Pediatric Research最新文献

{"title":"A systematic scoping review and gap analysis of questionnaires to assess multimorbidity among children.","authors":"Jogesh Murmu, Abhinav Sinha, Upasana Nayak, Somen Pradhan, Krushna Chandra Sahoo, Debdutta Bhattacharya, Sanghamitra Pati","doi":"10.1038/s41390-026-05046-9","DOIUrl":"https://doi.org/10.1038/s41390-026-05046-9","url":null,"abstract":"<p><p>Assessment tools specifically designed for children are crucial to addressing their unique healthcare needs, enabling more comprehensive and tailored care. This review intends to examine tools that assess multimorbidity in children to uncover critical gaps. This review followed PRISMA guidelines and is registered in PROSPERO (CRD42024520342). This review focused on tools/questionnaires/instruments that assess chronic diseases and multimorbidity among children aged 0-18 years. The search was performed from PubMed, Embase, Web of Science, and CINAHL databases. Eleven studies were included out of 11,876 records screened. The tools (CHQ, ISAAC, DAWBA, and MINI-KID) identified were initially created to assess one condition. They remain widely used in multimorbidity studies because of their validity and common usage, but re-purposing them can restrict full understanding of comorbidities. Other studies used or modified these tools to estimate multimorbidity constructs, with no specifically designed tool employed to estimate childhood multimorbidity. The risk of bias was generally moderate among cross-sectional studies and low among cohort studies. The existing child health questionnaires were not designed for assessing multimorbidity and vary widely in scope and focus. These findings underscore the urgent need for standardized, culturally acceptable, and pediatric-specific tools to assess multimorbidity. IMPACT: This review highlights critical gaps in pediatric multimorbidity assessment tools, emphasizing their limited scope, validity, and cultural adaptability. It analyzes existing methodologies, revealing inconsistencies in chronic condition coverage and a lack of validation across diverse populations. The study underscores the need for standardized, comprehensive tools to improve assessment accuracy and management. Findings suggest that developing multidimensional instruments will enhance precision and inform better healthcare strategies. Addressing these gaps is essential for equitable, evidence-based multimorbidity management in children, ultimately improving long-term health outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841503","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":"Impact of prebiotics, probiotics, and postbiotics on maternal and fetal health: mechanisms, efficacy, and safety across pregnancy.","authors":"Kit-Leong Cheong, Te Pan, Min Wang, Dongju Wang, Saiyi Zhong","doi":"10.1038/s41390-026-04983-9","DOIUrl":"https://doi.org/10.1038/s41390-026-04983-9","url":null,"abstract":"<p><p>Microbiome-directed biotics are gaining attention in obstetrics. This review clarifies terminology, mechanisms, clinical effects, and safety for prebiotics, probiotics, and postbiotics. Prebiotics are nondigestible substrates that are selectively used by host microbes to confer health benefits. Probiotics are defined as live microorganisms that improve health when given in adequate amounts. Postbiotics are preparations of nonviable microbes or their components that trigger beneficial responses. We summarize how these agents may influence maternal and fetal physiology across gut, immune, metabolic, vaginal, placental, and human milk contexts. In the gut, they reshape short-chain fatty acid and bile acid pools, modulate enteroendocrine hormones, and recalibrate basal immunity. They also tighten epithelial junctions and stimulate goblet cell mucin, which reduces microbial translocation, endotoxemia, and vascular strain. In the vaginal and urogenital niches, lactobacilli maintain acidity, suppress pathobionts, and may lower colonization risk. At the placenta and in milk, microbial metabolites and immune mediators, including human milk oligosaccharides and secretory IgA, carry maternal cues that shape fetal and neonatal development. Safety profiles differ by class. Prebiotics are generally well tolerated, with dose-dependent gastrointestinal symptoms most common. Probiotics require strain-level validation, viability control, and contaminant-free production. Postbiotics need to be verified inactivation and structural characterization. IMPACT: Provides a comprehensive, mechanism-based overview of how prebiotics, probiotics, and postbiotics influence maternal and fetal health across multiple physiological systems. Clarifies definitions, safety profiles, and quality standards for biotics in pregnancy, addressing current inconsistencies in research and commercial products. Integrates emerging evidence on postbiotics and vertical microbial transmission, offering a timely framework for future clinical applications and regulatory guidance.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856755","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":"Wired from the womb: a narrative review of fetal and neonatal connectomics via fMRI and emerging neurotechnologies.","authors":"Ankita Shukla, Vikas Chowdhary, Richard W Hall, Xiawei Ou","doi":"10.1038/s41390-026-05065-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05065-6","url":null,"abstract":"<p><p>Fetal and neonatal connectomics, utilizing functional magnetic resonance imaging (fMRI), offers critical insights into early brain development, with transformative potential for neonatal care. This review synthesizes peer-reviewed research from 2007 to 2025, tracing the historical evolution, methodological advancements, and clinical implications of fMRI-based connectomics in fetuses and neonates. Early studies introduced resting-state fMRI, while initiatives like the Developing Human Connectome Project (dHCP) have expanded the field through large-scale datasets. Methodologies, including resting-state fMRI, independent component analysis, and network modeling, have identified small-world and modular network architectures, with predictive value for cognitive and language outcomes. Despite advantages like non-invasiveness and early disorder detection, challenges include motion artifacts in fMRI data acquisition, blood-oxygen-level-dependent (BOLD) response variability, and sometimes sedation requirements. Future directions involve refining long-term outcome predictions, integrating multimodal imaging (e.g., EEG, NIRS), and developing neonatal intensive care unit (NICU) protocols. This review, drawing on available peer-reviewed sources, highlights the field's growth and limitations, advocating for standardized protocols and interdisciplinary collaboration to bridge research and clinical practice, ultimately improving outcomes for high-risk neonates. IMPACT: This review of fetal and neonatal connectomics adds the following to existing literature. Systematic, historical review of the development of fetal and neonatal connectomics using fMRI. Detailed resources for researchers to utilize existing databases for interpretation of findings as well as describing the technical, biological, and ethical challenges limiting clinical application of these findings. Provides key research gaps in translating connectomics findings into clinical applications as well as suggestions for addressing those gaps.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856778","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":"Dietary Inflammatory Index and cardiometabolic and inflammatory profiles in children and adolescents with type 1 diabetes: a cross-sectional study.","authors":"İsmail Mücahit Alptekin, Tuba Ekinci Gezmiş, Fatma Betül Özgeriş, Zehra Şahin, Nurinnisa Öztürk, Zerrin Orbak","doi":"10.1038/s41390-026-05069-2","DOIUrl":"https://doi.org/10.1038/s41390-026-05069-2","url":null,"abstract":"<p><strong>Background: </strong>Nutritional management is central to pediatric type 1 diabetes (T1DM). The Dietary Inflammatory Index (DII) quantifies the inflammatory potential of diet, but evidence in pediatric T1DM remains limited. This study evaluated whether higher DII scores are associated with poorer glycemic control and adverse inflammatory profiles in children and adolescents with T1DM.</p><p><strong>Methods: </strong>Seventy-eight pediatric patients with T1DM (5-19 years; 59.0% girls) were evaluated using 3-day dietary records, anthropometry, and biomarkers including HbA1c, lipid profile, and inflammatory/adipokine markers (CRP, IL-6, TNF-α, leptin, adiponectin). DII scores were calculated from dietary intake data. Associations between DII and outcomes were tested using covariate-adjusted general linear models controlling for age, sex, BMI, energy intake, and diabetes duration.</p><p><strong>Results: </strong>In adjusted models, higher DII was independently associated with higher HbA1c (B = 0.48; 95% CI 0.32-0.63; p < 0.001), LDL-C (B = 7.62; 95% CI 5.36-9.87; p < 0.001), TNF-α (B = 150.58; 95% CI 127.99-173.17; p < 0.001), and leptin (B = 730.60; 95% CI 629.14-832.06; p < 0.001), and with lower adiponectin (B = - 70.15; 95% CI - 79.93 to -60.37; p < 0.001). Higher DII showed greater energy, total fat, saturated fat, and cholesterol, and lower fiber, vitamin A, omega-3, vitamin E, and β-carotene.</p><p><strong>Conclusions: </strong>More pro-inflammatory dietary profiles were associated with worse metabolic control and higher inflammatory burden, supporting DII as a clinically relevant dimension in pediatric T1DM nutritional assessment.</p><p><strong>Impact: </strong>In children/adolescents with T1DM, higher DII is linked to poorer metabolic status, worse glycemic control, and higher BMI/body-composition risk markers. In covariate-adjusted models, higher DII is independently associated with higher HbA1c and LDL-C and with an unfavorable adipokine/inflammatory profile (higher TNF-α and leptin, lower adiponectin). These associations persist after adjusting for age, sex, BMI, energy intake, and diabetes duration, indicating an independent association with cardiometabolic/inflammatory burden. Nutrition care may incorporate dietary inflammatory potential alongside carbohydrate counting; more fiber, unsaturated fats/omega-3, antioxidants; less saturated/ultra-processed foods may be relevant to prospective/interventional testing, potentially to improve long-term pediatric outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856787","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 of diagnostic yield and clinical utility of genome sequencing in critically ill infants.","authors":"Carolina A Moreno, Marina de França, Joana R M Prota, Michele P Migliavacca, Anne C B Teixeira, Bruna M C de Azevedo, Lucas S de Santana, Eduardo Perrone, Jéssica G A Espolaor, Luiza A Virmond, Renata M Minillo, Renata Y Yamada, Vivian P Cintra, Caio R D C Quaio, José R M Ceroni, Kelin Chen, Thiago Y T Silva, Antonio V C Coelho, Gustavo S de Oliveira, José B Nascimento Junior, Livia M S Moura, Luciana S Mofatto, Marcel P Caraciolo, Rafael L M Guedes, Rodrigo A S Barreiro, Catarina S Gomes, Roseli F Rodrigues, Lucas R Correia, Ana P A Oliveira, Carolina D Carlos, Marina C da Matta, Matheus M Lima, Nuria B Zurro, Ana F M Ferreira, Gabriela B C Colichio, Gabriela P Campilongo, Renata M R da Silva, Letícia T Ferreira, Priscila I Higaki, Karla O Pelegrino, Allan C de Oliveira, Cecília Micheletti, Rodrigo A Fock, Anna C X M Sobreira, Andriene S Dos Santos, Raquel T B da Silva, Joselito Sobreira Filho, Mariane B A L Laurentino, Paula T Lyra, Ana L G Cunha, Camila C M Mendes, Joziele S Lima, Carlos E Steiner, Denise P Cavalcanti, Julia L Heleno, Chong A Kim, Magda M S Carneiro-Sampaio, Werther B de Carvalho, Ester S Ramos, Marcela L de Almeida, Mariana P L Ferriani, Tatiana F de Almeida, João B Oliveira","doi":"10.1038/s41390-026-04861-4","DOIUrl":"https://doi.org/10.1038/s41390-026-04861-4","url":null,"abstract":"<p><strong>Background: </strong>Genome sequencing (GS) has proven effective in reducing morbidity in critically ill infants, however, equitable access to testing remains a challenge in some populations. This study evaluates the use of GS in critically ill infants in Brazil, focusing on diagnostic yield and clinical utility.</p><p><strong>Methods: </strong>A national prospective study was conducted through a public-private partnership. GS was performed on infants under one year of age admitted to intensive care units. Clinical utility was evaluated based on physician perception, impact on clinical management, relevance for infants or family members/caregivers, and implications for genetic counseling.</p><p><strong>Results: </strong>GS was performed on 100 infants, yielding a confirmed molecular diagnosis in 32% of cases. An additional 7% were classified as likely diagnostic, resulting in a potential diagnostic yield of 39%. The median turnaround time was 13 days (7-25 days). Physicians recognized clinical utility for 81.1% of participants. Diagnostic and negative test results impacted clinical management, genetic counseling and/or demonstrated relevance for infants and families in 100% and 86.9% of reports, respectively.</p><p><strong>Conclusion: </strong>This study represents the largest South American cohort of critically ill infants evaluated by GS and provides a model for national implementation. Assessing clinical utility provided a comprehensive view of GS's impact.</p><p><strong>Impact: </strong>This article shows that genome sequencing (GS) in critically ill infants has clinical utility beyond diagnostic yield and management changes. Our study provides additional genomic data from a population typically underrepresented in international genomic research. This study represents the largest cohort of critically ill infants evaluated by GS in South America, providing a model for national-level implementation of GS in a resource-constrained setting.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856789","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":"Family reflections: bridging the gap between pediatric and adult care in autism.","authors":"Andy Shih","doi":"10.1038/s41390-026-05032-1","DOIUrl":"https://doi.org/10.1038/s41390-026-05032-1","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841486","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":"Congenital H-type tracheoesophageal fistula: Experience from a large Chinese center.","authors":"Yong Zhao, Zonghan Li, Shihui Tan, Junmin Liao, Shuangshuang Li, Dingding Wang, Kaiyun Hua, Yichao Gu, Yanan Zhang, Xinyue Tan, Zhaohong Zheng, Jinghua Jiao, Dan Don, Dayan Sun, Jinshi Huang","doi":"10.1038/s41390-026-05050-z","DOIUrl":"https://doi.org/10.1038/s41390-026-05050-z","url":null,"abstract":"<p><strong>Background: </strong>To present the clinical characteristics, diagnostic approach, therapeutic management, and outcomes of congenital H-type tracheoesophageal fistula (H-TEF) based on the experience of the National Center for Children's Health in China.</p><p><strong>Methods: </strong>A retrospective review of patients with H-TEF from 2007 to 2025 was performed. Patients were stratified by the occurrence of major complications (Clavien-Dindo grade ≥ III) for comparative analysis. Univariate analyses were performed to identify associated risk factors.</p><p><strong>Results: </strong>The study cohort comprised 51 patients. The median age at diagnosis was 1 month. Bronchoscopy demonstrated the highest detection rate (100%), followed by upper gastrointestinal contrast study (UGI) (96%). None of the patients who underwent precise fistula localization (with placement of a polyester traction suture) developed anastomotic leakage or recurrent fistula. The overall complication rate was 41.2%, with a major complication rate of 29.4%. No statistically significant risk factors for major complications were identified within this cohort.</p><p><strong>Conclusions: </strong>Modifying patient positioning during UGI can enhance its diagnostic ability. Precise localization of the fistula tract and the use of nerve monitoring may help minimize postoperative complications. While no risk factors achieved statistical significance, the study was not powered to exclude potential clinically relevant effects.</p><p><strong>Impact: </strong>An upper gastrointestinal contrast study can reach a diagnostic yield of 96% under proper positioning during the procedure. Intraoperative precision localization of the fistula demonstrated favorable outcomes and reduced surgical complexity. No recurrent laryngeal nerve injury occurred in any patient who underwent intraoperative nerve monitoring (overall incidence 13.73%). Complications occurred in 41.2% (29.4% major). No statistically significant risk factors were detected, although clinical effects cannot be entirely ruled out due to the limited cohort size. Despite representing the largest reported cohort in China to date, future prospective, multi-center studies with extended follow-up are warranted.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841515","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":"Mapping the palliative care needs of children with cancer: a scoping review through the bio-psycho-socio-spiritual lens.","authors":"Vani Verma, Harshitha D, Arun Ghoshal, Edlin Glane Mathias, Krithika S Rao, Anuja Damani, Archana Iyengar, Vasudeva Bhat K, Naveen Salins","doi":"10.1038/s41390-026-05036-x","DOIUrl":"https://doi.org/10.1038/s41390-026-05036-x","url":null,"abstract":"<p><strong>Background: </strong>Paediatric palliative care (PPC) is essential in alleviating the multidimensional burden of cancer for children and their families, yet their needs remain insufficiently understood across diverse settings. This scoping review mapped the palliative care needs of children with cancer through the bio-psycho-socio-spiritual lens, examining how these needs relate to quality of life and highlighting gaps in current practice.</p><p><strong>Methods: </strong>A systematic search was conducted across six databases for studies published in English between January 2014 and December 2024, guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and Arksey and O'Malley's framework.</p><p><strong>Results: </strong>Forty-six studies from 22 countries were included, with most originating from high-income settings and limited representation from low- and middle-income countries. Marked disparities were observed between high-income and low- and middle-income settings, particularly in the representation of social and spiritual domains and the availability of structured paediatric palliative care services. Physical symptoms such as pain and fatigue were consistently reported, while emotional distress, social isolation, and caregiver burden were common but often lacked structured interventions. Spiritual needs were the least explored, reflecting a significant gap in holistic care. The majority of studies focused on hospital-based settings, with minimal attention to home and community care.</p><p><strong>Conclusion: </strong>Findings underscore substantial unmet PPC needs across all domains, particularly in resource-limited contexts. There is an urgent need for culturally sensitive, family-centred, and standardised approaches that integrate child- and caregiver perspectives. This review provides evidence to guide clinical practice, inform policy, and shape future research agendas in paediatric palliative oncology.</p><p><strong>Impact: </strong>This scoping review synthesises evidence on the multidimensional palliative care needs of children with cancer across bio-psycho-socio-spiritual framework. It integrates fragmented evidence into a single, holistic map of paediatric palliative care needs across physical, psychological, social, and spiritual domains. It informs clinical practice, outcome measurement, and policy by highlighting unmet and underrepresented palliative care needs in paediatric oncology. This work informs clinical practice, outcome selection, and policy development for integrated paediatric palliative oncology services.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841525","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":"Machine learning and SHAP-based risk assessment of PICC-related bloodstream infections in premature infants at the time of clinical suspicion.","authors":"Yongqin Guo, Yingying Dou, Wenxia Song, Lihong Wang, Li Wang","doi":"10.1038/s41390-026-05049-6","DOIUrl":"https://doi.org/10.1038/s41390-026-05049-6","url":null,"abstract":"<p><strong>Background: </strong>Peripherally inserted central catheter-related bloodstream infections (PICC-CRBSI) pose a serious threat to preterm infants. This study aimed to develop and validate an interpretable machine learning model for risk assessment of PICC-CRBSI at the time of clinical suspicion.</p><p><strong>Methods: </strong>A total of 490 preterm infants who underwent PICC insertion in a tertiary hospital NICU in China were prospectively enrolled from January 2024 to October 2025. After feature selection, prediction models were constructed using four machine learning algorithms. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis. The optimal model was interpreted using Shapley additive explanations (SHAP).</p><p><strong>Results: </strong>CRBSI occurred in 68 patients (13.88%). The Random Forest model demonstrated the best performance, with AUC values of 0.973 and 0.934 in the training and validation sets, and overall accuracy of 0.945 and 0.905. SHAP analysis revealed that C-reactive protein(CRP), white blood cell count, and respiratory rate had the most significant influence on the model's predictive performance.</p><p><strong>Conclusion: </strong>The random forest model demonstrated robust performance for risk assessment of PICC-CRBSI in preterm infants at the time of clinical suspicion. These findings may support clinical risk stratification and provide hypothesis-generating insights into key factors associated with PICC-CRBSI.</p><p><strong>Impact: </strong>Develops a high-performance, interpretable random forest model for risk assessment of peripherally inserted central catheter-related bloodstream infection (PICC-CRBSI) in preterm infants at the time of clinical suspicion. Addresses a gap in the literature by integrating the SHAP method to transparently identify and prioritize key risk-associated features (e.g., C-reactive protein and white blood cell count), enhancing the clinical interpretability of the model. Provides a practical approach for risk stratification, with potential to support clinical assessment and improve the understanding of PICC-CRBSI risk in neonatal intensive care.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841539","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":"Adipocytokine imbalance and bone mineral properties in Hispanic youth.","authors":"Reem S Shawar, Maurice Puyau, Nancy Butte, Fida Bacha","doi":"10.1038/s41390-026-04944-2","DOIUrl":"https://doi.org/10.1038/s41390-026-04944-2","url":null,"abstract":"<p><strong>Background: </strong>Childhood obesity may have a negative impact on bone mineral properties, with unclear underlying mechanisms. We investigated the relationship of adipocytokine imbalance to bone mineral properties in adolescence, and sex related differences.</p><p><strong>Methods: </strong>A cohort of 501 pubertal Hispanic youth (47% male), 10-19 years of age underwent assessment of body composition, bone mineral content (BMC) and density (BMD) by DXA; fasting glucose, insulin, estradiol, testosterone, leptin, and adiponectin concentrations. HOMA-IR and leptin to adiponectin ratio (LAR) were calculated. Cardiorespiratory fitness (CRF) as reflected by VO₂ max was measured using a treadmill ramp protocol.</p><p><strong>Results: </strong>LAR was higher in youth with obesity and with overweight compared with normal weight. LAR negatively contributed to the variance in BMC (β = -0.096, p = 0.001) (R² = 0.887, p < 0.001) together and independently of HOMA-IR, sex steroids, and CRF. This relationship persisted in males but weakened in females when the 2 sexes were examined separately. Similar findings were seen with BMD as the dependent variable.</p><p><strong>Conclusions: </strong>LAR has a negative relationship with BMC and BMD in pubertal youth, with a more notable adverse relationship in males. This suggests that adipocytokine dysregulation may contribute to the adverse effects of childhood obesity on bone mineral properties, with sex-differences related to body fat topography.</p><p><strong>Impact: </strong>Childhood obesity associated adipokine imbalance, as reflected by leptin to adiponectin ratio, has a negative relationship with bone mineral content and density in adolescence. This adverse relationship is more notable in males compared with females. These findings contribute to our understanding of the complex effects of obesity on bone mineral content and density in children and adolescents. The findings emphasize the importance of prevention and management of youth-onset obesity to prevent metabolic complications and their impact on skeletal health.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841452","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}