Pediatric Research最新文献

{"title":"Advocating for the vulnerable: addressing anaphylaxis in infancy through awareness, research, and policy.","authors":"Eryn Fox, Adam Haines, Punita Ponda","doi":"10.1038/s41390-025-03827-2","DOIUrl":"https://doi.org/10.1038/s41390-025-03827-2","url":null,"abstract":"<p><strong>Impact: </strong>Infant anaphylaxis, a life-threatening condition, remains poorly understood due to limited research in this vulnerable population. Financial, ethical, and regulatory barriers hinder pediatric research, leaving critical gaps in knowledge. Physician advocacy is vital in addressing these challenges by urging policymakers to prioritize increased funding for pediatric studies at national and international levels. Enhanced investment would support improved diagnosis and management of poorly understood conditions early in life, offering better outcomes for infants and their families. By advancing research in this area, we can address significant unmet needs and foster healthier futures for our youngest patients.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441407","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":"Neuroprotective effects of vitamin C on hypoxic-ischemic brain injury in neonatal mice.","authors":"Kaiyi Liu, Xiaoqing Chen, Fangbing Chen, Wenjuan Dai, Shiyi Zheng, Bi Ze, Wenhao Zhou, Yifeng Lin","doi":"10.1038/s41390-025-03926-0","DOIUrl":"https://doi.org/10.1038/s41390-025-03926-0","url":null,"abstract":"<p><strong>Background: </strong>Hypoxic ischemia (HI) is one of the common causes of neonatal brain injury, leading to neurodevelopmental disorders such as cerebral palsy, epilepsy, and cognitive deficits. In this study, we evaluated neuroprotective effects of vitamin C on the neonatal HI brain injury mouse model.</p><p><strong>Methods: </strong>Brain damage measurement, sensorimotor function in the neonatal period, learning and memory ability in adulthood were carried out in mice treated with vitamin C daily for 7 consecutive days following HI brain injury at postnatal day 7.</p><p><strong>Results: </strong>Vitamin C treatment significantly reduced the hippocampus damage area, infarction volume, hippocampal neuron loss, and suppressed the neuroinflammation after HI injury. Additionally, it improved performance on neonatal sensorimotor function tests and learning and memory ability in adulthood.</p><p><strong>Conclusions: </strong>Vitamin C reduced brain injury and improved functional recovery in the neonatal hypoxic ischemia brain damage (HIBD) model.</p><p><strong>Impact: </strong>Vitamin C treatment significantly reduced neuron loss and suppressed the neuroinflammation after hypoxic-ischemic brain injury. Vitamin C treatment enhanced sensorimotor functions in neonates and improved cognitive abilities in adults after hypoxic-ischemic brain injury. Vitamin C could be an attractive candidate drug in clinical trials of hypoxic-ischemic encephalopathy therapy.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441472","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":"From data to policy: two-dose meningococcal vaccine series are highly immunogenic.","authors":"Adam Z Blatt, Michael J Smith","doi":"10.1038/s41390-025-03940-2","DOIUrl":"https://doi.org/10.1038/s41390-025-03940-2","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441427","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":"Between-center variability in the outcome of VLBW infants is not affected by socioeconomic deprivation.","authors":"Csaba Nador, Andrea Valek, Attila Juhasz, Csilla Nagy, Eszter Bodrogi, Miklos Szabo, Agnes Jermendy","doi":"10.1038/s41390-025-03937-x","DOIUrl":"https://doi.org/10.1038/s41390-025-03937-x","url":null,"abstract":"<p><strong>Background: </strong>While outcomes of very low birth weight (VLBW) infants have improved significantly in high-income countries over recent decades, data from Central-Eastern Europe are lacking. The study aimed to evaluate trends in VLBW infant outcomes and hypothesized that a variability exists in the performance of NICUs in Hungary.</p><p><strong>Methods: </strong>This was a population-based cohort study of VLBW infants, conducted between 2014-2016 (Epoch 1); and between 2019-2021 (Epoch 2) involving all Level III NICUs in Hungary. The primary composite outcome was death or any of the five major morbidities. Adjustments were made for case-mix and hospital-level factors, and the impact of deprivation, a composite index of socioeconomic status, was assessed.</p><p><strong>Results: </strong>The composite outcome decreased from 39.1% in Epoch 1 (n = 3438) to 34.3% in Epoch 2 (n = 3084) (p < 0.001). Mortality rate reduced significantly by 1.7% (p = 0.028). The rate of late-onset sepsis dropped by 4.8% (p < 0.001). The adjusted odds of adverse composite outcome decreased 5% yearly (aOR 0.95 (95% C.I. 0.92-0.97)). There was a significant between-center variability in the composite outcome, but it showed no correlation with the deprivation.</p><p><strong>Conclusions: </strong>Composite outcome trends improved over time, but substantial variability persists among NICUs which cannot be explained by patient characteristics, patient volume, or deprivation.</p><p><strong>Impact statement: </strong>Our study presents the first comprehensive, population-based analysis of VLBW infant outcomes in the Central-Eastern European region. Composite outcome trends of death and the five major morbidities have shown significant improvement over the past decade among VLBW infants in Hungary. A substantial variability exists between the performance of level III NICUs, independent of case-mix and patient volume. The odds of adverse outcome in VLBW infants is not correlated with deprivation, a municipal level metric of socioeconomic status.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433611","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":"Effect of early antibiotic exposure on necrotizing enterocolitis and growth in extremely preterm infants.","authors":"Katie M Strobel, Thomas R Wood, Gregory C Valentine, Olivia C Brandon, D Taylor Hendrixson, Dennis E Mayock, Krystle M Perez, Mihai Puia-Dumitrescu, Patrick J Heagerty, Sandra E Juul","doi":"10.1038/s41390-025-03928-y","DOIUrl":"https://doi.org/10.1038/s41390-025-03928-y","url":null,"abstract":"<p><strong>Background: </strong>The relationship between early antibiotic exposure, necrotizing enterocolitis (NEC), and growth faltering (GF) in extremely preterm infants is unknown.</p><p><strong>Methods: </strong>We evaluated the association between peripartum and postnatal antibiotic exposure in the first week after birth with NEC and GF in this secondary analysis of Preterm Erythropoietin Neuroprotection Trial subjects. NEC was defined as Bell's stage ≥ IIA; GF was defined as decreased weight, length, or head circumference (HC) z-score from birth to discharge of < -0.8. Multivariable analyses were adjusted with maternal and infant factors.</p><p><strong>Results: </strong>A total of 891 infants survived the first week and were included in the NEC analyses, while 828 infants survived to discharge and were included in the growth analyses. For every 1-day increase in infant antibiotic exposure during the first week after birth, there was a significantly increased adjusted hazard of NEC (aHR/day 1.14 [1.01-1.28], p = 0.034). Antibiotics for 3-4 days and 5-7 days total in the first week were associated with increased odds of weight GF (aOR 1.90 [1.21-2.99], aOR 2.32 [1.44-3.74]), length GF (aOR 1.76 [1.22-2.59], aOR 1.88 [1.26-2.80]), and HC GF (aOR 1.75 [1.08-2.84], aOR 1.87 [1.14-3.08]).</p><p><strong>Conclusion: </strong>Increased antibiotic exposure in the first week after birth was associated with NEC and GF risk.</p><p><strong>Impact: </strong>In this post-hoc analysis of a large multi-site trial, we found infant antibiotic exposure in the first week after birth was associated with an increased hazard of necrotizing enterocolitis in the extremely preterm infant after adjusting for maternal and infant factors. First week antibiotic exposure in the extremely preterm infant was associated with an increased odds of weight, linear, and head circumference growth faltering after adjusting for maternal and infant factors. These findings encourage the judicious use of early antibiotics in extremely preterm infants.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425969","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":"Physiological responses to retinopathy of prematurity screening: indirect ophthalmoscopy versus ultra-widefield retinal imaging.","authors":"Ravi Purohit, Fatima Usman, Amanda Ie, Marianne van der Vaart, Shellie Robinson, Miranda Buckle, Luke Baxter, Michelle Clee, Amanda Clifford, Eleri Adams, Rebeccah Slater, Chetan K Patel, Caroline Hartley, Kanmin Xue","doi":"10.1038/s41390-025-03906-4","DOIUrl":"https://doi.org/10.1038/s41390-025-03906-4","url":null,"abstract":"<p><strong>Background/aims: </strong>Retinopathy of prematurity (ROP) screening is vital for early disease detection in very premature infants but can cause physiological instability. This study compares the physiological response to binocular indirect ophthalmoscopy (BIO) with indentation and non-contact ultra-widefield (UWF) retinal imaging in non-ventilated neonates. The impact of the Dandle WRAP, a specialised swaddling aid, on UWF imaging was also assessed.</p><p><strong>Methods: </strong>This retrospective study included 86 ROP screening events in 66 non-ventilated infants aged 35.3 weeks (range 30.6-44.6). Vital signs were continuously recorded, evaluating immediate (within 15 min) and longer-term (within 12 h) physiological responses.</p><p><strong>Results: </strong>ROP screening significantly increased heart and respiratory rates and decreased oxygen saturation within 15 min of screening. No significant differences in physiological responses were found between BIO and UWF imaging, although there was a trend towards lower maximum heart rate with UWF imaging. The Dandle WRAP did not significantly alter physiological responses but improved the ease and speed of UWF imaging.</p><p><strong>Conclusion: </strong>UWF imaging does not increase physiological instability compared to BIO in non-ventilated infants. Specialised swaddling aids may facilitate the imaging procedure.</p><p><strong>Impact: </strong>ROP screening can be distressing for premature infants and induce physiological instability during and after the examination. We deployed non-contact ultra-widefield retinal imaging as the default method of ROP screening and show that it induces comparable physiological responses as traditional indirect ophthalmoscopy in non-ventilated babies. Dandle WRAP swaddling facilitated handling and speed of retinal imaging. The study demonstrates that imaging-based ROP screening is safe and efficacious in non-ventilated neonates, and continuous multimodal physiological recordings can provide detailed assessment of the effects of procedures and medications.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414527","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":"Upper airway obstruction during sleep in infants with laryngomalacia is frequently sleep-position-dependent.","authors":"Turkka Kirjavainen, Mervi Kanerva, Hanna-Leena Kukkola, Johanna Nokso-Koivisto","doi":"10.1038/s41390-025-03919-z","DOIUrl":"https://doi.org/10.1038/s41390-025-03919-z","url":null,"abstract":"<p><strong>Background: </strong>Laryngomalacia is the most common congenital airway anomaly causing breathing difficulties in infants. Severe laryngomalacia is often associated with obstructive sleep apnea (OSA).</p><p><strong>Methods: </strong>We re-evaluated 14-year pediatric sleep center polysomnography (PSG) data in infants with fluoroscopy-verified laryngomalacia.</p><p><strong>Results: </strong>The study included 79 infants, with a median corrected age of 8 weeks (interquartile range, IQR 5-13) and a laryngomalacia clinical score of 10/14 (IQR 7-11). Most (78%) PSG studies were daytime studies. In PSG, laryngomalacia-related breathing difficulty appeared as a sleep stage and position-dependent OSA with laborious breathing. PSG allowed position comparison in 69 infants. In the supine sleeping position, a median obstructive apnea and hypopnea-index (OAHI) was 22 h^-1 (IQR 10-50) compared with 7 h^-1 (IQR 1-26) in the side sleeping position (p < 0.0001). In the supine, breathing was also more laborious, and end-tidal carbon dioxide 99th percentile levels were higher than in the side sleeping position (p < 0.0001). The degree of OSA (OAHI) showed only a weak correlation with the laryngoscopy severity score (R² 0.10, p = 0.005).</p><p><strong>Conclusions: </strong>In infant laryngomalacia, the degree of upper airway obstruction is frequently more severe in the supine than in the side sleeping position. However, some variability remains in the response.</p><p><strong>Impact: </strong>Laryngomalacia is the most common congenital airway anomaly causing breathing difficulties in infants. Obstructive breathing events and obstructive sleep apnea are common in severe laryngomalacia even though the stridor often diminishes or resolves during sleep. We observed that in young infants with laryngomalacia, the appearance of upper airway obstruction is both sleep position and sleep-stage dependent. Compared to the supine sleeping position, the side sleeping position reduced the frequency of obstructive events and breathing effort, and lowered end-tidal carbon dioxide 99th percentile levels.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414540","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":"Bartter syndrome as natural experiment if furosemide (re)opens the ductus arteriosus.","authors":"Tim Hundscheid, Michiel F Schreuder, Willem P de Boode","doi":"10.1038/s41390-025-03933-1","DOIUrl":"https://doi.org/10.1038/s41390-025-03933-1","url":null,"abstract":"<p><strong>Impact: </strong>Furosemide increases renal prostaglandin synthesis and animal studies show reopening of the ductus arteriosus in rats exposed to furosemide. Nevertheless, large cohort studies in preterm infants do not support this hypothesis. Bartter syndrome, a rare genetic renal disorder with excessive fluid and salt-loss, is similar to continuous furosemide exposure. We hypothesize that Bartter syndrome could be considered as a natural experiment. Although most infants with Bartter syndrome are born prematurely, there are no cases found in literature with a patent ductus arteriosus which suggest that the contribution of furosemide to (re)opening of the ductus arteriosus in humans might be negligible.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414272","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":"Assessment, detection, and validation of clinical associations of thirdhand smoke exposure (ADVOCATE) study protocol.","authors":"E Melinda Mahabee-Gittens, Georg E Matt, Nicolas Lopez-Galvez, Eunha Hoh, Penelope J E Quintana, Nathan G Dodder, Roman A Jandarov, Lara Stone, Chase A Wullenweber, Jasjit S Ahluwalia, Ashley L Merianos","doi":"10.1038/s41390-025-03915-3","DOIUrl":"https://doi.org/10.1038/s41390-025-03915-3","url":null,"abstract":"<p><strong>Background: </strong>Thirdhand smoke (THS) pollution is the residue of secondhand smoke (SHS) remaining in homes long after active smoking has ceased. This study is the first to characterize the clinical correlates of THS exposure (THSe) in children independent of secondhand smoke exposure (SHSe). The prevalence, sociodemographic characteristics, tobacco smoke exposure patterns, sources, clinical, and biomarker effects associated with THSe will be examined.</p><p><strong>Method: </strong>Smoking and nonsmoking parents and their 0-11-year-olds (N = 1013) were recruited. Children were categorized into tobacco smoke exposure (TSE) groups via biochemical validation with salivary cotinine and hand nicotine: (1) no exposure group (NEG); (2) THSe-only group (TEG); and (3) Mixed SHSe and THSe group (MEG). At enrollment, 6-weeks, and 6-months, parental assessments and children's biological and home samples were obtained and analyzed for SHSe, THSe, THS pollution, inflammatory and oxidative stress markers.</p><p><strong>Results: </strong>The mean (SD) child age was 5.8 (3.4) years; 50.7% were female; and 97% were non-Hispanic (97.0%); 67.5% were White, 25.7% were Black, 6.8% were Other/unknown race. In total, 57.9%, 18.2%, and 21.9% were classified in the NEG, TEG, and MEG, respectively. Sample and data analyses are ongoing.</p><p><strong>Conclusion: </strong>This project will provide unique insights into how THSe in the absence of SHSe affects the clinical, inflammatory, and oxidative responses in children.</p><p><strong>Impact: </strong>This is the first prospective longitudinal study to examine the prevalence of thirdhand smoke exposure in children of nonsmokers. Unlike prior tobacco smoke exposure research, this study will examine the contribution of thirdhand smoke exposure to pediatric health outcomes. Results will provide unique insights into how thirdhand smoke exposure in the absence of secondhand smoke exposure affects the clinical, inflammatory, and oxidative responses in children of nonsmokers.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414271","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":"Synergism between TLR4 and B. infantis in the development of the premature intestine.","authors":"Wuyang Huang, Karim Djebali, Ky Young Cho, Kimberly Gardner, Alessio Fasano, Di Meng, W Allan Walker","doi":"10.1038/s41390-024-03676-5","DOIUrl":"10.1038/s41390-024-03676-5","url":null,"abstract":"<p><strong>Background: </strong>Intestinal microbiota has a role in early life maturation including maturation of intestinal immune function. However, the interaction of the TLR4 with colonizing bacteria in intestinal development is incompletely understood.</p><p><strong>Methods: </strong>An established human immature small intestinal cell line, human fetal intestinal organoids, and wild-type (WT) and TLR4 gene knockout (TLR4 ^-/-) neonatal mice were used to test the synergism between the innate immune receptor TLR4 and postbiotics from Bifidobacteria longum subsp. infantis (B. infantis) in development of the premature intestine.</p><p><strong>Results: </strong>TLR4-mediated postbiotics induced immature enterocyte proliferation and filamentous actin (F-actin) maturation both at the mRNA and protein levels. Proliferation of mRNA levels increased in wild-type mice but not in TLR4 ^-/- mice fed by postbiotics, both in the ileum and colon. Postbiotics can also change tight junction distribution in WT neonatal colon but not in TLR4 ^-/- mice.</p><p><strong>Conclusions: </strong>Our data suggest a novel regulation of intestinal development by a synergistic role of the innate immune receptor TLR4 and early life colonizing bacteria, such as B. infantis. This study should provide new insights into the mechanisms of intestinal maturation as well as opportunities to target novel approaches to NEC prevention and treatment.</p><p><strong>Impact: </strong>The innate immune system and postbiotics affect immature intestinal development. The innate immune receptor TLR4 prevention of NEC. Mechanism of prevention of NEC. This is the first time this has been demonstrated in human fetal intestine. In vitro process for future clinical studies for prevention of NEC.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409857","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}