Objective: To evaluate the association between neuroimaging and outcome in infants with congenital cytomegalovirus (cCMV), focusing on qualitative MRI and quantitative diffusion-weighted imaging of white matter abnormalities (WMAs). Methods: Multicentre retrospective cohort study of 160 infants with cCMV (103 symptomatic). A four-grade neuroimaging scoring system was applied to cranial ultrasonography and MRI acquired at ≤3 months. WMAs were categorised as multifocal or diffuse. Temporal-pole WMAs (TPWMAs) consisted of swollen or cystic appearance. Apparent diffusion coefficient (ADC) values were obtained from frontal, parieto-occipital and temporal white matter regions. Available follow-up MRI at ≥6 months (N=14) was additionally reviewed. Neurodevelopmental assessment included motor function, cognition, behaviour, hearing, vision and epilepsy. Adverse outcome was defined as death or moderate/severe disability. Results: Neuroimaging scoring was associated with outcome (p<0.001, area under the curve 0.89±0.03). Isolated WMAs (IWMAs) were present in 61 infants, and WMAs associated with other lesions in 30. Although TPWMAs and diffuse pattern often coexisted in infants with IWMAs (p<0.001), only TPWMAs were associated with adverse outcomes (OR 7.8; 95% CI 1.4 to 42.8), including severe hearing loss in 20% and hearing loss combined with other moderate/severe disabilities in 15%. Increased ADC values were associated with higher neuroimaging scores, WMAs based on visual assessment and IWMAs with TPWMAs. ADC values were not associated with outcome in infants with IWMAs. Findings suggestive of progression of WMAs on follow-up MRI included gliosis and malacia. Conclusions: Categorisation of neuroimaging severity correlates with outcome in cCMV. In infants with IWMAs, TPWMAs provide a guide to prognosis.

We determined the mitochondrial status of a group of HIV-infected children, some with body fat abnormalities (BFA). We included 24 controls, 16 HIV-infected untreated, 26 HIV-infected treated, 6 BFA-untreated, and 21 BFA-treated patients. Genetic, translational, and functional mitochondrial values were measured. As compared with controls, mitochondrial DNA depletion and a reduction in functionality were found in BFA groups.

Background: Children with congenital cytomegalovirus (cCMV) can develop late-onset sensorineural hearing loss (LO-SNHL). In this study, we aim to assess the characteristics and predictors of LO-SNHL in infants with cCMV having normal hearing at the first neonatal assessment. Methods: A retrospective study within the European Registry of Children with cCMV (www.ccmvnet.org) was performed. Included children had cCMV and a normal first audiological assessment by Auditory Brainstem Response (ABR). Late-onset hearing loss (LO-SNHL) is defined as the presence of sensorineural hearing loss after an initial normal hearing test. Hearing evaluation was performed at birth, at 6 months of age, and at least annually up to 6 years of age. Results: Seven hundred twenty-one children with normal audiological tests at birth were included, and 47/721 (6.5%) developed LO-SNHL. LO-SNHL was diagnosed at a range of 4–65 months of age [median (IQR) age: 34.3 (15.1–48.7) months]. Children with LO-SNHL had a higher proportion of abnormalities on physical examination at birth (45.7% vs. 20.8%; P < 0.001): petechiae (17.4% vs. 6.0%; P = 0.008), splenomegaly (8.7% vs. 2.3%; P = 0.031), hepatomegaly (13% vs. 2.9%; P = 0.001), microcephaly (15.2% vs. 4.5%; P = 0.005) and small for gestational age (21.7% vs. 8.3% P = 0.005). Children with LO-SNHL showed lower platelet count at birth [177500.0 (88750.0–261250.0)/μL vs. 243500.0 (173000.0–304000.0)/μL; P = 0.012], and higher blood viral load at birth [3.7 log (3.3–4.4) vs. 3.4 log (2.7–3.9) IU/mL; P = 0.013] and had more frequent white matter involvement (27.7% vs. 14.7%; P = 0.03) and ventriculomegaly (20.7% vs. 4.6%; P = 0.001) on birth magnetic resonance imaging. Overall, symptomatic children at birth showed a higher risk of developing LO-SNHL than asymptomatic children (32/317, 10.1%, vs. 15/404, 3.7%; P < 0.0001). Among asymptomatic children, only 0.3% developed severe or profound LO-SNHL in the best ear. In multivariate logistic regression analysis, ventriculomegaly [odds ratio (OR): 7.503 (1.78–27.9)], white matter abnormalities [OR: 3.19 (1.010–9.01)], and splenomegaly [OR: 3.679 (1.56–8.506)] at birth were associated with the development of LO-SNHL (Fig. 1). Conclusions: Among this large cohort of children with cCMV and a first normal audiological assessment, the risk of LO-SNHL was 6.5%. Asymptomatic children developed LO-SNHL in 3.7% of the cases versus 10.1% in symptomatic cases. In multivariate logistic regression analysis, ventriculomegaly, white matter abnormality, and splenomegaly at birth were associated with LO-SNHL.

Antimicrobial stewardship programs (ASP) reduce the inappropriate use of antimicrobial agents. Traditionally, paediatric osteoarticular infections have been treated with prolonged intravenous antibiotics; however, evidence suggests that shorter intravenous therapy followed by oral narrow-spectrum antibiotics is effective. The aim of this study is to assess the impact of an ASP on the treatment of acute haematogenous bone and joint infections (AH-BJI) in children.We performed a single-centre quasi-experimental study comparing antibiotic use in paediatric [0–18 years] inpatients with AH-BJI before (2015–2016 period 1 [P1]) and after (2017-june 2023 period 2 [P2]) the implementation of a multifaceted hospital ASP with post-prescription review with feedback as the primary strategy. ASP also promoted a first-line empiric antibiotics change in the local protocol in June 2020. The study describes and compares the demographic and clinical characteristics among patients who were recruited prospectively during their hospital admission or in outpatient clinics. The primary outcomes were the length of antibiotic therapy, length of hospital stay, sequelae, readmission and fatality rates. Two-hundred-eighty-five patients were included (60 in P1 and 225 in P2). The length of parenteral antibiotic treatment and the length of hospital stay were significantly lower in P2 (median [IQR] days, P1: 8.5[7.0–12.0] vs P2: 7[4.5–8.0], p < 0.001; and P1: 8.5[7.0–11.0] vs P2: 7[5.0–9.0], p < 0.001, respectively). After June 2020, 3rd generation cephalosporin use decreased in patients < 5 years old (96/119[81%] vs 6/57[10%] cases; p < 0.001). The rates of sequelae, readmission (2/60[3.3%] in P1 and 8/225[3.6%] in P2) and mortality remained unchanged. Conclusion: After ASP implementation, the length of parenteral antibiotic treatment, length of hospital stay, and 3rd generation cephalosporin use in children with AH-BJI were reduced safely. What is Known:• Antimicrobial Stewardship Programmes (ASPs) have been shown to be effective for optimising antibiotic prescriptions and reducing antimicrobial resistance. There is still limited literature about ASPs in the paediatric population.• Paediatric bone and joint infections were traditionally treated with prolonged intravenous antibiotics. However, current evidence suggests that shorter intravenous therapy followed by oral narrow-spectrum antibiotics is equally effective. What is New:• Implementing an ASP with post-prescription review with feedback as main strategy, in a tertiary paediatric hospital, safely reduced the duration of intravenous treatment and length of hospital stay for children with acute haematogenous bone and joint infections (AH-BJI).• The ASP helped to reduce the use of 3rd generation cephalosporin in children with AH-BJI.