Emma Kinderziekenhuis

Socio-emotional development represents an essential dimension of contemporary education, while non-formal education provides valuable contexts for fostering these competencies. This study investigates parents’ perceptions regarding the role of non-formal activities in supporting the socio-emotional development of primary school students. The research is based on a quantitative approach and involved the administration of a structured questionnaire to a sample of 53 parents whose children participate in various non-formal educational activities. The results indicate that, according to parents’ perceptions, participation in non-formal education is associated with improvements in social interaction, cooperation, emotional expression, and self-confidence. At the same time, the perceived impact varies depending on the type and frequency of activities as well as the child’s individual characteristics. Overall, the findings highlight the potential of non-formal education to complement formal learning and to support the holistic development of students.

Damage to the intestinal epithelial barrier is a hallmark of inflammatory diseases such as necrotizing enterocolitis. Specialized proresolving mediators (SPMs), such as lipoxin A4, resolvin D1, and resolvin E1, which are derived from essential fatty acids, have been shown to aid in resolving inflammation and promote mucosal healing. This study aimed to explore the effects of specific SPMs on intestinal inflammatory response in an early life in vitro model. We established 3-dimensional and 3-dimensional organoid cultures from fetal and pediatric intestines and investigated the effect of an SPM cocktail (lipoxin A4, resolvin D1, and resolvin E1) on gut epithelial maturation and barrier function. An inflammatory response of the gut barrier was provoked by lipopolysaccharide and flagellin stimulations combined with proinflammatory cytokines, tumor necrosis factor-α, and interferon gamma. Additionally, repetitive mechanical wounding was developed to test the effects of the SPM cocktail on 2-dimensional organoid monolayers. Under physiological conditions, we observed no effect of SPM cocktail treatment on gut epithelial maturation. Upon cytokine challenge, there was no modulation of the inflammatory tone of the gut barrier by the SPM cocktail. However, during the repetitive wounding and recovery assay, SPM cocktail treatment accelerated barrier recovery and maintained barrier integrity for 24 hours after repeated injuries. Our findings suggest that the SPM cocktail does not affect bacterial product- or cytokine-induced epithelial inflammation, although it may accelerate epithelial barrier recovery in mechanically wounded monolayers. These results provide valuable insights into the therapeutic potential of SPMs in neonatal intestinal inflammation. SIGNIFICANCE STATEMENT: Using early life intestinal organoid models, we found that although specialized proresolving mediators did not alter cytokine- or bacterial product-induced inflammation, they significantly enhanced epithelial barrier recovery following repeated mechanical injury.

Clinical practice variation in the management of recurrent idiopathic focal segmental glomerulosclerosis (rFSGS) is poorly defined and likely hinders successful clinical trial design. We conducted an online survey between June 2024 and September 2024 of Pediatric Nephrology Research Consortium (PNRC) and European Society for Pediatric Nephrology (ESPN) members to evaluate global clinical practice patterns in the management of pediatric rFSGS and physician perceptions of barriers to rFSGS clinical trial participation. Of 120 responses (50 PNRC members from the US and Canada and 70 ESPN members from Europe, Asia, and South America), all respondents were physicians and 50% were transplant program medical directors. Pretransplant mutation analysis was routine in 104 (87%) centers, and native nephrectomy was routine for patients with and without hypoalbuminemia in 77 (66%) and 23 (19%) centers, respectively. Forty-two (35%) centers reported routine therapeutic interventions to prevent rFSGS prior to kidney transplantation; this increased to 79 centers (66%) in patients with previous recurrence. Plasmapheresis was the first therapeutic intervention in most centers, although it was used significantly more often in North America (96%) than Europe (77%; p = 0.005). Rituximab was administered in 102 (85%) centers as treatment for rFSGS. Common barriers to recruitment and inclusion of patients in clinical trials of rFSGS were limited site resources (36%), recipient/family reluctance (10%), and operational and logistical issues (26%). Heterogeneity of practice patterns in the management of pediatric rFSGS and barriers to clinical trials requires collaborative efforts to study and reach consensus on prevention and management of rFSGS.

Real-world data collection can contribute to quality improvement for rare diseases in several ways. To evaluate a method developed to integrate real-world evidence in guidelines addressing rare diseases (REGARD). A guideline on omphalocele was developed following the GIN-McMaster Guidelines 2.0 checklist. After the guideline panel selected clinical questions, systematic literature searches were performed. When published evidence was scarce, REGARD was introduced. Data from the European Pediatric Surgical Audit (EPSA) patient registry was provided to clinical experts after which they noted their observations of treatment effect in structured observation forms (SOFs). Feasibility, added value and acceptability of REGARD were evaluated using a cross-sectional study design. EPSA data were available for seven of the twelve clinical questions selected for this guideline (58%). In 4/7 clinical questions (57%), REGARD contributed to the panels’ decision on a recommendation. Reasons to disregard the supplementary evidence during the formation of a recommendation were: uncertainty about the validity of the observations due to small sample sizes and doubt about the association between the observed outcomes and the intervention because the registry data lacked information on the clinical indication for a chosen treatment. This study evaluates a method to connect real-world data collection to guideline development in rare diseases, highlighting both the challenges and benefits this method has to offer. Although the methodology requires refinement and the EPSA registry must be optimized, we believe it holds significant promise as a tool for developing guidelines for rare diseases.

The European Paediatric Surgeons' Association (EUPSA) and the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) conducted a survey to assess the current surgical management and care practices for esophageal atresia (EA) in order to assess changes over the past decade.An online survey consisting of 56 questions was administered to EUPSA members and ERNICA representatives between March and September 2025. The questionnaire covered seven domains: center structure, preoperative assessment, surgical management of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients and long-gap EA, postoperative care, long-term follow-up, and the management of complications. Results were compared to practices reported in a previous EUPSA Network Office survey in 2013.There were a total of 202 respondents from 41 countries with 60% from European Union countries. Compared with previous surveys, the routine use of preoperative bronchoscopy and the use of trans-anastomotic tubes were found to be significantly more common (both p < 0.001). A marked increase in preference for thoracoscopic techniques for EA-TEF was observed (p < 0.001). The routine use of chest drains, elective paralysis, and contrast studies prior to feeding initiation also rose significantly over the decade (p ≤ 0.004). Yet for many areas of care, there remains variation between surgeons, and structured long-term follow-up arrangements are not universal.The findings demonstrate increased standardization and suggest increased adherence to recommendations in the management of EA-TEF. However, significant variation persists in long-term follow-up, transition-to-adult-care programs, and structured quality-of-life assessment, highlighting areas for future harmonization across European centers.

AimThe gut microbiome plays a crucial role in health and disease, and its involvement in postoperative complications like anastomotic leakage (AL) is of growing interest. Despite substantial preclinical evidence linking microbiome alterations to surgical outcomes, human studies are scarce, particularly those exploring the perioperative dynamics of the gut microbiome beyond a single time point. This descriptive, hypothesis‐generating pilot study aims to elucidate the perioperative changes in the faecal microbiome of patients undergoing rectal cancer surgery.MethodSeventeen patients from Amsterdam University Medical Centers participated in the IMARI‐study and the IntAct‐trial between April 2020 and April 2022. All patients in these studies underwent rectal resection for malignancy with a primary anastomosis, with or without a diverting ileostomy. Samples collected included preoperative stool, intraoperative anastomotic colonic tissue and swab and postoperative stool. Bacterial DNA was extracted and analysed using 16S rRNA gene sequencing.ResultsAn increase in Enterococcus and Streptococcus was observed postoperatively compared to preoperative and intraoperative samples. Postoperative samples showed a significant decrease in alpha diversity compared to preoperative and intraoperative samples. Beta diversity analysis revealed distinct clustering of postoperative stool and ileostomy samples. Preoperative oral antibiotics significantly altered the intraoperative microbiome composition and reduced postoperative alpha diversity.ConclusionThis pilot study reveals significant perioperative shifts in the gut microbiome of rectal cancer patients. These findings underscore the importance of considering microbiome dynamics perioperatively when designing and interpreting studies that correlate the microbiome with clinical outcomes. However, the conclusions should be viewed as preliminary and require confirmation in larger studies, including causal relation, to postoperative outcomes.

The population-related incidence of pediatric battery ingestion is 1.18 episodes per 100,000 children per year in the Netherlands with 17% complications. Battery swallowing in young children is a life-threatening emergency-urgent action and increased awareness among politicians, industry and healthcare professionals are essential to prevent serious harm. • Battery ingestion can lead to severe complications and mortality. • Young children are prone to accidental button battery ingestion due to oral exploration. • Esophageal impaction and related complications are more common in children compared to adults due to small anatomy. • The incidence rate of pediatric battery ingestion is rarely described worldwide. In the Netherlands, the incidence is 1.18 per 100,000 children per year. • Unfortunately, complications are relatively often after ingestion (17%).

Background: Growth impairment and poor nutritional status are recognized complications of pediatric inflammatory bowel disease (IBD), yet data specific to ulcerative colitis (UC) are limited. This systematic review aims to provide an overview of current knowledge on growth, nutritional status, and body composition in children and adolescents with UC. Methods: A systematic literature search was performed up to August 2025. Studies including patients aged 5–22 years with confirmed UC were reviewed. Results related to growth, nutritional status, and body composition were narratively synthesized to summarize findings. Results: Fifteen studies with 1575 patients with UC met inclusion criteria, comprising 5 prospective, 5 cross-sectional, and 5 retrospective designs. Although the included studies were conducted in broader IBD cohorts, only UC-specific outcomes were reported. The data were limited by sample size, heterogeneity in patient characteristics, outcome definitions, and assessment methods. The majority of patients had prolonged disease with remission or mild activity. Growth failure prevalence ranged from 7% to 36%, with weight deficits being more common than height deficits. Undernutrition affected up to 25% of patients, with variability across studies. Overweight and obesity were also observed, though most studies showed no significant differences between UC patients and controls. Only five very small studies assessed body composition, reporting inconsistent findings regarding reductions in lean body mass. Conclusions: Growth impairment and poor nutritional status can occur in children and adolescents with UC. Larger, standardized, high-quality studies focused specifically on UC are needed to better characterize its impact on growth and nutritional status, including the essential integration of body composition assessment.

While gut microbiome dysbiosis is known to play a role in colorectal cancer (CRC) initiation and progression, its role in CRC recurrence remains unclear. This study investigates whether the gut microbiome is associated with CRC recurrence. In a prospective observational cohort, preoperative fecal samples from patients with stage I to III CRC undergoing surgical resection were analyzed using 16S rRNA gene sequencing. Alpha diversity and beta diversity were compared between patients with and without recurrence, and differential abundance analyses were conducted to identify bacterial genera associated with recurrence risk. Among 294 patients, 61 (21%) patients developed recurrence during a median follow-up of 56 months, with a median time to recurrence of 19 months. Alpha diversity did not differ between groups, but beta diversity analysis revealed significantly distinct microbial clustering in patients with recurrence, particularly those with locoregional recurrence. Differential abundance analysis identified five bacterial genera associated with locoregional recurrence (Acidaminococcus, Alloprevotella, Butyrivibrio, Ruminococcaceae CAG-352, and Lachnospiraceae UCG-003), one with distant recurrence (Megamonas), and two with overall recurrence (Anaeroplasma, Porphyromonas). Stratifying patients into high- and low-abundance subgroups revealed that those with a high relative abundance of Porphyromonas had an increased risk of overall recurrence (hazard ratio, 2.80 [95% CI, 1.54 to 5.10]). Patients with CRC who develop locoregional recurrence exhibit a distinct preoperative fecal microbial composition compared with those without recurrence. Our findings provide novel insights into the role of the intestinal microenvironment in recurrence and identify Porphyromonas as a potential fecal biomarker for overall recurrence risk.