Pediatric Research最新文献

{"title":"A pilot study of ultra-low-dose chest CT combined with co-production in cystic fibrosis care.","authors":"Richard Zhang, Andrew Phelps, Kelvin MacDonald, Anne Stone","doi":"10.1038/s41390-025-04379-1","DOIUrl":"https://doi.org/10.1038/s41390-025-04379-1","url":null,"abstract":"<p><strong>Background: </strong>This pilot study determined whether ultra-low-dose chest tomography (ULDCT) is a feasible tool to assess structural airway abnormalities in adolescents and young adults with cystic fibrosis (CF) taking elexacaftor/tezacaftor/ivacaftor (ETI). We explored if reviewing ULDCT findings with people with cystic fibrosis (PwCF) would impact adherence and satisfaction with airway clearance therapy (ACT).</p><p><strong>Methods: </strong>PwCF aged 12-25 years taking ETI underwent ULDCT and completed surveys on ACT and medication adherence and satisfaction. Participants reviewed ULDCT findings with a physician and completed follow-up surveys 8-16 weeks later.</p><p><strong>Results: </strong>In all, 20 subjects (45% male, median age 18 years, median body mass index 22.7 kg/m², and 45% F508del homozygous) completed baseline questionnaires and 17 completed ULDCT (median dose length product 6.6 milligray.cm) and post-ULDCT surveys. Findings revealed 13 subjects had bronchiectasis. Baseline surveys revealed 50% of participants reported not completing ACT the week prior to enrollment. Post-ULDCT, 82% reported completing ACT in the prior week. Reported unintentional and purposeful nonadherence to ACT decreased post-ULDCT.</p><p><strong>Conclusion: </strong>ULDCT is feasible for assessing structural lung abnormalities in adolescents and young adults with CF taking ETI. Incorporating ULDCT with co-production techniques may improve patient satisfaction and align the treatment goals between PwCF and their care team.</p><p><strong>Impact: </strong>This study demonstrates the utility of ultra-low-dose chest CT (ULDCT) to assess structural airway abnormalities in people with CF (PwCF) taking elexacaftor/tezacaftor/ivacaftor (ETI) at risk for airway disease. Findings add to the literature of alternative imaging methods in CF. ULDCT identified a high rate of bronchiectasis among PwCF taking ETI in this study. Data suggest a role for ULDCT in the co-production of ACT recommendations in this population. Incorporating ULDCT with co-production techniques may help align the treatment goals of PwCF and their care team.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086675","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":"Benefits and risks of therapeutic hypothermia for hypoxic-ischemic encephalopathy in late preterm infants.","authors":"Mohamed El-Dib, Dalal Abdelgadir, Kaashif A Ahmad, Mariam Ayed, Jennifer Burnsed, Raul Chavez-Valdez, Mehmet N Cizmeci, Alexa Craig, Floris Groenendaal, Alistair J Gunn, Ratchada Kitsommart, Thomas Lancaster, Ashley M Lucke, Atul Malhotra, Jeremy D Marks, Amit Mathur, Ulrike Mietzsch, Khorshid Mohammad, Frances J Northington, Eric S Peeples, Eilon Shany, Bharati Sinha, Sylke J Steggerda, Paulina Toso, Michael Weiss, Santina Zanelli, Terrie Inder","doi":"10.1038/s41390-025-04428-9","DOIUrl":"https://doi.org/10.1038/s41390-025-04428-9","url":null,"abstract":"<p><p>Therapeutic hypothermia (TH) is standard care for term neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE), but its use in preterm infants 33-35 weeks' gestational age (GA) remains controversial. This review article summarizes the biological rationale, clinical evidence, and real-world experience supporting or challenging TH in this population. Preclinical models show neuroprotective effects of TH at developmental stages equivalent to late preterm infants. Retrospective studies suggest feasibility but report higher complication rates, particularly at 34 weeks. We critically evaluate the only randomized controlled trial (RCT) to date, which reported no benefit and possible harm with TH in 33-35 weeks' GA infants. However, this study had important limitations, including baseline imbalances, limited stratification by GA and encephalopathy severity, and lack of neuroimaging or EEG data. A recent international survey of 88 centers reveals heterogeneous practices, with many continuing TH at 34-35 weeks' GA despite the trial's findings. Real-world experience from 22 centers shows lower mortality than reported in the RCT. TH may remain appropriate for select 35 weeks' GA infants, but routine use in 34 weeks' GA and earlier infants should be limited to research settings. Future studies should stratify by GA and include standardized neurological assessments to inform practice. IMPACT OF THIS REVIEW: Summarizes preclinical and retrospective clinical data supporting the biological plausibility and feasibility of therapeutic hypothermia (TH) in late preterm infants. Critically examines the limitations of the only RCT of TH in this population and explains why its findings should not be generalized to all 33-35 weeks' GA infants. Highlights real-world evidence showing lower mortality and supports continued TH use at 35 weeks' GA while urging caution at 34 weeks or below pending further data.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086679","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":"Reliability of two-dimensional versus M-mode echocardiography for left atrium/aortic diameter ratio and fractional shortening in extremely preterm infants.","authors":"Uthaya Kumaran Kanagaraj, Michael Castaldo, Melissa Braschel, Anna Harris, Souvik Mitra","doi":"10.1038/s41390-025-04389-z","DOIUrl":"https://doi.org/10.1038/s41390-025-04389-z","url":null,"abstract":"<p><strong>Background: </strong>In extremely preterm neonates, left atrium to aortic root ratio (LA:Ao) and fractional shortening (FS) are commonly used to assess left atrial dilation and left ventricle (LV) function in targeted neonatal echocardiography (TNE), respectively. This study aims to compare the interrater reliability of two-dimensional (2D) and motion mode (M-mode) echocardiography for LA:Ao and FS in preterm infants.</p><p><strong>Methods: </strong>A retrospective study was conducted on infants born <29 weeks gestational age who underwent TNE between October 2020 and September 2023. Interrater reliability for LA:Ao and FS was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots.</p><p><strong>Results: </strong>A total of 79 scans were assessed independently by 3 observers. Median (IQR) gestational age was 25.9 (25-27.3) weeks and birth weight was 797 (627.5-916.8) grams. The ICC for LV FS was 0.72 (95% CI: 0.40-0.85) for M-mode and 0.73 (95% CI: 0.56-0.83) for 2D-mode. The ICC for LA: Ao ratio was 0.87 for both M-mode (95% CI: 0.73-0.93) and 2D-mode (95% CI: 0.80-0.92).</p><p><strong>Conclusion: </strong>Both 2D and M-modes are reliable markers for measuring LA:Ao ratio in extremely preterm infants. FS should be interpreted cautiously as a marker of LV systolic function due to moderate reliability.</p><p><strong>Impact: </strong>Both two-dimensional (2D) and motion mode (M-mode) showed good interrater reliability for left atrium and aortic root (LA:Ao) ratio measurements. Findings support the interchangeable use of either modality in Targeted Neonatal Echocardiography (TNE) protocols for assessing left atrial dilation. Fractional shortening (FS) demonstrated only moderate reliability across both modes, reinforcing the need for caution when using FS alone to evaluate left ventricular function in extremely preterm infants. Results highlight the importance of standardized TNE-specific training and routine quality assurance (QA) processes to minimize variability and ensure consistency in clinical and research echocardiographic assessments.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086700","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":"Behavioral and dietary factors in U.S. early childhood type II diabetes.","authors":"Ayden Dunn, Paige Brinzo, Sahar Kaleem, Austin Lent, Madison Etzel, Jennifer Mendonca, Vama Jhumkhawala, Milad Khoury, Lea Sacca","doi":"10.1038/s41390-025-04417-y","DOIUrl":"https://doi.org/10.1038/s41390-025-04417-y","url":null,"abstract":"<p><strong>Background: </strong>Our study examines changes in the nationwide prevalence of US childhood T2D in the 0-5 age group category between 2016 and 2020.</p><p><strong>Methods: </strong>We used five years of NSCH data on children aged 0-17 years and isolated data from the subgroup of children aged 0-5 years for a focused analysis on early childhood T2D. Survey questions were selected for two independent variables, dietary factors and physical activity factors. The dependent variable, T2D severity, was based on parental reporting of whether the child was diagnosed with T2D by their healthcare provider, status of disease, and the severity of the condition. Means, proportions, and chi-square tests were used to compare the frequency of dietary and physical activity factors by T2D severity classification.</p><p><strong>Results: </strong>In 2016 and 2020, childhood T2D was significantly associated with the presence of a library in the child's neighborhood. In 2017, it was also associated with access to free or reduced cost meals. For the early childhood subgroup, significant associations occurred in 2016 for receiving neighbor help and in 2019 regarding walkability levels in the child's neighborhood.</p><p><strong>Conclusions: </strong>Programs designed to prevent diabetes in children should address broader issues of food access and food quality.</p><p><strong>Impact: </strong>Childhood diabetes prevention programs should address broader issues of food access and quality. Research is needed on early childhood Type II diabetes behavioral and environmental risk factors. Our study provides exploratory estimates of change in the nationwide prevalence of US childhood T2D.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086593","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":"Turning the tide on gestational diabetes mellitus to protect social-emotional development.","authors":"Edna F Roche","doi":"10.1038/s41390-025-04395-1","DOIUrl":"https://doi.org/10.1038/s41390-025-04395-1","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086758","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":"School readiness in children born preterm.","authors":"Kamini Raghuram, Nicole Bando, Magdalena Janus","doi":"10.1038/s41390-025-04421-2","DOIUrl":"https://doi.org/10.1038/s41390-025-04421-2","url":null,"abstract":"<p><p>Approximately 7-9% of children worldwide are born preterm [<37 weeks gestational age (GA)], and ~15% of these preterm births occur at <32 weeks GA (very preterm). Advances in modern medicine have dramatically improved the survival of preterm children. However, preterm birth influences a vulnerable period of brain growth in which there is rapid gain in volume, maturation, and connectivity. Several aspects of neonatal intensive care, including altered sensory exposures and acute illness, compounded by social risk factors affect the developing brain. School readiness, understood as the state of child developmental health at school entry, is an outcome of genetic predisposition and the experiences and environment children are exposed to since birth and is a predictor of future academic trajectory. Children born preterm face a range of challenges, especially at times of transition, such as school entry. Academic underachievement in preterm children is common as evidenced by higher needs for grade repetition and remedial assistance. Educational concerns may be prevented most efficiently before school entry with supportive services that promote school readiness. This narrative review will allow readers to gain a comprehensive understanding of school readiness in children born preterm, associated risk factors, potential interventions, and implications for practice. IMPACT: Children born preterm, particularly those born very preterm, remain vulnerable to delays in school readiness, even in the context of having standardized assessments showing performance within the typical range at earlier stages in childhood (i.e. in toddlerhood). Routine neurodevelopmental assessment of preterm children at entry to school is not performed, although there is increasing recognition of issues impacting academic performance and adjustment into school. This review summarizes the available literature around school readiness in preterm children, which will allow for early recognition of school readiness difficulties and opportunities for targeted interventions to improve longer term outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081291","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":"Can postnatal steroids or initial mode of respiratory support really impact lung function at adulthood in preterm survivors?","authors":"Shivanthan Shanthikumar, David N Matlock, David G Tingay, Sherry E Courtney","doi":"10.1038/s41390-025-04391-5","DOIUrl":"https://doi.org/10.1038/s41390-025-04391-5","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075572","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":"The overlooked subgroup: preterm neonates with elevated serum creatinine outside neonatal AKI criteria.","authors":"Chih-Chia Chen, Yung-Chieh Lin, Chao-Ching Huang","doi":"10.1038/s41390-025-04365-7","DOIUrl":"https://doi.org/10.1038/s41390-025-04365-7","url":null,"abstract":"<p><strong>Background: </strong>To characterize risks and outcomes of preterm neonates with elevated serum creatinine (SCr) not meeting acute kidney injury (AKI) criteria.</p><p><strong>Methods: </strong>This cohort study included neonates <31 weeks' gestation admitted to a university hospital. Elevated SCr was defined as exceeding the 95th percentile for postnatal age without meeting standard AKI criteria in neonates <28 or 28-30 weeks. Perinatal/neonatal risks and discharge outcomes were compared among elevated SCr, SCr-AKI, and no SCr-AKI subgroups.</p><p><strong>Results: </strong>Among 810 infants, 156 had SCr-AKI, 623 had no SCr-AKI, and 31 had elevated SCr. Compared to no SCr-AKI, the elevated SCr subgroup had lower birthweight, higher rates of small-for-gestational-age, respiratory distress, hemodynamic instability, prolonged invasive ventilation, lower anthropometric z-scores, and higher mortality, despite similar gestational age. Compared to SCr-AKI, they had higher gestational age and higher rates of small-for-gestational-age, with similar mortality. Adjusted models showed elevated SCr (adjusted relative risk [aRR], 3.74) and SCr-AKI (aRR, 3.95) predicted higher mortality versus no SCr-AKI.</p><p><strong>Conclusion: </strong>Gestational age-specific SCr references are critical for identifying preterm neonates with elevated SCr levels outside AKI criteria, who face neonatal risks and distinct mortality outcomes.</p><p><strong>Impact statement: </strong>The risks and outcomes of preterm neonates with elevated serum creatinine (SCr) levels that do not meet Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) criteria require further investigation. These neonates have distinct exposure profiles compared to those with KDIGO SCr-AKI and a poorer prognosis than those without SCr-AKI. They also have higher mortality than neonates without SCr-AKI. Our findings highlight the importance of gestational age-specific SCr reference values in neonatal care to better identify at-risk preterm infants beyond KDIGO criteria, enabling early intervention and improved outcomes.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081265","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":"Immune landscape in liver of neonatal mice with phlebotomy-induced anemia.","authors":"Balamurugan Ramatchandirin, Wenjia Wang, Marie Amalie Balamurugan, Yasemin Alnahhas, Suneetha Desiraju, Arjun Subrramanya, Juanitaa George Raj, Zainab D Lawal, Megan Ferris, George Tseng, Liza Konnikova, Krishnan MohanKumar","doi":"10.1038/s41390-025-04361-x","DOIUrl":"https://doi.org/10.1038/s41390-025-04361-x","url":null,"abstract":"<p><strong>Background: </strong>Severe anemia is a common comorbidity in preterm infants in the neonatal intensive care unit, which is caused by phlebotomy, low erythropoietin levels, low red blood cell (RBC) lifespan, and exacerbated by the underlying erythropoietic immaturity. Anemia causes tissue hypoxia, which may alter the hematopoiesis niche in the liver. This study utilized our preclinical mouse model of phlebotomy-induced anemia (PIA) to investigate the immune cell atlas in the liver.</p><p><strong>Methods: </strong>C57BL/6 mice were subjected to timed phlebotomy between postnatal days 2-10 to induce severe anemia. Immune cells in anemic liver were characterized by Single-cell (sc) RNA-sequencing and a flow cytometry approach.</p><p><strong>Results: </strong>The scRNA-seq analysis revealed that PIA is associated with an altered immune landscape of the neonatal murine liver. We identified increased numbers of Ly6C2⁺monocytes and Gypa⁺erythroid cells and decreased numbers of lymphocytes (CD20⁺ [MS4a1]-B cells and Tcells) in the anemic liver. Further analysis of monocytes revealed a pro-inflammatory and highly chemotactic phenotype, while erythroid cells displayed a downregulation of inflammatory markers and maturational deficits. Lymphocytes (B and T cells) exhibited suppressed lipid metabolism processes, including those of steroids and hormones.</p><p><strong>Conclusion: </strong>PIA in neonatal mouse pups is associated with myelopoiesis (specifically monopoiesis) and erythropoiesis while suppressing lymphopoiesis in the liver.</p><p><strong>Impact: </strong>Anemia is nearly universal in preterm infants and is associated with increased morbidity and mortality worldwide, investigation of immune cell response in settings of preclinical anemia may be an index of therapeutic targets to modulate the response in anemia-related comorbidity. Our findings showed that phlebotomy-induced anemia in murine pup alters liver hematopoiesis including myelopoiesis and stressed erythropoiesis with suppressed lymphopoiesis. This study sheds light on emergency myelopoiesis, stressed erythropoiesis, and deficiency of lymphocytes in anemic liver, which may provide novel insight into the development of therapeutics to treat anemia in preterm infants and neonates.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081349","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":"Minding the maternal diet: specific foods or dietary patterns for the prevention of food allergies in offspring.","authors":"Myrto-Kalliopi Maragkou, Emilia Vassilopoulou","doi":"10.1038/s41390-025-04384-4","DOIUrl":"https://doi.org/10.1038/s41390-025-04384-4","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081329","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}