European Journal of Pediatrics最新文献

{"title":"Developmental functional brain network abnormalities in autism spectrum disorder comorbid with attention deficit hyperactivity disorder.","authors":"Tiantian Wang, Yang Xue, Zakaria Ahmed Mohamed, Feiyong Jia","doi":"10.1007/s00431-025-05989-x","DOIUrl":"10.1007/s00431-025-05989-x","url":null,"abstract":"<p><p>Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) often co-occur. Developmental stages significantly influence the variations in brain alterations. However, whether ASD comorbid with ADHD (ASD + ADHD) represents a unique neural characteristic from ASD without comorbid ADHD (ASD-alone), or instead manifests a shared neural correlate associated with ASD across diverse age cohorts remain unclear. This study examined topological properties and functional connectivity (FC) patterns through resting-state functional magnetic resonance imaging data from the Autism Brain Imaging Data Exchange II. Participants were divided into two age cohorts: childhood (under 12 years) and adolescence (12-18 years), consisting of 171 ASD pediatric patients and 111 typically developing (TD) controls. These cohorts were further classified into subgroups of ASD + ADHD, ASD-alone, and TD controls to compare across the age categories. The age, intelligence quotient, and gender of participants across three groups were matched within childhood and adolescence stages. We constructed functional brain networks, conducted graph-theory analysis, and analysed FC for both age cohorts. The findings revealed that both ASD + ADHD and ASD-alone shared some FC dysfunctions in the Default Mode Network (DMN) and atypical global metrics. Additionally, each group demonstrated unique neural FC and topological profiles that evolved with development.</p><p><strong>Conclusions: </strong>This study highlights the neural profiles of ASD + ADHD from a developmental perspective and suggests age-considerate approaches in clinical treatments.</p><p><strong>What is known: </strong>• ASD + ADHD shared some neural correlate associated with ASD-alone and also had specific neurobiological mechanisms which were different from ASD-alone. • Developmental stages significantly influence the variations in brain alterations observed in ASD or ADHD.</p><p><strong>What is new: </strong>• Both ASD + ADHD and ASD-alone shared some FC dysfunctions in the Default Mode Network and atypical global metrics. • ASD + ADHD and ASD-alone demonstrated unique neural FC and topological profiles that evolved with development.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"166"},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing bronchiolitis severity: a comparative analysis of two commonly used clinical scoring systems.","authors":"Nikhil Rajvanshi, Jashan Mittal, Prawin Kumar, Jagdish Prasad Goyal","doi":"10.1007/s00431-025-06000-3","DOIUrl":"10.1007/s00431-025-06000-3","url":null,"abstract":"<p><p>The purpose of this study to compare the effectiveness of the Bronchiolitis Severity Score (BSS) and the Respiratory Distress Assessment Instrument (RDAI) in determining bronchiolitis severity and predicting outcomes. Additionally, it aimed to establish optimum cutoff points for both scores. In this prospective observational study, clinical details of enrolled infants, along with assessments using both scoring tools, were recorded. The performance of these scores in predicting \"severe disease,\" defined by respiratory support requirements other than nasal prongs, PICU admission, respiratory acidosis, and/or altered consciousness, was evaluated. A total of 64 infants diagnosed with bronchiolitis were enrolled with a median age of 5 (3.8) months, and 16 (25%) infants had severe disease. BSS showed 25% sensitivity and 97.9% specificity at established cutoffs of > 8 for severe bronchiolitis. BSS performed better than RDAI in differentiating severe bronchiolitis [AUC, 0.733 vs 0.605; p = 0.035]. New cutoffs of > 5 points for BSS and > 8 points for RDAI increased BSS sensitivity to 68.8% and RDAI sensitivity to 56.3%.</p><p><strong>Conclusion: </strong>BSS demonstrated superior discriminative ability compared to RDAI in identifying severe bronchiolitis. New cutoff points enhanced BSS's ability to classify severe cases while establishing a cutoff for RDAI. Additional studies are required to validate these revised cutoffs.</p><p><strong>What is known: </strong>• Bronchiolitis severity score (BSS) and Respiratory Distress Assessment Instrument (RDAI) helps in determining bronchiolitis severity.</p><p><strong>What is new: </strong>• BSS has superior discriminatory ability as compared to RDAI in determining bronchiolitis severity. • This study also highlights that neither BSS nor RDAI is perfect, emphasizing the importance of clinical judgment over scoring systems.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"167"},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"M-mode measurement of diaphragm excursion.","authors":"Yusuke Hoshino","doi":"10.1007/s00431-025-06003-0","DOIUrl":"10.1007/s00431-025-06003-0","url":null,"abstract":"","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"168"},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of severe hypoglycemia management in children and adolescents with type 1 diabetes in a Belgian tertiary pediatric care center: impact of intranasal glucagon and cost analysis.","authors":"Antoine Harvengt, Anaïs Maure, Maude Beckers, Laure Boutsen, Chloé Brunelle, Elise Costenoble, Philippe Lysy","doi":"10.1007/s00431-025-05992-2","DOIUrl":"10.1007/s00431-025-05992-2","url":null,"abstract":"<p><p>To evaluate the management and costs of severe hypoglycemia (SH) in children and adolescents with type 1 diabetes (T1D) in our Belgian tertiary pediatric care center. In the EPI-GLUREDIA study, clinical parameters from children and adolescents with T1D were retrospectively analyzed from July 2017 to June 2024. The characteristics of SH and its treatment were collected during the medical consultation following the SH episode. Between July 2017 and June 2024, 208 cases of SH were recorded in 113 children and adolescents with T1D, with an average age of 13.6 years and T1D duration of 6.2 years. Oral glucose was the most common treatment (47.4%), while glucagon was used in only 25.4% of cases and more frequently in boys (30.8%) than in girls (18.7%). Notably, only 43% of SH episodes were treated according to international guidelines. A significant increase in glucagon use was observed after reimbursement of its intranasal form in Belgium in January 2022. After 2022, glucagon use significantly increased (28/81 vs. 25/129; p = 0.013), particularly among teachers and educators (18/49 vs. 10/78; p = 0.002). The average direct cost of treating SH was €187.9, with costs ranging from €0 to €1092.5 depending on the treatment method.Conculusion: Our study underscores the difficulty in managing SH in young people with T1D, with only 43% being treated as per guidelines. Since 2022, the increased use of the intranasal form of glucagon in Belgium led to reduced healthcare costs and improved care of patients experiencing SH.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"162"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound evaluation of gastric emptying for two different quantities of milk in elementary school-aged children.","authors":"Xiaofang Liu, Xianjun Li, Guohua Liu, Yuxi Yan, Haotian Fang, Bin Zhang","doi":"10.1007/s00431-025-06001-2","DOIUrl":"10.1007/s00431-025-06001-2","url":null,"abstract":"<p><p>Current guidelines recommend 6-h milk fasting in periprocedural settings; however, recent evidence suggests potential overconservativeness and supports more liberal pediatric fasting protocols. This study assessed the gastric emptying of two different milk quantities in elementary school-age children using gastric ultrasonography. This prospective crossover trial involved 30 healthy children who fasted overnight on two separate occasions within one month, consuming either 5 or 10 mL/kg of milk. Gastric ultrasonography assessed the gastric antrum cross-section area in the right lateral decubitus position at intervals until milk emptying. The time for the gastric antrum to return to baseline and the gastric emptying time was recorded. After consuming 5 mL/kg of milk, the time for the gastric antrum to return to baseline varied from 1.5 to 3.5 h (mean: 2.35 ± 0.56 h; median: 2.50 (2.00-2.63) hours). The gastric emptying time ranged from 1.5 to 4.0 h, with the mean and median time of 2.63 ± 0.54 h and 2.50 (2.50-3.00) hours, respectively. With 10 mL/kg of milk, the time for the gastric antrum to return to baseline ranged from 2.0 to 5.0 h, with a mean of 3.35 ± 0.62 h and a median time of 3.50 (3.00-4.00) hours. The gastric emptying time ranged from 2.0 to 5.0 h with a mean and median time of 3.62 ± 0.61 h and 3.50 (3.38-4.00) hours. Subgroup analysis revealed no significant differences between children of different genders or body mass indexes.</p><p><strong>Conclusion: </strong>The gastric return and emptying times are different for both milk quantities, both shorter than the 6-h fasting recommendation, supporting the liberal fasting protocols recommended by the European Society of Anaesthesiology and Intensive Care.</p><p><strong>Clinical trials registration: </strong>This trial was registered in the Chinese Clinical Trial Registry (Registration number ChiCTR2300077790) on November 20, 2023.</p><p><strong>What is known: </strong>• The ESAIC guidelines recommend a 4-h fasting period for milk products in periprocedural settings for children.</p><p><strong>What is new: </strong>• Our research demonstrates that cow's milk is emptied from the stomach within 4 h, supporting the ESAIC recommendations.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"163"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elective thoracoscopic surgery for congenital lung malformations: what age to operate?","authors":"Yuqing Zhao, Dan Liu, Yanan Wang, Zhiyi Niu, Huimin Jia, Yuzuo Bai","doi":"10.1007/s00431-025-05990-4","DOIUrl":"10.1007/s00431-025-05990-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the characteristics of congenital lung malformations (CLMs) in patients from infancy to adulthood, and to determine the optimal timing for thoracoscopic surgery.</p><p><strong>Methods: </strong>All patients with CLMs who underwent thoracoscopic surgery between 2017 and 2023 were retrospectively reviewed. The patients were divided into five age groups: 1-6 months, 6-12 months, 1-4 years, 4-16 years, and >16 years. Clinical characteristics and surgical outcomes were compared and analyzed for variance among the age groups.</p><p><strong>Results: </strong>A total of 173 patients with CLM were included. Thirteen (7.5%) patients were categorized in the 1-6 months age group, 44 (25.4%) in the 6-12 months age group, 58 (33.5%) in the 1-4 years age group, 30 (17.3%) in the 4-16 years age group, and 28 (16.2%) in the > 16 years age group. The median age at surgery was 2.3 years (range: 1 month to 74 years). The operative time was shortest in the 1-4 years age group at 86.5 min (interquartile range: 57.3-131.5 min, p < 0.01). The results of the multivariate regression analysis indicated that age > 4 years (odds ratio [OR]: 8.70, p < 0.01) and previous infection (OR: 3.75, p < 0.01) increased the risk of operative adhesions, which increased the risk of major complications and conversion to open thoracotomy.</p><p><strong>Conclusion: </strong>Thoracoscopic surgery for CLMs is safe and feasible at all ages. Age < 4 years may predict uneventful surgical outcomes due to fewer operative adhesions.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"165"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European central hypoventilation syndrome consortium description of congenital central hypoventilation syndrome neonatal onset.","authors":"Benjamin Dudoignon, Jochen Peters, Maria Giovanna Paglietti, Maria Angeles Garcia Teresa, Martin Samuels, Agneta Markstrom, Nuria Madureira, Panagiota Chaitidou-Kolb, Plamen Bokov, Christophe Delclaux","doi":"10.1007/s00431-025-05969-1","DOIUrl":"10.1007/s00431-025-05969-1","url":null,"abstract":"<p><p>It is known that in most cases of congenital central hypoventilation syndrome (CCHS), apnoeas and hypoventilation occur at birth. Nevertheless, a detailed description of initial symptoms, including pregnancy events and diagnostic tests performed, is warranted in infants with neonatal onset of CCHS, that is, in the first month of life. The European Central Hypoventilation Syndrome Consortium created an online patient registry from which 97 infants (44 females) with CCHS of neonatal onset and PHOX2B mutation from 10 countries were selected. The typical pregnancy is characterized by polyhydramnios (44%), fetal heart rate abnormalities on cardiotocography (36%), emergency cesarean sections. (30%) and a normal gestational age (14% preterm birth). The typical findings within the first days are the presence of respiratory distress (96%), often necessitating rapid intubation (44%) and, less frequently, cardiopulmonary resuscitation at birth (14%). These symptoms lead to a suspicion of CCHS after (median [interquartile]) 7 days [4; 12] since birth that is confirmed by genotype testing at 32 days [22; 61]. Daytime evaluation of blood gas is a frequent assessment leading to CCHS suspicion (n = 61/97, 63%; 95% confidence interval: 52-72) while a polysomnography is obtained in 45/97 infants (46%, 95% confidence interval: 36-57), demonstrating NREM hypoventilation in 44/45 infants (98%).</p><p><strong>Conclusion: </strong>Our multicentre descriptive study shows that polyhydramnios is overrepresented during pregnancy, rapid respiratory failure is the main symptom leading to intubation in approximately half of infants and daytime alveolar hypoventilation is the main indicator prompting genetic testing.</p><p><strong>What is known: </strong>• The initial symptoms and exams leading to congenital central hypoventilation syndrome diagnosis have mainly been described in single centre studies.</p><p><strong>What is new: </strong>• Our multicentre European study confirms that polyhydramnios is overrepresented during pregnancy and that polysomnography is obtained in half of the infants only.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"161"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher bone mineral density at six years of age in very preterm-born infants fed human milk compared to formula feeding. A secondary analysis of an RCT.","authors":"Line H Toftlund, Signe Sparre Beck-Nielsen, Lone Agertoft, Susanne Halken, Gitte Zachariassen","doi":"10.1007/s00431-024-05935-3","DOIUrl":"10.1007/s00431-024-05935-3","url":null,"abstract":"<p><p>In very preterm-born infants, nutritional intake is important to reduce the risk of severe metabolic bone disease including the risk of a lower bone mineral density (BMD). The aim of this study was to evaluate bone mineral content (BMC) and BMD (measured as BMC per bone area (BA)) at six years of age in very preterm-born infants fed different diets post-discharge. Data on this topic so far is insufficient, and with this study we aim to supply more useful data. A prospective follow-up study of 281 children born very preterm (gestational age ≤ 32 + 0 weeks) and enrolled in a multicentre RCT on post-discharge nutrition. Infants fed human milk (HM) were randomised respectively to be fed unfortified HM (UHM) or fortified human milk (FHM) from hospital discharge to four months' corrected age. Those not fed HM received a preterm formula (PF). At six years of age, BMD and BMC in all the children were established by means of a dual-energy X-ray absorptiometry (DXA) scan (Lunar Prodigy) and adjusted for sex, age, and anthropometrics. A total of 192 very preterm-born children (59 fed UHM, 67 FHM and 66 PF) had a DXA scan performed at median 6 (5.8-8.3) years of age. No significant difference was found comparing UHM and FHM according to height, weight, BA, BMC, and BMD at six years of age. However, a multiple regression analysis showed significantly improved BMD in breastfed children compared to PF-fed children.</p><p><strong>Conclusions: </strong>Fortified compared to non-fortified human milk post-discharge did not have an impact on BMD at 6 years of age in very preterm-born infants. Breastfed children demonstrated higher BMD than formula-fed children.</p><p><strong>What is known: </strong>• Adequate nutritional intake is important to improve growth and to reduce the risk of severe bone disease in very preterm born infants. • Bone mineralization is attained later in preterm born infants compared to term born infants.</p><p><strong>What is new: </strong>• Feeding human milk with fortification compared to non-fortified human milk did not improve bone mineral density in children born very preterm in this follow-up study at six years of age. • Feeding human milk compared to formula was associated with increased BMD at six years of age among very preterm born infants.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"160"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zero vegetable or fruit consumption and its associated factors among children aged 6 to 23 months in Kenya: a multilevel analysis of a large population-based survey.","authors":"Enyew Getaneh Mekonen, Mohammed Seid Ali, Belayneh Shetie Workneh","doi":"10.1007/s00431-025-05995-z","DOIUrl":"10.1007/s00431-025-05995-z","url":null,"abstract":"<p><p>Poor consumption of fruits and vegetables is associated with an increased risk of non-communicable diseases, micronutrient deficiency, and undernutrition. Fruit and vegetable consumption is generally low worldwide, particularly in rural regions of many low- and middle-income countries. This study aimed to determine the prevalence and determinants of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya using the most recent Kenya Demographic and Health Survey. A cross-sectional study was employed using data from the most recent nationally representative KDHS 2022. A weighted sample of 2,965 children aged between 6 to 23 months who were living with their mother was included in the study. Data extracted from the KDHS 2022 data sets were cleaned, recoded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel logistic regression was used to determine the factors associated with the dependent variable. Finally, variables with a p-value less than 0.05 were declared statistically significant. The proportion of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya was 45.50% (95% CI: 43.71%-47.30%). Factors like maternal education [AOR = 0.59; 95% CI (0.37, 0.93)], maternal occupation [AOR = 0.60; 95% CI (0.47, 0.76)], media exposure [AOR = 0.59; 95% CI (0.43, 0.80)], wealth index [AOR = 0.68; 95% CI (0.49, 0.95)], place of delivery [AOR = 0.69; 95% CI (0.51, 0.94)], number of ANC visits [AOR = 1.30; 95% CI (1.05, 1.62)], child's age [AOR = 0.30; 95% CI (0.21, 0.41)], community media exposure [AOR = 0.30; 95% CI (0.21, 0.41)], community literacy [AOR = 0.29; 95% CI (0.20, 0.43)], and community poverty [AOR = 1.46; 95% CI (1.04, 2.05)] were significantly associated with zero vegetable or fruit consumption.</p><p><strong>Conclusion: </strong>The proportion of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya was high. Zero vegetable or fruit consumption was significantly associated with maternal education, maternal occupation, media exposure, wealth index, place of delivery, number of ANC visits, child's age, community media exposure, community literacy, and community poverty. Giving attention to jobless, media-non-exposed mothers, poor wealth status, who gave birth at home, who had no formal education, attended < 4 ANC visits, and children aged 6 to 8 months is recommended.</p><p><strong>What is known: </strong>• Dietary recommendations for fruit and vegetable consumption were not met by many children in low and middle-income countries.</p><p><strong>What is new: </strong>• The proportion of zero vegetable or fruit consumption among children aged 6 to 23 months in Kenya was high.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"164"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory physiological changes post initiation of neurally adjusted ventilatory assist in preterm infants with evolving or established bronchopulmonary dysplasia.","authors":"Basma Mohamed, Anay Kulkarni, Donovan Duffy, Anne Greenough, Sandeep Shetty","doi":"10.1007/s00431-025-05997-x","DOIUrl":"10.1007/s00431-025-05997-x","url":null,"abstract":"<p><p>To assess respiratory changes after neurally adjusted ventilatory assist (NAVA) initiation in preterm infants with evolving or established bronchopulmonary dysplasia (BPD). Premature infants born less than 32 weeks gestation with evolving or established BPD initiated on invasive or non-invasive (NIV) NAVA were included. Respiratory data: PCO_₂ and SpO₂/FiO₂ (S/F) ratio before and at 4, 24, 48 h post-NAVA initiation were collected. Eighty-eight infants, median GA 25.1 (range 22.7-30.3) weeks, with 191 NAVA episodes were included. Infants born < 32 weeks with evolving and established BPD showed improvements in PCO_₂ and S/F ratio 48 h post-NAVA compared to prior: 7.6 (4.5-11.8) versus 8.1 (4.7-13.1) kPa; p < 0.001 and 285 (118-471) versus 276 (103-471); p = 0.013, respectively. Improvements were observed in invasive NAVA: 7.6 (4.5-11.8) versus 8.5 (4.7-12.4) kPa; p = 0.001, 290 (148-471) versus 271 (103-467); p = 0.002, and NIV-NAVA: 7.5 (4.6-11.7) versus 7.9 (5.2-13.1) kPa; p = 0.001, 283 (128-471) versus 294 (114-471); p = 0.002. Severe BPD infants had reductions in PCO_₂ 48 h post-initiation: 7.2 (5.6-9.7) versus 8.0 (5.4-11.7) kPa; p = 0.002, with lower FiO₂ requirements 0.37 (0.21-0.65) versus 0.43 (0.21-0.8); p = 0.011, and improved S/F ratios 263 (146-471) versus 219 (114-457); p = 0.006. On subgroup analysis, similar improvements were noted in; PCO₂ levels in invasive NAVA (p = 0.011) and NIV-NAVA (p = 0.002), S/F ratios in invasive NAVA (p = 0.046) and NIV-NAVA (p = 0.002) and FiO₂ in invasive NAVA (p = 0.034) and NIV-NAVA (p = 0.053).Conclusion: NAVA improves CO_₂ clearance and oxygenation in infants with evolving or established and severe BPD at 48 h post-initiation. In severe BPD, NAVA also reduced oxygen requirements What is Known: • NAVA has the potential to improve CO₂ clearance and oxygenation by optimising alveolar ventilation, adapting to the infant's breathing patterns, and enhancing gas exchange. What is New: • The beneficial effects of NAVA are sustained in infants with evolving or established bronchopulmonary dysplasia (BPD), improving carbon dioxide clearance and oxygenation at 48 hours after initiation.</p>","PeriodicalId":11997,"journal":{"name":"European Journal of Pediatrics","volume":"184 2","pages":"159"},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}