Frontiers in Pediatrics最新文献

{"title":"Impact of fast advancement and early fortification of enteral feedings in preterm infants, a retrospective, observational study.","authors":"Enrique Gomez-Pomar, Holly Clarke, Jamie Adams","doi":"10.3389/fped.2025.1544381","DOIUrl":"10.3389/fped.2025.1544381","url":null,"abstract":"<p><p>We aimed to evaluate the outcomes and growth of preterm infants at a Neonatal Intensive Care Unit that focuses on early initiation, fast advancement, and early fortification of enteral feeds.</p><p><strong>Methods: </strong>Retrospective study conducted at a community hospital level III NICU. Extensive feeding data and outcomes were collected by utilizing a NutritionIQ software application, NICUtrition®. Infants born between 26- and 34-weeks gestational age were included, whereas infants with congenital defects, deceased or with incomplete data were excluded. Frequency and descriptive statistical analysis were conducted using chi-square and Fisher's exact test. Unadjusted odds ratios were computed for categorical variables and general linear models were conducted to adjust for covariates (birth weight and gestational age) in sensitivity analyses.</p><p><strong>Results: </strong>A total of 297 preterm infants were included. On average, infants reached target enteral feeds of at least 120cc/kg/day and received fortification by day 6 of life. Achievement of target enteral feeds within the first week of life was associated with improved delta z-scores for weight and length as well as significantly less rates of sepsis. Infants that achieved target enteral feedings and fortification during the first week of life were associated with significantly improved delta z-scores for weight, length, and head circumference. Contrary to expectations, the use of Mother's Own Milk alone was not associated with improved outcomes.</p><p><strong>Conclusions: </strong>This study highlights the association of early initiation, faster advancement and fortification of enteral feedings on preterm infants. These interventions improved growth metrics (weight, head circumference, and length z-scores) and were associated with decreased prevalence of sepsis.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1544381"},"PeriodicalIF":2.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232122","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":"Percutaneous leverage reduction with kirschner-wire fixation assisted by elbow arthrography for pediatric radial neck fractures.","authors":"Hai Jiang, Tao Li","doi":"10.3389/fped.2025.1571774","DOIUrl":"10.3389/fped.2025.1571774","url":null,"abstract":"<p><strong>Objective: </strong>Radial neck fractures in children can easily become complicated if not managed properly. Percutaneous reduction using the leverage technique with or without internal fixation with a Kirschner wire (K-wire) is a minimally invasive approach for treating angulated radial neck fractures in children. The study aims to evaluate the radiological and clinical outcomes of percutaneous leverage reduction assisted by elbow arthrography for pediatric radial neck fractures.</p><p><strong>Methods: </strong>From January 2016 to June 2020, we treated 47 children with angulated radial neck fractures, including 35 boys and 12 girls. The patient's age ranged from 2 to 13 years, with an average age of 6 years 9 months. According to Judet classification, 21 cases were classified as Type III, 15 cases as Type IVa and 11 cases as Type IVb. To overcome the difficulty of reduction caused by the absence of the ossified radial head centers in young children, we used intraoperative elbow arthrography to assist with the reduction. After achieving satisfactory reduction, one or two K-wires were inserted percutaneously to fix the fracture site and prevent reduction loss.</p><p><strong>Results: </strong>All cases were followed up for an average of 43 months, ranging from 24 months to 90 months. No radial head necrosis or synostosis of the proximal ulna and radius was observed during the long-term follow-up. No epiphyseal arrest or valgus of the elbow was noted at the end of the follow-up. According to the Metaizeau reduction classification, 42 cases were rated excellent, and 5 cases as good. Based on the Metaizeau clinical classification, 45 cases were excellent and 2 were good.</p><p><strong>Conclusion: </strong>Closed reduction assisted by intraoperative elbow arthrography, combined with percutaneous leverage technique and internal fixation with K-wires, achieved satisfactory reduction and functional outcomes in children with angulated radial neck fractures, even in cases where the radial head ossification centers were not yet visible.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1571774"},"PeriodicalIF":2.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232185","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":"25OH vitamin D3 in biliary atresia: a simple and under-utilised diagnostic method.","authors":"Fangjuan Song, Wanfu Li, Zhida Chen, Ayiguzali Maimaijiang, Yaqi Wang","doi":"10.3389/fped.2025.1658405","DOIUrl":"10.3389/fped.2025.1658405","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Biliary atresia is a form of pediatric cholangiopathy that affects the bile ducts of the liver. If left undiagnosed and untreated, it often leads to liver failure and death within 1-2 years of age. The treatment approach for this condition is recognized as the Kasai surgical procedure,which has been shown to achieve optimal outcomes when performed within 60 days of age. Furthermore, the timing of surgery has been identified as a crucial factor in determining patient prognosis. The current clinical practice involves the use of ultrasound as a primary diagnostic tool. Serum γ-glutamyltranspeptidase and other biochemical indicators are utilized in the diagnosis of biliary atresia, yet challenges persist regarding the occurrence of false-positive results. Consequently, there is an urgent clinical necessity to investigate non-invasive indicators for the early diagnosis of BA in children, with the objective of enhancing the accuracy of early diagnoses. In clinical practice, we frequently encounter cases of severe vitamin D deficiency in children diagnosed with BA. In recent years, the association between vitamin D and liver fibrosis in chronic liver disease has been substantiated. The objective of this study was to ascertain the clinical value and significance of 25(OH)D3 in the early diagnosis of BA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The best early diagnosis of BA is currently clinically inconclusive, and no test can confirm the diagnosis before surgery. To explore the clinical value of 25(OH)D3 in the diagnosis of biliary atresia (BA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The observation group comprised paediatric patients with biliary atresia admitted to the First Affiliated Hospital of Xinjiang Medical University between January 2024 and March 2025. The control group consisted of paediatric patients with cholestatic diseases caused by conditions other than biliary atresia during the same period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were significant differences in ultrasound results, serum γ-glutamyl transpeptidase level and 25(OH)D3 level between the BA group and the non-BA group (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). The level of γ-glutamyl transpeptidase in the BA group was significantly higher than that in the non-BA group (&lt;i&gt;P&lt;/i&gt; &lt; 0.05), the level of direct bilirubin in the BA group was significantly higher than that in the non-BA group (&lt;i&gt;P&lt;/i&gt; &lt; 0.05), and the level of 25(OH)D3 in the BA group was significantly lower than that in the non-BA group (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). A 25(OH)D3 cut-off level of 20.59 or lower combined with ultrasound results, or a 25(OH)D3 cut-off level of 20.59 or lower, ultrasound results, and serum γ-glutamyl transpeptidase cut-off levels of 283.89 or higher were combined to increase the sensitivity by 2.5%, specificity by 1.96%, PPV by 2.5%, NPV by 1.96%, and accuracy by 2.20% compared with 25(OH)D3 alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The level of 25(OH)D3 can be used as a new force for diagnosing BA to p","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1658405"},"PeriodicalIF":2.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232364","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":"A novel <i>ANK1</i> frameshift mutation associated with neonatal hereditary spherocytosis: a case report.","authors":"Xin Qing, Jimo Zhu, Xiaoshi Zhu, Yu Zhang, Junchao Deng, Binzhi Tang","doi":"10.3389/fped.2025.1666585","DOIUrl":"10.3389/fped.2025.1666585","url":null,"abstract":"<p><strong>Background: </strong>Hereditary spherocytosis (HS) is a genetically inherited hemolytic anemia resulting from erythrocyte membrane defects, predominantly associated with genetic mutations in membrane protein genes such as <i>ANK1</i> and <i>SPTB</i>. The disease exhibits considerable heterogeneity in both clinical manifestations and age of onset, presenting substantial diagnostic challenges for clinicians, particularly in pediatric cases.</p><p><strong>Case presentation: </strong>The patient was a 29-day-old boy who had experienced persistent anemia and a medical history of neonatal hyperbilirubinemia since birth. Upon admission, the infant lacked typical HS manifestations such as splenomegaly, jaundice, and spherocytosis on the peripheral blood smear. Whole-exome sequencing identified a novel frameshift mutation c.3556delG (EX30, NM_000037.4), resulting in an amino acid alteration p.Glu1186Lysfs*3. Subsequent Sanger sequencing-based family segregation analysis confirmed that this mutation originated from the paternal allele. Based on the characteristic clinical manifestations and genetic findings, a definitive diagnosis of HS was established.</p><p><strong>Conclusions: </strong>In neonates presenting with unexplained recurrent anemia, particularly those with a history of neonatal hyperbilirubinemia, HS should be suspected. Due to the atypical manifestations, genetic analysis serves as a pivotal tool in the early diagnosis of HS, and novel genetic mutations may be identified, which can subsequently be added to the genetic database.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1666585"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232148","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 the association between reading and writing postures and comorbidity of myopia and scoliosis in junior middle school students.","authors":"Yanjiao Wang, Dongling Yang, Fengyun Zhang, Wenjuan Qi, Qiuying Lu, Haotian Wu, Chunyan Luo","doi":"10.3389/fped.2025.1576575","DOIUrl":"10.3389/fped.2025.1576575","url":null,"abstract":"<p><strong>Objective: </strong>Given the emerging co-prevalence of myopia and scoliosis as significant public health challenges among Chinese adolescents, and considering sustained poor reading/writing postures as a potential shared risk factor contributing to onset, progression, and comorbidity, this study aimed to investigate the epidemiological association between myopia and scoliosis, specifically evaluate the synergistic effects of poor reading/writing postures on these conditions, and establish evidence-based strategies for coordinated prevention of comorbid orthopaedic-ophthalmic disorders.</p><p><strong>Methods: </strong>The study population comprised adolescents aged 11-15 years enrolled in junior middle schools across Shanghai. All participants underwent comprehensive ocular examinations, standardized scoliosis screening, and completed structured questionnaires assessing demographic and behavioral risk factors.</p><p><strong>Results: </strong>This study included 9,583 middle school students (mean age 12.59 ± 1.17 years). Overall myopia prevalence was 77.6%, while the scoliosis prevalence was 1.7%. Notably, 87.2% of the scoliosis cohort had concurrent myopia, compared to 77.4% in the non-scoliosis group. The dual-disease comorbidity rate was 1.5% (males: 1.0%; females: 2.1%). Multivariable logistic regression analysis revealed that poor reading/writing postures (OR = 1.17, 95% CI: 1.02-1.34) and scoliosis screening positivity (OR = 1.74, 95% CI: 1.09-2.76) were significantly associated with increased myopia risk. Conversely, myopia demonstrated a bidirectional association with elevated scoliosis susceptibility (OR = 1.73, 95% CI: 1.09-2.75). For dual-disease cases, advancing school grade and female sex were positively correlated with comorbidity. Systematic implementation of postural breaks after 30-minute near-work intervals (OR = 0.65, 95% CI: 0.46-0.91) and teacher-mediated posture monitoring (OR = 0.66, 95% CI: 0.45-0.97) significantly reduced comorbidity risks compared to sporadic practice.</p><p><strong>Conclusions: </strong>A significant bidirectional association exists between adolescent myopia and scoliosis, with non-ergonomic reading/writing postures identified as a shared modifiable risk factor. Education functional departments should implement evidence-based interventions including postural ergonomics education, routine vision and spinal screening programs, and structured postural breaks after near-work intervals to mitigate dual-disease burdens in adolescents.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1576575"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212539","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":"Sleep quality moderated the mediating effect of BMI and waist circumference on the relationship between screen time and mental health in Chinese adolescents.","authors":"Yi Wang, Huipan Wu, Jian Wu, Yuanyuan Ma, Jinxian Wang","doi":"10.3389/fped.2025.1602512","DOIUrl":"10.3389/fped.2025.1602512","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate whether body mass index and waist circumference can moderate the relationship between screen time and adolescent mental health, and whether sleep quality can moderate these effects.</p><p><strong>Method: </strong>Using a stratified cluster random sampling method, 5,713 adolescents aged 13-18 years were selected from six administrative regions in China for a questionnaire survey. Data analysis used statistical methods such as Pearson correlation analysis. The mediation model was tested using the PROCESS (version 3.3) SPSS macro model 4 developed by Hayes, and model 7 was used to test the moderation model.</p><p><strong>Results: </strong>Screen time was negatively correlated with adolescent mental health (<i>r</i> = -0.10, <i>p</i> < 0.001) and positively correlated with BMI (<i>r</i> = 0.03, <i>p</i> < 0.05). Screen time has a significant negative effect on adolescents' mental health [<i>β</i> = -0.20, SE = 0.07, <i>p</i> < 0.01, 95% CI = (-0.34, -0.06)], while BMI mediates the relationship between screen time and mental health [<i>β</i> = -0.89, SE = 0.12, <i>p</i> < 0.001, 95% CI = (-1.11, -0.66)]. Additionally, sleep quality moderates the relationship between screen time and mental health in adolescents [<i>β</i> = 0.04, SE = 0.01, <i>p</i> < 0.001, 95% CI = (0.02, 0.07)]. There was no correlation between screen time and waist circumference (<i>r</i> = -0.005, <i>p</i> > 0.05), but there was a negative correlation between waist circumference and mental health (<i>r</i> = -0.04, <i>p</i> < 0.01). Waist circumference did not mediate the relationship between screen time and mental health (<i>p</i> > 0.05), nor did sleep quality moderate the relationship between screen time and waist circumference (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>BMI plays a partial mediating role between screen time and mental health among Chinese adolescents. Additionally, sleep quality weakens the association between screen time and mental health. Therefore, it is recommended to alleviate mental health issues caused by excessive screen time among adolescents by promoting sleep quality.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1602512"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232357","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":"Correction: Complications and clinical factors associated with pediatric percutaneous endoscopic gastrostomy in a Colombian cohort.","authors":"Carlos Augusto Cuadros Mendoza, Mario Javier Rosero Portilla, Verónica Pico Quintero, Edgar Fabián Manrique-Hernández, Alexandra Hurtado-Ortiz, Maricel Licht-Ardila, Alejandra Mendoza-Monsalve","doi":"10.3389/fped.2025.1701519","DOIUrl":"https://doi.org/10.3389/fped.2025.1701519","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fped.2025.1623355.].</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1701519"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232146","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":"Epidemiology and clinical aspect of pediatric mushroom poisonings: a 15-year retrospective analysis.","authors":"ShaoCong Zheng, Xuejiao Miao, Shan He","doi":"10.3389/fped.2025.1621891","DOIUrl":"10.3389/fped.2025.1621891","url":null,"abstract":"<p><strong>Background: </strong>Mushroom poisoning is a significant public health concern, particularly in pediatric populations, where developmental differences in toxin metabolism and organ vulnerability pose unique clinical challenges. Despite its geographic and seasonal patterns, pediatric mushroom poisoning remains underrepresented in the literature, necessitating further investigation into its epidemiological and clinical characteristics.</p><p><strong>Methods: </strong>This 15-year retrospective cohort study analyzed 73 pediatric cases (aged ≤14 years) of mushroom poisoning at a tertiary hospital in Southwest China. Epidemiological, clinical, and laboratory data were collected, and statistical analyses were performed using SPSS 26.0.</p><p><strong>Results: </strong>Epidemiological data revealed seasonal clustering in summer and autumn, predominantly affecting older children (≥7 years). <i>Boletus spp.</i> accounted for most cases (71.2%), followed by <i>Amanita</i> (8.2%). Clinical presentations included gastrointestinal (72.6%) and neurotoxic symptoms (69.9%), with hallucinations more prevalent in non-liver injury cases (56.9% vs. 0%, <i>p</i> = 0.02). Severe hepatic injury, marked by elevated liver enzymes (ALT, AST, LDH) and coagulation dysfunction (APTT, PT), correlated with higher HOPE6 scores (≥3) and 100% mortality (4 deaths). The HOPE6 scoring system demonstrated prognostic utility, with a pediatric-specific threshold (≥3) predicting adverse outcomes, contrasting with adult thresholds (≥2).</p><p><strong>Conclusions: </strong>This study highlights the critical role of hepatic injury in mortality and underscores age-dependent variations in clinical thresholds for risk stratification in pediatric mushroom poisoning. Early intensive care is advocated to improve outcomes. Future research should focus on multicenter prospective cohorts to further validate these findings and assess therapeutic interventions.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1621891"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232142","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":"Editorial: Insights in pediatric nephrology.","authors":"Michael L Moritz, Agnieszka Swiatecka-Urban, Vera Hermina Koch","doi":"10.3389/fped.2025.1671358","DOIUrl":"https://doi.org/10.3389/fped.2025.1671358","url":null,"abstract":"","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1671358"},"PeriodicalIF":2.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212531","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 NEC cases registered in the human milk bank database.","authors":"Katsumi Mizuno, Yuka S Wada, Motoichiro Sakurai, Yuki Tani, Masafumi Miyata, Jun Shindo, Shigeru Nishimaki, Hiroki Den","doi":"10.3389/fped.2025.1679676","DOIUrl":"10.3389/fped.2025.1679676","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in extremely low birth weight infants (ELBWIs), despite widespread donor human milk (DHM) use. This study examined NEC cases among DHM recipients to explore potential contributing factors.</p><p><strong>Methods: </strong>We retrospectively analyzed 1,425 infants registered in Japan's human milk bank database (2018-2023). NEC cases at Bell stage ≥ II were confirmed by attending physicians. Infants who received DHM only after NEC onset were excluded. Cases were categorized by onset timing and associated clinical factors.</p><p><strong>Results: </strong>Among 1,324 very low birth weight infants, 21 (1.58%) developed NEC, with 20 requiring surgical intervention. Median gestational age and birth weight were 25.1 weeks and 637 g, respectively. NEC onset was classified as follows: within 7 days of birth (<i>n</i> = 5), after 2 months (<i>n</i> = 5), after formula or fortifier use (<i>n</i> = 6), associated with hemodynamic changes (<i>n</i> = 7), or of unknown etiology (<i>n</i> = 4). Common factors included symptomatic PDA, congenital heart disease, infection, formula exposure, and ophthalmologic procedures.</p><p><strong>Conclusion: </strong>NEC can develop despite DHM use, often in association with early infections, PDA, or fortification. Strategies to further reduce NEC incidence should include management of hemodynamic instability, delayed formula introduction, and use of exclusive human milk-based diets. Further research should explore potential roles of ophthalmologic interventions and human milk fortifiers in NEC development.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"13 ","pages":"1679676"},"PeriodicalIF":2.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212489","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}