Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic practices, and current treatment regimens of IDA, medical records of children referred to pediatric hematologists for iron deficiency in a five-year period at tertiary institutions (Zagreb, Rijeka, Split, Osijek) throughout Croatia were retrospectively analyzed. Eight hundred and sixty-four children, predominately of preschool age, were referred mainly by the primary care pediatricians, who, in general, performed basic diagnostics but failed to initiate oral iron therapy in half of the patients. Approximately one-third of patients were symptomatic, with inadequate nutrition prevailing as underlying etiology. Dextriferron was the preferred iron formulation among hematologists, with a median dose of 5 mg/kg, with acceptable compliance rates (63.5–93.2%). Hospital admission rates varied among the centers (9.4–35%), and so did transfusion policies (6.4–22.9%). The greatest difference was observed in the frequency of parenteral iron administration (0.3–21.5%). In conclusion, the burden of childhood IDA, even in a high-income country, remains substantial, necessitating consistent implementation of national guidelines and additional education of primary health care providers.

Survival rates for children treated for malignant diseases continue to improve, yet many survivors face persistent late oral complications that affect function, aesthetics, and quality of life. Oncological therapy, especially at a young age and following head and neck radiotherapy or intensive chemotherapy, can disrupt dental and craniofacial development, resulting in dental developmental disorders, enamel defects, salivary gland dysfunction, caries susceptibility, periodontal problems, trismus, and osteoradionecrosis of the jaw. Although these effects are partially known, they are frequently underrecognized in routine practice, and many children do not receive adequate long-term dental follow-up. A key challenge highlighted in the recent literature is the absence of structured, evidence-based guidelines for monitoring and managing late oral effects. The article emphasizes the need for clearer recommendations, better communication of oncological treatment histories, and stronger integration of dental professionals within survivorship care. Developing standardized follow-up protocols will be essential to ensure timely detection, consistent management, and improved oral health outcomes for childhood cancer survivors. This article is intended as a narrative review, synthesizing available evidence from key publications to highlight clinically relevant late oral complications and gaps in current survivorship care.

Survival rates for children treated for malignant diseases continue to improve, yet many survivors face persistent late oral complications that affect function, aesthetics, and quality of life. Oncological therapy, particularly when administered early in childhood, can disrupt dental and craniofacial development, resulting in dental developmental disorders, enamel defects, salivary gland dysfunction, caries susceptibility, periodontal problems, trismus, and osteoradionecrosis of the jaw. Although these effects are partially known, they are frequently underrecognized in routine practice, and many children do not receive adequate long-term dental follow-up. A key challenge highlighted in recent literature is the absence of structured, evidence-based guidelines for monitoring and managing late oral effects. The article emphasizes the need for clearer recommendations, better communication of oncological treatment histories, and stronger integration of dental professionals within survivorship care. Developing standardized follow-up protocols will be essential to ensure timely detection, consistent management, and improved oral health outcomes for childhood cancer survivors.

Celiac disease (CD) is an autoimmune disease triggered by gluten in genetically predisposed individuals with reported global prevalence in children from 0.31% to 0.9%. Despite the increasing prevalence of CD, many patients remain undiagnosed. Several point-of-care tests (POC) for CD have been developed that can be used as useful screening tool. We aimed to determine the prevalence of CD in first-grade pupils in Primorje-Gorski Kotar county, Croatia using POC test. Methods: Biocard celiac test that detects IgA antibodies to tissue transglutaminase in whole blood was used to screen for celiac disease in healthy first-grade children born in 2011 and 2012 who consumed gluten without restrictions. Results: 1478 children were tested and none of them were tested positive with rapid test. In 10 children (0,6%) IgA deficiency has been suspected; only 4 of them agreed to be tested further for total IgA, anti-tTG and anti DGP antibodies. IgA deficiency was confirmed in 3 patients and in all 4 children CD has been excluded. Conclusion: In this, to our knowledge first prospective study in Croatia, we haven’t found children with celiac disease. Further research is needed to establish the true epidemiology of CD in Primorje-Gorski Kotar County and to confirm the value of rapid test in comparison with standard antibody CD testing.

Pneumocystis jirovecii pneumonia (PJP) is a severe and potentially life-threatening opportunistic infection in immunocompromised patients, especially those with hematologic malignancies. Although routine prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) has significantly reduced its incidence, breakthrough infections still occur, most commonly due to poor adherence to prophylactic therapy. This case report highlights the risks of non-adherence to PJP prophylaxis in adolescents and underscores the importance of early diagnostic suspicion and multidisciplinary management. A 15-year-old female patient with acute lymphoblastic leukemia presented during her seventh month of maintenance therapy (methotrexate and 6-mercaptopurine) in a compromised general condition with tachycardia, tachypnea, and hypoxemia, following a 24-hour history of fever and dry cough. Heteroanamnestic data revealed prolonged non-adherence to TMP-SMX prophylaxis. Imaging showed diffuse bilateral interstitial infiltrates on chest radiography and ground-glass opacities on high-resolution computed tomography (HRCT). PJP was confirmed via polymerase chain reaction (PCR) from bronchoalveolar lavage and a positive serum 1,3-β-D-glucan test. Treatment included intravenous TMP-SMX, corticosteroids, and high-flow nasal cannula oxygen therapy. The course was complicated by pancytopenia, likely secondary to TMP-SMX, and febrile neutropenia. A multidisciplinary approach, including social and psychiatric support, addressed non-adherence. The patient was discharged in good condition; maintenance therapy was continued, and prophylaxis was switched to monthly aerosolized pentamidine administered in the hospital setting. PJP prevention in pediatric oncology remains a significant challenge, as inconsistent adherence can rapidly lead to severe clinical deterioration. Our experience suggests that successful outcomes depend on addressing psychosocial barriers early. Transitioning to supervised, hospital-administered alternatives, such as aerosolized pentamidine, alongside multidisciplinary support, may help ensure adherence to prophylaxis in vulnerable oncology patients.