Berber Kapitein

Children are extremely vulnerable to climate-related environmental impacts and air pollution due to both biological and behavioral factors. Despite the emerging evidence of the increasing effects of climate change on the world and on children’s health, policies to drive change and halt the effects are lacking. Climate change is causing Europe to heat up faster than other continents. Here, we assessed the evidence-based effects of climate change and air pollution on child health in Europe. A scoping review was performed to map the impact of climate-related exposures on the health of children in Europe. A literature search was conducted in three bibliographic databases (PubMed, Embase.com, and Cochrane Database of Systematic Reviews/Cochrane Central Register of Controlled Trials), for studies published between January 1, 2014, and November 11, 2024. Studies were included if they met the following criteria: original studies performed in Europe, addressing climate-related exposures (i.e., the effects of air pollution, heat stress and/or wildfires) on clinical outcomes in neonates, infants, and children (2.5 and PM ₁₀ exposure); few studies assessed other climate-related outcomes such as heat stress or wildfires. Conclusion : Climate change is an active driver of pediatric morbidity in Europe, posing urgent respiratory, neurological, and perinatal risks amplified by social inequality. Protecting future generations demands a paradigm shift in healthcare that moves beyond treating acute symptoms to addressing upstream environmental drivers, including the integration of environmental exposure data into clinical practice. What is Known: • Children are biologically vulnerable to environmental hazards and more prone to climate-related exposures. • Europe is warming up faster than other continents; therefore, children in Europe are at increased risk of climate-related adverse health outcomes. What is New: • This scoping review confirms climate change may lead to increased pediatric morbidity in Europe, linking air pollution, heat stress, and wildfires to perinatal, respiratory, metabolic, and neurological risks. • European studies regarding climate change and children’s health have mainly focused on the impact of air pollution, but hardly focused on the impact of heat stress,  highlighting the need for broader research and a coordinated pan-European change in political interventions tackling climate change.

Objectives: Emerging evidence shows that health disparities contribute to an increased risk of severe asthma. Therefore, the study objectives were to explore how socioeconomic disparities influence the risk of severe paediatric asthma in the Netherlands. Methods: In this nationwide cohort study, all children aged 2–17 years living in the Netherlands between 2018 and 2022 were included. Asthma definitions were based upon individually linked data from nonpublic Dutch registry databases on asthma-related health expenditures including hospital and paediatric intensive care unit (PICU) admissions. Geospatial analysis was used to identify hot spots based on the regions with the highest counts of severe asthma. Additionally, the impact of various socioeconomic variables ( e.g. housing, migration background and socioeconomic status) on the primary outcome of severe asthma was assessed using a linear probability model. Results: The total study population consisted of 4 538 020 children. Children from the lowest income class had twice the odds of severe asthma (p<0.001) and were 2.6 times more likely to be admitted to the PICU compared to the highest income class (p<0.001). Other socioeconomic disadvantage factors for severe (acute) asthma are, in order of level of association, living in a rental house, having a migration background and having a lower socioeconomic status score based on income, education and employment history. Conclusions: We identified several socioeconomic disparities that were increased in children with severe asthma and severe acute asthma at the PICU in the Netherlands. Comprehensive assessment and mitigation of these determinants may improve health equity in paediatric severe asthma and enhancement of asthma care.

Background: Severe acute asthma (SAA) in children can be life-threatening. There has been a significant rise in paediatric intensive care unit (PICU) admissions due to SAA over the past two decades. While asthma is a heterogeneous disease, its underlying pathophysiological pathways remain underexplored. This study aimed to assess the value of non-invasive targeted exhaled breath metabolomics analysis to better characterise SAA. Methods: Breath samples from 17 children admitted to the PICU with SAA (cases) and 27 children with controlled severe asthma (controls) were analysed using thermal desorption gas chromatography–mass spectrometry (TD-GC-MS). Results: A targeted volatile organic compound (VOC) analysis identified 25 compounds, of which 16 were shared between groups. Four VOCs were significantly more often present in SAA, and nine VOCs exhibited higher concentrations in SAA. Longitudinal analysis of VOCs from follow-up samples of 10 cases showed no significant temporal differences, reinforcing the reproducibility of identified biomarkers. Conclusions: This study exemplifies the potential of exhaled breath analysis to provide insights into the molecular background of SAA. Breath metabolomics may enable early recognition of severe asthma attacks and preventive therapeutic interventions in children with severe asthma.

Background: The incidence of severe asthma exacerbations (SAE) requiring a pediatric intensive care unit (PICU) admission during the coronavirus disease 2019 (COVID‐19) pandemic (and its association with public restrictions) is largely unknown. We examined the trend of SAE requiring PICU admission before, during, and after COVID‐19 restrictions in Amsterdam, the Netherlands, and its relationship with features such as environmental triggers and changes in COVID‐19 restriction measures.Methods: In this single‐center, retrospective cohort study, all PICU admissions of children aged ≥2 years for severe asthma at the Amsterdam UMC between 2018 and 2022 were included. The concentrations of ambient fine particulate matter (PM_2.5) and pollen were obtained from official monitoring stations.Results: Between January 2018 and December 2022, 228 children were admitted to the PICU of the Amsterdam UMC for SAE. While we observed a decrease in admissions during periods of more stringent restriction, there was an increase in the PICU admission rate for SAE in some periods following the lifting of restrictions. In particular, following the COVID‐19 restrictions in 2021, we observed a peak incidence of admissions from August to November, which was higher than any other peak during the indicated years. No association with air pollution or pollen was observed.Conclusion: We hypothesize that an increase in clinically diagnosed viral infections after lockdown periods was the reason for the altered incidence of SAE at the PICU in late 2021, rather than air pollution and pollen concentrations.

Context: The negative effects of socioeconomic, environmental and ethnic inequalities on childhood respiratory diseases are known in the development of persistent asthma and can result in adverse outcomes. However, little is known about the effects of these disparities on pediatric intensive care unit (PICU) outcomes in respiratory diseases. Objective: The purpose of this systematic review is to evaluate the literature on disparities in socioeconomic, environmental and ethnic determinants and PICU outcomes. We hypothesize that these disparities negatively influence the outcomes of children's respiratory diseases at the PICU. Methods: A literature search (in PubMed, Embase.com and Web of Science Core Collection) was performed up to September 30, 2022. Two authors extracted the data and independently evaluated the risk of bias with appropriate assessment methods. Articles were included if the patients were below 18 years of age (excluding neonatal intensive care unit admissions), they concerned respiratory diseases and incorporated socioeconomic, ethnic or environmental disparities. Results: Eight thousand seven hundred fourty‐six references were reviewed, and 15 articles were included; seven articles on the effect of socioeconomic status, five articles on ethnicity, one on the effect of sex and lastly two on environmental factors. All articles but one showed an unfavorable outcome at the PICU. Conclusion: Disparities in socioeconomic (such as a low‐income household, public health insurance), ethnic and environmental factors (such as exposure to tobacco smoke and diet) have been assessed as risk factors for the severity of children's respiratory diseases and can negatively influence the outcomes of these children admitted and treated at the PICU.

Pediatric intensive care admissions for severe acute asthma during the COVID-19 pandemicSomayeh Bazdar1, 2, 3*, Sarah van den Berg4, 5*, Niels W. Rutjes4, Lizan D. Bloemsma1, 2, 3, George S. Downward6, 7, Letty A. De Weger8, Suzanne W.J. Terheggen-Lagro3, Yolanda de Wit-van Wijck1, 2, 3, Anke H. Maitland van der Zee1, 2, 3,4, Berber Kapitein5Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The NetherlandsAmsterdam Institute for Infection and Immunity, Amsterdam, The NetherlandsAmsterdam Public Health, Amsterdam, The NetherlandsDepartment of Pediatric Pulmonology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The NetherlandsPediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The NetherlandsLeiden University Medical Center, Department of Pulmonology and Department of Public Health and Primary Care, Postbus 9600, 2300 RC Leiden, The Netherlands* Co-first author: Both Somayeh Bazdar and Sarah van den Berg are first authors and contributed equally.Running title : Severe acute asthma during COVID-19

Background – The incidence of pediatric asthma exacerbations during the COVID-19 pandemic has been evaluated; however, the incidence of severe acute asthma (SAA) requiring a Pediatric Intensive Care Unit (PICU) admission is unknown. Furthermore, we examined several factors which might influence this incidence, such as environmental triggers or changes in COVID-19 lockdown regulations. Methods – In this single-center, retrospective cohort study running from 2018 to 2021, all PICU admissions for SAA of children above two years of age at a tertiary hospital in the Netherlands were included. Information on potential asthma triggers during the pandemic, including viral infections, concentrations of ambient fine particulate matter (PM2.5) and pollen index were evaluated. Results – In total, 168 children were included in this study. While we observed a decrease in PICU admissions for SAA during lockdown periods, there was an increase in the admission rates in the periods without a lockdown, with the highest peak from August to November of 2021. This peak in the fall of 2021 did not align with pollen or ambient PM2.5 concentrations (r _s =-0.04 for pollen and r _s =0.23 for PM2.5). Discussion – COVID-19 lockdowns influenced the admission rates for SAA at the PICU both during and after the lockdowns in the Netherlands. We hypothesize that an increase in viral infections after lockdown periods was the reason for the altered incidence of SAA at the PICU in late 2021, rather than air pollution and pollen concentrations.

Context – The negative effects of socioeconomic, environmental and ethnic inequalities on childhood respiratory diseases are known in the development of persistent asthma and can result in adverse outcomes. However, little is known about the effects of these disparities on pediatric intensive care unit (PICU) outcomes in respiratory diseases. Objective – The purpose of this systematic review is to evaluate the literature on disparities in socioeconomic, environmental and ethnic determinants on PICU outcomes. We hypothesize that these disparities negatively influence the outcomes of children’s respiratory diseases at the PICU. Methods – A literature search (in PubMed, Embase.com and Web of Science Core Collection) was performed up to September 30, 2022. Two authors extracted the data and independently evaluated the risk of bias with appropriate assessment methods. Articles were included if the patients were below 18 years of age (excluding neonatal intensive care unit admissions), they concerned respiratory diseases and incorporated socioeconomic, ethnic or environmental disparities. Results – Of 8746 references reviewed, 15 articles were included; seven articles on the effect of socioeconomic status, five articles on ethnicity, one on the effect of sex and lastly two on environmental factors. All articles but one showed an unfavorable outcome at the PICU. Conclusion – Disparities in socioeconomic (such as a low-income household, public health insurance), ethnic and environmental factors (such as exposure to tobacco smoke and diet) have been assessed as risk factors for the severity of children’s respiratory diseases and can negatively influence the outcomes of these children at the PICU.