health and proper planning of dental treatment are essential components of comprehensive care for children with CHD.

Purpose of the study. Presentation of current recommendations regarding the prevention of infective endocarditis in children with congenital heart defects; discussion of the principles of safe dental treatment, including management of patients with implantable cardiac electronic devices (CIED), and a presentation of an organizational model for interdisciplinary care.

Materials and Methods. A narrative review was conducted of the current guidelines of the American Heart Association (AHA, 2021), the European Society of Cardiology (ESC, 2023), and the available literature on the prevention of IZW, dental treatment of children with WWS, and the safety of procedures using ultrasonic devices in patients with CIED.

Results. Current recommendations indicate that antibiotic prophylaxis prior to dental procedures should be limited to patients at the highest risk for dental-related infections. However, systematic dental care, effective control of infection foci, and maintaining proper oral hygiene are of paramount importance. Procedures using piezoelectric scalers canbe safely performed on most patients with CIED, provided that appropriate precautions are taken. Effective care for a child with CHD requires close collaboration between a pediatric cardiologist, a dentist, and a primary care physician.

Conclusions. Prevention of infective endocarditis in children with WWS is based primarily on maintaining good oral health and conducting individualized risk assessments. An interdisciplinary care model and adherence to current guidelines enable safe dental treatment and reduce the risk of infectious complications.

Keywords: congenital heart defects, infective endocarditis, antibiotic prophylaxis, pediatric dentistry, oral health

ABSTRACT

Background. Congenital heart disease (CHD) is the most common congenital anomaly and one of the major risk factors for infective endocarditis (IE). Advances in pediatric cardiology and cardiac surgery have substantially improved long-term survival, making the long-term prevention of complications all the more important. Maintaining good oral health and appropriate dental care are essential components of comprehensive care for children with CHD.

Objective. To summarize current recommendations for the prevention of infective endocarditis in children with congenital heart disease, discuss safe dental care—including for patients with cardiovascular implantable electronic devices (CIEDs)—and present an interdisciplinary model of care.

Materials and Methods. A narrative review was conducted based on the latest guidelines from the American Heart Association (2021) and the European Society of Cardiology (2023), supplemented by recent literature on the prevention of infective endocarditis, pediatric dental care, and the safety of dental procedures in patients with CIED.

Results. Current guidelines recommend antibiotic prophylaxis only for patients at the highest risk of infective endocarditis who are undergoing selected invasive dental procedures. Greater emphasis is placed on maintaining good oral hygiene, effectively controlling sources of oral infection, and receiving regular preventive dental care. Piezoelectric ultrasonic scaling is considered safe in most patients with CIED when appropriate precautions are taken. Effective care requires close collaboration between pediatric cardiologists, dentists, and primary care physicians.

Conclusions. Prevention of infective endocarditis in children with congenital heart disease (CHD) should primarily focus on maintaining good oral health and conducting individualized risk assessments. An interdisciplinary model of care and adherence to current guidelines enable safe dental treatment while minimizing the risk of infectious complications.

Key words: congenital heart defects, infective endocarditis, antibiotic prophylaxis, pediatric dentistry, oral health

 

The Impact of Pacifier Use on Infant Health and Development—Current Evidence and Recommendations

The Impact of Pacifier Use on Infant Health and Development: Current State of Knowledge and Recommendations

Katarzyna Parcińska, Magdalena Chazan, Dominika Lewandowska, Katarzyna Otrębska

Pediatr Rev 2026; 55 (3): 43-49

DOI: 10.26625/10262

SUMMARY

A pacifier is one of the most commonly used accessories in the care of infants and young children. Its function is based on the physiological mechanism of non-nutritive sucking, which plays a significant role in emotional regulation, soothing the child, and supporting adaptive processes during the first months of life. Despite its widespread use, the impact of the pacifier on a child’s health and development remains the subject of numerous discussions in the scientific literature.

The purpose of this study is to present the current state of knowledge regarding the benefits and possible adverse effects associated with pacifier use in infants and young children. This paper reviews scientific studies on the impact of pacifier use on the risk of sudden infant death syndrome (SIDS), the incidence of acute otitis media, the development of malocclusions, the course and duration of breastfeeding, speech development, pain relief in infants, and supporting the development of preterm infants.

An analysis of the available literature indicates that pacifier use may have both benefits and health risks. The most important benefits include a calming effect, a reduced risk of SIDS, effective pain relief during medical procedures, and support for the development of oral-motor functions in preterm infants. Prolonged and intensive pacifier use may be associated with an increased risk of recurrent otitis media, the development of malocclusions, and a potential impact on speech development.

In summary, the impact of a pacifier on a child’s health is multifaceted and depends primarily on the child’s age, as well as the duration and frequency of its use. Proper parental education and individualized clinical management allow for the safe and informed use of this tool in child care.

Keywords: pacifiers , non-nutritive sucking, infants, malocclusion, breastfeeding

ABSTRACT

Pacifiers are widely used in the care of infants and young children worldwide. Their effect is based on non-nutritive sucking, a physiological mechanism that plays an important role in emotional regulation, soothing, and supporting early developmental adaptation. Despite their widespread use, the impact of pacifiers on infant health and development remains a topic of ongoing debate in the scientific literature.

The aim of this paper is to present the current evidence regarding the benefits and potential adverse effects associated with pacifier use in infants and young children. The study reviews scientific literature addressing the relationship between pacifier use and several health outcomes, including the risk of sudden infant death syndrome (SIDS), acute otitis media, the development of malocclusion, the duration and success of breastfeeding, speech and language development, pain relief during medical procedures, and feeding progression in preterm infants.

The analysis indicates that pacifier use may offer several benefits, such as a calming effect, a reduced risk of SIDS, effective pain relief during minor medical procedures, and improved oral-motor development in preterm infants. However, prolonged and frequent pacifier use has been associated with an increased risk of recurrent otitis media, dental malocclusions, and possible effects on language development.

In conclusion, the effects of pacifier use are influenced by multiple factors and depend largely on the child’s age, as well as the duration and intensity of use. Appropriate parental education and individualized clinical guidance are essential for safe and informed pacifier use in infant care.

Key words: pacifiers , non-nutritive sucking, infants, dental malocclusions, breastfeeding

 

 

Epidemiology and Management of Zygzag Viper Bites

Epidemiology and Algorithm for the Management of a Common European Adder Bite

Aleksandra Kamińska, Grzegorz Nazar

Pediatr Rev 2026; 55 (3): 52-56

DOI: 10.26625/10263

SUMMARY

The common European adder (Vipera berus) is the only species of venomous snake found naturally in Poland and is responsible for the vast majority of native snakebite cases. Although most bites are mild or moderate and have a good prognosis, some patients—especially children and those with severe systemic symptoms—may develop severe envenomation requiring intensive treatment. The venom of V. berus is a complex mixture of enzymatic and non-enzymatic toxins, including phospholipase A₂, metalloproteinases, serine proteases, and hyaluronidase, which exhibit cytotoxic, proteolytic, and pro-inflammatory effects, leading to tissue damage, edema, bleeding, and hemostatic disorders. Prehospital management includes limiting physical activity, immobilizing the bitten limb, avoiding ineffective first-aid methods, and urgently transporting the patient to the hospital. In-hospital treatment is primarily based on monitoring the clinical condition, symptomatic treatment, and the administration of a specific antitoxin in patients with progressive local or systemic symptoms. Early diagnosis of severe poisoning and the implementation of appropriate management in accordance with current guidelines significantly improve the prognosis and reduce the risk of complications.

Keywords: Vipera berus, common viper, snake bite, venom poisoning, antivenom, emergency medicine, Poland

ABSTRACT

Vipera berus ( the common European adder) is the only venomous snake native to Poland and is responsible for nearly all indigenous snakebite envenomations. Although most bites result in mild to moderate local symptoms and have a favorable prognosis, severe systemic complications may occur, particularly in children and susceptible individuals. The venom contains a complex mixture of enzymatic and non-enzymatic toxins, including phospholipases A₂, metalloproteinases, serine proteases, and hyaluronidases, which induce cytotoxic, proteolytic, and pro-inflammatory effects leading to tissue damage, edema, hemorrhage, and coagulation disturbances. Appropriate first aid consists of limiting physical activity, immobilizing the affected limb, avoiding harmful interventions such as tourniquets or wound incision, and ensuring prompt transport to the hospital for observation and further evaluation. Hospital management is primarily supportive and includes clinical monitoring, laboratory assessment, symptomatic treatment, and administration of antivenom in patients with progressive local swelling or systemic manifestations of envenomation. Early recognition of severe envenomation and timely initiation of appropriate therapy are essential for optimizing clinical outcomes.

Key words: Vipera berus, snakebite, envenomation, venom, antivenom, emergency medicine, Poland

 

HLH-2024 – Current Diagnostic Criteria for Hemophagocytic Lymphohistiocytosis

HLH-2024 – Current Diagnostic Criteria for Hemophagocytic Lymphohistiocytosis

Magdalena Wołowiec, Iwona Malinowska, Paweł Łaguna

Pediatr Rev 2026; 55 (3): 57-62

DOI: 10.26625/10264

SUMMARY

Both the primary and secondary forms of hemophagocytic lymphohistiocytosis (HLH) are diseases with a dynamic course and a poor prognosis. Rapid establishment of an accurate diagnosis and initiation of treatment are essential for the patient’s survival. The proposed new diagnostic criteria for the disease are well-grounded in clinical practice, and the suggested strategy for functional and genetic testing serves as a helpful diagnostic tool in patients with suspected HLH.

Keywords: HLH , diagnostic criteria, genetic testing, lymphocyte function tests, cytotoxicity

ABSTRACT

Both primary and secondary forms of hemophagocytic lymphohistiocytosis (HLH) are diseases with a dynamic course and a serious prognosis. Rapid establishment of the correct diagnosis and initiation of treatment are crucial for the patient’s survival. The proposed new diagnostic criteria for the disease are well-supported by clinical practice, and the suggested strategy of functional and genetic testing serves as a helpful diagnostic tool for patients suspected of having HLH.

Key words: HLH , diagnostic criteria, genetic diagnostics, functional lymphocyte assays, cytotoxicity

 

Rice protein hydrolysates in dietary management for children with cow’s milk protein allergy

Formulas containing hydrolyzed rice proteins in the dietary management of children with cow’s milk protein allergy

Julia Tworowska, Mieczysława Czerwionka-Szaflarska

Pediatr Rev 2026; 55 (3): 64-68

DOI: 10.26625/10265

SUMMARY

Cow’s milk protein allergy (CMPA) is one of the most common food allergies in infancy. The cornerstone of treatment remains an elimination diet using an appropriate milk substitute. In recent years, rice protein hydrolysates (RPH) have attracted increasing interest as an alternative to cow’s milk protein hydrolysates. RPHs are foods for special medical purposes, free of cow’s milk proteins and appropriately supplemented with exogenous amino acids. Available clinical studies indicate that RPHs are well tolerated by most children with both IgE-mediated and IgE-independent CMPA, facilitate the resolution of clinical symptoms, and ensure normal growth. Current guidelines from ESPGHAN, EAACI, and DRACMA recognize HRFs as one of the possible dietary management options for children with ABMK. HRFs may be of particular practical importance for children who dislike the taste of milk hydrolysates and in families who prefer plant-based formulas. Safety data on rice-based formulas indicate that inorganic arsenic levels in available products fall within current safety standards. Rice protein hydrolysates are an effective and safe alternative to cow’s milk protein hydrolysates for most children with mild to moderate forms of ABMK. However, it remains necessary to tailor treatment to the individual and to continue collecting data on the use of rice protein hydrolysates in more severe forms of the disease.

Keywords: cow’s milk protein allergy , rice protein hydrolysate, infant nutrition, elimination diet, food allergy

ABSTRACT

Cow’s milk protein allergy (CMPA) is one of the most common food allergies in infancy. Dietary elimination combined with the use of an appropriate substitute formula remains the cornerstone of treatment. In recent years, hydrolyzed rice protein formulas (HRF) have emerged as an alternative to extensively hydrolyzed cow’s milk formulas. HRF are food products for special medical purposes, free of cow’s milk proteins and supplemented with essential amino acids. Available clinical studies indicate that HRF are well tolerated in most children with both IgE-mediated and non-IgE-mediated CMPA, contribute to symptom improvement, and support normal growth. Current guidelines recognize HRF as one of the possible dietary management options for children with CMPA. HRF may be particularly useful for children who refuse extensively hydrolyzed milk formulas due to taste or smell, as well as for families who prefer plant-based dietary options. Current safety data indicate that inorganic arsenic levels in commercially available HRF remain within accepted safety limits.

Key words: cow’s milk protein allergy, hydrolyzed rice formula, infant nutrition, elimination diet, food allergy

 

 

M-CHAT-R/F (Modified Autism Screening Questionnaire for the Post-Infant Period) as Part of the 2-Year-Old Checkup—A Practical Guide for Pediatricians

M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up) as part of the 2-year-old health checkup – a practical guide for pediatricians

Patryk Domarecki, Katarzyna Plata-Nazar

Pediatr Rev 2026; 55 (3): 69-76

DOI: 10.26625/10266

SUMMARY

Early diagnosis of autism spectrum disorders (ASD) is crucial to the effectiveness of therapeutic interventions. Despite the presence of clear symptoms as early as around age 2, the average age at which the diagnosis is made still exceeds age 3. The ideal setting for conducting population-based screening is a primary care physician’s office during a 2-year-old’s routine checkup.

The purpose of this publication is to provide a practical guide to conducting the M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up) within the Polish primary care system and to provide pediatricians and family physicians with a ready-to-use screening algorithm.

The article describes in detail the two-step M-CHAT-R/F procedure (baseline questionnaire and follow-up interview), the principles for interpreting results based on a 3-level risk scale, and outlines pathways for further diagnostic and therapeutic management within the Polish healthcare system. The paper includes a complete, ready-to-use diagnostic worksheet.

The implementation of standardized M-CHAT-R/F screening into the routine assessment practice of primary care physicians provides a practical solution to systemic barriers and diagnostic gaps, enabling a significant acceleration in the timing of specialized early intervention for child development.

Keywords: autism spectrum disorders , screening, M-CHAT-R/F, primary care, 2-year-old checkup

ABSTRACT

Early identification of autism spectrum disorder (ASD) is critical to the effectiveness of therapeutic interventions. Despite the presence of clear symptoms around age 2, the average age at diagnosis is still over 3 years. The primary care setting during a routine 2-year-old checkup provides an ideal opportunity for population-based screening.

The purpose of this publication is to provide a practical description of how to implement the M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up) screening tool in Polish primary care settings, and to provide pediatricians and family physicians with a ready-to-use screening algorithm.

This paper outlines the two-stage M-CHAT-R/F procedure (the initial questionnaire and the follow-up interview), explains how to interpret risk scores based on a three-tier risk stratification system, and describes referral pathways within the Polish healthcare system. The study includes a comprehensive, ready-to-reproduce diagnostic checklist.

Implementing standardized M-CHAT-R/F screening as part of routine well-child visits in primary care addresses systemic barriers and the diagnostic gap, significantly accelerating the initiation of specialized early developmental intervention.

Key words: autism spectrum disorder, autism screening, M-CHAT-R/F, primary health care

 

 

ORIGINAL WORKS

Can My Child Work Out at the Gym? An Analysis of Systematic Literature Reviews and Meta-Analyses on the Participation of the Pediatric Population in Strength Training—Part I

Can My Child Exercise in a Gym Setting? An Analysis of Systematic Reviews and Meta-Analyses on Strength/Resistance Training in Children – Part I

Edyta Tekień, Robert Makuch, Tomasz Piotrowski, Izabela Janiec, Krystyna Grela, Maciej Kołodziej, Wojciech Feleszko, Jakub S. Gąsior

Pediatr Rev 2026; 55 (3): 77-93

DOI: 10.26625/10267

SUMMARY

Introduction. A progressive decline in muscle strength and cardiorespiratory fitness has been observed among children and adolescents. Currently, the importance of building muscle strength reserves as early as childhood is emphasized, as this is essential for maintaining physical fitness in later stages of life. Early introduction of strength training (ST) can counteract functional limitations and promote the development of healthy habits.

Purpose of the study. The aim of this study is to evaluate the efficacy, safety, and dosing guidelines for TS in healthy children and adolescents based on an analysis of systematic literature reviews incorporating a meta-analysis.

Material and methods: An umbrella review of meta-analyses was conducted according to the Preferred Reporting Items for Overviews of Reviews guidelines. PubMed and Cochrane databases were searched using the PICO criteria (P – population ; I – intervention ; C – comparison / control intervention ; O – outcome ). Fifteen meta-analyses on healthy populations published between 1996 and 2023 were included in the analysis. The methodological quality of the studies was assessed using the AMSTAR 2 tool.

Results. An analysis of the results from the included studies suggests that TS may be an effective method for increasing muscle strength across all age groups. TS has been shown to have a positive effect on fundamental motor skills (sprinting, jumping, throwing), to promote favorable changes in body composition (reduction in body fat), and to improve bone mineral density. TS contributes to increased self-esteem and a sense of efficacy, as well as improved cognitive function.

Conclusions. TS is a safe form of exercise for the pediatric population (from about 7–8 years of age), provided that qualified supervision is ensured, the exerciser’s technique is impeccable, and the workload is increased progressively.

Keywords: strength training , resistance training, adolescents, pediatric population, muscle strength, physical activity, safety

ABSTRACT

Introduction. Contemporary pediatric populations show a progressive decline in muscular strength and cardiorespiratory fitness. Concepts such as “strengthspan” emphasize the importance of developing a reserve of muscular strength early in life, which is critical for maintaining functional capacity later in life. Early implementation of resistance training may counteract functional limitations and facilitate the establishment of sustainable health-promoting behaviors.

Objective. The aim of this study (Part I) is to evaluate the effectiveness, safety, and dosing principles of resistance training as an intervention in healthy children and adolescents, based on systematic reviews and meta-analyses.

Materials and Methods. An umbrella review of meta-analyses was conducted in accordance with the Preferred Reporting Items for Overviews of Reviews guidelines. The PubMed and Cochrane databases were systematically searched (up to October 2024) using PICO (P – population, I – intervention, C – comparison/control intervention, O – outcome) criteria. A total of 15 meta-analyses involving healthy pediatric populations, published between 1996 and 2023, were included. The methodological quality of the included studies was assessed using the AMSTAR 2 tool.

Results. The synthesis of evidence confirms that resistance training is an effective method for increasing muscle strength across all pediatric age groups. Positive effects were also observed in fundamental movement skills (e.g., sprinting, jumping, and throwing), favorable changes in body composition (including reductions in body fat and body mass index in overweight or obese individuals), and improvements in bone mineral density. Additionally, resistance training is associated with psychosocial benefits (including enhanced self-esteem and self-efficacy) as well as improvements in cognitive function.

Conclusions. Resistance training is a safe form of physical activity for children (ages 7–8 and older), provided that qualified supervision, proper technique, and progressive load prescription are ensured.

Key words: strength training, resistance training, adolescents, pediatric population, muscular strength, physical activity, safety

 

 

CASE STUDIES

Use of a Long-Acting Clotting Factor in a Patient with Hemophilia B

Use of a coagulation factor with an extended half-life in a patient with hemophilia B

Hanna Stelmach, Ewa Celi, Paweł Łaguna

Pediatr Rev 2026; 55 (3): 96-99

DOI: 10.26625/10268

SUMMARY

Hemophilia B is a rare, X-linked bleeding disorder resulting from a deficiency of coagulation factor IX (FIX). Severe forms of the disease require regular replacement therapy. In recent years, a significant therapeutic advance has been the introduction of extended half-life (EHL) FIX concentrates, which enable more effective and convenient prophylaxis against bleeding. This paper presents a clinical case report and our experience with the use of an extended-half-life FIX concentrate.

Keywords: hemophilia B, long-acting factor IX concentrate, albutrepenonakog alfa

ABSTRACT

Hemophilia B is a rare X-linked bleeding disorder caused by a deficiency of coagulation factor IX (FIX). Severe forms of the disease require regular replacement therapy. In recent years, a significant therapeutic advance has been the introduction of extended half-life (EHL) FIX concentrates, which allow for more effective and convenient bleeding prophylaxis. This publication presents a clinical case report and the authors’ experience with the use of an extended half-life FIX concentrate.

Key words: hemophilia B, extended half-life FIX concentrate, albutrepenonacog alfa

 

Allergic Reaction to Intramuscular Administration of a GnRH Analog in a Girl Treated for Central Precocious Puberty—A Case Report

An allergic reaction to subcutaneous administration of a GnRH analog in a girl treated for central precocious puberty: a case study

Aleksandra Kamińska, Anna Alska, Małgorzata Myśliwiec

Pediatr Rev 2026; 55 (3): 100-106

DOI: 10.26625/10269

SUMMARY

Precocious puberty (PP) is a significant clinical problem due to its somatic and psychosocial consequences and the need to differentiate between central and peripheral causes. We present the case of a girl with central precocious puberty who was treated with triptorelin and developed a hypersensitivity reaction, leading to premature discontinuation of therapy.

The patient was born as a result of a pregnancy complicated by gestational diabetes, hypertension, and a urinary tract infection in the mother. Her medical history revealed delayed speech development, swallowing disorders, generalized hypotonia, PFO/ASD II, and genetically confirmed thrombophilia. She remained under the care of several specialty clinics. Signs of puberty, including breast enlargement, the appearance of pubic hair, acne, oily hair, and accelerated growth, appeared around 7.5 years of age. At the age of 9 years and 2 months, she was hospitalized at the Department of Pediatrics, Diabetology, and Endocrinology for evaluation for precocious puberty. The examination revealed Tanner stage P3/Th3, and the LHRH stimulation test showed a pubertal response. Imaging studies and bone age assessment confirmed the diagnosis of central precocious puberty; the patient was enrolled in a treatment program with triptorelin (Diphereline).

After one year of therapy, the progression of pubertal development was halted and bone maturation was slowed, confirming the effectiveness of the treatment. After approximately 1.5 years of therapy, a delayed local hypersensitivity reaction occurred following the administration of triptorelin, manifesting as erythema, pruritus, and swelling at the injection site. The reaction recurred after a subsequent dose administered in a hospital setting, leading to a diagnosis of hypersensitivity to the drug and discontinuation of therapy before the target height was reached. This case highlights the efficacy of GnRH analogs in the treatment of PDP, but also the need to monitor for rare adverse effects that may limit the ability to continue treatment.

Keywords: precocious puberty, gonadotropin-releasing hormone analogs (aGnRH), triptorelin, Diphereline, allergic reaction

ABSTRACT

Central precocious puberty (CPP) can lead to adverse physical growth and psychosocial outcomes if left untreated. We present the case of a girl with CPP who was successfully treated with triptorelin but developed a delayed hypersensitivity reaction, leading to premature discontinuation of therapy.

The patient was born following a pregnancy complicated by gestational diabetes, maternal hypertension, and a urinary tract infection. Her medical history included delayed speech development, swallowing difficulties, generalized hypotonia, PFO/ASD II, and genetically confirmed thrombophilia. Signs of puberty, including breast development, pubic hair growth, acne, oily hair, and accelerated growth velocity, appeared at approximately 7.5 years of age. At 9 years and 2 months, she underwent an endocrine evaluation. Physical examination revealed Tanner stage P3/B3 development, and a GnRH stimulation test demonstrated a pubertal response. Bone age assessment and imaging findings supported the diagnosis of CPP, and treatment with triptorelin (Diphereline) was initiated through the national drug program.

After one year of therapy, clinical and ultrasonographic findings demonstrated effective suppression of pubertal progression, including stabilization of secondary sexual characteristics, reduction in uterine size, and slowing of bone maturation. However, after approximately 18 months of treatment, the patient developed a delayed local hypersensitivity reaction characterized by erythema, pruritus, and swelling at the injection site several hours after administration. The reaction recurred following a subsequent dose administered under hospital supervision, confirming hypersensitivity to triptorelin. Consequently, treatment was discontinued before the planned therapeutic endpoint had been reached.

This case demonstrates the efficacy of GnRH analogue therapy in CPP and highlights the importance of recognizing rare hypersensitivity reactions that may require discontinuation of treatment.

Key words: precocious puberty, gonadotropin-releasing hormone analogs (aGnRH), triptorelin, Dipherelin, allergic reaction

 

 

EDUCATIONAL MATERIALS

Dermatology for Pediatricians – Clinical Case No. 5

Dermatology for Pediatricians — Clinical Riddle No. 5

Daniel Nette, Martyna Sławińska

Pediatr Rev 2026; 55 (3): 108-110

DOI: 10.26625/10270

 

Dermatology for Pediatricians – Clinical Case No. 6

Dermatology for Pediatricians – Clinical Riddle No. 6

Daniel Nette, Natalia Staranowicz, Martyna Sławińska

Pediatr Rev 2026; 55 (3): 112-114

DOI: 10.26625/10271

 

Children Outside the Standard Family Model—A Pediatrician’s Responsibilities Toward Abused Children and Children in Foster Care

The Pediatrician’s Responsibilities Toward Abused Children and Children in Foster Care

Wojciech Rożdżeński

Pediatr Rev 2026; 55 (3): 115-126

DOI: 10.26625/10272

 

 

QUESTIONS AND ANSWERS

Selected Questions from the Final Medical Exam – Spring 2026

Preparation of answers to questions from the state specialty exam in pediatrics

Magdalena Chazan, Natalia Stalony

Pediatr Rev 2026; 55 (3): 127-133

DOI: 10.26625/10273