Frontiers in Pediatrics最新文献

{"title":"Complications of thoracoscopic TEF clipping for fistula ligation: a case report of polymer clip migration into the right main bronchus and recurrent fistula.","authors":"Annika Brandau, Jan-Hendrik Gosemann, Hannes Heublein, Ulrich Herbert Thome, Annett Bläser, Daniel Gräfe, Freerk Prenzel, Martin Lacher, Richard Wagner","doi":"10.3389/fped.2025.1639780","DOIUrl":"10.3389/fped.2025.1639780","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheoesophageal fistula (TEF) in neonates with esophageal atresia (EA) is conventionally closed by open or thoracoscopic surgery. We present a case of a rare yet potentially life-threatening complication following thoracoscopic ligation of a TEF, using a polymer clip.</p><p><strong>Case report: </strong>A term boy (GA: 42 + 1 weeks; BW: 3,110 g) underwent thoracoscopic TEF repair for Type C EA. We ligated the fistula using a polymer clip followed by primary esophageal anastomosis on the second day of life. At ten weeks of age, we readmitted the infant due to recurrent bronchitis and episodes of postprandial coughing. Flexible bronchoscopy revealed that the polymer clip, previously employed for fistula closure, had migrated into the right main bronchus and was subsequently retrieved. Despite clip removal, persistent coughing prompted further evaluation, revealing a recurrent TEF on contrast esophagography. An interdisciplinary team successfully obliterated the recurrent fistula using endoscopic chemocauterization with trichloroacetic acid (TCA) via rigid bronchoscopy. Additionally, due to a developing anastomotic stricture, the patient required four balloon dilations and a single triamcinolone injection. At the three-year follow-up, the patient is eating well and thriving normally.</p><p><strong>Conclusion: </strong>This case underscores the potential complications associated with thoracoscopic TEF closure via clipping. The application of transfixing sutures may offer a more secure and durable closure, reducing the risk of post-surgical complications such as clip migration and fistula recurrence.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1639780"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12507367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258042","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":"Application of ultrasound measurement of optic nerve sheath diameter to guide hyperosmolar therapy in children with intracranial hypertension.","authors":"Yanping Hua, Jiawei Wang, Yong Li, Yuhao Shen, Leihua Jiang, Jiaowei Wu","doi":"10.3389/fped.2025.1632992","DOIUrl":"10.3389/fped.2025.1632992","url":null,"abstract":"<p><strong>Purpose: </strong>Assessing the Clinical Value of Optic Nerve Sheath Diameter (ONSD) Ultrasonography in Pediatric Severe Intracranial Hypertension Monitoring and Treatment Efficacy Evaluation.</p><p><strong>Methods: </strong>This study included 86 critically ill children with intracranial hypertension, and used bedside ultrasound to dynamically monitor the diameter of the optic ONSD to evaluate the status of intracranial hypertension. The experimental group (<i>n</i> = 33) underwent three daily ONSD ultrasound monitoring throughout the treatment process, with a baseline value of >5.2 mm set as the intervention threshold based on the guidelines of the American Society for Neurocritical Care; The control group (<i>n</i> = 53) was monitored using traditional clinical signs. The efficacy evaluation was conducted using the National Institute of Health Stroke Scale (NIHSS), and core indicators such as the duration of neurological function recovery, Intensive Care Unit (ICU) hospitalization period, and incidence of complications were comprehensively compared between the two groups of children.</p><p><strong>Result: </strong>ONSD measurements, hyperosmolar agent [mannitol, hypertonic saline(HTS)] were adjusted accordingly. The treatment group demonstrated significantly shorter duration of hyperosmolar agents compared to controls. Although the ultrasound-guided group showed reduced hospitalization duration relative to the control group, this difference did not reach statistical significance. Neurological outcomes evaluated by discharge Glasgow Coma Scale (GCS) scores revealed clinically meaningful differences: the treatment group exhibited higher proportion of fully conscious patients and lower incidence of consciousness with both parameters showing statistical significance.</p><p><strong>Conclusion: </strong>The implementation of optimized neurological intensive care protocols incorporating multimodal monitoring demonstrates significant prognostic benefits. ONSD measurement offers clinical advantages as a rapid, non-invasive modality for detecting intracranial pressure fluctuations, establishing its utility in therapeutic monitoring for pediatric patients with severe intracranial hypertension.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1632992"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12507365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258074","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":"Quantitative ¹³C-urea breath test values predict peptic ulcer risk in <i>Helicobacter pylori</i> -infected children: a retrospective study.","authors":"Xiaoting Pan, Youtao Chen, Haibo Li, Hong Ye","doi":"10.3389/fped.2025.1684120","DOIUrl":"10.3389/fped.2025.1684120","url":null,"abstract":"<p><strong>Background: </strong>The quantitative ¹³C-urea breath test (¹³C-UBT) is valuable for diagnosing <i>Helicobacter pylori</i> (H. pylori) infection. However, pediatric-specific thresholds and their association with peptic ulcer (PU) disease remain inadequately defined. This study aimed to identify optimal pediatric delta over baseline (DOB) thresholds for diagnosing H. pylori infection and explore associations with ulcer risk in children.</p><p><strong>Methods: </strong>In this retrospective study, 1,034 consecutive children aged 3-18 years undergoing ¹³C-UBT with endoscopy and histopathological evaluation at Fujian Children's Hospital (May 2021-May 2025) were enrolled. DOB cutoff values were determined by ROC analysis. Logistic regression and restricted cubic spline (RCS) analyses evaluated associations between DOBs and ulcer risk.</p><p><strong>Results: </strong>The optimal pediatric-specific cutoff was 5.285% [Sensitivity 84%, Specificity 90%, area under the curve (AUC) 0.879]. Children with ulcers had significantly higher median DOBs than those without (3.1% vs. 1.9%; <i>P</i> < 0.001). A clear dose-response trend was observed across DOB quartiles (<i>P</i> < 0.001). Ulcer risk increased with DOB up to approximately 36.39‰, beyond which the risk plateaued.</p><p><strong>Conclusions: </strong>A DOB cutoff of 5.285‰ provides excellent diagnostic accuracy for pediatric <i>H. pylori</i> infection. Higher DOBs correlate strongly with increased bacterial load, mucosal inflammation, and peptic ulcer (PU) risk up to ∼36.39‰, indicating a saturation effect. Quantitative DOB thus offers diagnostic and prognostic utility, supporting its integration into regional pediatric guidelines.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1684120"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258058","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":"Trends in adolescent pertussis burden: a systematic analysis from 1990 to 2021 in global, regional, and national within the global burden of disease study 2021, with forecasts for 2046.","authors":"Huihui Zhu, Fangfang Lv, Shunhang Wen, Ming Xu, Hailin Zhang","doi":"10.3389/fped.2025.1601110","DOIUrl":"10.3389/fped.2025.1601110","url":null,"abstract":"<p><strong>Background: </strong>Pertussis, a highly contagious respiratory disease caused by Bordetella pertussis, traditionally associated with children, is now increasingly transmitted by adolescents (ages 10-19) and adults. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), we estimated the disease burden of pertussis among adolescents.</p><p><strong>Methods: </strong>We analyzed adolescent pertussis data from GBD 2021, assessing prevalence, incidence, mortality, and Disability-Adjusted Life Year (DALY) rate across global, regional, and national levels. Temporal trends were quantified with the Estimated Annual Percentage Change (EAPC), and decomposition and prediction models were employed for further insights.</p><p><strong>Results: </strong>From 1990 to 2021, adolescent pertussis prevalence, incidence, mortality, and DALY rate declined markedly worldwide. Declines were most pronounced in High and High-middle Socio-Demographic Index (SDI) regions, whereas Low SDI regions maintained the highest burden in 2021. Across the 21 GBD regions, the prevalence, incidence, mortality, and DALY rates have all declined. However, in Central Sub-Saharan Africa, the number of prevalence cases, incidence cases, deaths, and DALYs have increased, while these values have significantly decreased among adolescents in the other 20 GBD regions. Nationally and territorially, the study found substantial variability in the burden of pertussis among adolescents. Decomposition analysis indicated that epidemiological changes primarily drove the decline in most regions, though population growth contributed to increases in some areas. Projection models suggest that the global adolescent pertussis burden will reach its peak in 2022, followed by a gradual decline through 2046.</p><p><strong>Conclusions: </strong>Despite an overall global decline, pertussis remains a public health concern among adolescents due to their role in disease transmission. Strengthening epidemiological understanding in this age group is essential for effective prevention and control strategies.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1601110"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258053","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":"Lung consolidation absorption time in 238 pediatric cases of mycoplasma pneumoniae pneumonia.","authors":"YueXu Ou, Jie Cao, Bin Qin, ZhengXiu Luo, HongQiang Du, YuanHui Duan, FengHua Chen, JiWei Zhou, YuanYuan Li, YingLan Zheng, XiaoMing Gan","doi":"10.3389/fped.2025.1606834","DOIUrl":"10.3389/fped.2025.1606834","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the lung consolidation absorption time and rate in children with mycoplasma pneumoniae pneumonia (MPP) and evaluate the impact of bronchoalveolar lavage (BAL) on absorption.</p><p><strong>Methods: </strong>Children hospitalized with MPP and lung consolidation in Children's Hospital of Chongqing Medical University, between January 2018 and May 2024, were included for analysis. Patients were divided into BAL and non-BAL groups. Propensity score matching (PSM) was used to adjust for baseline differences between groups, and sub-group analyses were performed to assess the effect of BAL on lung consolidation absorption speed.</p><p><strong>Results: </strong>Among 238 children with MPP and lung consolidation, females slightly outnumbered males (129 vs. 109), with a mean age of approximately 5 years. Most children received azithromycin as the first-line treatment. Lung consolidation accounted for 4.48% (IQR: 2.61%-7.35%) of the total lung volume pre-treatment, with an absorption rate of 96.08% (IQR: 88.02%-98.95%) observed during follow-up at a median interval of 17 days (IQR: 15-21 days). The median absorption speed was 2.15 cc/day (IQR: 1.23-4.01 cc/day), with complete absorption occurring within 18.96 days (IQR: 16.14-23.33 days). Comparative analysis of the BAL and non-BAL groups revealed significant differences in fever duration, hs-CRP levels, consolidation-to-total lung volume ratio at admission, follow-up intervals, and consolidation absorption speed. Following 1:1 propensity score matching (PSM) to control for confounding factors, a statistically significant but small-to-medium effect persisted, with the median absorption rate remaining higher in the BAL group (2.13 cc/day) compared to the non-BAL group (1.60 cc/day).</p><p><strong>Conclusions: </strong>Using CT scan to evaluate consolidation changes in children with Mycoplasma pneumonia, most children have 96% resolution within 2-3 weeks timeframe. Those who had a bronchoscopy may have a faster resolution rate but undertaking a flexible bronchoscopy under these circumstances is not a standard procedure in most settings.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1606834"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258083","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":"Mobile ECMO for inter-hospital transport of pediatric patients: experience from 22 cases.","authors":"Yufan Yang, Xiangni Wang, Xiulan Lu, Xinping Zhang, Jiaotian Huang, Zhenghui Xiao","doi":"10.3389/fped.2025.1664454","DOIUrl":"10.3389/fped.2025.1664454","url":null,"abstract":"<p><strong>Objective: </strong>To summarize the management experience of inter-hospital transport of critically ill children with extracorporeal membrane oxygenation (ECMO) in our hospital and provide evidence for the mobile ECMO for inter-hospital transport of pediatric patients.</p><p><strong>Methods: </strong>Critically ill patients treated with ECMO transported to our hospital from January 2020 to July 2025 were included in this study and analyzed general information, disease types, cannulation methods, ECMO transport distances, patient conditions before and after ECMO deployment, complications during the transport, and outcome. The lesson was drawn up regarding individual protection, transport procedures, transport equipment, teamwork, monitoring during transport, and quality control, providing an evidence-based foundation for the mobile ECMO for inter-hospital transport process of critically ill children.</p><p><strong>Results: </strong>A total of 22 critically ill pediatric patients were successfully transported to our hospital supported with ECMO by ambulance. The oldest child was 13-years-old, and the median age of the cohort was 76.00 (19.00, 132.00) months. The primary diseases included acute respiratory distress syndrome (ARDS), fulminant myocarditis, avian influenza, heart failure, and persistent pulmonary hypertension of the neonate. The median transport distance was 180.00 (134.00, 233.00) km, and the patients had no complications during the transport. Subsequently, 17 patients recovered and were discharged from the hospital. Five patients developed with multiple organ failure soon after the separation of ECMO. The ECMO duration was 126.50 (83.00, 155.00) h. No infection in any medical staff and nursing staff.</p><p><strong>Conclusion: </strong>The availability and safety of mobile ECMO for inter-hospital transport of critically ill children could be improved with the support of a well-equipped technical team in a time-effective manner, saving patient lives.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1664454"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258030","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":"Variants of unknown significance in fetal heart malformations: distribution and impact on prenatal decision-making.","authors":"Qingsong Wang, Jun Yin, Xiaomeng Zhang, Huimin Ou, Fuyan Li, Yundong Zhang, Caiyu Guo, Weiyi Wan, Yongyu Cao, Tongyong Luo, Xianmin Wang","doi":"10.3389/fped.2025.1605899","DOIUrl":"10.3389/fped.2025.1605899","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the distribution patterns of variants of unknown significance (VUS) in fetuses with heart malformations (CHD) combined with extracardiac abnormalities and their impact on prenatal decision-making.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the chromosomal microarray analysis (CMA) data of 697 cases of fetal heart malformations (including simple, complex, and combined with extracardiac abnormalities) and 2,689 controls from Sichuan Provincial Maternal and Child Health Care Hospital between January 2020 and August 2022. Copy number variants (CNVs) were classified according to the ACMG guidelines (pathogenic, VUS, benign), and the differences in VUS detection rates and their impact on pregnancy outcomes were compared among groups.</p><p><strong>Results: </strong>Among 697 fetuses with prenatally diagnosed cardiac malformations, 602 (86.37%) had simple, 69 (9.90%) complex, 18 (2.58%) combined with structural extracardiac anomalies, and 8 (1.15%) with soft markers. Karyotype abnormalities occurred in 4.74% (26/549), 16.36% (9/55), 27.78% (5/18), and 12.50% (1/8) of these groups, respectively, all exceeding controls (4.71%, <i>P</i> < 0.05). Pathogenic CNVs were detected in 4.88% (27/553), 7.69% (5/65), 8.33% (2/24), and 0% (0/2), respectively; the first three rates were significantly higher than controls (1.38%, <i>P</i> < 0.05, <i>P</i> = 0.002, <i>P</i> = 0.033). VUS rates rose progressively: 0.54% (3/553), 1.54% (1/65), 12.50% (3/24), and 100% (2/2). Among nine VUS-positive pregnancies, six resulted in live-born infants without abnormalities; three were terminated due to additional malformations or parental anxiety.</p><p><strong>Conclusion: </strong>Fetuses with cardiac malformations accompanied by structural extracardiac anomalies carry the highest genetic risk; karyotyping combined with CMA should therefore be performed routinely. Complex cardiac malformations also warrant concurrent testing, whereas simple malformations and those with soft markers can be evaluated individually.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1605899"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257997","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":"Analysis of risk factors contributing to neonatal pneumonia in low birth weight neonates.","authors":"Xiaoli Xu, Yongmin Deng, Jingjing Han, Jing Wang, Rui Huang, Xiaoyan Zhao","doi":"10.3389/fped.2025.1620077","DOIUrl":"10.3389/fped.2025.1620077","url":null,"abstract":"<p><strong>Objective: </strong>The current study aims to investigate the high-risk determinants associated with the occurrence of pneumonia in low birth weight (LBW) neonates.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted at The First Hospital of Hebei Medical University, a tertiary care center in Shijiazhuang, China, for neonates born between January 2019 and December 2023. From a cohort of 230 LBW neonates admitted to the NICU, 90 neonates diagnosed with pneumonia were designated as the observation group, while 50 LBW neonates without pneumonia were selected as the control group. Statistical hypothesis testing was employed for data analysis, including univariate and multivariable logistic regression analyses.</p><p><strong>Results: </strong>Univariate analysis identified several significant risk factors for neonatal pneumonia, including low birth weight, prematurity (gestational age <37 weeks), small-for-gestational-age (SGA) status, neonatal anemia, patent ductus arteriosus, neonatal hyperbilirubinemia, maternal hypothyroidism during pregnancy, and prenatal infection (<i>P</i> < 0.05). Multivariable logistic regression analysis that included all significant univariate predictors revealed that birth weight (OR for <1,600 g vs. ≥2,200 <i>g</i> = 7.112, 95% CI: 1.650-30.651) and small-for-gestational-age status (OR = 2.598, 95% CI: 1.152-5.859) remained as the sole independent risk factors for neonatal pneumonia in LBW neonates.</p><p><strong>Conclusion: </strong>Birth weight and small-for-gestational-age status are independent risk factors for neonatal pneumonia in low birth weight neonates. SGA neonates born at very early gestational ages (<32 weeks) represent a particularly high-risk subgroup.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1620077"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258081","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":"Combination of echocardiography with systemic hemodynamic parameters for early risk stratification of hemodynamically significant patent ductus arteriosus in preterm infants.","authors":"Cuie Chen, Yuechong Cui, Shujun Chen, Jiaonv Chen, Lirong Zhao, Yuanyuan Sun, Liuqing Ji, Guoliang Wang","doi":"10.3389/fped.2025.1616706","DOIUrl":"10.3389/fped.2025.1616706","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamically significant patent ductus arteriosus (hsPDA) is a major contributor to morbidity and mortality in extremely preterm infants. Both echocardiographic assessment and systemic hemodynamic monitoring have emerged as valuable tools for evaluating cardiovascular status during the early postnatal period. This study aimed to evaluate whether echocardiographic and systemic hemodynamic parameters within 72 hours can predict the development of hsPDA in preterm infants.</p><p><strong>Methods: </strong>In this prospective study, 98 infants born at our institution between October 2022 and March 2025 were enrolled based on inclusion criteria of gestational age ≤32 weeks and birth weight ≤1,500 g. Hemodynamic monitoring was conducted using the Non-Invasive Cardiac System (NICaS) at 24, 48, and 72 hours after birth, each followed immediately by echocardiographic evaluation.</p><p><strong>Results: </strong>Among 98 preterm infants, 85 had patent ductus arteriosus (PDA) at 24 hours, with 30 progressing to hsPDA. The hsPDA group had significantly lower gestational age and birth weight. Maternal eclampsia or preeclampsia, placental abruption, neonatal asphyxia, alveolar surfactant need, mechanical ventilation within 72 hours, and higher fluid intake in the first 24 hours were more frequent in this group. These infants required prolonged respiratory support and parenteral nutrition, and showed higher rates of intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). Compared to non-hsPDA infants, those with hsPDA had larger ductus arteriosus (DA) diameters, higher DA diameter/weight ratios at 48 and 72 hours, and elevated left atrium-to-aortic root (LA/Ao) ratios at 24, 48, and 72 hours. Stroke index (SI), cardiac output index (CI), and total body water percent (TBW%) were increased, while total peripheral resistance index (TPRI) was reduced at 48 and 72 hours. Multivariate analysis identified maternal eclampsia/preeclampsia, surfactant use, DA diameter-to-weight ratio, LA/Ao, and TBW% at 48 and 72 hours as independent risk factors. A combined model achieved high predictive accuracy (AUC = 0.981, sensitivity = 100%, specificity = 90.0%).</p><p><strong>Conclusion: </strong>This study demonstrated that combining echocardiographic parameters with systemic hemodynamic indicators at 72 hours of life provides significant predictive value for identifying preterm infants with a gestational age ≤32 weeks and birth weight ≤1,500 g who are at risk of developing hsPDA.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1616706"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250513","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":"Remimazolam in pediatric anesthesia: a systematic review for clinical decision-making.","authors":"Yi Zhang, Qiuxiang Chen, Linyun Wang, Qingjun Zeng, Haishan Cui, Shuang Guo, Fei Xiang, Yunbo Mo","doi":"10.3389/fped.2025.1662752","DOIUrl":"10.3389/fped.2025.1662752","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam's role in pediatric anesthesia is evolving. We systematically reviewed 2024-2025 evidence to establish a clinical decision-making framework for its use.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic search identified 23 studies (15 RCTs) involving 2,847 pediatric patients for narrative synthesis.</p><p><strong>Results: </strong>Remimazolam demonstrated superior hemodynamic stability vs. propofol (cardiovascular complications: RR 0.30, 95% CI 0.20-0.46) and reduced emergence delirium by 61% (RR 0.39, 95% CI 0.21-0.70). The CES1 G143E polymorphism was identified as a genetic basis for prolonged sedation, reducing drug clearance >90%. Critical limitations include a 15% re-sedation rate post-flumazenil, a complete lack of data in infants <1 year, and unknown long-term neurodevelopmental safety.</p><p><strong>Conclusion: </strong>Remimazolam represents a valuable anesthetic tool with specific advantages in pediatric anesthesia. While it demonstrates superior hemodynamic stability and reduced emergence delirium compared to standard agents, it is not a universal replacement for established anesthetics. Current evidence supports its use in specific clinical scenarios, particularly for preventing post-sevoflurane emergence delirium and in hemodynamically unstable patients. However, the absence of infant and long-term neurodevelopmental safety data necessitates continued research before widespread adoption.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251058023, PROSPERO CRD420251058023.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1662752"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250511","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}